Early effects of the ex vivo evaluation system on graft function after swine lung transplantation

目的：体外肺评估（Ex - vivo）已经发展成为一种有用的方法，通过它来评估心脏死亡（DCD）供者在移植前捐赠的肺。然而，体外循环本身在移植物上的安全性尚未得到充分的研究。本研究的目的是利用猪肺移植模型来评估体外循环的效果。方法：采用热缺血2 h和不热缺血2 h的肺。为了评估移植后移植物的功能，左肺在离体或冷保存2小时后移植；术后随访6小时左肺静脉（PO_2）血气分析。比较离体（+）组和离体（-）组的数据。结果：离体（-）组PO_2/FiO_2显著高于离体（+）组，直至移植后3 h。两组PO_2/FiO_2水平在移植后6小时均升高并趋于相似（p分别<0.001和p=0.004）。结论：体外系统的负面影响是有限的，仅在移植后立即出现。因此，在DCD猪肺移植中，体外系统似乎是安全的。

Objectives : Ex vivo lung evaluation (ex vivo) has been developed as a useful method by which to assess lungs from donation after cardiac death (DCD) donors prior to transplant. However, the safety of the ex vivo circulation itself on grafts has not been fully investigated. The aim of this study is to evaluate the effects of the ex vivo circuit using a swine lung transplant model.Methods : Lungs with or without 2-hour warm ischemia were used. To assess posttransplant graft function, the left lung was transplanted after 2-hour ex vivo or cold preservation; blood gas analysis of the left pulmonary vein (PO_2) was performed during the 6-hour posttransplant follow-up period. Data were compared between the ex vivo (+) and ex vivo (-) groups.Results : PO_2/FiO_2 in the ex vivo (-) group was significantly greater than that in the ex vivo (+) group until 3 hours after transplant. The PO_2/FiO_2 levels in both groups then increased and became similar at 6 hours after transplant regardless of whether ischemic or nonischemic lungs (p<0.001 and p=0.004, respectively) were used.Conclusions : Negative effects of the ex vivo system was limited and seen only immediate posttransplant period. Therefore, in DCD swine lung transplantation, the ex vivo system appears to be safe.