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

脑死亡供体肺短缺是一个全球性问题。虽然在日本，双侧活体供体肺叶移植比脑死亡供体肺移植更受欢迎，但通常无法确保两个活体供体。为探讨脑死亡供体单肺与对侧活体肺叶序贯移植的可行性，设计犬模型，替代脑死亡双侧单肺移植或双侧活体肺叶移植。从供体比格犬收获左单肺移植物，并在冷盐水浸泡（4 ℃）下保存6小时。还从另一只比格犬中收获右上叶和中叶阻滞，并以相同的方式保存1小时。在受体比格犬中，首先进行左单肺植入。在局部冷却下不进行第一肺再通气和再灌注，在心肺支持机下植入右肺上中叶阻滞，支气管与受体右主支气管，肺动脉以端侧方式与下干连接，肺静脉与上级肺静脉连接。在移植完成后，切除受体自体右下叶和纵膈叶，然后在两肺中开始通气和再灌注，逐渐减少心肺支持。左侧移植物的缺血时间约为8小时，右侧为2小时。监测呼吸和循环变化长达6小时，并研究最有效的管理。

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.