Palleschi A, Mendogni P, Tosi D, Montoli M, Carrinola R, Mariolo A V, Briganti F, Nosotti M
Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Transplant Proc. 2017 May;49(4):686-691. doi: 10.1016/j.transproceed.2017.02.021.
Lung transplantation is a limited by donor pool shortage. Despite the efforts to extend the graft acceptability with recurrent donor criteria reformulations, previous cardiothoracic surgery is still considered a contraindication. A donor who underwent cardiac surgery could potentially provide an ideal lung but high intraoperative risks and intrinsic technical challenges are expected during the graft harvesting. The purpose of this study is to present our dedicated protocol and four clinical cases of successful lung procurements from donors who had a previous major cardiac surgery. One donor had ascending aortic root (AAR) substitution, another had mitral valve substitution, and two had coronary artery bypass surgery. The others' eligibility criteria for organ allocation, such as ABO compatibility, PaO/FiO ratio, absence of aspiration, or sepsis were respected. In one of the cases with previous coronary bypass grafting, the donor had a veno-arterial extracorporeal membrane oxygenation support. Consequently, the grafts required an ex vivo lung perfusion evaluation. We report the technical details of procurement and postoperative courses of recipients. All procurements were uneventful, without lung damage or waste of abdominal organs related to catastrophic intraoperative events. All recipients had a successful clinical outcome. We believe that successful transplantation is achievable even in a complicated setting, such as cases involving donors with previous cardiac surgery frequently are. Facing lung donor shortage, we strongly support any effort to avoid the loss of possible acceptable lungs. In particular, previous major cardiac surgery does not strictly imply a poor quality of lungs as well as unsustainable graft procurement.
肺移植受到供体库短缺的限制。尽管通过反复重新制定供体标准来努力扩大移植物的可接受性，但既往心胸外科手术仍被视为禁忌证。接受过心脏手术的供体可能会提供理想的肺，但在获取移植物过程中预计会有较高的术中风险和内在技术挑战。本研究的目的是介绍我们专门的方案以及4例从既往接受过心脏大手术的供体成功获取肺的临床病例。1例供体进行了升主动脉根部置换，另1例进行了二尖瓣置换，还有2例进行了冠状动脉搭桥手术。其他器官分配的合格标准，如ABO血型相容性、氧合指数、无误吸或败血症等均得到遵守。在1例既往有冠状动脉搭桥手术的病例中，供体接受了静脉-动脉体外膜肺氧合支持。因此，移植物需要进行体外肺灌注评估。我们报告了获取的技术细节及受体的术后病程。所有获取过程均顺利，未发生与灾难性术中事件相关的肺损伤或腹部器官浪费。所有受体均获得了成功的临床结局。我们认为，即使在复杂的情况下，如涉及既往有心脏手术的供体的病例，成功移植也是可以实现的。面对肺供体短缺的问题，我们强烈支持任何避免可能可接受的肺丧失的努力。特别是，既往心脏大手术并不严格意味着肺质量差以及不可持续的移植物获取。
