Technique for Prolonged Normothermic Ex Vivo Lung Perfusion
Technique for Prolonged Normothermic Ex Vivo Lung Perfusion
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DOI：
10.1016/j.healun.2008.09.003
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发表时间：
2008-12-01
影响因子：
8.9
通讯作者：
Keshavjee, Shaf
中科院分区：
文献类型：
--
作者：
Cypel, Marcelo;Yeung, Jonathan C.;Keshavjee, Shaf
背景资料：低温诱导的细胞代谢抑制排除了在器官保存期间发生实质性修复过程的可能性。本研究的目的是开发一种技术，延长（12小时）离体肺灌注（EVLP）在常温下的评估和保护性维护的供体lung.Methods：6双肺块从35公斤的猪和5个单一的人肺进行了12小时的常温EVLP使用脱细胞Steen解决方案。在动物研究中，在EVLP结束时将左肺移植到受体中并再灌注4小时以评估延长的EVLP对移植后肺功能的影响。EVLP期间采用机械通气的保护模式，并控制肺血管中的灌注流量和压力。肺氧合能力（Δ Po-2），肺血管阻力和气道压力在该系统中进行了评估。在人肺EVLP结束时，将红细胞加入到灌注液中至红细胞压积为20%，以研究有细胞和无细胞的肺功能评估。在长时间常温EVLP期间的这种稳定性转化为移植后良好的肺功能（Pao（2）/Fio（2）：527 +/- 22 mm Hg）、低水肿形成（湿/干比：5.24 +/- 0.38）和移植后保留的肺组织学。脱细胞灌注评估肺功能准确相关移植后移植function.Conclusions：十二个小时的EVLP在生理温度下使用脱细胞灌注液是可以实现的，并保持供体肺，而不造成显着的额外伤害。该系统可用于评估、维持和治疗受损的供体肺。J Heart Lung Transplant 2008;27：1319-25.版权所有（C）2008国际心肺移植学会。
Background: The inhibition of cellular metabolism induced by hypothermia obviates the possibility of substantial reparative processes occurring during organ preservation. The aim of this study was to develop a technique of extended (12-hour) ex vivo lung perfusion (EVLP) at normothermia for assessment and protective maintenance of the donor lung.Methods: Six double-lung blocks from 35-kg pigs and 5 single human lungs were subjected to 12 hours of normothermic EVLP using acellular Steen Solution. In the animal studies, the left lung was transplanted into recipients at the end of EVLP and reperfused for 4 hours to evaluate the impact of prolonged EVLP on post-transplant lung function. A protective mode of mechanical ventilation with controlled perfusion flows and pressures in the pulmonary vasculature were employed during EVLP. Lung oxygenation capacity (Delta Po-2), pulmonary vascular resistance and airway pressures were evaluated in the system. Red blood cells were added to the perfusate to a hematocrit of 20% at the end of human lung EVLP to study lung functional assessment with and without cells.Results: Lung function was stable during 12 hours of EVLP. This stability during prolonged normothermic EVLP translated into excellent post-transplant lung function (Pao(2)/Fio(2): 527 +/- 22 mm Hg), low edema formation (wet/dry ratio: 5.24 +/- 0.38) and preserved lung histology after transplantation. The acellular perfusion assessment of lung function accurately correlated with post-transplant graft function.Conclusions: Twelve hours of EVLP at physiologic temperatures using an acellular perfusate is achievable and maintains the donor lungs without inflicting significant added injury. This system can be used to assess, maintain and treat injured donor lungs. J Heart Lung Transplant 2008;27:1319-25. Copyright (C) 2008 by the International Society for Heart and Lung Transplantation.