Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Transplant Center, Cleveland Clinic, Cleveland, Ohio.
Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
J Surg Res. 2021 Apr;260:190-199. doi: 10.1016/j.jss.2020.11.069. Epub 2020 Dec 18.
Currently, pulmonary edema is evaluated via surgical inspection and palpation in donor lungs, and there is no quantitative standard diagnostic tool for evaluating pulmonary edema in donor procurement and ex vivo lung perfusion (EVLP). The purpose of this study was to investigate the significance of lung weight at the donor hospital and lung weight during EVLP as a complementary parameter of transplant suitability in EVLP.
Twenty-one of rejected human lungs were perfused in cellular EVLP. Transplant suitability was evaluated at 2 h as per standard criteria of Lund-protocol EVLP.
Lung weight at donor hospital was significantly correlated with PaO/FiO (P/F) ratio in EVLP (r = -0.44). There was a significant difference in lung weight at donor hospital between suitable cases (n = 13) and nonsuitable cases (n = 8). Light lung group (lung weight at donor hospital < 1280 g; n = 17) was suitable for transplant in 76%, whereas none of heavy lung group (lung weight at donor hospital ≥ 1280 g; n = 4) was suitable (P < 0.05). Lung weight at 2 h and lung weight change during EVLP were significantly associated with P/F ratio at 2 h and transplant suitability (P < 0.05, each).
Our findings demonstrate that lung weight at donor hospital, lung weight change, and lung weight at 2 h of EVLP might be a predictor of P/F ratio and transplant suitability in cellular EVLP.
目前，肺水肿通过手术检查和供体肺触诊来评估，而对于供体获取和体外肺灌注（EVLP）中的肺水肿，尚无定量标准的诊断工具。本研究旨在探讨供体医院时的肺重量和 EVLP 期间的肺重量作为 EVLP 中移植适用性的补充参数的意义。
21 个废弃的人类肺在细胞 EVLP 中进行灌注。根据 Lund-protocol EVLP 的标准标准，在 2 小时时评估移植适用性。
供体医院时的肺重量与 EVLP 中的 PaO/FiO（P/F）比值呈显著负相关（r=-0.44）。在供体医院时的肺重量在适合病例（n=13）和不适合病例（n=8）之间存在显著差异。轻肺组（供体医院时的肺重量<1280g；n=17）的移植适合率为 76%，而重肺组（供体医院时的肺重量≥1280g；n=4）均不适合（P<0.05）。2 小时时的肺重量和 EVLP 期间的肺重量变化与 2 小时时的 P/F 比值和移植适用性显著相关（P<0.05，各）。
我们的研究结果表明，供体医院时的肺重量、EVLP 期间的肺重量变化和 2 小时时的肺重量可能是细胞 EVLP 中 P/F 比值和移植适用性的预测因子。
