Olbertz Carolin, Pizanis Nikolaus, Bäumker Hagen, Kalka Katharina, Aigner Clemens, Rauen Ursula, Nolte Ingo, Kamler Markus, Koch Achim
Thoracic Transplantation, Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University Hospital Essen Essen, Germany.
Small Animal Clinic, University of Veterinary Medicine Hannover, Foundation Hannover, Germany.
Am J Transl Res. 2020 Jan 15;12(1):153-161. eCollection 2020.
Ex vivo Lung Perfusion (EVLP) is a promising tool to increase the donor pool for lung transplantation. Custodiol-N solution was originally designed for organ preservation during cold static preservation (CSP) and was successfully used for machine perfusion in kidneys. It was the aim of this study to compare the lung functional outcomes after 4 hours of EVLP using modified Custodiol-N or STEEN Solution as perfusion solution.
In a porcine DCD model, lungs were perfused either with STEEN Solution (Standard SS, n=8) or modified Custodiol-N with added 1.1 g/l glucose monohydrate and 50 g/l dextran 40 (CD, n=8). For a third group 7 g/l albumin was supplemented to modified Custodiol-N (CDA, n=8). During four hours of EVLP pulmonary gas exchange and activities of lactate dehydrogenase (LDH) and alkaline phosphatase (AP) in perfusate were recorded.
Lungs that underwent EVLP with modified Custodiol-N showed significantly higher oxygen capacity (ΔpO averaged over four hours of EVLP: SS: 236.28 ± 47.26 mmHg, CD: 402.79 ± 30.33 mmHg, CDA: 414.86 ± 9.77 mmHg) than lungs perfused with STEEN Solution. The addition of albumin did not have a significant effect on lung function but these lungs showed lower wet/dry ratio.
In a porcine DCD model of 9 hours CSP followed by four hours of EVLP the use of modified Custodiol-N as perfusion solution was feasible and associated with higher oxygen capacity than STEEN Solution. The addition of albumin seems to further stabilize lung function.
体外肺灌注（EVLP）是一种很有前景的增加肺移植供体库的工具。Custodiol-N溶液最初设计用于冷静态保存（CSP）期间的器官保存，并成功用于肾脏的机器灌注。本研究的目的是比较使用改良的Custodiol-N或STEEN溶液作为灌注液进行4小时EVLP后的肺功能结果。
在猪脑死亡后捐赠模型中，肺分别用STEEN溶液（标准SS组，n = 8）或添加1.1 g/l一水葡萄糖和50 g/l右旋糖酐40的改良Custodiol-N（CD组，n = 8）灌注。第三组在改良的Custodiol-N中补充7 g/l白蛋白（CDA组，n = 8）。在4小时的EVLP期间，记录肺气体交换以及灌注液中乳酸脱氢酶（LDH）和碱性磷酸酶（AP）的活性。
使用改良Custodiol-N进行EVLP的肺显示出比用STEEN溶液灌注的肺显著更高的氧合能力（EVLP四小时内平均ΔpO：SS组：236.28±47.26 mmHg，CD组：402.79±30.33 mmHg，CDA组：414.86±9.77 mmHg）。添加白蛋白对肺功能没有显著影响，但这些肺显示出较低的湿/干比。
在9小时CSP后接着4小时EVLP的猪脑死亡后捐赠模型中，使用改良的Custodiol-N作为灌注液是可行的，并且与STEEN溶液相比具有更高的氧合能力。添加白蛋白似乎能进一步稳定肺功能。
