1
|
Gao P, Li C, Ning Y, Wu J, Zhang P, Liu X, Su Y, Zhao D, Chen C. Improvement of surgical techniques for orthotopic single lung transplantation in rats. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:673. [PMID: 35845494 PMCID: PMC9279794 DOI: 10.21037/atm-22-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
Background Although orthotopic single lung transplantation in rats has long been established, this model is still highly challenging. Therefore, we made several modifications in anesthesia, lung extraction, vascular clamp, and transplantation procedures for this model. Methods Fifty cases of rat left lung transplantation were performed using traditional procedures and modified surgical techniques, respectively. Two hundred Sprague Dawley male rats, half as donors and half as recipients, were randomized equally to the two groups. The modifications included orotracheal intubation via a video laryngoscope, retrograde perfusion following anterograde perfusion, a Rummel tourniquet for the occlusion of pulmonary vessels, flushing the vessels and cuffs before anastomosis with heparin, and a simple pleural drainage. The surgical time, warm and cold ischemia time, vascular complications, and survival rate on postoperative day seven were compared between the two groups. Results The modified surgical techniques significantly reduced the surgical duration (35.7 vs. 46.3 min, P<0.01), warm ischemia time (16.3 vs. 28.8 min, P<0.01), and vascular complications (2% vs. 16%, P=0.04). Moreover, the survival rate on postoperative day 7 was higher in the improved surgical techniques group (96% vs. 80%, P=0.03). Conclusions We described the improvement of surgical techniques for orthotopic single lung transplantation in rats, which could shorten anastomoses time, reduce vascular complications, and improve survival rate.
Collapse
Affiliation(s)
- Peigen Gao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Chongwu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Ye Ning
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Pei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Xiucheng Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Yiliang Su
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Engineering Research Center of Lung Transplantation, Shanghai, China
| |
Collapse
|
2
|
Gohrbandt B, Warnecke G, Fischer S, Simon AR, Gottlieb J, Niehaus A, Böthig D, Haverich A, Strueber M. Retrogradein situversus antegrade pulmonary preservation in clinical lung transplantation: a single-centre experience. Eur J Cardiothorac Surg 2015; 49:55-62. [DOI: 10.1093/ejcts/ezv108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 01/19/2015] [Indexed: 11/13/2022] Open
|
3
|
A standardized model of brain death, donor treatment, and lung transplantation for studies on organ preservation and reconditioning. Intensive Care Med Exp 2014; 2:12. [PMID: 26266913 PMCID: PMC4513016 DOI: 10.1186/2197-425x-2-12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We set a model of brain death, donor management, and lung transplantation for studies on lung preservation and reconditioning before transplantation. METHODS Ten pigs (39.7 ± 5.9 Kg) were investigated. Five animals underwent brain death and were treated as organ donors; the lungs were then procured and cold stored (Ischemia). Five recipients underwent left lung transplantation and post-reperfusion follow-up (Graft). Cardiorespiratory and metabolic parameters were collected. Lung gene expression of cytokines (tumor necrosis factor alpha (TNFα), interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interferon gamma (IFNγ), high mobility group box-1 (HMGB-1)), chemokines (chemokine CC motif ligand-2 (CCL2-MCP-1), chemokine CXC motif ligand-10 (CXCL-10), interleukin-8 (IL-8)), and endothelial activation markers (endothelin-1 (EDN-1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), selectin-E (SELE)) was assessed by real-time polymerase chain reaction (PCR). RESULTS Tachycardia and hypertension occurred during brain death induction; cardiac output rose, systemic vascular resistance dropped (P < 0.05), and diabetes insipidus occurred. Lung-protective ventilation strategy was applied: 9 h after brain death induction, PaO2 was 192 ± 12 mmHg at positive end-expiratory pressure (PEEP) 8.0 ± 1.8 cmH2O and FiO2 of 40%; wet-to-dry ratio (W/D) was 5.8 ± 0.5, and extravascular lung water (EVLW) was 359 ± 80 mL. Procured lungs were cold-stored for 471 ± 24 min (Ischemia) at the end of which W/D was 6.1 ± 0.9. Left lungs were transplanted and reperfused (warm ischemia 98 ± 14 min). Six hours after controlled reperfusion, PaO2 was 192 ± 23 mmHg (PEEP 8.7 ± 1.5 cmH2O, FiO2 40%), W/D was 5.6 ± 0.4, and EVLW was 366 ± 117 mL. Levels of IL-8 rose at the end of donor management (BD, P < 0.05); CCL2-MCP-1, IL-8, HMGB-1, and SELE were significantly altered after reperfusion (Graft, P < 0.05). CONCLUSIONS We have set a standardized, reproducible pig model resembling the entire process of organ donation that may be used as a platform to test in vivo and ex vivo strategies of donor lung optimization before transplantation.
