Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg.
Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg.
J Heart Lung Transplant. 2014 May;33(5):528-35. doi: 10.1016/j.healun.2014.01.854. Epub 2014 Jan 24.
The shortage of donor lungs restricts the number of lung transplantations that can be performed. However, extension of the donor pool using organs donated after cardiac death (DCD) could potentially increase the number of patients who undergo transplantation. To establish acceptance among hospital personnel and the donor's next of kin for the uncontrolled DCD procedure we proposed a simplified preservation regime for intrapleural cooling of the donor lungs.
In an uncontrolled DCD model, 12 pigs were randomized to intrapleural lung cooling using either a standard method with two bilateral chest tubes and intermittent pleural fluid exchanges, or a simplified, less-invasive method with a single bilateral chest tube and filling of the pleural space without fluid exchange. Lungs were explanted and graft function was assessed during ex vivo lung perfusion (EVLP) and by histologic examination.
Although the mean temperature after 120 minutes of intrapleural cooling was significantly higher in the lungs cooled using the simplified method (25.9°C vs 13.5°C), this did not affect the oxygenation capacity, pulmonary vascular resistance or dynamic compliance of the lungs, as recorded during EVLP. Furthermore, no differences were found between the lungs preserved by the two methods with respect to the wet/dry ratio, levels of myeloperoxidase in bronchoalveolar lavage, or at histologic examination.
The simplified technique for DCD lung cooling results in a higher preservation temperature but does not affect lung function during EVLP, which implies that this less invasive method can be used in the uncontrolled DCD setting. This is another step forward in the development of a simplified preservation routine for DCD.
为了在医院工作人员和供者的近亲属中建立对非控制性 DCD 程序的接受度，我们提出了一种简化的经胸膜腔内冷却供者肺的保存方案。
在非控制性 DCD 模型中，将 12 只猪随机分为两组，一组采用标准方法，即双侧胸腔置管和间歇性胸膜腔液体交换，另一组采用简化方法，即单侧双侧胸腔置管和不进行液体交换的胸膜腔填充。在离体肺灌注（EVLP）和组织学检查中评估供肺的移植功能。
尽管在经胸膜腔内冷却 120 分钟后，简化方法冷却的肺的平均温度明显更高（25.9°C 比 13.5°C），但这并未影响 EVLP 期间记录的氧合能力、肺血管阻力或肺动态顺应性。此外，在 EVLP 期间，两种方法保存的肺在湿/干比、支气管肺泡灌洗液中髓过氧化物酶水平或组织学检查方面没有差异。
简化的 DCD 肺冷却技术会导致更高的保存温度，但不会影响 EVLP 期间的肺功能，这意味着这种微创方法可用于非控制性 DCD 环境。这是 DCD 简化保存方案发展的又一步。
