Date H, Matsumura A, Manchester J K, Obo H, Lima O, Cooper J M, Sundaresan S, Lowry O H, Cooper J D
Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, Mo.
J Thorac Cardiovasc Surg. 1993 Mar;105(3):480-91.
We used a canine left lung allotransplantation model to evaluate 24-hour lung preservation with two different electrolyte solutions, low-potassium dextran and low-potassium dextran with 1% glucose. To investigate changes in the energy status during preservation, we analyzed the lungs for adenosine triphosphate, phosphocreatine, and several metabolites of the glycolysis pathway and the citric acid cycle: glucose, glucose-6-phosphate, lactate, citrate, and malate. We also devised and evaluated a pulmonary cooling jacket to prevent rewarming of the lung during implantation. The lungs were divided into four groups. Groups I (n = 10) and II (n = 6) were flushed with low-potassium dextran and groups III (n = 6) and IV (n = 6) were flushed with low-potassium dextran solution with 1% glucose. The cooling jacket was used for groups II and IV only. After 24-hour preservation at 10 degrees C, the left lungs were implanted into the recipient animals. Function of the transplanted left lung was assessed during temporary (10 minutes) occlusion of the contralateral pulmonary artery while both lungs were ventilated with 100% oxygen. This assessment was performed at 1 hour and at 3, 8, and 22 days after transplantation. Immediately after transplantation the arterial oxygen tension was 279 +/- 70 mm Hg in group I, 376 +/- 56 mm Hg in group II, 523 +/- 41 mm Hg in group III, and 518 +/- 50 mm Hg in group IV. The arterial oxygen tension in groups III and IV were significantly greater than in group I (p < 0.05). Of the lungs preserved with low-potassium dextran solution with 1% glucose solution, 11 of 12 (92%) showed excellent lung function (arterial oxygen tension > 300 mm Hg) at 3 days; only 10 of 16 lungs preserved with low-potassium dextran achieved this level of function. Glucose, glucose-6-phosphate, lactate, citrate and malate levels decreased significantly during 24-hour preservation with low-potassium dextran solution; they were stable with low-potassium dextran solution with 1% glucose. Adenosine triphosphate and phosphocreatine were stable for 24 hours with both low-potassium dextran and low-potassium dextran solution with 1% glucose. The cooling jacket provided uniform cooling of the lung parenchyma during implantation, and significant increase in temperature was observed in its absence, with topical cooling by cold saline solution.(ABSTRACT TRUNCATED AT 400 WORDS)
我们使用犬左肺同种异体移植模型，用两种不同的电解质溶液（低钾右旋糖酐和含1%葡萄糖的低钾右旋糖酐）评估24小时肺保存效果。为研究保存期间能量状态的变化，我们分析了肺组织中的三磷酸腺苷、磷酸肌酸以及糖酵解途径和柠檬酸循环的几种代谢产物：葡萄糖、6-磷酸葡萄糖、乳酸、柠檬酸和苹果酸。我们还设计并评估了一种肺部冷却套，以防止植入过程中肺复温。肺被分为四组。第一组（n = 10）和第二组（n = 6）用低钾右旋糖酐冲洗，第三组（n = 6）和第四组（n = 6）用含1%葡萄糖的低钾右旋糖酐溶液冲洗。冷却套仅用于第二组和第四组。在10℃保存24小时后，将左肺植入受体动物体内。在对侧肺动脉暂时阻断（10分钟）期间，当双肺均用100%氧气通气时，评估移植左肺的功能。在移植后1小时、3天、8天和22天进行该评估。移植后立即测量，第一组动脉血氧分压为279±70mmHg，第二组为376±56mmHg，第三组为523±41mmHg，第四组为518±50mmHg。第三组和第四组的动脉血氧分压显著高于第一组（p < 0.05）。在用含1%葡萄糖的低钾右旋糖酐溶液保存的肺中，12个中有11个（92%）在3天时显示出优异的肺功能（动脉血氧分压> 300mmHg）；而用低钾右旋糖酐保存的16个肺中只有10个达到了这一功能水平。在低钾右旋糖酐溶液保存24小时期间，葡萄糖、6-磷酸葡萄糖、乳酸、柠檬酸和苹果酸水平显著下降；而在含1%葡萄糖的低钾右旋糖酐溶液中它们保持稳定。三磷酸腺苷和磷酸肌酸在低钾右旋糖酐和含1%葡萄糖的低钾右旋糖酐溶液中24小时均保持稳定。冷却套在植入过程中为肺实质提供了均匀冷却，若没有它，肺温度会显著升高，用冷盐溶液局部冷却也会有同样效果。（摘要截选至400字）
