Cross-circulation for extracorporeal support and recovery of the lung
Cross-circulation for extracorporeal support and recovery of the lung
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DOI：
10.1038/s41551-017-0037
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发表时间：
2017-03-01
影响因子：
28.1
通讯作者：
Vunjak-Novakovic, Gordana
中科院分区：
文献类型：
--
作者：
O'Neill, John D.;Guenthart, Brandon A.;Vunjak-Novakovic, Gordana
可移植供体器官的短缺会产生深远的后果，特别是对于患有终末期肺病的患者来说，移植仍然是唯一的最终治疗方法。尽管离体肺灌注的进步已经能够对勉强不可接受的供体肺进行评估和修复，但该技术的临床使用仅限于大约 6 小时。将体外器官支持的持续时间从数小时延长至数天，将使供体肺的恢复和接受者特异性操作得以延长，从而扩大供体器官库并改善长期结果。通过使用临床相关的猪模型，我们在这里报告了交叉循环平台的开发，其中接受者支持实现了 36 小时的常温灌注，维持健康的肺部并允许受伤的肺部恢复。扩展的支持使得能够对所有体外肺进行多尺度的治疗干预。肺超出了移植标准，接受者能够耐受交叉循环，在整个 36 小时的支持过程中生理参数没有显着变化。我们的研究结果表明，交叉循环应该能够对体外器官提供更广泛的支持和干预。
The shortage of transplantable donor organs has profound consequences, especially for patients with end-stage lung disease, for which transplantation remains the only definitive treatment. Although advances in ex vivo lung perfusion have enabled the evaluation and reconditioning of marginally unacceptable donor lungs, clinical use of the technique is limited to similar to 6 h. Extending the duration of extracorporeal organ support from hours to days would enable longer recovery and recipient-specific manipulations of the donor lung, with the goal of expanding the donor organ pool and improving long-term outcomes. By using a clinically relevant swine model, here we report the development of a cross-circulation platform wherein recipient support enabled 36 h of normothermic perfusion that maintained healthy lungs and allowed for the recovery of injured lungs. Extended support enabled multiscale therapeutic interventions in all extracorporeal lungs. Lungs exceeded transplantation criteria, and recipients tolerated cross-circulation with no significant changes in physiologic parameters throughout 36 h of support. Our findings suggest that cross-circulation should enable extended support and interventions in extracorporeal organs.