Extension of donor lung preservation with hypothermic storage after normothermic ex vivo lung perfusion

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• 作者：Michael Kuan Yew Hsin ; MD ; Ilker Iskender ; MD ; Daisuke Nakajima ; MD ; Manyin Chen ; MD ; Hyunhee Kim ; MSc ; Pedro Reck dos Santos ; MD ; Jin Sakamoto ; MD ; Jingu Lee ; MD ; Kohei Hashimoto ; MD ; Constantine Harmantas ; BSc ; David Hwang ; MD ; Tom Waddell ; MD ; PhD ; Mingyao Liu ; MD ; MSc ; Shaf Keshavjee ; MD ; Marcelo Cypel ; MD ; ^{Marcelo.cypel@uhn.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：lung preservation ; ex vivo lung perfusion ; lung transplantation ; lung evaluation ; lung resuscitation ; lung physiology
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：35
• 期：1
• 页码：130-136
• 全文大小：2111 K

文摘

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.