Extension of donor lung preservation with hypothermic storage after normothermic ex vivo lung perfusion Academic Article uri icon

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abstract

  • BACKGROUND: Ex vivo lung perfusion (EVLP) allows normothermic evaluation and treatment of donor lungs not currently acceptable for transplant and improves organ use. Donor lungs undergo a period of cold preservation before (cold ischemic time [CIT]-1) and after (CIT-2) EVLP. We investigated the effect of an extended CIT-2 on lung function after transplantation. METHODS: Explanted pig lungs, preserved in low-potassium dextran flush (Perfadex) at 4°C for 10 hours, were subjected to 6 hours of EVLP. They were subsequently allocated to 2 groups: short CIT-2 (CIT-2 = 2 hours; n = 5), and long CIT-2 (CIT-2 = 10 hours; n = 5). In a control group (n = 6), explanted lungs were placed in cold static preservation for 24 hours without EVLP. After the total preservation period, the left lung was transplanted in all groups. RESULTS: After 4 hours of reperfusion, oxygenation function, acute lung injury score, inflammatory markers, and cell death pathway markers were similar between short and long CIT-2 groups. Both EVLP groups fared significantly better than the control group in oxygenation function (p < 0.05). CONCLUSIONS: The intervention of EVLP improved lung function after transplantation, and this was not affected by a prolonged cold static preservation time after EVLP. These results provide the basis for a practical prolonged lung preservation strategy using a combination of cold and warm preservation techniques, which may improve lung transplantation logistics and outcomes.

authors

  • Hsin, Michael Kuan Yew
  • Iskender, Ilker
  • Nakajima, Daisuke
  • Chen, Manyin
  • Kim, Hyunhee
  • dos Santos, Pedro Reck
  • Sakamoto, Jin
  • Lee, Jingu
  • Hashimoto, Kohei
  • Harmantas, Constantine
  • Hwang, David
  • Waddell, Tom
  • Liu, Mingyao
  • Keshavjee, Shafique
  • Cypel, Marcelo

publication date

  • January 2016