Pêgo-Fernandes Paulo Manuel, Mariani Alessandro Wasum, Medeiros Israel Lopes de, Pereira Artur Eugenio de Azevedo, Fernandes Flávio Guimarães, Valle Unterpertinger Fernando do, Canzian Mauro, Jatene Fabio Biscegli
Department of Thoracic Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Rev Bras Cir Cardiovasc. 2010 Oct-Dec;25(4):441-6. doi: 10.1590/s0102-76382010000400006.
Only about 15% of the potential candidates for lung donation are considered suitable for transplantation. A new method for ex vivo lung perfusion (EVLP) has been developed and can be used for evaluation and reconditioning of "marginal" and unacceptable lungs. This is a report of functional evaluation experience with ex vivo perfusion of twelve donor lungs deemed unacceptable in São Paulo, Brazil.
After harvesting, the lungs are perfused ex vivo with Steen Solution, an extra-cellular solution with high colloid osmotic pressure. A membrane oxygenator connected to the circuit receives gas from a mixture of nitrogen and carbon dioxide and maintains a normal mixed venous blood gas level in the perfusate. The lungs are gradually rewarmed, reperfused and ventilated. They are evaluated through analyses of oxygenation capacity, pulmonary vascular resistance (PVR), lung compliance (LC).
The arterial oxygen pressure (with inspired oxygen fractions of 100%) increased from a mean of 193.3 mmHg in the organ donor at the referring hospital to a mean of 495.3 mmHg during the ex vivo evaluation. After 1 hour of EVLP, mean PVR was 737.3 dynes/sec/cm5, and mean LC was 42.2 ml/cmH2O.
The ex vivo evaluation model can improve oxygenation capacity of "marginal" lungs rejected for transplantation. It has a great potential to increase lung donor availability and, possibly, to reduce the waiting time on the list.
在潜在的肺捐赠者中，仅有约15%被认为适合移植。一种新的体外肺灌注（EVLP）方法已被开发出来，可用于评估和修复“边缘性”及不合格的肺。本文报告了对巴西圣保罗12例被判定为不合格的供体肺进行体外灌注功能评估的经验。
肺组织获取后，用斯滕溶液（一种具有高胶体渗透压的细胞外溶液）进行体外灌注。连接到回路的膜式氧合器从氮气和二氧化碳的混合气体中获取气体，并维持灌注液中正常的混合静脉血气水平。肺组织逐渐复温、再灌注并通气。通过分析氧合能力、肺血管阻力（PVR）和肺顺应性（LC）对肺组织进行评估。
（吸入氧分数为100%时）动脉血氧分压在转诊医院的器官供体时平均为193.3 mmHg，在体外评估期间平均升至495.3 mmHg。体外肺灌注1小时后，平均肺血管阻力为737.3达因/秒/厘米⁵，平均肺顺应性为42.2毫升/厘米水柱。
体外评估模型可提高因移植不合格而被拒绝的“边缘性”肺的氧合能力。它在增加肺供体可用性以及可能缩短等待名单时间方面具有巨大潜力。
