Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada.
the Department of Physiology and Pharmacology, Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada.
J Heart Lung Transplant. 2017 May;36(5):577-585. doi: 10.1016/j.healun.2016.11.010. Epub 2016 Dec 1.
Ex vivo lung perfusion (EVLP) provides opportunities to treat injured donor lungs before transplantation. We investigated whether lung lavage, to eliminate inflammatory inhibitory components, followed by exogenous surfactant replacement, could aid lung recovery and improve post-transplant lung function after gastric aspiration injury.
Gastric acid aspiration was induced in donor pigs, which were ventilated for 6 hours to develop lung injury. After retrieval and 10 hours of cold preservation, EVLP was performed for 6 hours. The lungs were randomly divided into 4 groups (n = 5, each): (1) no treatment (control), (2) lung lavage, (3) surfactant administration, and (4) lung lavage, followed by surfactant administration. After another 2-hour period of cold preservation, the left lung was transplanted and reperfused for 4 hours.
Physiologic lung function significantly improved after surfactant administration during EVLP. The EVLP perfusate from the lavage + surfactant group showed significantly lower levels of interleukin (IL)-1β, IL-6, IL-8, and secretory phospholipase A. Total phosphatidylcholine was increased, and minimum surface tension was recovered to normal levels (≤5 mN/m) in the bronchioalveolar fluid after surfactant administration. Lysophosphatidylcholine in bronchioalveolar fluid was significantly lower in the lavage + surfactant group than in the surfactant group. Post-transplant lung function was significantly better in the lavage + surfactant group compared with all other groups.
Lung lavage, followed by surfactant replacement during EVLP, reduced inflammatory mediators and prevented hydrolysis of phosphatidylcholine, which contributed to the superior post-transplant function in donor lungs with aspiration injury.
体外肺灌注 (EVLP) 为在移植前治疗受损供体肺提供了机会。我们研究了灌洗以消除炎症抑制成分，随后用外源性表面活性剂替代，是否可以帮助肺恢复并改善胃抽吸损伤后移植后的肺功能。
在供体猪中诱导胃酸抽吸，然后通气 6 小时以发展肺损伤。取回后冷藏 10 小时后，进行 EVLP 治疗 6 小时。将肺随机分为 4 组（n = 5，每组）：（1）无治疗（对照），（2）肺灌洗，（3）表面活性剂给药，和（4）肺灌洗，随后给予表面活性剂。再经过 2 小时的冷藏期后，将左肺移植并再灌注 4 小时。
EVLP 期间表面活性剂给药后肺生理功能显著改善。灌洗+表面活性剂组的 EVLP 灌洗液中白细胞介素 (IL)-1β、IL-6、IL-8 和分泌型磷脂酶 A 的水平显著降低。总磷酯酰胆碱增加，表面活性剂给药后支气管肺泡液中的最小表面张力恢复到正常水平（≤5 mN/m）。支气管肺泡液中的溶血磷酯酰胆碱在灌洗+表面活性剂组中明显低于表面活性剂组。与所有其他组相比，灌洗+表面活性剂组移植后的肺功能明显更好。
EVLP 期间灌洗，随后用表面活性剂替代，可减少炎症介质并防止磷酯酰胆碱水解，从而有助于改善有抽吸损伤的供体肺的移植后功能。
