The mode of death in the non-heart-beating donor has an impact on lung graft quality
The mode of death in the non-heart-beating donor has an impact on lung graft quality
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DOI：
10.1016/j.ejcts.2009.05.010
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发表时间：
2009-11-01
影响因子：
3.4
通讯作者：
Van Raemdonck, Dirk E. M.
中科院分区：
文献类型：
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作者：
Van De Wauwer, Caroline;Neyrinck, Arne P.;Van Raemdonck, Dirk E. M.
目的：我们假设心脏死亡前的濒死期可能会对无心跳供体（NHBDs）的肺移植物质量产生负面影响。在实验模型中比较了不同的死亡模式。方法：将非肝素化猪分为三组（每组n = 6）。组I [FIB]中的动物通过室颤导致立即循环停止而处死。在第II组[EXS]中，对动物放血（45 +/- 11 min）。在第III组[HYP]中，通过断开动物与呼吸机的连接诱导缺氧性心脏骤停（13 +/- 3 min）。在HYP和EXS中，在死亡前采集血样，用于测量儿茶酚胺水平。原位温热缺血1小时后，将未冲洗的肺冷冻并储存3小时（4 ℃）。然后在我们的离体再灌注模型中在60分钟期间测试左肺性能。再灌注结束时测定支气管灌洗液中总蛋白浓度。结果如下：与EXS组（15 ± 3）相比，HYP组（50 ± 8）的尸检前去甲肾上腺素（mcg l（-1））浓度（基线：0.03 ± 0）升高至更高水平; p = 0.0074。再灌注60分钟时，HYP组的PO 2（mmHg）显著低于FIB组（445 +/- 64 vs 621 +/- 25; p < 0.05），但与EXS组（563 +/- 51）相比无显著差异。肺血管阻力（dynes S cm（-5））在EXS（p < 0.001）和HYP（NS）中最初高于FIB（分别为15824 +/- 5052和8557 +/- 4933 vs 1482 +/- 61），但此后恢复正常。HYP的湿干重比高于FIB（5.2 +/- 0.3 vs 4.7 +/- 0.2，p = 0.041），但不高于EXS（4.9 +/- 0.2）。总蛋白（g l（-1））浓度较高，尽管在HYP和EXS中与FIB相比不显著（分别为18 +/-6和13 +/-4 vs 4.5 +/-1.3）。结论：NHBD的死前濒死阶段会诱发交感风暴，导致毛细血管渗漏，伴肺水肿和再灌注时氧合减少。当在受控（HYP）与非受控（EXS和FIB）环境中恢复时，NHBD肺的移植物质量似乎较差。(C)2009年欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Objective: We hypothesised that the agonal phase prior to cardiac death may negatively influence the quality of the pulmonary graft recovered from non-heart-beating donors (NHBDs). Different modes of death were compared in an experimental model. Methods: Non-heparinised pigs were divided into three groups (n = 6 per group). Animals in group I [FIB] were sacrificed by ventricular fibrillation resulting in immediate circulatory arrest. In group II [EXS], animals were exsanguinated (45 +/- 11 min). In group III [HYP], hypoxic cardiac arrest (13 +/- 3 min) was induced by disconnecting the animal from the ventilator. Blood samples were taken pre-mortem in HYP and EXS for measurement of catecholamine levels. After 1 h of in situ warm ischaemia, unflushed lungs were explanted and stored for 3 h (4 degrees C). Left lung performance was then tested during 60 min in our ex vivo reperfusion model. Total protein concentration in bronchial lavage fluid was measured at the end of reperfusion. Results: Pre-mortem noradrenalin (mcg l(-1)) concentration (baseline: 0.03 +/- 0) increased to a higher level in HYP (50 +/- 8) vs EXS (15 3); p = 0.0074. PO2 (mmHg) at 60 min of reperfusion was significantly worse in HYP compared to FIB (445 +/- 64 vs 621 +/- 25; p < 0.05), but not to EXS (563 +/- 51). Pulmonary vascular resistance (dynes S cm(-5)) Was initially higher in EXS (p < 0.001) and HYP (NS) vs FIB (15824 +/- 5052 and 8557 +/- 4933 vs 1482 +/- 61, respectively) but normalised thereafter. Wet-to-dry weight ratio was higher in HYP compared to FIB (5.2 +/- 0.3 vs 4.7 +/- 0.2, p = 0.041), but not to EXS (4.9 +/- 0.2). Total protein (g l(-1)) concentration was higher, although not significant in HYP and EXS vs FIB (18 +/- 6 and 13 +/- 4 vs 4.5 +/- 1.3, respectively). Conclusion: Pre-mortem agonal phase in the NHBD induces a sympathetic storm leading to capillary leak with pulmonary oedema and reduced oxygenation upon reperfusion. Graft quality appears inferior in NHBD lungs when recovered in controlled (HYP) vs uncontrolled (EXS and FIB) setting. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.