Tanaka Shin, Umeda Masashi, Ujike Hiroyuki, Ryuko Tsuyoshi, Tomioka Yasuaki, Miyoshi Kentaroh, Okazaki Mikio, Sugimoto Seiichiro, Toyooka Shinichi
Department of General Thoracic and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan.
Department of General Thoracic Surgery, Shimane University Graduate School of Medicine, Shimane, Japan.
Gen Thorac Cardiovasc Surg. 2025 Mar 16. doi: 10.1007/s11748-025-02137-y.
To overcome limitations of traditional ex vivo lung perfusion (EVLP) for controlled donation after circulatory death (cDCD) lungs, this study aimed to evaluate a novel pulmonary abdominal normothermic regional perfusion (PANRP) technique, which we uniquely designed, for in situ assessment of lungs from cDCD donors.
We modified the abdominal normothermic regional perfusion circuit for simultaneous lung and abdominal organ assessment using independent extracorporeal membrane oxygenation components. Blood was oxygenated via a membrane oxygenator and returned to the body, with pulmonary flow adjusted to maintain pressure < 25 mmHg. Femoral cannulation was performed, and the lungs were ventilated with standard settings. Organ function was assessed over 2 h using PaO2/FiO2, AST, ALT, BUN, and Cr measurements to monitor perfusion and oxygen delivery.
PANRP maintained stable lung function, with P/F ratios above 300, and preserved abdominal organ parameters, including stable AST, ALT, BUN, and Cr levels. Adequate urine output was observed, indicating normal renal function. Pulmonary artery pressure remained < 20 mmHg, and pulmonary vascular resistance was kept at 400 dyn・s/cm, showing no signs of lung dysfunction or injury throughout the circuit.
PANRP offers a promising alternative to traditional EVLP for cDCD lung evaluation, allowing in situ assessment of multiple organs simultaneously. This approach may overcome logistical and economic challenges associated with ex vivo techniques, enabling a more efficient evaluation process. Further studies are warranted to confirm its clinical applicability and impact on long-term outcomes.
为克服传统体外肺灌注（EVLP）用于循环死亡后捐赠（cDCD）肺的局限性，本研究旨在评估一种我们独特设计的新型肺腹部常温区域灌注（PANRP）技术，用于原位评估cDCD供体的肺。
我们对腹部常温区域灌注回路进行了改良，使用独立的体外膜肺氧合组件同时评估肺和腹部器官。血液通过膜式氧合器进行氧合后回输到体内，调节肺血流量以维持压力<25 mmHg。进行股动脉插管，并采用标准设置对肺进行通气。通过测量动脉血氧分压/吸入氧分数值（PaO2/FiO2）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、血尿素氮（BUN）和肌酐（Cr），在2小时内评估器官功能，以监测灌注和氧输送情况。
PANRP维持了稳定的肺功能，氧合指数高于300，并保持了腹部器官参数，包括稳定的AST、ALT、BUN和Cr水平。观察到尿量充足，表明肾功能正常。肺动脉压保持<20 mmHg，肺血管阻力维持在400 dyn・s/cm，整个回路未出现肺功能障碍或损伤的迹象。
对于cDCD肺评估，PANRP为传统EVLP提供了一种有前景的替代方法，可同时对多个器官进行原位评估。这种方法可能克服与体外技术相关的后勤和经济挑战，实现更高效的评估过程。有必要进一步开展研究以确认其临床适用性及其对长期结果的影响。
