Examination of fat embolism removal by warm retrograde perfusion from lung grafts with fat embolism in a porcine model

Research Project

Project/Area Number	18K16420
Research Category	Grant-in-Aid for Early-Career Scientists
Allocation Type	Multi-year Fund
Review Section	Basic Section 55040:Respiratory surgery-related
Research Institution	Kawasaki Medical School (2019) Okayama University (2018)
Principal Investigator	Kurosaki Takeshi 川崎医科大学, 医学部, 講師 (20756051)
Project Period (FY)	2018-04-01 – 2020-03-31
Project Status	Completed (Fiscal Year 2019)
Budget Amount *help	¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000) Fiscal Year 2019: ¥2,600,000 (Direct Cost: ¥2,000,000、Indirect Cost: ¥600,000) Fiscal Year 2018: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
Keywords	肺移植 / 脂肪塞栓 / 臓器管理 / Extended criteria donor / 肺保存液還流法 / 再灌流障害
Outline of Final Research Achievements	In Experiment 1, using lung grafts with fat embolism in a porcine donor model, it was examined whether there is a change in the removal rate of fat embolism by retrograde warm perfusion. In the conventional retrograde perfusion (Cold group), the removal rate of fat was only 8% of the dose, whereas in this perfusion(Warm group), the removal rate was 25%, which was significantly different. There was no significant difference in the pulmonary function and hemodynamics during the 3-h period after reperfusion. These results were published in the General Thoracic Cardiovascular Surgery. In Experiment 2, first, lung transplantation was carried out by healthy pigs in order to stabilize the lung transplantation technique. In particular, pulmonary vein anastomosis was the most difficult, but when the technique was stable, lung transplantation of the control group (fat embolus Cold group) was started. Due to time constraints, only two cases were able to complete the experiment.
Academic Significance and Societal Importance of the Research Achievements	脂肪塞栓を伴った肺を移植した場合、肺移植後急性期に移植肺機能不全を起こす場合がある。本研究では逆行性温還流を行った方がより多くの脂肪塞栓を除去することが可能であり、移植肺機能不全を来す可能性を軽減できるのではないかと思われる。また、脂肪塞栓肺で基準外の肺の適切な管理方法がわかることで、ドナー肺の使用率向上に寄与できる可能性が示唆される。