Charles Eric J, Huerter Mary E, Wagner Cynthia E, Sharma Ashish K, Zhao Yunge, Stoler Mark H, Mehaffey J Hunter, Isbell James M, Lau Christine L, Tribble Curtis G, Laubach Victor E, Kron Irving L
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
Department of Pathology, University of Virginia Health System, Charlottesville, Virginia.
Ann Thorac Surg. 2016 Dec;102(6):1845-1853. doi: 10.1016/j.athoracsur.2016.06.043. Epub 2016 Sep 7.
Despite the critical need for donor lungs, logistic and geographic barriers hinder lung utilization. We hypothesized that lungs donated after circulatory death subjected to 6 hours of cold preservation after ex vivo lung perfusion (EVLP) would have similar outcomes after transplantation as lungs transplanted immediately after EVLP, and that both would perform superiorly compared with lungs transplanted immediately after procurement.
Donor porcine lungs were procured after circulatory death and 15 minutes of warm ischemia. Three groups (n = 5 per group) were randomized: immediate left lung transplantation (Immediate group), EVLP for 4 hours followed by transplantation (EVLP group), or EVLP for 4 hours followed by 6 hours of cold preservation followed by transplantation (EVLP+Cold group). Lungs were reperfused for 2 hours before obtaining pulmonary vein samples for partial pressure of oxygen/fraction of inspired oxygen ratio calculations, airway pressures for compliance measurements, and wet/dry weight ratios.
The partial pressure of oxygen/fraction of inspired oxygen ratios in the EVLP and EVLP+Cold groups were significantly improved compared with those in the Immediate group (429.7 ± 51.8 and 436.7 ± 48.2 versus 117.4 ± 22.9 mm Hg, respectively). In addition, dynamic compliance was significantly improved in the EVLP and EVLP+Cold groups compared with immediate group (26.2 ± 4.2 and 27.9 ± 3.5 versus 11.1 ± 2.4 mL/cmHO, respectively). There were no differences in oxygenation capacity or dynamic compliance between the EVLP and EVLP+Cold groups. Inflammatory cytokine levels were significantly lower in the EVLP and EVLP+Cold groups.
Lungs donated after circulatory death can be successfully transplanted as much as 6 hours after EVLP. Cold preservation of lungs after ex vivo assessment and rehabilitation may improve organ allocation, even to distant recipients, without compromising allograft function.
尽管对供肺有迫切需求，但物流和地理障碍阻碍了肺的利用。我们假设，在体外肺灌注（EVLP）后进行6小时冷保存的循环死亡后捐赠的肺，移植后的结果与EVLP后立即移植的肺相似，并且两者与获取后立即移植的肺相比表现更优。
在循环死亡和15分钟热缺血后获取供体猪肺。将三组（每组n = 5）随机分组：左肺立即移植（立即组）、EVLP 4小时后移植（EVLP组）或EVLP 4小时后进行6小时冷保存然后移植（EVLP + 冷组）。在获取肺静脉样本以计算氧分压/吸入氧分数比、测量气道压力以评估顺应性以及测量湿/干重比之前，肺再灌注2小时。
与立即组相比，EVLP组和EVLP + 冷组的氧分压/吸入氧分数比显著改善（分别为429.7 ± 51.8和436.7 ± 48.2，而立即组为117.4 ± 22.9 mmHg）。此外，与立即组相比，EVLP组和EVLP + 冷组的动态顺应性显著改善（分别为26.2 ± 4.2和27.9 ± 3.5，而立即组为11.1 ± 2.4 mL/cmH₂O）。EVLP组和EVLP + 冷组之间的氧合能力或动态顺应性无差异。EVLP组和EVLP + 冷组的炎症细胞因子水平显著较低。
循环死亡后捐赠的肺在EVLP后长达6小时可成功移植。体外评估和修复后对肺进行冷保存可能改善器官分配，即使是对远处的受者，且不影响同种异体移植物功能。
