Faccioli Eleonora, Verzeletti Vincenzo, Mammana Marco, Dell'Amore Andrea, Melan Luca, Shamshoum Fares, Rosellini Edoardo, Boscolo Annalisa, Pezzuto Federica, Navalesi Paolo, Calabrese Fiorella, Rea Federico, Schiavon Marco
Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy.
Anesthesia and Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy.
J Clin Med. 2024 Dec 5;13(23):7412. doi: 10.3390/jcm13237412.
Lung transplantation is the most effective treatment for end-stage respiratory diseases, but its application is limited by the shortage of organs. Ex vivo lung perfusion (EVLP) has emerged as a promising technique to evaluate and recondition donor lungs previously deemed unsuitable for transplantation. However, limitations such as lung contusions, air leaks, and perfusate extravasation, especially in portable EVLP systems, hinder the procedure. Despite prolonged perfusions that can result in blood pooling at the lung bases due to fixed lung positioning and diminished oncotic pressure, in some cases, extending perfusion time beyond the typical 5-6 h could benefit extended-criteria lungs, addressing factors such as edema or logistical complications. We present an innovative protocol involving prolonged EVLP, pronation of the graft, and the addition of anti-edematous drugs to the perfusate. This novel approach, previously tested in animal models, enhances lung reconditioning and expands the donor pool. Our findings suggest that this strategy overcomes key limitations of standard EVLP, offering a valuable solution for improving the availability of transplantable lungs.
肺移植是终末期呼吸系统疾病最有效的治疗方法，但其应用因器官短缺而受到限制。体外肺灌注（EVLP）已成为一种有前景的技术，用于评估和修复先前被认为不适于移植的供肺。然而，诸如肺挫伤、漏气和灌注液外渗等局限性，尤其是在便携式EVLP系统中，阻碍了该操作。尽管长时间灌注可能由于肺固定位置和血浆渗透压降低导致肺底部血液淤积，但在某些情况下，将灌注时间延长至典型的5 - 6小时以上可能有益于边缘供肺，解决诸如水肿或后勤并发症等因素。我们提出了一种创新方案，包括延长EVLP、移植肺俯卧位以及在灌注液中添加抗水肿药物。这种新方法先前已在动物模型中进行测试，可增强肺修复并扩大供体库。我们的研究结果表明，该策略克服了标准EVLP的关键局限性，为提高可移植肺的可用性提供了有价值的解决方案。
