Buchko Max T, Himmat Sayed, Stewart Catherine J, Hatami Sanaz, Dromparis Peter, Adam Benjamin A, Freed Darren H, Nagendran Jayan
Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Transplant Proc. 2019 Jul-Aug;51(6):2022-2028. doi: 10.1016/j.transproceed.2019.03.042. Epub 2019 Jul 11.
Extended periods of ex vivo lung perfusion (EVLP) lead to several inadvertent consequences including accumulation of lactate and increasing electrolyte concentrations in the perfusate. We sought to determine whether continuous hemodialysis (CHD) of the perfusate would be a suitable modality for improving ionic homeostasis in extended EVLP without compromising functional outcomes.
Twelve porcine lungs were perfused using EVLP for 24 hours. All lungs were ventilated with negative pressure ventilation. Lungs in the treatment group (n = 6) underwent continuous hemodialysis of the perfusate. Functional parameters, edema formation, and histopathologic analysis were used to assess graft function. Electrolyte and lactate profiles were also followed to assess the efficiency of hemodialysis.
Lungs in both treatment and control groups demonstrated stable and acceptable oxygenation to 24 hours. Lungs demonstrated a decrease in compliance over time. There was no difference in oxygenation and compliance between groups. CHD-EVLP lungs had higher pulmonary vascular resistance and pulmonary artery pressures. Despite increased perfusion pressures, weight gain at both 11 and 23 hours was not different between groups. Perfusate sodium and lactate concentrations were significantly lower in the CHD-EVLP group.
The addition of continuous hemodialysis to EVLP did not improve graft function up to 24 hours despite improved maintenance of perfusate composition.
长时间的体外肺灌注（EVLP）会导致一些意外后果，包括乳酸积累和灌注液中电解质浓度升高。我们试图确定对灌注液进行持续血液透析（CHD）是否是一种在不影响功能结果的情况下改善延长的EVLP中离子稳态的合适方式。
使用EVLP对12个猪肺进行24小时灌注。所有肺均采用负压通气。治疗组（n = 6）的肺对灌注液进行持续血液透析。使用功能参数、水肿形成和组织病理学分析来评估移植物功能。还跟踪电解质和乳酸谱以评估血液透析的效率。
治疗组和对照组的肺在24小时内均表现出稳定且可接受的氧合。随着时间的推移，肺的顺应性下降。两组之间的氧合和顺应性没有差异。CHD-EVLP组的肺血管阻力和肺动脉压较高。尽管灌注压升高，但两组在11小时和23小时时的体重增加没有差异。CHD-EVLP组灌注液中的钠和乳酸浓度显著较低。
尽管灌注液成分的维持得到改善，但在EVLP中添加持续血液透析在24小时内并未改善移植物功能。