Collapse
|
4
|
Mariani AW, Medeiros IL, Pêgo-Fernandes PM, Fernandes FG, Unterpertinguer FDV, Fernandes LM, Cardoso PF, Canzian M, Jatene FB. Cold ischemia or topical-ECMO for lung preservation: a randomized experimental study. SAO PAULO MED J 2014; 132:28-35. [PMID: 24474077 PMCID: PMC10889451 DOI: 10.1590/1516-3180.2014.1321594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/15/2013] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Lung preservation remains a challenging issue for lung transplantation groups. Along with the development of ex vivo lung perfusion, a new preservation method known as topical-ECMO (extracorporal membrane oxygenation) has been proposed. The present study compared topical-ECMO with cold ischemia (CI) for lung preservation in an ex vivo experimental model. DESIGN AND SETTING Randomized experimental study, conducted at a public medical school. METHOD Fourteen human lungs were retrieved from seven brain-dead donors that were considered unsuitable for transplantation. The lung bloc was divided and each lung was randomized to be preserved by means of topical-ECMO or CI (4-7 °C) for eight hours. These lungs were then reconnected to an ex vivo perfusion system for functional evaluation. Lung biopsies were obtained at three times. The functional variables assessed were oxygenation capacity (OC) and pulmonary artery pressure (PAP); and the histological variables were lung injury score (LIS) and apoptotic cell count (ACC). RESULTS The mean OC was 468 mmHg (± 81.6) in the topical-ECMO group and 455.8 (± 54) for CI (P = 0.758). The median PAP was 140 mmHg (120-160) in the topical-ECMO group and 140 mmHg (140-150) for CI (P = 0.285). The mean LIS was 35.57 (± 4.5) in the topical-ECMO group and 33.86 (± 6.1) for CI (P = 0.367). The ACC was 25.00 (± 9.34) in the topical-ECMO group and 24.86 (± 10.374) for CI (P = 0.803). CONCLUSIONS The present study showed that topical-ECMO was not superior to cold ischemia for up to eight hours of lung preservation.
Collapse
Affiliation(s)
| | - Israel Lopes Medeiros
- Department of Thoracic Surgery, Hospital de Messejana, Fortaleza, Brazil, MD, PhD. Attending Physician, Department of Thoracic Surgery, Hospital de Messejana, Fortaleza, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD, PhD. Full Professor of Thoracic Surgery, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Flavio Guimarães Fernandes
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, Medical Student, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Fernando Do Vale Unterpertinguer
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, Medical Student, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Lucas Matos Fernandes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD. Attending Physician, Department of Thoracic and Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Paulo Francisco Cardoso
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD, PhD. Professor, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Mauro Canzian
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD, PhD. Attending Physician, Department of Pathology, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina de Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Fabio Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD, PhD. Full Professor of Cardiovascular Surgery, Head of Thoracic and Cardiovascular Surgery Departament, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| |
Collapse
|
5
|
Munneke AJ, Rakhorst G, Petersen AH, van Oeveren W, Prop J, Erasmus ME. Flush at room temperature followed by storage on ice creates the best lung graft preservation in rats. Transpl Int 2013; 26:751-60. [DOI: 10.1111/tri.12113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 11/27/2012] [Accepted: 04/11/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Anita J. Munneke
- Department of Biomedical Engineering; UMCG; University of Groningen; Groningen; The Netherlands
| | - Gerhard Rakhorst
- Department of Surgery; UMCG; University of Groningen; Groningen; The Netherlands
| | - Arjen H. Petersen
- Department of Medical Biology section Pathology and Laboratory Medicine; UMCG; University of Groningen; Groningen; The Netherlands
| | - Wim van Oeveren
- Thorax Center University Medical Center Groningen; Groningen; The Netherlands
