Reconditioning Lungs Donated After Cardiac Death Using Short-Term Hypothermic Machine Perfusion
Reconditioning Lungs Donated After Cardiac Death Using Short-Term Hypothermic Machine Perfusion
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DOI：
10.1097/tp.0b013e31826f632e
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发表时间：
2012-11-27
期刊：
影响因子：
6.2
通讯作者：
Date, Hiroshi
中科院分区：
文献类型：
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作者：
Nakajima, Daisuke;Chen, Fengshi;Date, Hiroshi
背景低温机械灌注（HMP）是目前广泛应用于移植肾、肝保存的一种方法。本研究旨在探讨短期HMP是否能改善心源性死亡（DCD）后捐献肺的质量。在临床相关的非受控DCD模型中，将比格犬分为两组（每组n=5）：4小时热缺血+14小时静态冷藏（SCS组）或4小时热缺血+12小时SCS随后2小时HMP（HMP组）。在约10 ℃下使用STEEN溶液离心灌注进行HMP。两组均行左肺移植，再灌注4 h，评价移植后肺功能。HMP安全进行，不诱导任何氧化损伤。HMP时动态肺顺应性稳定，而肺血管阻力显著降低。HMP在移植前显微镜下消除了供体肺中残留的微血栓。HMP组再灌注后4小时肺组织三磷酸腺苷水平显著高于SCS组。HMP组再灌注4 h后支气管肺泡灌洗液中的血清丙二醛水平和促炎细胞因子水平显著低于SCS组。HMP组再灌注期间的生理肺功能明显优于SCS组。HMP还能显著减轻缺血再灌注损伤。短期HMP可使缺血损伤的DCD肺复苏，改善缺血再灌注损伤。
Background. Hypothermic machine perfusion (HMP) is widely used to preserve kidneys and livers for transplantation. This study investigated whether short-term HMP could improve the quality of lungs donated after cardiac death (DCD).Methods. In a clinically relevant uncontrolled DCD model, beagles were divided into two groups (n=5 each): 4 hr warm ischemia + 14 hr static cold storage (SCS group) or 4 hr warm ischemia + 12 hr SCS followed by 2 hr HMP (HMP group). HMP was performed using centrifugal perfusion with STEEN solution at approximately 10 degrees C. In both groups, the left lungs were then transplanted and reperfused for 4 hr to evaluate the posttransplantation lung functions.Results. HMP was performed safely, not inducing any oxidative damage. The dynamic pulmonary compliance was stable during HMP, whereas the pulmonary vascular resistance significantly decreased. HMP microscopically eliminated residual microthrombi in the donor lungs just before transplantation. The lung tissue adenosine triphosphate levels 4 hr after reperfusion were significantly higher in the HMP group compared with the SCS group. The serum malondialdehyde levels and proinflammatory cytokine levels in the bronchoalveolar lavage fluid 4 hr after reperfusion were significantly lower in the HMP group than in the SCS group. The physiologic lung functions during reperfusion were significantly better in the HMP group compared with the SCS group. HMP also significantly reduced ischemia-reperfusion injury in the microscopic findings.Conclusions. Short-term HMP could resuscitate ischemically damaged DCD lungs and ameliorate ischemia-reperfusion injury.