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Experimental Study to Develop a New Procedure for Living-Donor Lobar Lung Transplantation

开发活体肺叶肺移植新手术的实验研究

基本信息

批准号：
16591398
负责人：
DATE Hiroshi
金额：
$ 2.24万
依托单位：
OKAYAMA UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2004
资助国家：
日本
起止时间：
2004 至 2005
项目状态：
已结题

来源：
https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-16591398/
关键词：
Living-donor Lobar Lung Transplantation Donor Recipient Bronchial healing Pulmonary function 気管支吻合

项目摘要

Objective : Bilateral living-donor lobar lung transplantation has become an accepted alternative to cadaveric lung transplantation. Because only one lobe is implanted in each chest cavity, this procedure seems to be best suited for children and small adults. The purpose of this study was to develop a new transplant procedure which might be applied to large adult patients.Methods and Results : Unilateral double lobar lung transplantation was performed in 14 weight-matched pairs of dogs. In donor animals, the right middle, lower and cardiac lobes were separated as a right graft and the left lower lobe was separated as a left graft. In recipient animals, these two grafts were implanted in the right hemithorax after right pneumonectomy. The left graft was implanted as a right upper lobe, having been rotated 180 degrees along the vertical axis and then 180 degrees along the horizontal axis. The right graft was implanted in the natural anatomic position. Half of the recipients developed complications, such as pulmonary artery kinking and pulmonary venous thrombus, exclusively in the graft in the up-side down position. To avoid the risk of complications related to the nonanatomically positioned graft, we developed a technique of bilateral native lung-sparing lobar transplantation in which 2 grafts were implanted in the natural anatomic position. In an acute study, all six recipients showed excellent pulmonary function for 3 hours. In a chronic study, five of six (83%) recipients showed excellent pulmonary function for 3 weeks with good bronchial healing.Conclusions : Bilateral native lung-sparing lobar transplantation was technically possible and associated with satisfactory early pulmonary function with excellent bronchial healing in a canine experimental model.

目的：双侧活体大叶肺移植已成为身体肺移植的替代方案。由于每个胸腔只植入一个肺叶，这种手术似乎最适合儿童和小个子成人。本研究的目的是开发一种可应用于大型成人患者的新的移植方法。方法和结果：在14对体重匹配的犬身上进行了单侧双叶肺移植。在供体动物中，右中叶、下叶和心叶被分离为右移植物，左下叶被分离为左移植物。在受体动物中，这两种移植物在右全肺切除后植入右侧半胸腔。左侧移植物作为右上叶植入，沿垂直轴旋转180度，然后沿水平轴旋转180度。将右侧移植物植入自然解剖位置。一半的受者出现并发症，如肺动脉扭曲和肺静脉血栓，仅发生在倒置状态的移植物中。为了避免与非解剖位置的移植物相关的并发症的风险，我们开发了一种双侧保留肺的肺叶移植技术，在自然解剖位置植入两片移植物。在一项急性研究中，所有六名受试者都在3小时内表现出良好的肺功能。在一项慢性研究中，6例受者中有5例(83%)在3周内表现出良好的肺功能，且支气管愈合良好。结论：在犬实验性模型中，双侧自体肺叶移植在技术上是可行的，并与良好的早期肺功能和良好的支气管愈合有关。