Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Transplant Proc. 2024 Oct;56(8):1820-1827. doi: 10.1016/j.transproceed.2024.08.032. Epub 2024 Sep 5.
Full-flow perfusion during prolonged ex situ lung perfusion (ESLP) results in unacceptable pulmonary edema formation. Clinical ESLP at 30% to 50% predicted cardiac output (CO) supports acceptable physiologic outcomes; however, progressive pulmonary edema still develops. Lower flow rates may provide equivalent physiologic preservation with less edema formation due to reduced hydrostatic pressures. We report our results of moderate-flow (MF; 30% CO) vs low-flow (LF; 10% CO) negative pressure ventilation (NPV)-ESLP with transplantation.
Twelve pig lungs underwent 12-hours of NPV-ESLP with 30% or 10% CO (n = 6/group). Three left lungs per group were transplanted post-ESLP and assessed in vivo over 4 hours. Lung function was assessed by physiologic parameters, weight-gain, and pro-inflammatory cytokine profiles.
Results are MF vs LF (mean ± SEM). All lungs demonstrated acceptable oxygenation post-ESLP (454.2 ± 40.85 vs 422.7 ± 31.68, P = .28); however, after transplantation, the MF lungs demonstrated significantly better oxygenation (300.7 ± 52.26 vs 141.9 ± 36.75, P = .03). There was no significant difference in compliance after ESLP (21.38 ± 2.28 vs 16.48 ± 2.34, P = .08); however, pulmonary artery pressure (PAP; 10.89 ± 2.28 vs 21.11 ± 0.93, P = .06) and pulmonary vascular resistance (PVR; 438.60 ± 97.97 vs 782.20 ± 162.20, P = .05) were significantly higher in the LF group. Weight gain (%) post-ESLP and post-transplant was similar between groups (29.42 ± 5.72 vs 24.17 ± 4.42, P = .24; and 29.63 ± 7.23 vs 57.04 ± 15.78, P = .09). TNF-α and IL-6 were significantly greater throughout LF ESLP.
The MF NPV-ESLP results in superior lung function with less inflammation compared to LF NPV-ESLP.
在长时间的体外肺灌注（ESLP）过程中，全流量灌注会导致不可接受的肺水肿形成。临床 ESLP 以预测心输出量（CO）的 30%至 50%支持可接受的生理结果；然而，仍会逐渐发生肺水肿。较低的流量可能会由于静水压力降低而提供等效的生理保存和更少的水肿形成。我们报告了中度流量（MF；30%CO）与低流量（LF；10%CO）负压通气（NPV）-ESLP 与移植的结果。
12 只猪肺进行了 12 小时的 NPV-ESLP，CO 为 30%或 10%（每组 n = 6）。每组中的 3 个左肺在 ESLP 后进行移植，并在 4 小时内进行体内评估。通过生理参数、体重增加和促炎细胞因子谱评估肺功能。
结果为 MF 与 LF（平均值 ± SEM）。所有肺在 ESLP 后均表现出可接受的氧合作用（454.2 ± 40.85 与 422.7 ± 31.68，P =.28）；然而，移植后，MF 肺表现出明显更好的氧合作用（300.7 ± 52.26 与 141.9 ± 36.75，P =.03）。ESLP 后顺应性无显著差异（21.38 ± 2.28 与 16.48 ± 2.34，P =.08）；然而，肺动脉压（PAP；10.89 ± 2.28 与 21.11 ± 0.93，P =.06）和肺血管阻力（PVR；438.60 ± 97.97 与 782.20 ± 162.20，P =.05）在 LF 组中显著更高。ESLP 后和移植后的体重增加（%）在两组之间相似（29.42 ± 5.72 与 24.17 ± 4.42，P =.24；和 29.63 ± 7.23 与 57.04 ± 15.78，P =.09）。整个 LF ESLP 期间 TNF-α和 IL-6 显著增加。
与 LF NPV-ESLP 相比，MF NPV-ESLP 导致更好的肺功能和更少的炎症。
