Transplantes cardiopulmonar e pulmonar com doador em localidade distante

Fragomeni, Luis Sérgio; Bonser, Robert S; Kaye, Michael P; Jamieson, Stuart W

doi:10.1590/S0102-76381988000300007

Resumos

Em situações específicas, os transplantes clínicos cardiopulmonar e pulmonar são, hoje, formas estabelecidas de tratamento para estágio final de doença cardiopulmonar e pulmonar. A obtenção de doadores adequados permanece o maior problema e a remoção de órgãos em localidades distantes é, hoje, uma necessidade. Embora muitos métodos de preservação pulmonar possam ser empregados, para períodos isquémicos de até 5 horas, a hipotermia e o uso de solução cardioplégica com infusão da solução de Collins modificada no tronco pulmonar tem sido método simples e eficiente para preservação do bloco coração-pulmão. Descrevemos, aqui, o método corrente que empregamos, com o qual os transplantes cardiopulmonar e pulmonar combinados foram sucedidos de excelente função cárdio-respiratória.

transplante cardiopulmonar; transplante cardiopulmonar; transplante pulmonar; transplante pulmonar

In special situations, clinical heart-lung and lung transplantation are today established methods of therapy for end stage cardiopulmonary and pulmonary disease. Adequate donor availability remains a major problem and distant organ procurement is today a necessity. Although many methods of lung preservation can be used, for periods of up to 5 hours, hypothermic storage with cardioplegic arrest and pulmonary artery flush with modified Collins solution has proven to be a simple and reliable method of heart-lung preservation. We here describe our current method of heart-lung block protection, in which heart-lung and double lung transplantation were performed followed by excelent cardiac and pulmonary function.

cardiopulmonary transplantation; cardiopulmonary transplantation; pulmonary transplantation; pulmonary transplantation

ARTIGOS ORIGINAIS

Transplantes cardiopulmonar e pulmonar com doador em localidade distante

Distant donor procurement for heart-lung and lung transplantation

Luis Sérgio Fragomeni^I; Robert S. Bonser^II; Michael P. Kaye^II; Stuart W. Jamieson^II

^IDo Minnesota Heart and Lung Institute (Professor Convidado)

^IIDo Minnesota Heart and Lung Institute

^{Endereço para separatas} Endereço para separatas: Luís Sérgio Fragomeni Rua Uruguai, 1555, Aptº 41 96010 Passo Fundo, RS, Brasil

RESUMO

Em situações específicas, os transplantes clínicos cardiopulmonar e pulmonar são, hoje, formas estabelecidas de tratamento para estágio final de doença cardiopulmonar e pulmonar. A obtenção de doadores adequados permanece o maior problema e a remoção de órgãos em localidades distantes é, hoje, uma necessidade. Embora muitos métodos de preservação pulmonar possam ser empregados, para períodos isquémicos de até 5 horas, a hipotermia e o uso de solução cardioplégica com infusão da solução de Collins modificada no tronco pulmonar tem sido método simples e eficiente para preservação do bloco coração-pulmão. Descrevemos, aqui, o método corrente que empregamos, com o qual os transplantes cardiopulmonar e pulmonar combinados foram sucedidos de excelente função cárdio-respiratória.

Descritores: transplante cardiopulmonar; transplante cardiopulmonar, doadores; transplante pulmonar; transplante pulmonar, doadores.

ABSTRACT

In special situations, clinical heart-lung and lung transplantation are today established methods of therapy for end stage cardiopulmonary and pulmonary disease. Adequate donor availability remains a major problem and distant organ procurement is today a necessity. Although many methods of lung preservation can be used, for periods of up to 5 hours, hypothermic storage with cardioplegic arrest and pulmonary artery flush with modified Collins solution has proven to be a simple and reliable method of heart-lung preservation. We here describe our current method of heart-lung block protection, in which heart-lung and double lung transplantation were performed followed by excelent cardiac and pulmonary function.

Descriptors: cardiopulmonary transplantation, donors; cardiopulmonary transplantation; pulmonary transplantation, donors; pulmonary transplantation.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido para publicação em 10 de outubro de 1988.

Trabalho realizado no Minnesota Heart and Lung Institute. Minneapolis, Minnesota, USA.

