Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA.
Am J Transplant. 2012 Oct;12(10):2838-44. doi: 10.1111/j.1600-6143.2012.04175.x.
A recent clinical trial provided evidence that ex vivo lung perfusion (EVLP) results in optimized human donor lungs for transplantation. Excellent recipient outcomes were documented after 4 h of normothermic perfusion. We report a clinical case utilizing remote EVLP to assess and improve function of initially otherwise unacceptable injured donor lungs followed by transportation and subsequent bilateral lung transplantation in a patient with virally induced refractory respiratory failure supported with extracorporeal membrane oxygenation. This is the first lung transplantation with the application of remote EVLP, wherein the donor lungs were transported from the donor hospital to a center for EVLP and then transported to another hospital for transplantation. It is also the first case of lung transplantation in the United States utilizing EVLP for functional optimization leading to successful transplantation. Organ procurement data, EVLP assessment, and the pre- and postoperative course of the recipient are presented. The available evidence supporting EVLP, the humanitarian and cooperative utilization of lungs otherwise discarded, are discussed.
一项最近的临床试验提供了证据，证明离体肺灌注（EVLP）可使供体肺在移植前得到优化。在 4 小时的常温灌注后，记录到了出色的受者预后。我们报告了一个临床病例，该病例利用远程 EVLP 评估和改善最初因损伤而无法接受的供体肺的功能，然后在一名接受体外膜氧合支持的病毒引起的难治性呼吸衰竭患者中进行了运输和随后的双侧肺移植。这是首例应用远程 EVLP 进行的肺移植，供体肺从供体医院运送到 EVLP 中心，然后再运送到另一家医院进行移植。这也是美国首例利用 EVLP 进行功能优化以实现成功移植的肺移植病例。本文介绍了器官获取数据、EVLP 评估以及受者的术前和术后过程。讨论了支持 EVLP 的现有证据以及对原本废弃的肺进行人道主义和合作利用。
