1 Laboratoire de Recherche Chirurgicale and INSERM U999, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis Robinson, France. 2 Address correspondence to: Elie Fadel M.D., Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue (Paris-Sud University), 133 Avenue de la Resistance, 92350 Le Plessis Robinson, France.
Transplantation. 2014 Feb 27;97(4):413-8. doi: 10.1097/01.TP.0000441320.10787.c5.
Lung injury (LI) due to gastric-acid aspiration is associated with poor posttransplantation outcomes. We investigated the effects of ex vivo lung perfusion (EVLP) reconditioning and surfactant administration on LI due to gastric-acid aspiration.
Thirty piglets were allocated at random to five groups: the lungs were studied 24 hr after gastric juice-induced LI of the left lower lobe (LLL), LI followed by EVLP (4 hr), or LI followed by LLL surfactant lavage immediately before EVLP; sham animals were studied 24 hr after saline infusion alone or followed by EVLP. Gross anatomy, hemodynamics, and aerodynamics were evaluated; neutrophil and bacterial counts were determined in bronchoalveolar lavage (BAL) fluid and blood. LLLs were evaluated based on a semi-quantitative histologic score, apoptotic cell death (TUNEL), and inflammatory cytokine levels.
The sham and sham-EVLP groups were not significantly different. Compared with sham, LI animals had irreversible atelectasis, higher lung infection rates (P<0.0001) and BAL neutrophil percentages (P<0.0001), lower PaO2 (P=0.0006), higher IL-1 (P=0.022) and IL-8 (P=0.006), higher apoptotic cell percentages (P=0.007), and worse histologic severity scores (P<0.0001). EVLP alone did not improve these findings. Adding surfactant before EVLP returned PaO2, pulmonary vascular resistance, and apoptotic-cell percentage to sham-EVLP values but only partially improved the histologic severity score.
Local surfactant infusion immediately before EVLP improved the function of donor lungs injured by gastric juice aspiration. This strategy may hold promise for decreasing the shortage of donor lungs.
胃酸吸入导致的肺损伤（LI）与移植后不良结局相关。我们研究了体外肺灌注（EVLP）再处理和表面活性剂给药对胃酸吸入导致的 LI 的影响。
30 头小猪随机分为五组：左肺下叶（LLL）胃内容物诱导 LI 后 24 小时研究肺，LI 后进行 EVLP（4 小时），或 LI 后在进行 EVLP 前立即进行 LLL 表面活性剂灌洗；假手术组仅在单独给予生理盐水后或在给予生理盐水后进行 EVLP 后 24 小时研究肺。评估大体解剖、血液动力学和气动性；支气管肺泡灌洗液（BAL）和血液中的中性粒细胞和细菌计数。根据半定量组织学评分、凋亡细胞死亡（TUNEL）和炎症细胞因子水平评估 LLL。
假手术和假手术-EVLP 组无明显差异。与假手术相比，LI 动物出现不可逆性肺不张，肺感染率更高（P<0.0001）和 BAL 中性粒细胞百分比更高（P<0.0001），PaO2 更低（P=0.0006），IL-1 更高（P=0.022）和 IL-8 更高（P=0.006），凋亡细胞百分比更高（P=0.007），组织学严重程度评分更差（P<0.0001）。单独进行 EVLP 并不能改善这些发现。在 EVLP 前添加表面活性剂可将 PaO2、肺血管阻力和凋亡细胞百分比恢复到假手术-EVLP 值，但仅部分改善组织学严重程度评分。
在 EVLP 前立即给予肺内表面活性剂可改善因胃酸吸入而受损的供体肺的功能。这种策略可能有希望减少供体肺的短缺。