1 ANDREONE, P. A.; OLIVARI, M. T.; RING, S. W. - Clinical considerations of cardiac transplantation: preoperative and postoperative evaluation. Radiol. Clin. N. Am, 25(2): 357-366, 1987.
2 BALDWIN, J. C.; FRIST, W. H.; STARKEY, T. D.; HARJULA, A.; STARNES, V. A.; STINSON, E. B.; OYER, P. E.; SHUMWAY, N. E. - Distant graft procurement for combined heart and lung transplantation using pulmonary artery flush and simple topical hypothermia for graft preservation. Ann. Thorac. Surg, 43(6): 670-673, 1987.
3 BONSER, R. S.; FRAGOMENI, L. S.; KRIET, J. M.; KAYE, M. P.; JAMIESON, S. W.- Technique of clinical double lung transplantation. (No prelo, J. Heart Transpl
4 COOPER, J. D.; PEARSON, F. G.; PATTERSON, G. A.; TODD, T. R. J.; GINSBERG, R. J.; GOLDBERG, M.; DE MAJO, W. A. P. - Technique of successful lung transplantation in humans. J. Thorac. Cardiovasc. Surg, 93(2): 173-181, 1987.
5 DARK, J. H.; PATTERSON, G. A.; AL-JILAIHAWI, A. N.; HSU, H.; EGAN, T.; COOPER, J. D. - Experimental in bloc double lung transplantation. Ann. Thorac. Surg, 42(4): 394-398, 1986.
6 HARDESTY, R. L. & GRIFFITH, B. P. - Procurement for combined heart-lung transplantation: bilateral thoracotomy with sternal transection, cardiopulmonary bypass and profound hypothermia. J. Thorac. Cardiovasc. Surg, 89(5): 795-799, 1985.
7 HARJULA, A.; BALDWIN, J. C.; STARNES, V. A.; STINSON, E. B.; OYER, P. E.; JAMIESON, S. W.; SHUMWAY, N. E. - Proper donor selection for heart-lung transplantation: the Stanford experience. J. Thorac. Cardiovasc. Surg, 94(6): 874, 880, 1987.
8 HAVERICH, A.; SCOTT, W. C.; JAMIESON, S. W. - Twenty years of lung preservation: a review. J. Heart Transpl. 4: 234-240, 1985.
9 JAMIESON, S. W.; STINSON, E. B.; OYER, P. E.; BALDWIN, J. C.; SHUMWAY, N. E. - Operative technique for heart-lung transplantation. J. Thorac. Cardiovasc. Surg, 87(6): 930-935, 1984.
10 JAMIESON, S. W.; STINSON, E. R.; OYER, P. E.; REITZ, B. A.; BALDWIN, J.; MODRY, D.; DAWKINS, M. B.; THEODORE, J.; HUNT, S.; SHUMWAY, N. E. - Heart-lung transplantation for irreversible pulmonary hypertension. Ann. Thorac. Surg, 38(6): 554-562, 1984.
11 JAMIESON, S. W.; REITZ, B. A.; OYER, P. E.; BILLINGHAM, M.; MODRY, D.; BALDWIN, J.; STINSON, E. B.; HUNT, S.; THEODORE, J.; BIEBER, C. P.; SHUMWAY, N. E. - Combined heart and lung transplantation. Lancet, 1(8334): 1130-1131, 1983.
12 JAMIESON, S. W. & OGUNAIKE, H. O. - Cardiopulmonary transplantation. Surg. Clin. N. Am, 66(3): 491-501, 1986.
13 JONES, K. D.; CAVAROCCHI, N.; HAKIM, M.; CORYPEARCE, R.; ENGLISH, T. A. A.; WALLWORK, J. - A single flush technique for successful distant organ procurement in heart-lung transplantation. J. Heart Transpl, 4(6): 614, 1985.
14 KONTOS, G. J.; ADACHI, H.; BORKON, A. M.; CAMERON, D. E.; BAUMGARTNER, W. A.; HUTCHINS, G. M.; BRAWN, J.; REITZ, B. A. - A no-flush, core cooling technique for successful cardiopulmonary preservation in heart-lung transplantation. J. Thorac. Cardiovasc. Surg, 94(6): 836-842, 1987.
15 LADOWSKI, J. S.; KAPELANSKI, D. P.; TEODORI, M. F.; STEVENSON, W. C.; HARDESTY, R. L.; GRIFFITH, B. P. - Use of auto-perfusion for distant procurement of heart-lung allografts. J. Heart Transpl, 4: 330-333, 1985.
16 MODRY, D. L.; WALPOTH, B. W.; COHEN, R. G.; SEIFERT, E. C.; BLEESE, N. M.; WARNECKE, H.; BIEBER, C. P.; BILLINGHAM, M. E.; JAMIESON, S. W.; SHUMWAY, N. E. - Heart-lung preservation in the dog followed by lung transplantation: a new model for the assessment of lung preservation. J. Heart Transpl, 2: 287-298, 1983.
17 PATTERSON, G. A.; COOPER, J. D.; DARK, J. H.; JONES, M. T. - Experimental and clinical double lung transplantation. J. Thorac. Cardiovasc. Surg, 95(1): 70-74, 1988.
18 REICHART, B. A.; NOVITZKI, D.; COOPER, D. K.; CUNNINGHAM, M. S.; ROSE, A. G. - Successful orthotopic heart-lung transplantation in the baboon after 5 hours of cold ischemia with cardioplegia and Collins solution. J. Heart Transpl. 6(1): 15-22, 1987.
19. STARKEY, T. D.; SAKAKIBARA, N.; HAGBERG, R. C.; TAZELAAR, H. D.; BALDWIN, J. C.; JAMIESON, S. W. - Successful 6 hour cardiopulmonary preservation with simple hypothermic crystalloid flush. J. Heart Transpl, 5(4): 291-297, 1986.
20 STUART, R. S.; BAUMGARTNER, W. A.; BORKON, A. M.; BULKLEY, G. B.; BRAWN, J. D.; DE LA MONTE, S. M.; HUTCHINS, G. M.; REITZ, B. A. - Five hour hypothermic lung preservation with oxigen-free radical scavengers. Transpl. Proc, 17: 1454-1456, 1985.
21 TEODORI, M. F.; STEVENSON, W. C.; LADOWSKI, J. S.; KAPELANSKI, D. P.; GRIFFITH, B. P.; TRENTO, A.; BOROVETZ, H. S.; HARDESTY, R. L. - Autoperfusing heart-lung preparation for preservation in heartlung transplantation. Surg. Forum, 36(3): 311-313, 1985.
22 WATSON, D. C.; REITZ, B. A.; BAUMGARTNER, W. A.; RANEY, A. A.; OYER, P. E.; STINSON, E. B.; SHUMWAY, N. E. - Distant heart procurement for transplantation. Surgery, 86(1): 56-59, 1979.

