Noiseux N, Nguyen B K, Marsolais P, Dupont J, Simard L, Houde I, Lallier M, Langevin S, Cantin B, Ferraro P
Division of Cardiac and Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal; Centre de Recherche CHUM, Montréal, Québec, Canada.
Transplant Proc. 2009 Oct;41(8):3284-9. doi: 10.1016/j.transproceed.2009.08.041.
Because lung transplantation is the only effective therapy for terminal respiratory failure, the demand for donor lungs has increased steadily. However, the number of donors has remained fairly constant over the years, which results in an increasing duration of waiting for lung transplantation. To overcome the lack of organs, various strategies have been developed by transplant centers including use of marginal donors. To increase the lung utilization rate in multiorgan donors, we implemented a simple lung recruitment protocol involving a brief period of controlled sustained inflation. In 2005, the lung utilization rate in the transplant program at our institution was only 20% in multiorgan donors. With the lung recruitment protocol, the rate of lung utilization for transplantation increased to 33%, in 2006, 24% in 2007, and 24% in 2008. Following the lung recruitment protocol, the arterial oxygen tension/fraction of inspired oxygen ratio increased to greater than 15% in more than 40% of donors. We were able to improve gas exchange sufficiently that as many as two-thirds of the lungs were suitable for transplantation. During the protocol, no complications were reported, and no patient became hemodynamically unstable, precluding organ procurement. We believe that optimization of multiorgan donor management with simple interventions may improve oxygenation, reducing the number of inadequate donor lungs and increasing the overall donor pool and organ availability.
由于肺移植是终末期呼吸衰竭的唯一有效治疗方法，对供肺的需求稳步增加。然而，多年来供体数量一直相当稳定，这导致肺移植等待时间不断延长。为了克服器官短缺问题，移植中心制定了各种策略，包括使用边缘供体。为了提高多器官供体的肺利用率，我们实施了一个简单的肺募集方案，包括一段短暂的控制性持续充气。2005年，我们机构移植项目中多器官供体的肺利用率仅为20%。通过肺募集方案，2006年移植的肺利用率提高到33%，2007年为24%，2008年为24%。遵循肺募集方案后，超过40%的供体动脉血氧分压/吸入氧分数比提高到大于15%。我们能够充分改善气体交换，多达三分之二的肺适合移植。在该方案实施期间，未报告并发症，也没有患者出现血流动力学不稳定而无法进行器官获取。我们认为，通过简单干预优化多器官供体管理可能改善氧合，减少不适合的供肺数量，增加总体供体库和器官可获得性。
