Bronchodilator Inhalation During Ex Vivo Lung Perfusion Improves Posttransplant Graft Function After Warm Ischemia
Bronchodilator Inhalation During Ex Vivo Lung Perfusion Improves Posttransplant Graft Function After Warm Ischemia
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DOI：
10.1016/j.athoracsur.2016.07.066
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发表时间：
2017-02-01
影响因子：
4.6
通讯作者：
Date, Hiroshi
中科院分区：
文献类型：
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作者：
Hijiya, Kyoko;Chen-Yoshikawa, Toyofumi F.;Date, Hiroshi
背景我们假设，在移植前使用离体肺灌注（EVLP）系统和高剂量短效β（2）-肾上腺素能受体激动剂通气，可以修复心脏死亡供体捐献的受损肺移植物。通过静脉注射氯化钾在犬模型中诱导心脏骤停。在热缺血150分钟后，将肺随机分为两组：在EVLP期间吸入1，400 μ g丙卡特罗（BETA组，n = 5）或接受溶剂的对照组（CON组，n = 5）。在EVLP 120分钟后移植左肺。移植后240分钟测量功能变量、组织腺苷5 '-三磷酸水平和组织环磷酸腺苷水平。两组EVLP结束时的生理肺功能相似。然而，在移植后240分钟，观察到BETA组的移植物氧合、动态肺顺应性和降低的肺血管阻力显著优于CON组。BETA组肺移植后未见严重不良反应。在EVLP结束时和移植后240分钟，BETA组肺组织5 '-三磷酸腺苷水平和环磷酸腺苷水平显著高于CON组。EVLP期间高剂量丙卡特罗雾化吸入可改善移植后早期的肺移植物功能障碍，且无严重不良反应。这些数据表明，在EVLP期间使用丙卡特罗通气的肺再适应可改善移植后的肺移植功能。(C)2017胸外科医师协会
Background. We hypothesized that an injured lung graft from donation after cardiac death donors could be reconditioned before transplantation using an ex vivo lung perfusion (EVLP) system and ventilation with highdose short-acting beta(2)-adrenergic receptor agonists.Methods. Cardiac arrest was induced in a canine model by intravenous potassium chloride injection. Lungs were randomly assigned to two groups after 150 minutes of warm ischemia: inhalation of 1,400 mu g of procaterol (BETA group, n = 5) or control group receiving solvent (CON group, n = 5) during EVLP. Left lungs were transplanted after 120 minutes of EVLP. Functional variables, tissue adenosine 5 '-triphosphate levels, and tissue cyclic adenosine monophosphate levels were measured 240 minutes after transplantation.Results. Physiologic pulmonary function was similar at the end of EVLP in both groups. However, significantly better graft oxygenation, dynamic pulmonary compliance, and reduced pulmonary vascular resistance were observed in the BETA group than in the CON group 240 minutes after transplantation. No severe adverse effects were observed after lung transplantation in the BETA group. Lung tissue adenosine 5 '-triphosphate levels and cyclic adenosine monophosphate levels were significantly higher in the BETA group than in the CON group at the end of EVLP and at 240 minutes after transplantation.Conclusions. High-dose nebulized procaterol during EVLP ameliorated lung graft dysfunction at the early posttransplantation period without severe adverse effects. These data suggest that lung reconditioning with procaterol ventilation during EVLP improves lung graft function after transplantation. (C) 2017 by The Society of Thoracic Surgeons