Venkataraman A, Blackwell J W, Funkhouser W K, Birchard K R, Beamer S E, Simmons W T, Randell S H, Egan T M
Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, North Carolina.
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina.
Transplant Proc. 2017 Sep;49(7):1678-1681. doi: 10.1016/j.transproceed.2017.04.004.
We began to recover lungs from uncontrolled donation after circulatory determination of death to assess for transplant suitability by means of ex vivo lung perfusion (EVLP) and computerized tomographic (CT) scan. Our first case had a cold agglutinin with an interesting outcome.
A 60-year-old man collapsed at home and was pronounced dead by Emergency Medical Services personnel. Next-of-kin consented to lung retrieval, and the decedent was ventilated and transported. Lungs were flushed with cold Perfadex, removed, and stored cold. The lungs did not flush well. Medical history revealed a recent hemolytic anemia and a known cold agglutinin. Warm nonventilated ischemia time was 51 minutes. O-ventilated ischemia time was 141 minutes. Total cold ischemia time was 6.5 hours. At cannulation for EVLP, established clots were retrieved from both pulmonary arteries. At initiation of EVLP with Steen solution, tiny red aggregates were observed initially. With warming, the aggregates disappeared and the perfusate became red. After 1 hour, EVLP was stopped because of florid pulmonary edema. The lungs were cooled to 20°C; tiny red aggregates formed again in the perfusate. Ex vivo CT scan showed areas of pulmonary edema and a pyramidal right middle lobe opacity. Dissection showed multiple pulmonary emboli-the likely cause of death. However, histology showed agglutinated red blood cells in the microvasculature in pre- and post-EVLP biopsies, which may have contributed to inadequate parenchymal preservation.
Organ donors with cold agglutinins may not be suitable owing to the impact of hypothermic preservation.
我们开始从循环判定死亡后进行的非控制捐献中获取肺脏，以通过体外肺灌注（EVLP）和计算机断层扫描（CT）来评估其移植适宜性。我们的首例病例存在冷凝集素，结果令人关注。
一名60岁男性在家中晕倒，急救医疗服务人员宣布其死亡。近亲同意捐献肺脏，死者被进行通气并转运。肺脏用冷的Perfadex冲洗，摘除后冷藏保存。肺脏冲洗效果不佳。病史显示近期有溶血性贫血且已知存在冷凝集素。非通气热缺血时间为51分钟。通气缺血时间为141分钟。总冷缺血时间为6.5小时。在进行EVLP插管时，从双侧肺动脉中取出了已形成的血栓。在用Steen溶液启动EVLP时，最初观察到微小的红色聚集体。随着温度升高，聚集体消失，灌注液变红。1小时后，由于出现明显肺水肿，停止了EVLP。肺脏冷却至20°C；灌注液中再次形成微小的红色聚集体。体外CT扫描显示存在肺水肿区域以及右中叶呈锥形的不透明影。解剖显示有多个肺栓塞——可能的死因。然而，组织学检查显示在EVLP前后的活检中，微血管内有凝集的红细胞，这可能导致了实质保存不充分。
由于低温保存的影响，存在冷凝集素的器官捐献者可能不适合。
