Expeimental Study on Pulmonary Function and Lung Growth after Living-Donor Lobar Lung Transplantation

活体肺叶移植后肺功能和肺生长的实验研究

• 批准号: 12671310
• 负责人: DATE Hiroshi
• 金额: $ 1.92万
• 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: 2000
• 资助国家: 日本
• 起止时间: 2000 至 2001
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-12671310/
• 关键词: Living-Donor Lobar Lung Transplantation; Donor; Recipient; Pulmonary arteriral pressure; Arterial oxygen tension

Experiment 1: In an effort to address the donor shortage issue, living-donor lobar lung transplants have been performed with satisfactory results. The use of small grafts is potentially problematic because it could cause high pulmonary artery pressure resulting in lung edema. The purpose of this study was to evaluate the effect of small grafts on early pulmonary function and to identify the predictor for acceptable size discrepancy. Seventeen pairs of mongrel dog with various donor/recipient (D/R) sizes were used. Body weight, height, chest circumference and lung weight were measured as size parameters. Right middle, lower and cardiac lobes were implanted as a right lung of the recipient and left lower lobe was implanted as a left lung without using cardiopulmonary bypass. Pulmonary function of the recipient was measured for 6 hours after reperfusion. A significant negative correlation was found between D/R body weight ratio and mean pulmonary artery pressure at one hour (r=-0.594 ; p= … More 0.025). A significant correlation was found between D/R body weight ratio and arterial oxygen tension (Pa02) at 6 hours (r=0.704 ; p=0.007). There was no significant correlation between the other three size parameters and postoperative pulmonary function. All 8 recipients with D/R body weight ratio > 1.2 survived the 6-hour assessment period and their PaO2 exceeded 500 mmHg at 6 hours. D/R weight ratio is an important predictor of early pulmonary function in a canine living-donor lobar lung transplant model.Experiment 2 : For infants and small children, organ transplantation is limited by the size discrepancy between donor and recipient. To address this problem, the use of over-sized grafts from living-related donors could potentially expand the donor pool. The aim of this experimental study was to evaluate the effect of over-sized grafts on early pulmonary function and to identify an indicator for an acceptable size discrepancy. Fourteen bilateral lobar lung allotransplant operations were performed without cardiopulmonary bypass in weight mis-matched pairs of dogs. Animals were divided into two groups : Group I (n=7), Donor/Recipient lung volume ratio < 2.85 ; Group II (n=7), Donor/Recipient lung volume ratio > 2.85. Pulmonary function of the recipient was measured before chest closure, after chest closure, and after the ventilator was removed. Pulmonary vascular resistance and airway pressure significantly increased in group II after, chest closure (1493±195 dynes sec.cm-5 and 14.4± 0.9 mmHg versus 2784±140 dynes.sec.cm-5 and 23.4±1.2 mmHg, p<0.001). After the ventilator was removed, all recipients in group I showed Pa02 > 239 mmHg and PaC02 < 76 mmHg, whereas all recipients in group II showed Pa02 <116 mmHg and PaCO2 > 169 mmHg. The Donor/recipient chest circumference ratio was less than 1.3 in all but one dog in group I. Acceptable over-sized grafts provide adequate pulmonary function, although excessively over-sized grafts cause significant impairment in pulmonary function after the chest closure. Chest circumference provides a useful size match criteria when over-sized grafts are used in this canine experimental model. Less

