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Intérêt du monoxyde de carbone comme marqueur non invasif des lésions d’ischémie-reperfusion de poumons reconditionnés ex vivo

Abstract : Rationale: Ex vivo lung perfusion (EVLP) is a promising technique to reduce the shortage of organs available for transplantation. Carbon monoxide (CO) might help in the selection of grafts during EVLP as its endogenous production is increased by ischemia reperfusion.Objectives: To develop a measurement technique of exhaled CO (eCO) during EVLP and to study its variations depending on ischemia reperfusion injuries.Methods: Using a pig model of EVLP and using a laser spectrometer technique based on the principle of a resonant cavity (optical feedback cavity-enhanced absorption spectroscopy-OF-CEAS), we measured eCO under different ventilatory parameters, various polluted environments with poor (<0,015ppmv) or rich (9ppmv) CO gas, and after infusion of an inhibitor of heme oxygenase (SnPP). We then compared eCO after 30 min (D0) or 24 h (D1) of cold ischemia and determined the predictive value of eCO to select lung grafts.Results: In isolated lungs, the concentration of eCO reached 0.45 ± 0.19 ppmv. eCO peaks during the expiratory phase. Neither variations of the fraction of inspired oxygen, nor the pollution of the ambient air altered eCO. eCO concentrations were not different after SnPP infusion. eCO was higher on day 1 compared to day 0 (1.35 ± 0.259 vs. 0.951 ± 0.313 ppmv, p = 0.01) and correlated with an index of the permeability of the alveolar capillary membrane. The best treshold value of eCO determined from the ROC curve was 0.860 ppmv (sensitivity 1 (0.31 to 1), specificity of 0.44 (0.15 to 0.77), positive predictive value of 0, 37 (0.10 to 0.74), negative predictive value of 1 (0.39 to 1)).Conclusions: Measurements of eCO during EVLP is feasible. eCO is significantly higher when ischemia-reperfusion injuries are increased. However, eCO can not be used in isolation to select lung grafts.
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Maxime Maignan. Intérêt du monoxyde de carbone comme marqueur non invasif des lésions d’ischémie-reperfusion de poumons reconditionnés ex vivo. Médecine humaine et pathologie. Université Grenoble Alpes, 2015. Français. ⟨NNT : 2015GREAS030⟩. ⟨tel-01691721⟩

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