Modified low-flow ultrafiltration ameliorates hemodynamics and early graft function and reduces blood loss in living-donor lobar lung transplantation

我们于1998年在冈山大学医院成功进行了活体肺叶移植（LDLLT），这是日本首例肺移植（LT）。从1999年到2007年，我们对57例危重患者（47例LDLLT患者）进行了LT。再灌注肺损伤（RLI）发生在肺移植术后，是一种主要的术后并发症。死亡的一个主要原因是RLI和治疗尚未建立在LT。炎症介质在再灌注损伤的调制中起着重要的作用。LDLLT通常使用心肺转流术（CPB）进行。CPB可加重受者的炎症反应，CPB后移植物的再灌注可加重缺血再灌注损伤。改良超滤（MUF）已被开发为一种有效的灌注策略，以最大限度地减少心脏直视手术中CPB的不良反应。MUF可调节全身炎症介质，改善LT后的血液动力学和移植物功能。 ...更多信息 MUF在LT中的有效性报告已经显示。我们测量了在CPB下接受LDLLT手术的患者血浆中关键细胞因子和多形核弹性蛋白酶（PMN-E）的术中水平。本研究分析了MUF在减少接受LDLLT患者的心肺转流（CPB）相关肺损伤方面的临床应用。LT患者在CPB期间和之后表现出IL-6和PMN-E的显著升高。体外循环后IL-6水平明显升高。缺血和CPB时间与IL-6和PMN-E水平无关。我们的数据表明，炎症细胞因子和介质的产生是由CPB触发的，并且CPB后肺移植物的再灌注加速了IL-6的产生。MUF不能抑制血清IL-6水平的升高，也不能降低IL-8和PMN-E水平。MUF可改善移植血管的血流动力学和气体交换能力，减少术后失血量和输血量。该策略可最大限度地减少接受LDLLT患者的CPB相关不良反应。少

We have succeeded a living-donor lober lung transplantation (LDLLT) at Okayama University Hospital in 1998, which was the first lung transplantation (LT) in Japan. We performed LT in 57 critically ill patients (47 patients of LDLLT) from 1999 to 2007. Reperfusion lung injury (RLI) occurs following lung transplantation, and is a major post-operative complication. A major cause of the death is RLI and the treatment has not been established in LT. Inflammatory mediators play an important role in the modulation of reperfusion injury. LDLLT is generally performed with the use of cardiopulmonary bypass (CPB). CPB exacerbates inflammatory response in recipient and the reperfusion of grafts after CPB may deteriorate ischemia-reperfusion injury. Modified ultrafiltration (MUF) has been developed as an effective perfusion strategy to minimize the adverse effects of CPB in open heart surgery. MUF may modulate systemic inflammatory mediators and inprove hemoddynamics and graft function after LT. No … More report of the effectiveness of MUF in LT has shown. We measure intraoperative levels of key cytokines and polymorphonuclear elastase (PMN-E) in plasma in patients undergoing LDLLT surgery with CPB. This study analyzed the clinical application of MUF to minimize cardiopulmonary bypass (CPB)-related lung injury in patients undergoing LDLLT.LT patients demonstrated significant elevations of IL-6 and PMN-E during and after CPB. IL-6 production increased significantly after CPB. Ischemic and CPB time did not correlate with IL-6 and PMN-E levels. Our data suggest that production of inflammatory cytokines and mediators are triggered by CPB and that production of IL-6 is accelerated by reperfusion of lung grafts after CPB. MUF did not inhibit the increase of serum IL-6 level, nor decrease IL-8 and PMN-E levels. MUF brought improved hemodynamics and gas exchange capacity of transplanted grafts and lowered post-operative blood loss and blood transfusion requirement. This strategy may minimize CPB-related adverse effects in patients undergoing LDLLT. Less