实验1：为了解决供体短缺的问题，活体肺叶移植已经取得了令人满意的结果。小移植物的使用是潜在的问题，因为它可能导致肺动脉高压，导致肺水肿。本研究的目的是评估小移植物对早期肺功能的影响，并确定可接受的大小差异的预测因子。使用了17对具有不同供体/受体（D/R）大小的杂种犬。测量体重、身高、胸围和肺重量作为尺寸参数。在不使用体外循环的情况下，将右中叶、右下叶和右心叶植入受体的右肺，将左下叶植入受体的左肺。再灌注后6小时测定受体肺功能。D/R体重比与1小时平均肺动脉压呈显著负相关（r=-0.594 ; p= 0.0001）。 ...更多信息 0.025）。D/R体重比与6小时动脉血氧分压（Pa 02）之间存在显著相关性（r=0.704 ; p=0.007）。其他三个尺寸参数与术后肺功能无明显相关性。D/R体重比> 1.2的所有8名受体均存活6小时评估期，并且其PaO 2在6小时时超过500 mmHg。D/R重量比是犬活体肺叶移植模型早期肺功能的重要预测因子。实验2：对于婴幼儿，器官移植受者和供体之间的大小差异限制。为了解决这个问题，使用来自活体亲属供体的过大移植物可能会扩大供体库。本实验研究的目的是评估过大移植物对早期肺功能的影响，并确定可接受的尺寸差异的指标。在体重不匹配的狗对中，进行了14例双侧肺叶同种异体肺移植手术。将动物分为两组：组I（n=7），供体/供体肺体积比< 2.85 ;组II（n=7），供体/供体肺体积比> 2.85。分别于关胸前、关胸后及撤机后测定受体肺功能。第二组在关胸后肺血管阻力和气道压力显著增加（1493±195达因秒·厘米-5和14.4± 0.9毫米汞柱对2784±140达因秒·厘米-5和23.4±1.2毫米汞柱，p<0.001）。在移除呼吸机后，I组中所有受者显示Pa 02&gt; 239 mmHg和PaC 02 &lt; 76 mmHg，而II组中所有受者显示Pa 02 <116 mmHg and PaCO2 >169 mmHg。除第I组中的一只犬外，所有犬的供体/受体胸围比均小于1.3。可接受的过大移植物可提供足够的肺功能，尽管过大的移植物会导致胸部闭合后肺功能的显著损害。当在该犬实验模型中使用过大的移植物时，胸围提供了有用的尺寸匹配标准。少

项目成果

Takashi Fujita, Hiroshi Date, Kouji Ueda, Itaru Nagahiro, Motoi Aoe, Akio Andou, Nobuyoshi Shimizu: "Experimental Study on Size Matching in a Canine Living-Donor Lobar Lung Transplant Model"The Journal of Thoracic and Cardiovascular Surgery. 123. 104-109

Takashi Fujita、Hiroshi Date、Kouji Ueda、Itaru Nagahiro、Motoi Aoe、Akio Andou、Nobuyoshi Shimizu：“犬活体供体肺叶肺移植模型中尺寸匹配的实验研究”胸心血管外科杂志。

Fuiita T, Date H, Ueda K, Nagahiro I, Aoe M, Andou A, Shimizu N: "Experimental study on size matching in a canine living-donor lobar lung transplant model."J Thorac Cardiovasc Surg. 123. 104-9 (2002)

Fuiita T、Date H、Ueda K、Nagahiro I、Aoe M、Andou A、Shimizu N：“犬活体供体肺叶移植模型中尺寸匹配的实验研究。”J Thorac Cardiovasc Surg。

Takahiro Oto, Hiroshi Date, Koji Ueda, Makio Hayama, Itaru Nagahiro, Motoi Aoe, Akio Andou, Nobuyoshi Shimizu: "Experimental Study of Oversized Grafts in a Canine Living-Donor Lobar Lung Transplantation Model"The Journal of Heart and Lung Transplantation.

Takahiro Oto、Hiroshi Date、Koji Ueda、Makio Hayama、Itaru Nagahiro、Motoi Aoe、Akio Andou、Nobuyoshi Shimizu：“犬活体供体肺叶肺移植模型中超大移植物的实验研究”心肺移植杂志。

Oto T, Date H, Ueda K, Hayama M, Nagahiro I, Aoe M, Andou A, Shimizu N.: "Experimental study of oversized grafts in a canine living-donor lobar lung transplantation model."J Heart Lung Transplant. 20. 1325-30 (2001)

Oto T、Date H、Ueda K、Hayama M、Nagahiro I、Aoe M、Andou A、Shimizu N.：“犬活体供体肺叶移植模型中超大移植物的实验研究。”J心肺移植。