성견의 폐이식에서 PGE1 과 Verapamil을 이용한 폐보존 연구

Abstract

Clinical lung transplantations have gradually developed through improved surgical techniques, adequate immunosuppresive agents, and the development of lung preservation methods. However a major prominent obstacle is the shortage of suitable donor lungs with regard to the lung s organ specificity. In a trial to partially overcome these problems, we used a canine left lung transplant model for evaluating the efficacy of preservation method added the PGEL and Verapamil in flushing solution. Twenty-two mongrel dogs without discrimination between male and female, weighting 19~20 kg were used. Eleven left lung allotransplantations were made by matching pairs of dogs having similiar body weight. Donor lungs were flushed with low potassium dextran glucose(LPDG) included with 200 µg PGE1 and 20µgmol/L verapamil(Group I, n=4), LPDG included with 200 µg PGE1 (Group II, n=4) and LPDG only (Group III, n=3) repectively Following this procedure the donor lung was placed in triple sterile plastic bags filled with preservation fluid and then stored at 10°C for 24 hours. We analyzed left graft lung function by mean PAP and PVR, arterial blood oxygen tension analysis, chest X-ray and computed tomogram, ultiastructural change in biopsy study and perfusion lung scan. Assessment for the graft lung function was done at 15 minuies, 1 hour and 2 hours respectively after reperfusion and after 3 days and 7days. Assessment for hemodynamics and arterial blood gas analysis in left graft lung was done by occluding the right pulmonary artery for ten minutes using pulmonary artery cuff(PA cuff). The results demonstrate that the mean PAP and PVR revealed in the preserved transplants with verapamil (Group I) were less than those observed in transplants without verapamil(Group II and Group III) as the control. Better gas exchange was noted in the lungs receiving verapamil in the flush solution(Group I), especially from 2hour of postreperfusion period. There are no significant differences among groups in the assessment of chest computed lomogram and perfusion lung scan. But The lung flushed with Group I solution demostrated relatively well preserved ultrastructure compared with Group 31 and Group III solutions. In conclusion, thr present study suggests that LPDG solution included with PGE1 and verapamil provide better cellular preservation and tranplanted lung function than LPDG only and LPDG with PGE1.