| | - Jochum Prop
- Department of Medical Biology section Pathology and Laboratory Medicine; UMCG; University of Groningen; Groningen; The Netherlands
| | - Michiel E. Erasmus
- Thorax Center University Medical Center Groningen; Groningen; The Netherlands
| |
Collapse
|
6
|
Reconditioning lungs donated after cardiac death using short-term hypothermic machine perfusion. Transplantation 2013; 94:999-1004. [PMID: 23073465 DOI: 10.1097/tp.0b013e31826f632e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hypothermic machine perfusion (HMP) is widely used to preserve kidneys and livers for transplantation. This study investigated whether short-term HMP could improve the quality of lungs donated after cardiac death (DCD). METHODS In a clinically relevant uncontrolled DCD model, beagles were divided into two groups (n=5 each): 4 hr warm ischemia + 14 hr static cold storage (SCS group) or 4 hr warm ischemia + 12 hr SCS followed by 2 hr HMP (HMP group). HMP was performed using centrifugal perfusion with STEEN solution at approximately 10°C. In both groups, the left lungs were then transplanted and reperfused for 4 hr to evaluate the posttransplantation lung functions. RESULTS HMP was performed safely, not inducing any oxidative damage. The dynamic pulmonary compliance was stable during HMP, whereas the pulmonary vascular resistance significantly decreased. HMP microscopically eliminated residual microthrombi in the donor lungs just before transplantation. The lung tissue adenosine triphosphate levels 4 hr after reperfusion were significantly higher in the HMP group compared with the SCS group. The serum malondialdehyde levels and proinflammatory cytokine levels in the bronchoalveolar lavage fluid 4 hr after reperfusion were significantly lower in the HMP group than in the SCS group. The physiologic lung functions during reperfusion were significantly better in the HMP group compared with the SCS group. HMP also significantly reduced ischemia-reperfusion injury in the microscopic findings. CONCLUSIONS Short-term HMP could resuscitate ischemically damaged DCD lungs and ameliorate ischemia-reperfusion injury.
Collapse
|
7
|
Menezes AQ, Pêgo-Fernandes PM, Cardoso PFG, Braga KADO, Nepomuceno NA, Pazetti R, Correia AT, Canzian M, Santim JK, Jatene FB. Comparison of Celsior and Perfadex lung preservation solutions in rat lungs subjected to 6 and 12 hours of ischemia using an ex-vivo lung perfusion system. Clinics (Sao Paulo) 2012. [PMID: 23184209 PMCID: PMC3488991 DOI: 10.6061/clinics/2012(11)15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study evaluated the performance of lungs that were preserved with different solutions (Celsior, Perfadex or saline) in an ex vivo rat lung perfusion system. METHODS Sixty Wistar rats were anesthetized, anticoagulated and randomized into three groups (n = 20). The rats were subjected to antegrade perfusion via the pulmonary artery with Perfadex, Celsior, or saline, followed by 6 or 12 hours of ischemia (4ºC, n = 10 in each group). Respiratory mechanics, gas exchange and hemodynamics were measured at 10-minute intervals during the reperfusion of heart-lung blocks in an ex vivo system (IL2-Isolated Perfused Rat or Guinea Pig Lung System, Harvard Apparatus, Holliston, Massachusetts, USA; Hugo Sachs Elektronik, Germany) for 60 minutes. The lungs were prepared for histopathology and evaluated for edema following reperfusion. Group comparisons were performed using ANOVA and the Kruskal-Wallis test with a 5% level of significance. RESULTS Gas exchange was not significantly different between lungs perfused with either Perfadex or Celsior at the same ischemic times, but it was very low in lungs that were preserved with saline. Airway resistance was greater in the lungs that were preserved for 12 hours. Celsior lungs that were preserved for 6 and 12 hours exhibited lower airway resistance (p = 0.01) compared to Perfadex lungs. Pulmonary artery pressure was not different between the groups, and no significant differences in histopathology and apoptosis were observed between the groups. CONCLUSIONS Lungs that were preserved with Celsior or Perfadex exhibited similar gas exchange and histopathological findings. Airway resistance was slightly lower in the Celsior-preserved lungs compared with the Perfadex-preserved lungs.
