Stanzi Alessia, Neyrinck Arne, Somers Jana, Cauwenberghs Hans, Verbeken Eric, Santambrogio Luigi, Van Raemdonck Dirk
Laboratory for Experimental Thoracic Surgery, Department of Clinical and Experimental Medicine, KU Leuven University, Leuven, Belgium; Department of Thoracic Surgery, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Laboratory for Experimental Thoracic Surgery, Department of Clinical and Experimental Medicine, KU Leuven University, Leuven, Belgium; Department of Anesthesia, University Hospitals Leuven, Leuven, Belgium.
J Surg Res. 2014 Dec;192(2):647-55. doi: 10.1016/j.jss.2014.07.068. Epub 2014 Aug 7.
After normothermic ex vivo lung perfusion (EVLP), pulmonary grafts are usually flush-cooled and stored on ice until implantation although evidence for this practice lacks. We compared outcomes between 2 post-EVLP preservation strategies in a porcine left single-lung transplantation model.
After cold flush and 2-h EVLP, donor lungs were prepared and split. In [C], (n = 5) lungs cooled on device to 15°C were preserved in ice-water; in [W] (n = 5), lungs were disconnected from EVLP at 37°C and kept at room temperature. The left lung was transplanted in a recipient animal. Posttransplant, 6 h-monitoring included hourly assessment of pulmonary vascular resistance, pulmonary artery pressure, plateau airway pressure, compliance, and oxygenation before and after exclusion of the right lung. Lung biopsies and bronchoscopy with bronchoalveolar lavage (BAL) were performed at retrieval, at the end of EVLP (R lung), and 1 and 6 h after reperfusion (L lung).
Lungs in [W] showed the highest compliance (P < 0.05) and the lowest plateau airway pressure (not statistically significant) throughout the whole reperfusion period. Oxygenation and pulmonary artery pressure were similar between groups. Pulmonary vascular resistance was stable in [C], but rose after reperfusion in [W]. Histologic signs of lung injury and BAL neutrophilia were more pronounced in [C] at 1 h (not statistically significant and P < 0.05, respectively). BAL cytokine levels and lung tissue expression of intercellular adhesion molecule 1 did not differ between groups.
Normothermic preparation after EVLP results in similar graft performances compared with lung cooling after EVLP.
在常温体外肺灌注（EVLP）后，肺移植物通常会进行冲洗降温并置于冰上保存直至植入，尽管缺乏该做法的证据。我们在猪左单肺移植模型中比较了两种EVLP后保存策略的结果。
在冷冲洗和2小时的EVLP后，制备并分割供体肺。在[C]组（n = 5）中，在设备上冷却至15°C的肺保存在冰水中；在[W]组（n = 5）中，肺在37°C时与EVLP断开连接并保持在室温。将左肺移植到受体动物体内。移植后，6小时的监测包括每小时评估肺血管阻力、肺动脉压、平台气道压、顺应性以及在排除右肺前后的氧合情况。在获取时、EVLP结束时（右肺）以及再灌注后1小时和6小时（左肺）进行肺活检和支气管镜检查及支气管肺泡灌洗（BAL）。
在整个再灌注期间，[W]组的肺显示出最高的顺应性（P < 0.05）和最低的平台气道压（无统计学意义）。两组之间的氧合和肺动脉压相似。[C]组的肺血管阻力稳定，而[W]组在再灌注后升高。在1小时时，[C]组的肺损伤组织学迹象和BAL中性粒细胞增多更为明显（分别无统计学意义和P < 0.05）。两组之间的BAL细胞因子水平和细胞间黏附分子1的肺组织表达没有差异。
与EVLP后肺冷却相比，EVLP后的常温制备导致类似的移植物性能。
