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 Oct;56(8):1811-1819. doi: 10.1016/j.transproceed.2024.08.027. Epub 2024 Sep 6.
Reliable 24-hour preservation is required to optimize the rehabilitation potential of Ex Situ Lung Perfusion (ESLP). Other ESLP protocols include fresh perfusate replacement to counteract an accumulation of deleterious by-products. We describe the results of our reliable 24-hour negative pressure ventilation (NPV)-ESLP protocol with satisfactory acute post-transplant outcomes and investigate perfusate exchange (PE) as a modification to enhance prolonged ESLP.
Twelve pig lungs underwent 24 hours of NPV-ESLP using 1.5L of cellular perfusate (500 mL packed red blood cells and 1 L buffered perfusate). The Control (n = 6) had no PE; the PE (n = 6) had 500 mL replaced after 12 hours of NPV-ESLP with 1000 mL fresh perfusate. Three left lungs per group were transplanted.
Results are reported as Control vs PE (mean ± SEM). Both groups demonstrated stable and acceptable oxygenation during 24 hours of ESLP with final PF ratios of 527.5 ± 42.19 and 488.4 ± 35.38 (P = .25). Final compliance measurements were 20.52 ± 3.59 and 18.55 ± 2.91 (P = .34). There were no significant differences in pulmonary artery pressure after 24 hours of ESLP (10.02 ± 2.69 vs 14.34 ± 1.64, P = .10), and pulmonary vascular resistance only differed significantly at T12 (417.6 ± 53.06 vs 685.4 ± 81.19, P = .02). Percentage weight gain between groups was similar (24.32 ± 8.4 and 45.33 ± 7.76, P = .07). Post-transplant left lung oxygenation was excellent (327.3 ± 14.62 and 313.3 ± 15.38, P = .28). There was no significant difference in % weight gain of lungs post-transplant (22.20 ± 7.22 vs 14.36 ± 9.96, P = .28).
Acceptable lung function was maintained during 24-hour NPV-ESLP and post-transplant regardless of PE.
为了优化离体肺灌注（ESLP）的康复潜力，需要进行可靠的 24 小时保存。其他 ESLP 方案包括更换新鲜灌注液以对抗有害副产品的积累。我们描述了我们可靠的 24 小时负压通气（NPV）-ESLP 方案的结果，该方案具有令人满意的急性移植后结果，并研究了灌注液交换（PE）作为增强长时间 ESLP 的一种改良方法。
12 只猪肺接受了 24 小时的 NPV-ESLP，使用 1.5L 细胞灌注液（500ml 浓缩红细胞和 1L 缓冲灌注液）。对照组（n=6）无 PE；PE 组（n=6）在 NPV-ESLP 12 小时后用 1000ml 新鲜灌注液更换 500ml。每组有 3 个左肺进行移植。
结果以对照组与 PE 组（均值±SEM）报告。两组在 ESLP 24 小时期间均表现出稳定且可接受的氧合作用，最终 PF 比分别为 527.5±42.19 和 488.4±35.38（P=0.25）。最终顺应性测量值分别为 20.52±3.59 和 18.55±2.91（P=0.34）。24 小时 ESLP 后肺动脉压无显著差异（10.02±2.69 vs 14.34±1.64，P=0.10），仅在 T12 时肺血管阻力有显著差异（417.6±53.06 vs 685.4±81.19，P=0.02）。两组间体重增加百分比相似（24.32±8.4 和 45.33±7.76，P=0.07）。移植后左肺氧合作用良好（327.3±14.62 和 313.3±15.38，P=0.28）。移植后肺的体重增加百分比无显著差异（22.20±7.22 vs 14.36±9.96，P=0.28）。
无论是否进行 PE，在 24 小时 NPV-ESLP 和移植后都可以维持可接受的肺功能。
