Heart Center Leipzig, Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany.
Ann Thorac Surg. 2012 Mar;93(3):913-9; discussion 919-20. doi: 10.1016/j.athoracsur.2011.11.033.
Extended criteria donors, non-heart-beating donors (NHBD), and living donation are options to overcome the organ shortage for lung transplantation (LTx). However little is known about the impact of the donor lung on ischemia-reperfusion injury (IRI), which often leads to high mortality rates.
Recipient pigs (N=32) were divided equally into 4 groups according to their donor status: (1) living donor=control group, (2) conventional heart-beating donor, (3) non-heart-beating donor according to Maastricht category I (NHBD-I), and (4) Maastricht category IV (NHBD-IV). After cold flush and 3 hours of hypothermic preservation, a single left LTx was performed. Thereafter only the transplanted left lung was ventilated and perfused to assess isolated left lung function at 1 and 2 hours after LTx compared with before LTx.
No significant differences were seen between the 4 groups regarding wet-to-dry weight ratio, mean airway pressure, or compliance. Arterial oxygenation and alveolar-arterial difference showed significant differences between the groups (p<0.05). Two-way analysis of variance (ANOVA) for the factors brain death and cardiac arrest found significantly increased alveolar-arterial differences for the brain-death group but not for the beating-heart donor group.
The use of lungs from brain-death donors and NHBDs has different effects on the occurrence of symptoms of IRI after LTx. Further observations and therapeutic strategies are necessary to minimize IRI when grafts from NHBDs are used.
为了克服肺移植（LTx）的器官短缺问题，可以选择使用扩展标准供体、非心脏死亡供体（NHBD）和活体捐献。然而，人们对供体肺引起的缺血再灌注损伤（IRI）的影响知之甚少，这往往导致高死亡率。
根据供体状况，将受体猪（N=32）平均分为 4 组：（1）活体捐献=对照组，（2）传统心跳供体，（3）符合马斯特里赫特 I 类标准的非心脏死亡供体（NHBD-I），（4）马斯特里赫特 IV 类标准（NHBD-IV）。冷灌洗和 3 小时低温保存后，进行单侧左 LTx。然后仅对移植的左肺进行通气和灌注，以在 LTx 后 1 小时和 2 小时与 LTx 前相比评估孤立的左肺功能。
4 组之间的湿重/干重比、平均气道压或顺应性没有显著差异。氧合动脉和肺泡-动脉差异在组间存在显著差异（p<0.05）。针对脑死亡和心脏骤停因素的双因素方差分析（ANOVA）发现，脑死亡组的肺泡-动脉差异显著增加，但心跳供体组没有。
脑死亡供体和 NHBD 肺的使用对 LTx 后 IRI 症状的发生有不同的影响。当使用 NHBD 供体的移植物时，需要进一步观察和治疗策略来最小化 IRI。
