Niman Eito, Miyoshi Kentaroh, Shiotani Toshio, Toji Tomohiro, Igawa Takuro, Otani Shinji, Okazaki Mikio, Sugimoto Seiichiro, Yamane Masaomi, Toyooka Shinichi
Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Diagnostic Pathology, Okayama University Hospital, Okayama, Japan.
J Thorac Dis. 2022 Aug;14(8):2802-2811. doi: 10.21037/jtd-22-226.
Brain-dead donors are susceptible to pulmonary atelectasis (AT). In procurement surgery, lung recruitment under circulatory conditions and cold-flushing for atelectatic donor lungs often provoke graft injury due to the acute blood inflow. We hypothesized that lung recruitment without blood circulation can mitigate graft injury. This study aimed to examine the benefits of lung recruitment subsequent to cardiac arrest using a porcine lung-transplant model.
Thirteen donor pigs were categorized into the non-atelectatic (No-AT) group (n=3) representing a healthy control group; AT-BCR group (n=5), in which AT was reverted by conventional blood-circulated recruitment (BCR); and AT-no-BCR group (n=5), in which AT was reverted by no-BCR following circulatory arrest. In the atelectatic donor models, the left main bronchus was ligated for 24 hours prior to lung procurement. Left lung transplantation (LTx) was subsequently performed in the thirteen recipient pigs. After 6 hours evaluation, the recipients were euthanized and the lung grafts were excised.
The post-transplant PaO/FiO ratio was significantly higher in the AT-no-BCR group than in the AT-BCR group (P=0.015). Wet/dry ratio, histological findings of graft injury and tissue interleukin-8 expression in the AT-no-BCR group were similar to those of the No-AT group.
Lung recruitment without circulation after circulatory arrest could be more protective for atelectatic donor lung than the conventional procedure.
脑死亡供体易发生肺不张（AT）。在获取手术中，循环条件下的肺复张以及对肺不张供体肺进行冷冲洗时，急性血流常引发移植物损伤。我们推测无血液循环的肺复张可减轻移植物损伤。本研究旨在使用猪肺移植模型检验心脏骤停后肺复张的益处。
13头供体猪被分为非肺不张（No-AT）组（n = 3），作为健康对照组；AT-BCR组（n = 5），通过传统的血液循环复张（BCR）恢复肺不张；以及AT-no-BCR组（n = 5），在循环骤停后通过无BCR恢复肺不张。在肺不张供体模型中，在获取肺之前将左主支气管结扎24小时。随后对13头受体猪进行左肺移植（LTx）。评估6小时后，对受体实施安乐死并切除肺移植物。
AT-no-BCR组移植后的PaO/FiO比值显著高于AT-BCR组（P = 0.015）。AT-no-BCR组的湿/干比值、移植物损伤的组织学结果以及组织白细胞介素-8表达与No-AT组相似。
循环骤停后无循环的肺复张对肺不张供体肺可能比传统方法更具保护作用。
