Haam Seokjin, Lee Sungsoo, Paik Hyo Chae, Park Moo Suk, Song Joo Han, Lim Beom Jin, Nakao Atsunori
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Eur J Cardiothorac Surg. 2015 Oct;48(4):542-7. doi: 10.1093/ejcts/ezv057. Epub 2015 Mar 6.
Lung transplantation is a well-established treatment of end-stage lung disease; however, it is limited by a shortage of donor lungs. To overcome this problem, donation after cardiac death (DCD) and ex vivo lung perfusion (EVLP) are being widely investigated. In this study, the effect of hydrogen gas, a known antioxidant, was investigated on a DCD lung model during EVLP.
Ten pigs were randomized into either a control (n = 5) or a hydrogen group (n = 5). After fibrillation by electric shock, no further treatment was administered in order to induce warm ischaemic injury for 1 h. The lungs were then procured, followed by 4 h of EVLP. During EVLP, the lungs were ventilated with room air in the control group, and with 2% hydrogen gas in the hydrogen group. Oxygen capacity (OC), pulmonary vascular resistance (PVR) and peak airway pressure (PAP) were measured every hour, and the expressions of interleukin-1 beta (IL-1β), IL-6 (IL-6), IL-8 (IL-8) and tumour necrosis factor-alpha (TNF-α) were evaluated in lung tissue after EVLP. Pathological evaluations were performed using lung injury severity (LIS) scores and the wet/dry ratio was also measured.
The OC in the hydrogen group was higher than in the control group, but the difference was not statistically significant (P = 0.0862). PVR (P = 0.0111) and PAP (P = 0.0189) were statistically significantly lower in the hydrogen group. Compared with the control group, the hydrogen group had a statistically significantly lower expression of IL-1β (P = 0.0317), IL-6 (P = 0.0159), IL-8 (P = 0.0195) and TNF-α (P = 0.0159). The LIS scores (P = 0.0358) and wet/dry ratios (P = 0.040) were also significantly lower in the hydrogen group.
Hydrogen gas inhalation during EVLP improved the function of DCD lungs, which may increase the utilization of DCD lungs.
肺移植是终末期肺病的一种成熟治疗方法；然而，它受到供肺短缺的限制。为克服这一问题，心脏死亡后捐赠（DCD）和体外肺灌注（EVLP）正在被广泛研究。在本研究中，研究了已知抗氧化剂氢气对EVLP期间DCD肺模型的影响。
将10头猪随机分为对照组（n = 5）和氢气组（n = 5）。电击致颤后，不再给予进一步治疗以诱导1小时的热缺血损伤。然后获取肺脏，接着进行4小时的EVLP。在EVLP期间，对照组的肺用室内空气通气，氢气组用2%氢气通气。每小时测量氧容量（OC）、肺血管阻力（PVR）和气道峰值压力（PAP），并在EVLP后评估肺组织中白细胞介素-1β（IL-1β）、IL-6、IL-8和肿瘤坏死因子-α（TNF-α）的表达。使用肺损伤严重程度（LIS）评分进行病理评估，并测量湿/干比。
氢气组的OC高于对照组，但差异无统计学意义（P = 0.0862）。氢气组的PVR（P = 0.0111）和PAP（P = 0.0189）在统计学上显著更低。与对照组相比，氢气组的IL-1β（P = 0.0317）、IL-6（P = 0.0159）、IL-8（P = 0.0195）和TNF-α（P = 0.0159）表达在统计学上显著更低。氢气组的LIS评分（P = 0.0358）和湿/干比（P = 0.040）也显著更低。
EVLP期间吸入氢气改善了DCD肺的功能，这可能会增加DCD肺的利用率。
