A Experimental Study for Pulmonary Transplantation from Non-heart-beating Donor.

在西方国家，肺移植已成为终末期肺病患者的一种可行选择。虽然有很多患者，但由于缺乏合适的供体，肺移植的数量有限。为了增加潜在供体的数量，已经进行了一些使用心脏停搏供体进行肺移植的实验研究。在日本，由于缺乏对脑死亡的公民同意，目前还没有从脑死亡供体进行移植。本研究利用犬左肺移植模型，探讨尸体肺移植在临床应用的可能性。并评价了几种用于从尸体供体获得稳定的移植后肺功能的发明和改进。（实验1）循环停止后的全身冷却可以防止供体肺的热缺血损伤。我们通过将供体犬在循环停止后浸入4C冷水中来评估全身冷却的效果 ...更多信息 移植后的肺功能全身降温4 h与室温热缺血4 h相比，移植后功能无明显差异。（实验2）根据实验1的结果，我们推测这是由于停止循环后血管内肺血栓的形成，并且向尸体肺施用大剂量尿激酶或重组组织型纤溶酶原激活剂（rt-PA）可能在保存前或保存期间分解肺毛细血管床内的纤维蛋白，从而导致受体的上级肺功能。采用相同的犬左肺移植模型，评价尿激酶或rt-PA的应用效果。供肺冲洗前注射120000 IU尿激酶或再灌注后立即输注5 γ rt-PA，即使4小时的供肺也能改善移植后的肺功能和血流动力学，我们认为4小时是临床肺移植准备的足够时间。这些结果表明，在日本没有理由不进行尸体肺移植。少

Lung Transplantation has become a feasible option for patients with end-stage lung disease in western countries. Although ther are many patients, the number of lung transplants performed is limited, due to the lack of suitable donors. To increase the number of potential donors, some experimental studies of lung transplantation using arrested heart donors have been performed. In Japan, no transplantation from brain-dead donor is carried out yet, because of the lack of citizn agreement for brain-death. This time, we investigate the possibility of cadaver lung transplantation in clinic using canine left-lung transplantation model. And several inventions and improvements were evaluated for obtaining a stable post-transplant pulmonary functions form cadaver donor.(Experiment 1) Whole-body cooling after circulatory arrest may prevents the donor lung from warm ischemic injury. We evaluated the effect of whole-body cooling by immersing the donor canine in 4C cold water after circulatory arrest … More on the post-transplant pulmonary functions. Comparing the 4-hour whole-body cooling to 4-hour room temperature warm ischemia, there was no significant differences about post-transplant functions.(Experiment 2) From the results of experiment 1, we speculate that this was due to intra-vascular pulmonary thrombi formation after cessation of circulation, and the administration of high-dose urokinase or recombinant tissue-type plasminogen activator (rt-PA) to the cadaver lungs might decompose the fibrin inside the pulmonary capillary bed prior to or during preservation and result in superior pulmonary function in recipients. Using the same canine left lung transplantation model, the effect of administration of urokinase or rt-PA was evaluated. 120000IU of urokinase injection just prior to the donor lung flushing or 5 gamma of rt-PA continuous infusion to the recipient just after reperfusion improved the post-transplant pulmonary function and hemodynamics with even 4-hour cadaver donor lungs.We think 4-hour is enough time to prepare the lung transplantation procedure in clinic. And these results show there is no reason not to carry out cadaver lung transplantation in Japan. Less