Luc Jessica G Y, Aboelnazar Nader S, Himmat Sayed, Hatami Sanaz, Haromy Alois, Matsumura Nobutoshi, Vasanthan Vishnu, White Christopher W, Mengel Michael, Freed Darren H, Nagendran Jayan
From the *Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; †Mazankowski Alberta Heart Institute, Edmonton, Canada; ‡Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; §Cardiovascular Research Centre, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; ¶Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan; ‖Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada; #Alberta Transplant Institute, Edmonton, Canada; and **Canadian National Transplant Research Program, Edmonton, Canada.
ASAIO J. 2017 Sep/Oct;63(5):672-678. doi: 10.1097/MAT.0000000000000550.
Normothermic ex vivo lung perfusion (EVLP) allows for assessment and reconditioning of donor lungs. Although a leukocyte filter (LF) is routinely incorporated into the EVLP circuit; its efficacy remains to be determined. Twelve pig lungs were perfused and ventilated ex vivo in a normothermic state for 12 hours. Lungs (n = 3) were allocated to four groups according to perfusate composition and the presence or absence of a LF in the circuit (acellular ± LF, cellular ± LF). Acceptable physiologic lung parameters were achieved during EVLP; however, increased amounts of pro-inflammatory cytokines (TNF-α and IL-6) and leukocytes in the perfusate were observed despite the presence or absence of a LF. Analysis of cells washed off the LF demonstrates that it trapped leukocytes although being ineffective throughout perfusion as it became saturated over 12 hours of EVLP. We conclude that there is no objective evidence to support the routine incorporation of a LF during EVLP as it does not provide further benefit and its removal does not appear to cause harm. The lack of hypothesized benefit to a LF may be because of the saturation of the LF with donor leukocytes, leading to similar amounts of circulating leukocytes still present in the perfusate with and without a LF.
常温离体肺灌注（EVLP）可用于评估和修复供体肺。尽管白细胞滤器（LF）通常被纳入EVLP回路中，但其疗效仍有待确定。12个猪肺在常温状态下进行离体灌注和通气12小时。根据灌注液成分以及回路中是否存在LF，将肺（n = 3）分为四组（无细胞±LF，有细胞±LF）。在EVLP期间获得了可接受的生理性肺参数；然而，无论是否存在LF，灌注液中促炎细胞因子（TNF-α和IL-6）和白细胞的数量均增加。对从LF上洗脱的细胞进行分析表明，尽管在整个灌注过程中它因在12小时的EVLP中饱和而无效，但它捕获了白细胞。我们得出结论，没有客观证据支持在EVLP期间常规使用LF，因为它没有提供进一步的益处，并且去除它似乎也不会造成伤害。LF缺乏预期的益处可能是由于LF被供体白细胞饱和，导致无论有无LF，灌注液中仍存在相似数量的循环白细胞。