Collapse
Affiliation(s)
- Arteiro Queiroz Menezes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), São Paulo/SP, Brazil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Olland A, Santelmo N, Orsini B, Falcoz PE, Dorent R, Mal H, Thomas P, Massard G. Twinned single-lung transplantation: a privileged model for the study of recipient-dependent factors of outcome. Eur J Cardiothorac Surg 2012; 41:1357-64; discussion 1364-5. [PMID: 22241010 DOI: 10.1093/ejcts/ezr234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Lung transplantation is the only life-saving treatment for end-stage respiratory disease. The outcome will depend on the graft quality, surgical conditions and recipient factors. Twinned single-lung transplantation defines as two different recipients treated with lung grafts from the same donor. Recipient-dependent factors of the outcome can be studied more accurately as the graft quality is supposed equal for both recipients. METHODS We reviewed all single-lung transplantations performed in France between 1998 and 2008 in the French registry run by the 'Agence de Biomédecine'. Criteria for donor lung quality and twinned recipient data were recorded in a database. The whole medical history and the transplantation outcome were reviewed for each patient and compared with its twin recipient. We compared twins on the basis of their opposed characteristics and on the basis of the opposed endpoint outcome. Endpoints were primary graft dysfunction (PGD) grade III, and mortality at 1, 3 and 12 months. RESULTS A total of 387 single-lung transplantations were performed in 10 French centres; 180 were twinned recipients from 90 donors. Statistical analysis revealed a significantly different outcome for PGD only. PGD was significantly higher (P < 0.05) in fibrosis recipients compared with emphysema twins. In 28 pairs (31%), the outcome was discordant for PGD, and fibrosis was significantly more often involved compared with emphysema (P = 0.04). Sixty-two pairs had a similar outcome: two pairs showed PGD in both recipients while 60 pairs were free of PGD. CONCLUSIONS We conclude that recipient's disease is a major determinant of the outcome. Fibrosis is associated with an increased risk for PGD.
Collapse
Affiliation(s)
- Anne Olland
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Cypel M, Yeung JC, Hirayama S, Rubacha M, Fischer S, Anraku M, Sato M, Harwood S, Pierre A, Waddell TK, de Perrot M, Liu M, Keshavjee S. Technique for prolonged normothermic ex vivo lung perfusion. J Heart Lung Transplant 2009; 27:1319-25. [PMID: 19059112 DOI: 10.1016/j.healun.2008.09.003] [Citation(s) in RCA: 364] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 08/27/2008] [Accepted: 09/03/2008] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The inhibition of cellular metabolism induced by hypothermia obviates the possibility of substantial reparative processes occurring during organ preservation. The aim of this study was to develop a technique of extended (12-hour) ex vivo lung perfusion (EVLP) at normothermia for assessment and protective maintenance of the donor lung. METHODS Six double-lung blocks from 35-kg pigs and 5 single human lungs were subjected to 12 hours of normothermic EVLP using acellular Steen Solution. In the animal studies, the left lung was transplanted into recipients at the end of EVLP and reperfused for 4 hours to evaluate the impact of prolonged EVLP on post-transplant lung function. A protective mode of mechanical ventilation with controlled perfusion flows and pressures in the pulmonary vasculature were employed during EVLP. Lung oxygenation capacity (DeltaPo(2)), pulmonary vascular resistance and airway pressures were evaluated in the system. Red blood cells were added to the perfusate to a hematocrit of 20% at the end of human lung EVLP to study lung functional assessment with and without cells. RESULTS Lung function was stable during 12 hours of EVLP. This stability during prolonged normothermic EVLP translated into excellent post-transplant lung function (Pao(2)/Fio(2): 527 +/- 22 mm Hg), low edema formation (wet/dry ratio: 5.24 +/- 0.38) and preserved lung histology after transplantation. The acellular perfusion assessment of lung function accurately correlated with post-transplant graft function. CONCLUSIONS Twelve hours of EVLP at physiologic temperatures using an acellular perfusate is achievable and maintains the donor lungs without inflicting significant added injury. This system can be used to assess, maintain and treat injured donor lungs.
