Laboratory for Experimental Thoracic Surgery, Department of Thoracic Surgery, KU Leuven, Leuven, Belgium.
Department of Morphology and Molecular Pathology, University Hospitals Leuven, Leuven, Belgium.
J Surg Res. 2014 Mar;187(1):316-23. doi: 10.1016/j.jss.2013.11.1100. Epub 2013 Nov 25.
Formation of microthrombi after circulatory arrest is a concern for the development of reperfusion injury in lung recipients from donation after circulatory death (DCD) donors. In this isolated lung reperfusion study, we compared the effect of postmortem heparinization with preharvest retrograde pulmonary flush or both.
Domestic pigs (n = 6/group) were sacrificed by ventricular fibrillation and left at room temperature for 1 h. This was followed by 2.5 h of topical cooling. In control group [C], no heparin and no pulmonary flush were administered. In group [R], lungs were flushed with Perfadex in a retrograde way before explantation. In group [H], heparin (300 IU/kg) was administered 10 min after cardiac arrest followed by closed chest massage for 2 min. In the combined group, animals were heparinized and the lungs were explanted after retrograde flush [HR]. The left lung was assessed for 60 min in an ex vivo reperfusion model.
Pulmonary vascular resistance at 50 and 55 min was significantly lower in [R] and [HR] groups compared with [C] and [H] groups (P < 0.01 and P < 0.001) and at 60 min in [R], [H], and [HR] groups compared with [C] group (P < 0.001). Oxygenation, compliance, and plateau airway pressure were more stable in [R] and [HR] groups. Plateau airway pressure was significantly lower in [R] group compared with the [H] group at 60 min (P < 0.05). No significant differences in wet-dry weight ratio were observed between the groups.
This study suggests that preharvest retrograde flush is more protective than postmortem heparinization to prevent reperfusion injury in lungs recovered from donation after circulatory death donors.
循环停止后微血栓的形成是引起心肺死亡供体来源肺移植受者再灌注损伤的一个关注点。在这项离体肺再灌注研究中，我们比较了死后肝素化与收获前逆行肺冲洗或两者联合的效果。
通过心室颤动处死国内猪（每组 n=6），并使其左心房在室温下放置 1 小时。然后，进行 2.5 小时的局部降温。在对照组[C]中，未给予肝素和肺冲洗。在组[R]中，在器官取出前采用逆行方式用 Perfadex 冲洗肺。在组[H]中，在心脏骤停后 10 分钟给予肝素（300IU/kg），随后进行 2 分钟的闭胸按摩。在联合组中，动物在肝素化后进行逆行冲洗[HR]，然后取出肺。在离体再灌注模型中评估左肺 60 分钟。
与 [C]组和[H]组相比，[R]组和[HR]组在 50 分钟和 55 分钟时的肺血管阻力显著降低（P<0.01 和 P<0.001），而在 60 分钟时，[R]组、[H]组和[HR]组与 [C]组相比，肺血管阻力显著降低（P<0.001）。[R]组和[HR]组的氧合、顺应性和平台气道压更稳定。在 60 分钟时，[R]组的平台气道压显著低于 [H]组（P<0.05）。各组之间的湿干重比无显著差异。
本研究表明，收获前逆行冲洗比死后肝素化更能预防心肺死亡供体来源肺移植受者再灌注损伤。
