Effective application of ET-Kyoto solution for clinical lung transplantation
Effective application of ET-Kyoto solution for clinical lung transplantation
复制标题
DOI：
10.1016/j.transproceed.2004.10.005
复制
发表时间：
2004-11-01
影响因子：
0.9
通讯作者：
Wada, H
中科院分区：
文献类型：
--
作者：
Chen, F;Fukuse, T;Wada, H
肺供体短缺和移植后缺血再灌注损伤一直是肺移植（LTx）面临的严重问题。解决这些问题的最重要策略之一是开发有效且高度可靠的肺保存方法。因此，我们开发了一种新的器官保存液，即细胞外型含海藻糖的京都液（ET-Kyoto）。在此，我们报告ET-Kyoto溶液用于尸体LTx的临床应用的首次经验。受赠者是一名患有肺气肿的38岁男性。捐献者是一名51岁男性，目前吸烟，有62包年的吸烟史。通气供体的 PaO2 为 340 Torr (FiO(2) = 1.0)。用补充有硝化甘油和二丁酰cAMP的ET-Kyoto溶液冲洗肺脉管系统。受者在体外循环上接受双侧序贯 LTx。左肺缺血时间为544分钟，右肺缺血时间为613分钟。再灌注后立即 PaO2 (FiO(2) = 1.0) 为 385 Torr。供肺太大，以至于在再灌注后 413 分钟（右）和 348 分钟（左）时进行了双侧部分切除。对切除的移植肺进行组织病理学检查，结构几乎正常。术后，PaO2 (FiO(2) = 1.0) 超过 400 Torr，最高可达 526 Torr。临床过程几乎平安无事。总之，ET-Kyoto 溶液可以安全地应用于临床尸体 LTx，具有延长的供肺和相对较长的缺血时间。 ET-Kyoto 溶液的功能和组织病理学效率得到了证实。使用 ET 京都溶液延长保存时间并保持质量将增加供体库并实现半选择性 LTx。
The shortage of lung donors and ischemia-reperfusion injury following transplantation have been grave problems in lung transplantation (LTx). One of the most important strategies to solve these problems is the development of effective and highly reliable methods for lung preservation. Therefore, we developed a new organ preservation solution, namely, the extracellular-type trehalose-containing Kyoto (ET-Kyoto) solution. Here we report the first experience of clinical application of ET-Kyoto solution for cadaveric LTx. The recipient was a 38-year-old man with pulmonary emphysema. The donor was a 51-year-old male current smoker with a smoking history of 62 pack-years. The ventilated donor's PaO2 was 340 Torr (FiO(2) = 1.0). The pulmonary vasculature was flushed with ET-Kyoto solution supplemented with nitroglycerine and dibutyryl cAMP. The recipient underwent bilateral sequential LTx on cardiopulmonary bypass. The ischemic time was 544 and 613 minutes for the left and right lung, respectively. PaO2 (FiO(2) = 1.0) was 385 Torr immediately after reperfusion. The donor lung was so large that bilateral partial resections were performed at 413 minutes (right) and 348 minutes (left) after reperfusion. On histopathologic examination of the resected transplanted lungs the structure was almost normal. Postoperatively, PaO2 (FiO(2) = 1.0) was over 400 Torr with or maximum of 526 Torr. The clinical course was almost uneventful. In conclusion, ET-Kyoto solution may be safely applied in clinical cadaveric LTx with extended donor lungs and relatively long ischemic times. Functional and histopathological efficiency of ET-Kyoto solution was confirmed. Longer preservation times with preserved quality using ET Kyoto solution would increase the donor pool and enable semielective LTx.