Collapse
Affiliation(s)
- Marcelo Cypel
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Retrograde Flush Following Warm Ischemia in the Non-Heart-Beating Donor Results in Superior Graft Performance at Reperfusion. J Surg Res 2009; 154:118-25. [DOI: 10.1016/j.jss.2008.06.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 05/22/2008] [Accepted: 06/04/2008] [Indexed: 11/20/2022]
|
11
|
Cellular electrophysiologic and mechanical evidence of superior vascular protection in pulmonary microcirculation by Perfadex compared with Celsior. J Thorac Cardiovasc Surg 2009; 137:492-8. [DOI: 10.1016/j.jtcvs.2008.08.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 05/29/2008] [Accepted: 08/28/2008] [Indexed: 11/13/2022]
|
12
|
Venuta F, Anile M. Invited Commentary. Ann Thorac Surg 2008; 86:1129-30. [DOI: 10.1016/j.athoracsur.2008.06.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 06/05/2008] [Accepted: 06/09/2008] [Indexed: 11/26/2022]
|
13
|
Ferraro P, Martin J, Dery J, Prenovault J, Samson L, Coutu M, Chen LQ, Poirier C, Noiseux N, Duranceau A, Berthiaume Y. Late Retrograde Perfusion of Donor Lungs Does Not Decrease the Severity of Primary Graft Dysfunction. Ann Thorac Surg 2008; 86:1123-9. [DOI: 10.1016/j.athoracsur.2008.05.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 05/14/2008] [Accepted: 05/15/2008] [Indexed: 10/21/2022]
|
14
|
Pradeau D, Stocco J, Chaumeil JC. [Solutions for organ preservation and other cardioplegic liquid formulations. Role of the hospital pharmacist]. ANNALES PHARMACEUTIQUES FRANÇAISES 2008; 66:1-18. [PMID: 18435981 DOI: 10.1016/j.pharma.2007.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2007] [Indexed: 11/19/2022]
Abstract
Solid organ transplantation is an increasing need and a well-established activity which requires maintaining the quality of the transplant from procurement through the entire, storage, transport and graft procedure. Solutions for organ preservation play a key role in this procedure, by minimizing the deleterious effects of both ischemia and reperfusion. As such, their qualitative and quantitative compositions have to be optimized and validated. The development strategy and formulations proposed for these solutions are analyzed in this review as well as the results of the clinical studies which have set up the relevant pharmacological and physicochemical criteria. The French regulatory status of these products is also discussed. A clear distinction has to be made between solutions for organ preservation which are classified as produits thérapeutiques annexes (therapeutic ancillary products) and cardioplegic liquid formulations which are considered as medicinal products and are subject to marketing approval. Finally, the roles of the hospital pharmacist in the evaluation, selection, purchase and proper use of these products are described.
Collapse
Affiliation(s)
- D Pradeau
- Laboratoire de développement analytique et galénique, Ageps, 7, rue du Fer à Moulin, 75221 Paris cedex 05, France.
| | | | | |
Collapse
|
15
|
Wittwer T, Franke UF, Sandhaus T, Thiene M, Groetzner J, Strauch JT, Wippermann J, Ochs M, Muehlfeld C. Preischemic iloprost application for improvement of graft preservation: which route is superior in experimental pig lung transplantation: inhaled or intravenous? Transplant Proc 2007; 39:1345-9. [PMID: 17580136 DOI: 10.1016/j.transproceed.2007.03.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 03/20/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Optimal allograft protection is essential in lung transplantation to reduce postoperative organ dysfunction. Although intravenous prostanoids are routinely used to ameliorate reperfusion injury, the latest evidence suggests a similar efficacy of inhaled prostacyclin. Therefore, we compared donor lung-pretreatment using inhaled lioprost (Ventavis) with the commonly used intravenous technique. METHODS Five pig lungs were each preserved with Perfadex and stored for 27 hours without (group 1) or with (group-2, 100 prior aerosolized of iloprost were (group 3) or iloprost (IV). Following left lung transplantation, hemodynamics, Po(2)/F(i)o(2), compliance, and wet-to-dry ratio were monitored for 6 hours and compared to sham controls using ANOVA analysis with repeated measures. RESULTS The mortality was 100% in group 3. All other animals survived (P < .001). Dynamic compliance and PVR were superior in the endobronchially pretreated iloprost group as compared with untreated organs (P < .05), whereas oxygenation was comparable overall W/D-ratio revealed significantly lower lung water in group 2 (P = .027) compared with group 3. CONCLUSION Preischemic alveolar deposition of iloprost is superior to IV pretreatment as reflected by significantly improved allograft function. This strategy offers technique to optimize pulmonary preservation.
