Wei Dong, Gao Fei, Yang Zhenkun, Wang Wei, Chen Yinglun, Lu Yan, Chen Jingyu
Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China.
Jiangsu Engineering Research Center of Organ Lung Preservation, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China.
Ann Transl Med. 2020 Feb;8(3):38. doi: 10.21037/atm.2019.10.17.
Ex vivo lung perfusion (EVLP) has developed as the most effective technique for estimating marginal donor lungs. This study attempted to extend the EVLP running time to 12 hours with a dialyzer rather than periodically replacing the perfusate.
Human donor lungs rejected by the clinical lung transplantation (LTx) team were obtained. After cold storage lasting 18-24 hours, lungs were randomly assigned to 2 groups: a control group and a perfusate purification (PP) group. The control group underwent EVLP in the traditional way, while a dialyzer was added into the circuit as a bypass in the PP group. The effects on lung function, microenvironment, inflammatory response, and cell death were evaluated.
A total of 8 rejected donor lungs were obtained and each group was assigned to 4 cases of EVLP. Three cases were prematurely terminated because of serious lung edema and decreased lung function. There were no significant differences in airway pressure, pulmonary artery pressure, and oxygen concentration between the two groups in the first 8 hours. The pH in the control group was significantly lower than that in the PP group, and the levels of potassium and lactate were significantly higher than those in the PP group. Inflammatory markers increased in both groups, while IL-6 and IL-10 were higher in the PP group in the first 6 hours. Hematoxylin and eosin (HE) staining revealed lung injuries in both groups, but no significant difference was noted in the HE-stained slides. There were significantly more TUNEL-positive cells in the control group (69.5%±4.0%) than in the PP group (47.5%±3.9%) (P=0.000).
Using the modified method of EVLP reduces the high cost caused by exchanging perfusion fluid per hour and could prolong the normothermic preservation time of donor lungs.
体外肺灌注（EVLP）已发展成为评估边缘供肺最有效的技术。本研究试图通过使用透析器而非定期更换灌注液，将EVLP运行时间延长至12小时。
获取被临床肺移植（LTx）团队拒收的人类供肺。在持续18 - 24小时的冷保存后，将肺随机分为两组：对照组和灌注液净化（PP）组。对照组采用传统方式进行EVLP，而PP组在回路中添加透析器作为旁路。评估其对肺功能、微环境、炎症反应和细胞死亡的影响。
共获取8个被拒收的供肺，每组分配4例进行EVLP。3例因严重肺水肿和肺功能下降而提前终止。两组在前8小时的气道压力、肺动脉压力和氧浓度无显著差异。对照组的pH值显著低于PP组，钾和乳酸水平显著高于PP组。两组炎症标志物均升高，而PP组在前6小时的IL - 6和IL - 10水平更高。苏木精和伊红（HE）染色显示两组均有肺损伤，但HE染色切片中未观察到显著差异。对照组的TUNEL阳性细胞（69.5%±4.0%）明显多于PP组（47.5%±3.9%）（P = 0.000）。
采用改良的EVLP方法可降低每小时更换灌注液所带来的高成本，并可延长供肺的常温保存时间。
