Moderate-Flow Perfusion is Superior to Low-Flow Perfusion in Ex Situ Lung Perfusion.

Autor: Forgie K; Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada., Fialka N; Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada., Watkins A; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada., Du K; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada., Himmat S; Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada., Hatami S; Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada., Khan M; Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada., Wang X; Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada., Edgar R; Ray Rajotte Surgical Medical Research Institute (SMRI) , Edmonton, AB, Canada., Buswell-Zuk KM; Ray Rajotte Surgical Medical Research Institute (SMRI) , Edmonton, AB, Canada., Freed D; Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Alberta Transplant Institute, Edmonton, AB, Canada; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada., Nagendran J; Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Alberta Transplant Institute, Edmonton, AB, Canada; Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada. Electronic address: jayan@ualberta.ca.
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2024 Oct; Vol. 56 (8), pp. 1820-1827. Date of Electronic Publication: 2024 Sep 05.
DOI: 10.1016/j.transproceed.2024.08.032
Abstrakt: Background: Full-flow perfusion during prolonged ex situ lung perfusion (ESLP) results in unacceptable pulmonary edema formation. Clinical ESLP at 30% to 50% predicted cardiac output (CO) supports acceptable physiologic outcomes; however, progressive pulmonary edema still develops. Lower flow rates may provide equivalent physiologic preservation with less edema formation due to reduced hydrostatic pressures. We report our results of moderate-flow (MF; 30% CO) vs low-flow (LF; 10% CO) negative pressure ventilation (NPV)-ESLP with transplantation.
Methods: Twelve pig lungs underwent 12-hours of NPV-ESLP with 30% or 10% CO (n = 6/group). Three left lungs per group were transplanted post-ESLP and assessed in vivo over 4 hours. Lung function was assessed by physiologic parameters, weight-gain, and pro-inflammatory cytokine profiles.
Results: Results are MF vs LF (mean ± SEM). All lungs demonstrated acceptable oxygenation post-ESLP (454.2 ± 40.85 vs 422.7 ± 31.68, P = .28); however, after transplantation, the MF lungs demonstrated significantly better oxygenation (300.7 ± 52.26 vs 141.9 ± 36.75, P = .03). There was no significant difference in compliance after ESLP (21.38 ± 2.28 vs 16.48 ± 2.34, P = .08); however, pulmonary artery pressure (PAP; 10.89 ± 2.28 vs 21.11 ± 0.93, P = .06) and pulmonary vascular resistance (PVR; 438.60 ± 97.97 vs 782.20 ± 162.20, P = .05) were significantly higher in the LF group. Weight gain (%) post-ESLP and post-transplant was similar between groups (29.42 ± 5.72 vs 24.17 ± 4.42, P = .24; and 29.63 ± 7.23 vs 57.04 ± 15.78, P = .09). TNF-α and IL-6 were significantly greater throughout LF ESLP.
Conclusions: The MF NPV-ESLP results in superior lung function with less inflammation compared to LF NPV-ESLP.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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