Harjula A, Baldwin J C, Starnes V A, Stinson E B, Oyer P E, Jamieson S W, Shumway N E
Department of Cardiovascular Surgery, Stanford University School of Medicine, Calif.
J Thorac Cardiovasc Surg. 1987 Dec;94(6):874-80.
Clinical cardiopulmonary transplantation is currently limited by the availability of suitable heart-lung donors. Distant graft procurement, with pretreatment, of the donor by intravenous prostaglandin E1 and cooling of the graft with pulmonary artery perfusion, is now clinically established and should increase the number of available donors. Between March 1981 and September 1986, 40 heart-lung transplantations were performed. The characteristics of the donor pool were analyzed. Gram stain of the donor tracheal aspirate revealed gram-positive bacteria in 80% and gram-negative organisms in 35%. Yeast was present on stain in 25% of the patients. Donor arterial oxygen tension was less than 100 torr inspired oxygen concentration 40%) repeatedly in one patient; this recipient died of lung failure at operation. Severe deterioration of allograft lung function was seen in 11 (27.5%) recipients. The causes of deterioration were substantial postoperative bleeding in six patients, sepsis in two, and acute rejection, poor lung function, and allograft heart failure in one patient each. HLA-A locus mismatch, poor donor alveolar-capillary gas exchange, tracheal colonization with heavy polymorphonuclear cells, and heavy bacteria and fungus resulted in increased operative mortality. Donor pretreatment with prostaglandin E1 was associated with improved survival. Recipient selection, emphasizing adequate liver function and absence of previous thoracic operation, careful surgical technique with minimal bleeding, and brief perfusion time were factors associated with improved survival. Early morbidity and mortality were principally related to recipient risk factors, and the strict criteria observed for selection of heart-lung donors were valid. The importance of appropriate recipient selection is underscored.
目前，临床心肺移植受到合适心肺供体可用性的限制。通过静脉注射前列腺素E1对供体进行预处理，并采用肺动脉灌注对移植物进行冷却，远距离获取移植物，目前已在临床上得到确立，这有望增加可用供体的数量。1981年3月至1986年9月期间，共进行了40例心肺移植手术。对供体库的特征进行了分析。供体气管吸出物的革兰氏染色显示，80%为革兰氏阳性菌，35%为革兰氏阴性菌。25%的患者染色可见酵母菌。1例患者的供体动脉血氧分压在吸入氧浓度为40%时反复低于100托；该受者在手术中死于肺衰竭。11例（27.5%）受者出现移植肺功能严重恶化。恶化原因包括6例患者术后大量出血、2例患者发生败血症，以及1例患者分别出现急性排斥反应、肺功能差和移植心衰竭。HLA - A位点不匹配、供体肺泡 - 毛细血管气体交换不良、气管内大量多形核细胞定植以及大量细菌和真菌导致手术死亡率增加。用前列腺素E1预处理供体与提高生存率相关。受者选择方面，强调肝功能良好且既往无胸部手术史、手术操作细致以减少出血、灌注时间短，这些都是与提高生存率相关的因素。早期发病率和死亡率主要与受者风险因素有关，为选择心肺供体所遵循的严格标准是有效的。强调了合适受者选择的重要性。
