Original pre-clinical scienceReconditioning of lungs donated after circulatory death with normothermic ex vivo lung perfusion
Section snippets
Animals
Beagle dogs, weighing from 9 to 15 kg (Kitayama Labes Co., Hongo Farm, Yamaguchi, Japan), were used in this study. All animals received humane care in compliance with the “Principals of Laboratory Animal Care,” formulated by the U.S. National Society for Medical Research, and the Guide for the Care and Use of Laboratory Animals, prepared by the U.S. Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication 85–23, revised 1996). The study was
Physiologic lung functions
One dog from each group died from severe pulmonary edema 2.5 hours after transplantation. They were excluded from the data analysis at 3 hours and 4 hours after transplantation.
Lung oxygenation was significantly improved by EVLP (p < 0.01; Figure 1A). Specifically, PaO2 at baseline of EVLP and the end of EVLP were 437 ± 68 mm Hg and 558 ± 35 mm Hg, respectively. Both dynamic pulmonary compliance and pulmonary vascular resistance were stable during EVLP (Figure 1B and C).
Post-transplant lung
Discussion
In this study we have demonstrated that normothermic EVLP with db-cAMP and NTG could resuscitate DCD lungs injured by 4 hours of warm ischemia, and could ameliorate ischemia–reperfusion injury compared with static cold storage. Cypel and colleagues established a successful prolonged EVLP system using an acellular perfusate, and suggested that this system can be used to assess, maintain and treat injured donor lungs.14 We have adapted their technique and confirmed excellent lung performance
Disclosure statement
The authors have no conflicts of interest to disclose.
Part of this work was presented at the 31st annual meeting and scientific sessions of the International Society for Heart and Lung Transplantation, April 2011, San Diego, California.
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Cited by (43)
Thoracic organ donation after circulatory determination of death
2023, Transplantation ReportsCitation Excerpt :This period includes the legal no-touch period that must be followed to confirm irreversibility and permanence of the cardiocirculatory arrest [26]. The severe warm ischemia-reperfusion injury (IRI) in DCD donation is known to be associated with primary graft dysfunction after lung transplantation, and a significant cause of post-lung transplant morbidity and mortality [27]. Considering the high energy expenditures of the heart, it is even more vulnerable to prolonged warm ischemia and subsequent reperfusion injury during DCD and this increases the risk of post-transplant primary graft dysfunction, vascular dysfunction, arrhythmia, myocardial cell death, and tissue injury [3,28].
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2020, Annals of Thoracic SurgeryCitation Excerpt :Indeed, any strategy that could increase the amount of acceptable WIT has the potential to increase the number of possible donors. In the laboratory, the use of EVLP alone or with targeted drug therapy has been reported previously as a means to assess and recondition lungs from DCD donors.12,13 In a study from the University of Virginia (Charlottesville, VA), Charles and colleagues12 showed that injured porcine lungs were rendered transplantable after reconditioning with EVLP and the use of an adenosine A2B receptor antagonist.
Hyperinflation With Pulmonary Dysfunction in Donor Lungs With Smoking History During Lung Perfusion
2020, Journal of Surgical ResearchCitation Excerpt :Ex vivo lung perfusion (EVLP) is a novel platform to provide assessment and treatment of initially rejected donor lungs.7 Some studies have suggested its potential role to expand the organ donor pool, detecting suitable lungs from marginal donors, including older ages, low PaO2/FiO2 ratio (P/F ratio) and smoking history.7-9 However, few studies have focused on smoker lung-specific pulmonary injury during EVLP.
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2017, Annals of Thoracic SurgeryEx vivo lung graft perfusion
2016, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :The same research group suggests that lung harvesting in non-controlled cardiac arrest situations may present some advantages in terms of lung function because of the absence of an agonic phase [67]. Several experimental studies have shown that EVLP normothermic preservation is probably better than prolonged cold ischaemia [32,68]. Other pig lung experimental studies have shown that re-cooling the lungs after EVLP it probably not necessary if transplantation surgery is performed a few minutes after EVLP [69].