Roberts C S, D'Armini A M, Egan T M
Department of Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7065, USA.
J Thorac Cardiovasc Surg. 1996 Sep;112(3):577-83. doi: 10.1016/S0022-5223(96)70038-7.
If lungs could be retrieved from cadavers after circulatory arrest, the critical shortage of donors for lung transplantation might be alleviated. To assess gas exchange after transplantation of lungs from cadaveric donors, we performed double-lung transplantation through sequential thoracotomies in 12 dogs. Donors were sacrificed by intravenous pentobarbital injection and then ventilated with 100% oxygen. Lungs were harvested 2 hours (n = 6) or 4 hours (n = 6) after death and flushed with 2 L modified Euro-Collins solution. Recipients underwent sequential right and left lung transplantation; they were then monitored while under anesthesia for 8 hours, with adjustments of the fraction of inspired oxygen. Nine of 12 recipients survived the 8-hour study period. Four of six dogs with cadaveric lungs retrieved 2 hours after death survived; deaths were from pulmonary embolism at 6 hours and pulmonary edema at 2 hours. Five of six dogs with cadaveric lungs retrieved 4 hours after death survived; one died of hypoxia during implantation of the left lung, while dependent on the right lung graft. Postoperative hemodynamic and gas exchange parameters were similar in both groups. Alveolar-arterial oxygen gradient rose significantly compared with baseline 1 hour after transplantation in both groups (462 +/- 60 vs 38 +/- 31 mmHg for 2-hour group, p < 0.0001, and 484 +/- 63 vs 38 +/- 14 mmHg for 4-hour group, p < 0.0002). By 8 hours after operation, the gradients had significantly decreased in both groups (105 +/- 37 mm Hg for 2-hour group and 146 +/- 53 mm Hg for 4-hour group) and were similar to baseline values. Extravascular lung water also rose significantly 1 hour after transplantation (15.7 +/- 2.8 vs 7.9 +/- 0.5 ml/kg for 2-hour group, p < 0.02, and 16.9 +/- 1.2 vs 6.6 +/- 0.4 ml/kg for 4-hour group, p < 0.0001) and decreased gradually during the 8-hour study period. Donor lungs retrieved at 2 and 4 hours postmortem afford similar recipient outcomes. Improvement in alveolar-arterial oxygen gradient and reduction in extravascular lung water during the study period imply that the ischemia-reperfusion injury induced by this model is reversible. If this approach could be safely introduced to clinical practice, substantially more transplant procedures could be performed.
如果能在循环停止后从尸体获取肺脏，肺移植供体严重短缺的状况或许能得到缓解。为评估尸体供体肺移植后的气体交换情况，我们通过序贯开胸术对12只犬进行了双肺移植。供体通过静脉注射戊巴比妥钠处死，然后用100%氧气进行通气。在死亡后2小时（n = 6）或4小时（n = 6）获取肺脏，并用2升改良的欧洲柯林斯溶液冲洗。受体接受序贯的右肺和左肺移植；然后在麻醉状态下监测8小时，同时调整吸入氧分数。12只受体中有9只在8小时的研究期内存活。在死亡后2小时获取尸体肺脏的6只犬中有4只存活；死亡原因分别是6小时时的肺栓塞和2小时时的肺水肿。在死亡后4小时获取尸体肺脏的6只犬中有5只存活；1只在依赖右肺移植植入左肺期间死于缺氧。两组术后的血流动力学和气体交换参数相似。两组在移植后1小时与基线相比，肺泡 - 动脉氧梯度均显著升高（2小时组为462±60 vs 38±31 mmHg，p < 0.0001；4小时组为484±63 vs 38±14 mmHg，p < 0.0002）。至术后8小时，两组的梯度均显著下降（2小时组为105±37 mmHg，4小时组为146±53 mmHg），且与基线值相似。血管外肺水在移植后1小时也显著升高（2小时组为15.7±2.8 vs 7.9±0.5 ml/kg，p < 0.02；4小时组为16.9±1.2 vs 6.6±0.4 ml/kg，p < 0.0001），并在8小时研究期内逐渐下降。死后2小时和4小时获取的供体肺脏给受体带来的结果相似。研究期内肺泡 - 动脉氧梯度的改善和血管外肺水的减少表明该模型诱导的缺血 - 再灌注损伤是可逆的。如果这种方法能安全地引入临床实践，就能进行更多的移植手术。