Endereço para separatas:

Luís Sérgio Fragomeni

Rua Uruguai, 1555, Aptº 41

96010 Passo Fundo, RS, Brasil

Datas de Publicação

Publicação nesta coleção
17 Fev 2011
Data do Fascículo
Dez 1988

Histórico

Recebido
10 Out 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1 ANDREONE, P. A.; OLIVARI, M. T.; RING, S. W. - Clinical considerations of cardiac transplantation: preoperative and postoperative evaluation. Radiol. Clin. N. Am, 25(2): 357-366, 1987.

[2] 2 BALDWIN, J. C.; FRIST, W. H.; STARKEY, T. D.; HARJULA, A.; STARNES, V. A.; STINSON, E. B.; OYER, P. E.; SHUMWAY, N. E. - Distant graft procurement for combined heart and lung transplantation using pulmonary artery flush and simple topical hypothermia for graft preservation. Ann. Thorac. Surg, 43(6): 670-673, 1987.

[3] 3 BONSER, R. S.; FRAGOMENI, L. S.; KRIET, J. M.; KAYE, M. P.; JAMIESON, S. W.- Technique of clinical double lung transplantation. (No prelo, J. Heart Transpl

[4] 4 COOPER, J. D.; PEARSON, F. G.; PATTERSON, G. A.; TODD, T. R. J.; GINSBERG, R. J.; GOLDBERG, M.; DE MAJO, W. A. P. - Technique of successful lung transplantation in humans. J. Thorac. Cardiovasc. Surg, 93(2): 173-181, 1987.

[5] 5 DARK, J. H.; PATTERSON, G. A.; AL-JILAIHAWI, A. N.; HSU, H.; EGAN, T.; COOPER, J. D. - Experimental in bloc double lung transplantation. Ann. Thorac. Surg, 42(4): 394-398, 1986.

[6] 6 HARDESTY, R. L. & GRIFFITH, B. P. - Procurement for combined heart-lung transplantation: bilateral thoracotomy with sternal transection, cardiopulmonary bypass and profound hypothermia. J. Thorac. Cardiovasc. Surg, 89(5): 795-799, 1985.

[7] 7 HARJULA, A.; BALDWIN, J. C.; STARNES, V. A.; STINSON, E. B.; OYER, P. E.; JAMIESON, S. W.; SHUMWAY, N. E. - Proper donor selection for heart-lung transplantation: the Stanford experience. J. Thorac. Cardiovasc. Surg, 94(6): 874, 880, 1987.

[8] 8 HAVERICH, A.; SCOTT, W. C.; JAMIESON, S. W. - Twenty years of lung preservation: a review. J. Heart Transpl. 4: 234-240, 1985.

