Possibility of sequential transplantation of brain-dead donor single lung and contralateral living-donor lobe

脑死亡供体单肺和对侧活体供体肺叶序贯移植的可能性

• 批准号: 14571264
• 负责人: MINAMI Masato
• 金额: $ 2.24万
• 依托单位: Osaka University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2002
• 资助国家: 日本
• 起止时间: 2002 至 2003
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-14571264/
• 关键词: brain-dead donor single lung transplantation; contralateral living-donor lobar lung transplantation; 片側生体肺葉移植

Brain-dead donor lung scarcity is a problem worldwide. Although in Japan bilateral living donor lobar lung transplantation is more popular than brain-dead donor lung transplantation, it is often impossible to ensure two living donors. To investigate the possibility of sequential transplantation of brain-dead donor single lung and contralateral living-donor lobe, instead of brain-dead bilateral single lung transplantation or bilateral living-donor lobar transplantation, canine model was designed. Left single lung graft was harvested from a donor beagle dog and preserved under cold saline immersion (4C) for 6 hours. Right upper and middle lobe block was also harvested from another beagle and preserved in the same manner for 1 hour. In a recipient beagle, left single lung implantation was made first. Without reventilation and reperfusion of the first lung under topical cooling, right upper and middle lobe block was implanted, under a cardio-pulmonary support machine, with bronchus to recipient right main bronchus, pulmonary artery to lower trunk in end to side fashion, and pulmonary vein to superior pulmonary vein. After the anastomoses were completed, recipient native right lower and mediastinal lobes were resected and then ventilation and reperfusion were started in both lungs with gradual tapering of the cardio-pulmonary support. Approximately ischemic time is 8 hours in the left graft and 2 hours in the right. Respiratoty and circulatory change were monitored up to 6hours and the most effective management was studied.

脑死亡的供体肺稀缺是一个世界性的问题。虽然在日本，双侧活体肺叶移植比脑死亡供体肺移植更受欢迎，但往往不可能保证两个活体供体。为探讨脑死亡供体单肺和对侧活体肺叶序贯移植替代脑死亡双侧单肺移植或双侧活体肺叶移植的可行性，设计了犬模型。取供体比格犬左肺，冷盐水浸泡(4C)保存6h。另取另一只比格犬的右上、中叶脑片，按同样方法保存1h。在受体比格犬中，首先进行左侧单肺植入。在不进行第一肺局部降温通气和再灌流的情况下，在心肺支持机下植入右上、中叶阻滞剂，支气管至受体右主支气管，肺动脉至下主干，肺静脉至上肺静脉。吻合完成后，切除受体右肺下叶和纵隔叶，在逐渐减少心肺支持的情况下，开始双肺的通气和再灌流。左侧移植物缺血时间约为8小时，右侧移植物约为2小时。监测呼吸和循环变化长达6小时，并探讨最有效的处理方法。