Collapse
Affiliation(s)
- T Wittwer
- Department of Cardiothoracic Surgery, University of Cologne, Kerpener Strasse 62, Cologne 50924, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Mühlfeld C, Müller K, Pallesen LP, Sandhaus T, Madershahian N, Richter J, Wahlers T, Wittwer T, Ochs M. Impact of preservation solution on the extent of blood-air barrier damage and edema formation in experimental lung transplantation. Anat Rec (Hoboken) 2007; 290:491-500. [PMID: 17377949 DOI: 10.1002/ar.20518] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A major aim in lung transplantation is to prevent the loss of structural integrity due to ischemia and reperfusion (I/R) injury. Preservation solutions protect the lung against I/R injury to a variable extent. We compared the influence of two extracellular-type preservation solutions (Perfadex, or PX, and Celsior, or CE) on the morphological alterations induced by I/R. Pigs were randomly assigned to sham (n = 4), PX (n = 5), or CE (n = 2) group. After flush perfusion with PX or CE, donor lungs were excised and stored for 27 hr at 4 degrees C. The left donor lung was implanted into the recipient, reperfused for 6 hr, and, afterward, prepared for light and electron microscopy. Intra-alveolar, septal, and peribronchovascular edema as well as the integrity of the blood-air barrier were determined stereologically. Intra-alveolar edema was more pronounced in CE (219.80 +/- 207.55 ml) than in PX (31.46 +/- 15.75 ml). Peribronchovascular (sham: 13.20 +/- 4.99 ml; PX: 15.57 +/- 5.53 ml; CE: 31.56 +/- 5.78 ml) and septal edema (thickness of alveolar septal interstitium, sham: 98 +/- 33 nm; PX: 84 +/- 8 nm; CE: 249 +/- 85 nm) were only found in CE. The blood-air barrier was similarly well preserved in sham and PX but showed larger areas of swollen and fragmented epithelium or endothelium in CE. The present study shows that Perfadex effectively prevents intra-alveolar, septal, and peribronchovascular edema formation as well as injury of the blood-air barrier during I/R. Celsior was not effective in preserving the lung from morphological I/R injury.
Collapse
|
17
|
Hirayama S, Shiraishi T, Shirakusa T, Higuchi T, Miller EJ. Prevention of neutrophil migration ameliorates rat lung allograft rejection. Mol Med 2007. [PMID: 17225868 DOI: 10.2119/2006-00036.hirayama] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chemokines activate and recruit specific leukocyte subpopulations. We sought to determine whether neutrophil migration, which can contribute to the development of ischemia-reperfusion injury, correlates with lung allograft rejection. Orthotopic left lung allotransplantation was performed from Brown Norway (donor) to Fisher 344 (recipient) rats. Because the role of activated neutrophils in the development of allograft rejection is believed to be biphasic, we used specific CXC receptor inhibition with antileukinate in 2 dosing regimens. Recipients were allocated into 4 groups; A (early administration) received 2 doses of antileukinate (10.0 mg/kg) intramuscularly 24 h before and immediately after transplantation; B (continuous administration) continuously received antileukinate intraperitoneally (10.0 mg/kg/day) for 7 days after surgery. Groups A or B were compared with individual controls that received PBS alone. The progression of rejection was assessed radiographically. Histologic evaluation of allograft rejection based on pathologic rejection grade, performed on day 7, demonstrated significantly lower histologic rejection in group B compared with the control group (2.1+/-1.0 vs. 3.3+/-0.5; P=0.018), whereas there was no significant difference in group A compared with the control group. There were no significant differences between the aeration scores of groups A or B compared with their control groups. Our data suggest that neutrophils may play a promoting role in the development of allograft rejection, and blockage of neutrophil migration may suppress acute lung allograft rejection.
