Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2012 Nov;144(5):1200-6. doi: 10.1016/j.jtcvs.2012.08.009. Epub 2012 Aug 31.
Normothermic ex vivo lung perfusion is a novel method to evaluate and improve the function of injured donor lungs. We reviewed our experience with 50 consecutive transplants after ex vivo lung perfusion.
A retrospective study using prospectively collected data was performed. High-risk brain death donor lungs (defined as Pao(2)/Fio(2) <300 mm Hg or lungs with radiographic or clinical findings of pulmonary edema) and lungs from cardiac death donors were subjected to 4 to 6 hours of ex vivo lung perfusion. Lungs that achieved stable airway and vascular pressures and Pao(2)/Fio(2) greater than 400 mm Hg during ex vivo lung perfusion were transplanted. The primary end point was the incidence of primary graft dysfunction grade 3 at 72 hours after transplantation. End points were compared with lung transplants not treated with ex vivo lung perfusion (controls).
A total of 317 lung transplants were performed during the study period (39 months). Fifty-eight ex vivo lung perfusion procedures were performed, resulting in 50 transplants (86% use). Of these, 22 were from cardiac death donors and 28 were from brain death donors. The mean donor Pao(2)/Fio(2) was 334 mm Hg in the ex vivo lung perfusion group and 452 mm Hg in the control group (P = .0001). The incidence of primary graft dysfunction grade 3 at 72 hours was 2% in the ex vivo lung perfusion group and 8.5% in the control group (P = .14). One patient (2%) in the ex vivo lung perfusion group and 7 patients (2.7%) in the control group required extracorporeal lung support for primary graft dysfunction (P = 1.00). The median time to extubation, intensive care unit stay, and hospital length of stay were 2, 4, and 20 days, respectively, in the ex vivo lung perfusion group and 2, 4, and 23 days, respectively, in the control group (P > .05). Thirty-day mortality (4% in the ex vivo lung perfusion group and 3.5% in the control group, P = 1.00) and 1-year survival (87% in the ex vivo lung perfusion group and 86% in the control group, P = 1.00) were similar in both groups.
Transplantation of high-risk donor lungs after 4 to 6 hours of ex vivo lung perfusion is safe, and outcomes are similar to those of conventional transplants. Ex vivo lung perfusion improved our center use of donor lungs, accounting for 20% of our current lung transplant activity.
常温离体肺灌注是一种评估和改善供肺损伤功能的新方法。我们回顾了 50 例连续接受离体肺灌注后的移植经验。
采用前瞻性收集数据的回顾性研究。高危脑死亡供肺（定义为 PaO2/FiO2<300mmHg 或肺有放射性或临床肺水肿表现）和心脏死亡供者的肺接受 4 至 6 小时的离体肺灌注。在离体肺灌注期间达到稳定气道和血管压力以及 PaO2/FiO2>400mmHg 的肺进行移植。主要终点是移植后 72 小时原发性移植物功能障碍 3 级的发生率。将终点与未接受离体肺灌注的肺移植（对照组）进行比较。
在研究期间（39 个月）共进行了 317 例肺移植。进行了 58 例离体肺灌注，共进行了 50 例移植（使用率为 86%）。其中，22 例来自心脏死亡供者，28 例来自脑死亡供者。离体肺灌注组供者 PaO2/FiO2 平均值为 334mmHg，对照组为 452mmHg（P=0.0001）。离体肺灌注组 72 小时原发性移植物功能障碍 3 级的发生率为 2%，对照组为 8.5%（P=0.14）。离体肺灌注组有 1 例（2%）和对照组有 7 例（2.7%）患者需要体外肺支持治疗原发性移植物功能障碍（P=1.00）。离体肺灌注组的中位拔管时间、重症监护病房住院时间和住院时间分别为 2、4 和 20 天，对照组分别为 2、4 和 23 天（P>0.05）。30 天死亡率（离体肺灌注组为 4%，对照组为 3.5%，P=1.00）和 1 年生存率（离体肺灌注组为 87%，对照组为 86%，P=1.00）在两组间相似。
高危供肺在接受 4 至 6 小时的离体肺灌注后进行移植是安全的，结果与常规移植相似。离体肺灌注改善了我们中心对供肺的利用，占我们目前肺移植活动的 20%。
