Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
Eur J Cardiothorac Surg. 2011 Jun;39(6):e175-80; discussion e180. doi: 10.1016/j.ejcts.2011.01.035. Epub 2011 Mar 3.
The use of non-heart-beating (NHB) lung donors has been propagated as an alternative besides heart-beating (HB) lung donors to overcome organ shortage. We evaluated the effectiveness of NHB lung transplantation.
The donor and recipient data of all 35 NHB category III lung transplantations (LTx) between January 2005 and December 2009 were reviewed. For comparison, we collected recipient and donor data of a cohort of 77 HB lung transplantations. In both groups, we assessed survival, primary graft dysfunction (PGD), forced expiratory volume in 1s (FEV(1)), acute rejection, and bronchiolitis obliterans syndrome (BOS).
Thirty-five NHB lung transplantations were performed, five single LTx and 30 bilateral LTx in 12 male and 23 female patients. The donor oxygenation capacity was 61 kPa (interquartile range (IQR), 56-64). Warm ischemia time in the donor was 29 min (IQR, 24-30). Cold ischemic time of the last implanted lung was 458 min (IQR, 392-522). Cardiopulmonary bypass was used 13 times. PGD (1-3) was observed in 45% of the patients at T0, in 42% at T24, in 53% at T48, and in 50% at T72. PGD 3 decreased from 24% at T0 to 6% at T72. The use of nitric oxide (NO) within 24h after transplantation was necessary in three patients with successful weaning in all. There was no significant difference for donor and recipient characteristics between NHB and HB lung transplantations. Survival, occurrence of PGD, and acute rejection was equal to the HB cohort. The incidence of BOS was lower in the NHB group. The measured FEV(1) tended to be better in the NHB group.
Lungs from nonheparinized category III NHB donors are well suited for transplantation and can safely increase the donor pool.
除了心跳供体（HB）肺源外，使用无心跳（NHB）肺供体已被宣传为一种可供选择的方法，以克服器官短缺的问题。我们评估了 NHB 肺移植的效果。
回顾了 2005 年 1 月至 2009 年 12 月期间所有 35 例 NHB Ⅲ类肺移植（LTx）的供体和受体数据。为了比较，我们收集了 77 例 HB 肺移植的受体和供体数据。在两组中，我们评估了生存率、原发性移植物功能障碍（PGD）、用力呼气量（FEV（1））、急性排斥反应和闭塞性细支气管炎综合征（BOS）。
共进行了 35 例 NHB 肺移植，其中 5 例为单肺移植，30 例为双肺移植，患者为 12 名男性和 23 名女性。供体的氧合能力为 61kPa（四分位距（IQR），56-64）。供体的热缺血时间为 29 分钟（IQR，24-30）。最后植入的肺的冷缺血时间为 458 分钟（IQR，392-522）。有 13 次使用体外循环。T0 时，45%的患者出现 1-3 级 PGD，T24 时为 42%，T48 时为 53%，T72 时为 50%。T0 时 PGD3 为 24%，T72 时降至 6%。在所有成功脱机的 3 例患者中，均在移植后 24 小时内需要使用一氧化氮（NO）。NHB 和 HB 肺移植之间，供体和受体特征无显著差异。生存率、PGD 发生率和急性排斥反应与 HB 组相当。BOS 的发生率在 NHB 组较低。FEV（1）的测量值在 NHB 组中也较好。
肝素化 III 类 NHB 无心跳供体的肺源非常适合移植，并可安全增加供体库。
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