Collapse
Affiliation(s)
- Shin Hirayama
- Department of Surgery II, Fukuoka University School of Medicine, Fukuoka, Japan
| | | | | | | | | |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW To describe recent advances in lung transplantation relevant to anesthesiologists. RECENT FINDINGS There is recent literature describing medical, surgical, anesthetic and critical care of lung transplant recipients. SUMMARY There have been substantial changes in preoperative selection and preparation of lung transplant recipients; these include donation after cardiac death, and improved lung-preservation solutions. Newer immunosuppression regimens have been successfully evaluated in clinical trials. Particular advances in anesthesia include endorsement of fluid restriction in thoracic surgery, greater use of transesophageal echocardiography, and postoperative extracorporeal membrane oxygenation.
Collapse
Affiliation(s)
- Paul S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia.
| | | | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Respiratory failure remains the most common complication in the perioperative period after lung transplantation. Consequently it is important to develop an approach to diagnosis and the treatment of respiratory failure in this population. This review highlights the advances made in the understanding and treatment of lung transplant patients in the early postoperative phase. Owing to its relative importance, advances in the understanding and treatment of ischaemia-reperfusion injury are highlighted. RECENT FINDINGS The causes of respiratory failure and the complications seen after transplantation are time dependent, with ischaemia-reperfusion, infection, technical problems and acute rejection being the most common in the early perioperative phase, and obliterative bronchiolitis, rejection, and infections secondary to bacteria, fungi, and viruses becoming more prevalent after 3 months. The advances in lung preservation and postoperative care may be overshadowed by an increase in the complexity of the recipients and the use of more marginal organs. An improved mechanistic understanding of ischaemia-reperfusion injury has translated into potential therapeutic targets. The development of prospective clinical trials, however, is hampered by a relatively small sample of patients and a significant degree of heterogeneity in the lung transplant population. SUMMARY Many advances have been made in the understanding of ischaemia-reperfusion injury. Owing to the acute and long-term implications of this complication, interventions that reduce the risk of developing ischaemia-reperfusion need to be evaluated in prospective clinical trials.
Collapse
Affiliation(s)
- John Granton
- Faculty of Medicine, University of Toronto, Pulmonary Hypertension Programme, Toronto General Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
20
|
Oto T, Rabinov M, Griffiths AP, Whitford H, Levvey BJ, Esmore DS, Williams TJ, Snell GI. Unexpected donor pulmonary embolism affects early outcomes after lung transplantation: A major mechanism of primary graft failure? J Thorac Cardiovasc Surg 2005; 130:1446. [PMID: 16256801 DOI: 10.1016/j.jtcvs.2005.07.025] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2005] [Revised: 06/30/2005] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Primary graft failure remains a significant cause of morbidity and mortality after lung transplantation, and its mechanism is not understood. Previously 2 case reports described fatal primary graft failure due to donor-related unexpected pulmonary embolism. This study investigated the incidence, early outcome, and risk factors of unexpected pulmonary embolism in lung transplantation. METHODS An exploratory retrograde donor lung flush before implantation to diagnose pulmonary embolism (emboli group) or no pulmonary embolism (no-emboli group) was performed in 74 of 122 consecutive lung transplantations. RESULTS The incidence of macroscopic unexpected pulmonary embolism was 38% (28% clot and 9% fat). In the emboli group, significantly decreased oxygenation (P < .05), increased pulmonary vascular resistance (P < .001), an increased proportion of opacity on chest radiograph (P = .03), prolonged intubation (P < .001) and intensive care unit stay (P < .01), and decreased 1-year survival (P = .03) were seen after transplantation. In multivariate analysis, pulmonary embolism was an independent risk factor for prolonged intubation (hazard ratio, 2.42; P < .01). In logistic regression, death due to trauma with fracture and a smoking history of more than 20 pack-years were significant donor risk factors for pulmonary embolism (adjusted odds ratio, 8.77 and 5.64; P = .02 and .04, respectively). No deleterious effects of the exploratory flush were seen. CONCLUSIONS Unexpected pulmonary embolism is relatively common, is potentially predicted by donor history (but not by arterial blood gas analysis or chest radiograph), and is associated with primary graft failure. Donor lungs with risk factors of pulmonary embolism should undergo an exploratory flush. When pulmonary embolism is diagnosed, further therapeutic strategies must be considered.
Collapse
Affiliation(s)
- Takahiro Oto
- Heart and Lung Transplant Unit, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | |
Collapse
|