Pierre Leif, Lindstedt Sandra, Ingemansson Richard
a Department of Cardiothoracic Surgery , Skåne University Hospital , Lund, Lund University , Sweden.
Scand Cardiovasc J. 2015;49(5):293-8. doi: 10.3109/14017431.2015.1052549. Epub 2015 Jul 16.
The pulmonary donor pool would increase substantially if lungs could be donated after cardiac death (DCD). There have been ethical and legal obstacles since administration of heparin and cooling has to be done immediately after cardiac death. This study examines whether ventilation of DCD lungs without administering heparin or cooling the lungs after cardiac death could improve graft function.
Twelve donor pigs with a mean bodyweight of 70 kg were randomized into two groups. Six animals were ventilated in situ with 50% oxygen, 4 L/min, and 5 cm H2O in positive end-expiratory pressure or PEEP for 2 h after cardiac death. Six animals served as non-ventilated controls and were exposed to warm ischemia for 2 h. After 2 h, all lungs were harvested and flush perfused with Perfadex(®) solution and stored at 8°C for another 2 h. An ex vivo lung perfusion or EVLP circuit was used for evaluation.
Non-ventilated lungs developed pulmonary edema, and had highly impaired blood gas levels and a significantly increased weight. The ventilated lungs demonstrated excellent blood gas levels and unchanged weight.
The increase in tolerable warm ischemic time in combination with avoiding heparinization and cooling might facilitate the use of DCD lungs for transplantation.
如果能够在心脏死亡后（DCD）捐献肺脏，肺脏供体库将大幅增加。由于必须在心脏死亡后立即给予肝素并进行降温，一直存在伦理和法律障碍。本研究探讨在心脏死亡后不给予肝素或对DCD肺脏进行降温的情况下进行通气是否能改善移植物功能。
将12只平均体重70千克的供体猪随机分为两组。6只动物在心脏死亡后原位通气，采用50%氧气、4升/分钟、呼气末正压（PEEP）为5厘米水柱，通气2小时。6只动物作为未通气对照组，经历2小时的热缺血。2小时后，所有肺脏均被摘取，用Perfadex（®）溶液进行冲洗灌注，并在8°C下再保存2小时。使用体外肺灌注（EVLP）回路进行评估。
未通气的肺脏出现肺水肿，血气水平严重受损，重量显著增加。通气的肺脏表现出良好的血气水平，重量未变。
可耐受热缺血时间的增加，同时避免肝素化和降温，可能有助于将DCD肺脏用于移植。
