Valenza F, Rosso L, Gatti S, Coppola S, Froio S, Colombo J, Dossi R, Pizzocri M, Salice V, Nosotti M, Reggiani P, Tosi D, Palleschi A, Pappalettera M, Ferrero S, Perazzoli A, Costantini D, Scalamogna M, Rossi G, Colombo C, Santambrogio L, Gattinoni L
Dipartimento di Anestesia, Terapia Intensiva e Subintensiva e Terapia del Dolore, Università degli Studi di Milano, Milano, Italy.
Transplant Proc. 2012 Sep;44(7):1826-9. doi: 10.1016/j.transproceed.2012.06.023.
Ex vivo lung perfusion (EVLP) has been validated as a valuable technique to increase the pool of organs available for lung transplantation.
After a preclinical experience, we obtained permission from the Ethics Committee of our institution to transplant lungs after EVLP reconditioning. ABO compatibility, size match, and donor arterial oxygen pressure (PaO(2))/fraction of inspired oxygen (FiO(2)) ≤ 300 mm Hg were considered to be inclusion criteria, whereas the presence of chest trauma and lung contusion, evidence of gastric content aspiration, pneumonia, sepsis, or systemic disease were exclusion criteria. We only considered subjects on an extra corporeal membrane oxygenation (ECMO) bridge to transplantation with rapid functional deterioration. Using Steen solution with packed red blood cells oxygenated with 21% O(2), 5% to 7% CO(2) was delivered, targeted with a blood flow of approximately 40% predicted cardiac output. Once normothermic, the lungs were ventilated with a tidal volume of 7 mL/kg a PEEP of 5 cmH(2)O and a respiratory rate of 7 bpm. Lungs were considered to be suitable for transplantation if well oxygenated [P(v-a) O(2) > 350 mm Hg on FiO(2) 100%], in the absence of deterioration of pulmonary vascular resistance and lung mechanics over the perfusion time.
From March to September 2011, six lung transplantations were performed, including two with EVLP. The functional outcomes were similar between groups: at T72 posttransplantation, the median PaO(2)/FiO(2) were 306 mm Hg (range, 282 to 331 mm Hg) and 323 mm Hg (range, 270 to 396 mm Hg) (P = 1, EVLP versus conventional). Intensive care unit ICU and hospital length of stay were similar (P = .533 and P = .663, respectively) with no mortality at 60 days in both groups. EVLP donors were older (49 ± 6 y versus 21 ± 7 y, P < .05), less well oxygenated (184 ± 6 mm Hg versus 570 ± 30, P < .05), displaying higher Oto scores (9.5 ± 0.7 versus 1.7 ± 1.5, P < .05).
The first 6 months of the EVLP program allowed us to increase the number of organs available for transplantation with short-term outcomes comparable to conventional transplantations.
体外肺灌注（EVLP）已被确认为一种有价值的技术，可增加可用于肺移植的器官数量。
经过临床前经验积累后，我们获得了所在机构伦理委员会的许可，可在EVLP修复后进行肺移植。ABO血型相容性、大小匹配以及供体动脉血氧分压（PaO₂）/吸入氧分数（FiO₂）≤300 mmHg被视为纳入标准，而存在胸部创伤和肺挫伤、胃内容物误吸、肺炎、败血症或全身性疾病的证据则为排除标准。我们仅考虑处于体外膜肺氧合（ECMO）过渡到移植阶段且功能迅速恶化的受试者。使用含浓缩红细胞的Steen溶液，用21% O₂进行氧合，输送5%至7%的CO₂，目标血流量约为预计心输出量的40%。一旦达到常温，肺以潮气量7 mL/kg、呼气末正压5 cmH₂O和呼吸频率7次/分钟进行通气。如果肺氧合良好[FiO₂ 100%时P（v - a）O₂> 350 mmHg]，且在灌注期间肺血管阻力和肺力学无恶化，则认为该肺适合移植。
2011年3月至9月，共进行了6例肺移植，其中2例采用了EVLP。两组的功能结局相似：移植后72小时，EVLP组和传统组的PaO₂/FiO₂中位数分别为306 mmHg（范围282至331 mmHg）和323 mmHg（范围270至396 mmHg）（P = 1，EVLP组与传统组）。重症监护病房（ICU）和住院时间相似（分别为P = 0.533和P = 0.663），两组60天内均无死亡。EVLP组的供体年龄较大（49±6岁对21±7岁，P < 0.05），氧合较差（184±6 mmHg对570±30，P < 0.05），Oto评分较高（9.5±0.7对1.7±1.5，P < 0.05）。
EVLP项目的前6个月使我们能够增加可用于移植的器官数量，其短期结局与传统移植相当。
