Mariani Alessandro Wasum, Medeiros Israel Lopes, Pêgo-Fernandes Paulo Manuel, Fernandes Flavio Guimarães, Unterpertinguer Fernando Do Vale, Fernandes Lucas Matos, Cardoso Paulo Francisco, Canzian Mauro, Jatene Fabio Biscegli
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Department of Thoracic Surgery, Hospital de Messejana, Fortaleza, Brazil, MD, PhD. Attending Physician, Department of Thoracic Surgery, Hospital de Messejana, Fortaleza, Brazil.
Sao Paulo Med J. 2014;132(1):28-35. doi: 10.1590/1516-3180.2014.1321594.
Lung preservation remains a challenging issue for lung transplantation groups. Along with the development of ex vivo lung perfusion, a new preservation method known as topical-ECMO (extracorporal membrane oxygenation) has been proposed. The present study compared topical-ECMO with cold ischemia (CI) for lung preservation in an ex vivo experimental model.
Randomized experimental study, conducted at a public medical school.
Fourteen human lungs were retrieved from seven brain-dead donors that were considered unsuitable for transplantation. The lung bloc was divided and each lung was randomized to be preserved by means of topical-ECMO or CI (4-7 °C) for eight hours. These lungs were then reconnected to an ex vivo perfusion system for functional evaluation. Lung biopsies were obtained at three times. The functional variables assessed were oxygenation capacity (OC) and pulmonary artery pressure (PAP); and the histological variables were lung injury score (LIS) and apoptotic cell count (ACC).
The mean OC was 468 mmHg (± 81.6) in the topical-ECMO group and 455.8 (± 54) for CI (P = 0.758). The median PAP was 140 mmHg (120-160) in the topical-ECMO group and 140 mmHg (140-150) for CI (P = 0.285). The mean LIS was 35.57 (± 4.5) in the topical-ECMO group and 33.86 (± 6.1) for CI (P = 0.367). The ACC was 25.00 (± 9.34) in the topical-ECMO group and 24.86 (± 10.374) for CI (P = 0.803).
The present study showed that topical-ECMO was not superior to cold ischemia for up to eight hours of lung preservation.
肺保存对于肺移植团队而言仍是一个具有挑战性的问题。随着体外肺灌注技术的发展，一种名为局部体外膜肺氧合（topical-ECMO）的新保存方法被提出。本研究在体外实验模型中比较了局部体外膜肺氧合与冷缺血（CI）用于肺保存的效果。
在一所公立医学院进行的随机实验研究。
从7名被认为不适于移植的脑死亡供体获取14个人肺。将肺块分割，每个肺随机采用局部体外膜肺氧合或冷缺血（4 - 7°C）保存8小时。然后将这些肺重新连接到体外灌注系统进行功能评估。在三个时间点获取肺组织活检样本。评估的功能变量为氧合能力（OC）和肺动脉压（PAP）；组织学变量为肺损伤评分（LIS）和凋亡细胞计数（ACC）。
局部体外膜肺氧合组的平均氧合能力为468 mmHg（±81.6），冷缺血组为455.8（±54）（P = 0.758）。局部体外膜肺氧合组的肺动脉压中位数为140 mmHg（120 - 160），冷缺血组为140 mmHg（140 - 150）（P = 0.285）。局部体外膜肺氧合组的平均肺损伤评分为35.57（±4.5），冷缺血组为33.86（±6.1）（P = 0.367）。局部体外膜肺氧合组的凋亡细胞计数为25.00（±9.34），冷缺血组为24.86（±10.374）（P = 0.803）。
本研究表明，在长达8小时的肺保存中，局部体外膜肺氧合并不优于冷缺血。
