Normothermic Ex Vivo Lung Perfusion in Clinical Lung Transplantation
Normothermic Ex Vivo Lung Perfusion in Clinical Lung Transplantation
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DOI：
10.1056/nejmoa1014597
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发表时间：
2011-04-14
影响因子：
158.5
通讯作者：
Keshavjee, Shaf
中科院分区：
文献类型：
--
作者：
Cypel, Marcelo;Yeung, Jonathan C.;Keshavjee, Shaf
超过80%的供体肺可能受到损伤，因此不适合移植。通过使用常温离体肺灌注（EVLP），可以在离体回路中灌注取回的供体肺，提供在移植前重新评估其功能的机会。在这项研究中，我们检查了移植接受EVLP的高风险供体肺的可行性。方法在这项前瞻性、非随机临床试验中，我们对被认为移植高风险的肺进行了4小时的EVLP。高危供体肺由特定标准定义，包括肺水肿和动脉氧分压与吸入氧分数的比值（PO（2）：FiO（2））小于300 mm Hg。随后移植功能可接受的肺。在同一时期内移植的无EVLP的肺用作对照。主要终点是移植后72小时原发性移植物功能障碍。次要终点为30天死亡率、支气管并发症、机械通气持续时间、重症监护室和住院时间。23个供体肺符合EVLP的入选标准;其中20个肺在EVLP期间生理功能保持稳定，PO（2）：FiO（2）比值中位数从供体肺的335 mmHg分别增加到灌注1小时和4小时的414和443 mmHg（P
BACKGROUNDMore than 80% of donor lungs are potentially injured and therefore not considered suitable for transplantation. With the use of normothermic ex vivo lung perfusion (EVLP), the retrieved donor lung can be perfused in an ex vivo circuit, providing an opportunity to reassess its function before transplantation. In this study, we examined the feasibility of transplanting high-risk donor lungs that have undergone EVLP.METHODSIn this prospective, nonrandomized clinical trial, we subjected lungs considered to be high risk for transplantation to 4 hours of EVLP. High-risk donor lungs were defined by specific criteria, including pulmonary edema and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PO(2):FiO(2)) less than 300 mm Hg. Lungs with acceptable function were subsequently transplanted. Lungs that were transplanted without EVLP during the same period were used as controls. The primary end point was primary graft dysfunction 72 hours after transplantation. Secondary end points were 30-day mortality, bronchial complications, duration of mechanical ventilation, and length of stay in the intensive care unit and hospital.RESULTSDuring the study period, 136 lungs were transplanted. Lungs from 23 donors met the inclusion criteria for EVLP; in 20 of these lungs, physiological function remained stable during EVLP and the median PO(2):FiO(2) ratio increased from 335 mm Hg in the donor lung to 414 and 443 mm Hg at 1 hour and 4 hours of perfusion, respectively (P