Department of Surgery, Division of Cardiac Surgery, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Transplant Proc. 2024 Jul-Aug;56(6):1406-1414. doi: 10.1016/j.transproceed.2024.04.027. Epub 2024 Jul 16.
Cold ex situ lung perfusion (ESLP) has demonstrated improved preservation in small animal ESLP compared to normothermic ESLP and cold static preservation. We hypothesized that cold negative pressure ventilation (NPV)-ESLP would improve graft function in a porcine transplantation model.
Four perfusate temperatures were examined with 12 hours NPV-ESLP in a large animal transplantation model. Pig lungs were allotted to four groups: (1) Normothermia (38°C, n = 6); (2) profound hypothermia (10°C, n = 6); (3) moderate hypothermia (20°C, n = 3); (4) subnormothermia (32°C, n = 3). A fifth group subnormothermic low-flow (SNLF) perfusion was examined to assess the effect of reduced cardiac output with cold perfusion (32°C, 10% cardiac output, n = 6).
Only Normothermic and SNLF groups demonstrated acceptable oxygenation after 12 hours NPV-ESLP and were transplanted. All other groups failed prematurely. After 12 hours of ESLP, Normothermic lungs demonstrated significantly greater dynamic compliance compared to SNLF lungs (P = .03). Edema formation post-ESLP was significantly worse in the SNLF group (P = .01). There was no significant difference in pulmonary artery pressures after ESLP (P = .10); however, pulmonary vascular resistance was significantly greater in the SNLF (P = .04). Isolated left lung oxygenation 4-hours post-transplant and left lung edema formation was not significantly different between Normothermic and SNLF post-transplant (P = .09). Proinflammatory cytokines were significantly greater during SNLF-ESLP (tumor necrosis factor alpha, P < .05).
Prolonged normothermic (38°C) NPV-ESLP is superior to 10, 20, and 32°C perfusion. Normothermic ESLP of porcine lungs results in superior graft function and reduced inflammation versus SNLF-ESLP.
与常温体外肺灌注（ESLP）和低温静态保存相比，低温离体肺灌注（ESLP）可显著改善小动物 ESLP 的保存效果。我们假设，在猪移植模型中，低温负压通气（NPV）-ESLP 将改善移植物功能。
在大型动物移植模型中，我们检查了 12 小时 NPV-ESLP 时的 4 种灌流液温度。猪肺被分配到 4 组：（1）常温（38°C，n = 6）；（2）深低温（10°C，n = 6）；（3）中低温（20°C，n = 3）；（4）亚低温（32°C，n = 3）。还检查了第五组低温低流量（SNLF）灌注，以评估低温灌注时降低心输出量对低温灌注的影响（32°C，心输出量 10%，n = 6）。
只有常温组和 SNLF 组在接受 12 小时 NPV-ESLP 并移植后才表现出可接受的氧合作用。所有其他组都过早失败。接受 12 小时 ESLP 后，常温组的动态顺应性明显大于 SNLF 组（P =.03）。ESLP 后，SNLF 组的水肿形成明显更严重（P =.01）。ESLP 后肺动脉压无显著差异（P =.10）；然而，SNLF 组的肺血管阻力明显更大（P =.04）。移植后 4 小时左肺氧合和左肺水肿形成在常温组和 SNLF 组之间无显著差异（P =.09）。移植后 SNLF-ESLP 时促炎细胞因子明显增加（肿瘤坏死因子-α，P <.05）。
长时间常温（38°C）NPV-ESLP 优于 10、20 和 32°C 灌注。与 SNLF-ESLP 相比，常温猪肺 ESLP 可改善移植物功能并减少炎症反应。