[9] 9 JAMIESON, S. W.; STINSON, E. B.; OYER, P. E.; BALDWIN, J. C.; SHUMWAY, N. E. - Operative technique for heart-lung transplantation. J. Thorac. Cardiovasc. Surg, 87(6): 930-935, 1984.

[10] 10 JAMIESON, S. W.; STINSON, E. R.; OYER, P. E.; REITZ, B. A.; BALDWIN, J.; MODRY, D.; DAWKINS, M. B.; THEODORE, J.; HUNT, S.; SHUMWAY, N. E. - Heart-lung transplantation for irreversible pulmonary hypertension. Ann. Thorac. Surg, 38(6): 554-562, 1984.

[11] 11 JAMIESON, S. W.; REITZ, B. A.; OYER, P. E.; BILLINGHAM, M.; MODRY, D.; BALDWIN, J.; STINSON, E. B.; HUNT, S.; THEODORE, J.; BIEBER, C. P.; SHUMWAY, N. E. - Combined heart and lung transplantation. Lancet, 1(8334): 1130-1131, 1983.

[12] 12 JAMIESON, S. W. & OGUNAIKE, H. O. - Cardiopulmonary transplantation. Surg. Clin. N. Am, 66(3): 491-501, 1986.

[13] 13 JONES, K. D.; CAVAROCCHI, N.; HAKIM, M.; CORYPEARCE, R.; ENGLISH, T. A. A.; WALLWORK, J. - A single flush technique for successful distant organ procurement in heart-lung transplantation. J. Heart Transpl, 4(6): 614, 1985.

[14] 14 KONTOS, G. J.; ADACHI, H.; BORKON, A. M.; CAMERON, D. E.; BAUMGARTNER, W. A.; HUTCHINS, G. M.; BRAWN, J.; REITZ, B. A. - A no-flush, core cooling technique for successful cardiopulmonary preservation in heart-lung transplantation. J. Thorac. Cardiovasc. Surg, 94(6): 836-842, 1987.

[15] 15 LADOWSKI, J. S.; KAPELANSKI, D. P.; TEODORI, M. F.; STEVENSON, W. C.; HARDESTY, R. L.; GRIFFITH, B. P. - Use of auto-perfusion for distant procurement of heart-lung allografts. J. Heart Transpl, 4: 330-333, 1985.

[16] 16 MODRY, D. L.; WALPOTH, B. W.; COHEN, R. G.; SEIFERT, E. C.; BLEESE, N. M.; WARNECKE, H.; BIEBER, C. P.; BILLINGHAM, M. E.; JAMIESON, S. W.; SHUMWAY, N. E. - Heart-lung preservation in the dog followed by lung transplantation: a new model for the assessment of lung preservation. J. Heart Transpl, 2: 287-298, 1983.

[17] 17 PATTERSON, G. A.; COOPER, J. D.; DARK, J. H.; JONES, M. T. - Experimental and clinical double lung transplantation. J. Thorac. Cardiovasc. Surg, 95(1): 70-74, 1988.

[18] 18 REICHART, B. A.; NOVITZKI, D.; COOPER, D. K.; CUNNINGHAM, M. S.; ROSE, A. G. - Successful orthotopic heart-lung transplantation in the baboon after 5 hours of cold ischemia with cardioplegia and Collins solution. J. Heart Transpl. 6(1): 15-22, 1987.

[19] 19. STARKEY, T. D.; SAKAKIBARA, N.; HAGBERG, R. C.; TAZELAAR, H. D.; BALDWIN, J. C.; JAMIESON, S. W. - Successful 6 hour cardiopulmonary preservation with simple hypothermic crystalloid flush. J. Heart Transpl, 5(4): 291-297, 1986.

[20] 20 STUART, R. S.; BAUMGARTNER, W. A.; BORKON, A. M.; BULKLEY, G. B.; BRAWN, J. D.; DE LA MONTE, S. M.; HUTCHINS, G. M.; REITZ, B. A. - Five hour hypothermic lung preservation with oxigen-free radical scavengers. Transpl. Proc, 17: 1454-1456, 1985.

[21] 21 TEODORI, M. F.; STEVENSON, W. C.; LADOWSKI, J. S.; KAPELANSKI, D. P.; GRIFFITH, B. P.; TRENTO, A.; BOROVETZ, H. S.; HARDESTY, R. L. - Autoperfusing heart-lung preparation for preservation in heartlung transplantation. Surg. Forum, 36(3): 311-313, 1985.

[22] 22 WATSON, D. C.; REITZ, B. A.; BAUMGARTNER, W. A.; RANEY, A. A.; OYER, P. E.; STINSON, E. B.; SHUMWAY, N. E. - Distant heart procurement for transplantation. Surgery, 86(1): 56-59, 1979.