The Lancet：美国首次成功地开展可呼吸的肺移植

“装在盒内的心脏(heart in a box)”是一种革命性的实验技术，它允许移植到受者体内的供者心脏保持温暖和跳动，而不是冻存在冰盒(ice cooler)中。如今，同样的技术正被用来传送能够“呼吸的肺部(breathing lung)”。

来自美国加州大学洛杉矶分校罗纳德-里根医学中心的肺部移植研究小组在2012年11月中期成功地开展了美国首例能够呼吸的肺部移植。这名57岁病人患有肺纤维化疾病。在这种疾病中，肺泡逐渐地被瘢痕组织所替代。该病人接受两个新的肺部移植，并且在进行7个小时手术之后正在恢复健康。相关研究结果于2012年10月10日在线发表在The Lancet期刊上。

这项突破性的移植实验涉及一种被称作器官保存系统(Organ Care System, OCS)的实验性器官保存设备。该设备让供者肺部在运输期间能够在体外接近于生理学状态下发挥功能和呼吸。而当前的标准方法涉及在冰盒内运输不能发挥功能且不能呼吸的肺部。

加州大学洛杉矶分校罗纳德-里根医学中心心脏与肺部移植项目主任、心胸外科教授Abbas Ardehali博士说，“器官从不意味着在冰上冻存。肺部是非常敏感性的，而且在捐献过程期间容易遭受损伤。这种低温储存方法并不允许在移植之前对肺部进行重新加热，但是这种大有希望的能够呼吸的肺部技术能够让我们在移植之前潜在地改善供者肺部的功能。”

加州大学洛杉矶分校当前正在领导一个国际的多中心合作的II期临床器官保存系统INSPIRE研究。这项临床研究的目的就是比较利用器官保存系统和利用标准冰盒运输的供者肺部。

doi:10.1016/S0140-6736(12)61344-0
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Normothermic perfusion of donor lungs for preservation and assessment with the Organ Care System Lung before bilateral transplantation: a pilot study of 12 patients

Gregor Warnecke MD, Javier Moradiellos MD, Igor Tudorache MD, Christian Kühn MD, Murat Avsar MD, Bettina Wiegmann MD, Wiebke Sommer MD, Fabio Ius MD, Claudia Kunze CTRN, Jens Gottlieb MD, Prof Andres Varela MD, Prof Axel Haverich MD

Background
Cold flush and static cold storage is the standard preservation technique for donor lungs before transplantations. Several research groups have assessed normothermic perfusion of donor lungs but all devices investigated were non-portable. We report first-in-man experience of the portable Organ Care System (OCS) Lung device for concomitant preservation, assessment, and transport of donor lungs.

Methods
Between Feb 18, and July 1, 2011, 12 patients were transplanted at two academic lung transplantation centres in Hanover, Germany and Madrid, Spain. Lungs were perfused with low-potassium dextran solution, explanted, immediately connected to the OCS Lung, perfused with Steen's solution supplemented with two red-cell concentrates. We assessed donor and recipient characteristics and monitored extended criteria donor lung scores; primary graft dysfunction scores at 0, 24, 48, and 72 h; time on mechanical ventilation after surgery; length of stays in hospital and the intensive-care unit after surgery; blood gases; and survival of grafts and patients.

Findings
Eight donors were female and four were male (mean age 44·5 years, range 14—72). Seven recipients were female and five were male (mean age 50·0 years, range 31—59). The preharvest donor ratio of partial pressure of oxyen (PaO2) to fractional concentration of oxygen in inspired air (FIO2) was 463·9 (SD 91·4). The final ratio of PaO2 to FIO2 measured with the OCS Lung was 471·58 (127·9). The difference between these ratios was not significant (p=0·72). All grafts and patients survived to 30 days; all recipients recovered and were discharged from hospital.

Interpretation
Lungs can be safely preserved with the OCS Lung, resulting in complete organ use and successful transplantation in our series of high-risk recipients. In November, 2011, we began recruitment for a prospective, randomised, multicentre trial (INSPIRE) to compare preservation with OCS Lung with standard cold storage.

Funding
TransMedics and German Federal Ministry of Education and Research.