Luc J G Y, Jackson K, Weinkauf J G, Freed D H, Nagendran J
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 Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Transplant Proc. 2017 Oct;49(8):1885-1892. doi: 10.1016/j.transproceed.2017.04.010.
Donation after circulatory death (DCD) has the potential to significantly alleviate the shortage of transplantable lungs. We report our initial experience with the use of portable ex vivo lung perfusion (EVLP) with the Organ Care System Lung device for evaluation of DCD lungs.
We performed a retrospective review of the DCD lung transplantation (LTx) experience at a single institution through the use of a prospective database.
From 2011 to 2015, 208 LTx were performed at the University of Alberta, of which 11 were DCD LTx with 7 (64%) that underwent portable EVLP. DCD lungs preserved with portable EVLP had a significantly shorter cold ischemic time (161 ± 44 vs 234 ± 60 minutes, P = .045), lower grade of primary graft dysfunction at 72 hours after LTx (0.4 ± 0.5 vs 2.1 ± 0.7, P = .003), similar mechanical ventilation time (55 ± 44 vs 103 ± 97 hours, P = .281), and hospital length of stay (29 ± 11 vs 33 ± 10 days, P = .610). All patients were alive at 1-year follow-up after LTx with improved functional outcomes and acceptable quality of life compared with before LTx, although there were no intergroup differences.
In our pilot cohort, portable EVLP was a feasible modality to increase confidence in the use of DCD lungs with validated objective evidence of lung function during EVLP that translates to acceptable clinical outcomes and quality of life after LTx. Further studies are needed to validate these initial findings in a larger cohort.
心脏死亡后器官捐献（DCD）有可能显著缓解可移植肺短缺的问题。我们报告了使用器官护理系统肺设备进行便携式体外肺灌注（EVLP）评估DCD肺的初步经验。
我们通过前瞻性数据库对单一机构的DCD肺移植（LTx）经验进行了回顾性分析。
2011年至2015年，阿尔伯塔大学共进行了208例LTx，其中11例为DCD LTx，7例（64%）接受了便携式EVLP。采用便携式EVLP保存的DCD肺冷缺血时间显著缩短（161±44分钟 vs 234±60分钟，P = 0.045），LTx术后72小时原发性移植物功能障碍分级较低（0.4±0.5 vs 2.1±0.7，P = 0.003），机械通气时间相似（55±44小时 vs 103±97小时，P = 0.281），住院时间也相似（29±11天 vs 33±10天，P = 0.610）。所有患者在LTx术后1年随访时均存活，与LTx术前相比，功能结局改善，生活质量可接受，尽管组间无差异。
在我们的试点队列中，便携式EVLP是一种可行的方式，可增加对DCD肺使用的信心，EVLP期间有经过验证的肺功能客观证据，这转化为LTx术后可接受的临床结局和生活质量。需要进一步研究在更大队列中验证这些初步发现。
