Cyclosporin A Administration During Ex Vivo Lung Perfusion Preserves Lung Grafts in Rat Transplant Model

Haam S, Noda K, Philips BJ, Harano T, Sanchez PG, Shigemura N.

Transplantation. 2020 Mar 20. doi: 10.1097/TP.0000000000003237. Online ahead of print. Transplantation. 2020.PMID: 32217944

Despite the benefits of ex vivo lung perfusion (EVLP) such as lung reconditioning, preservation and evaluation prior to transplantation, deleterious effects including activation of proinflammatory cascades and alteration of metabolic profiles have been reported. Although patient outcomes have been favorable, further studies addressing optimal conditions are warranted. In this study, we investigated the role of the immunosuppressant drug Cyclosporine A (CyA), in preserving mitochondrial function and subsequently preventing proinflammatory changes in lung grafts during EVLP.

Using rat heart-lung blocks after 1 hour cold preservation, an acellular normothermic EVLP system was established for 4 hours. CyA was added into perfusate at a final concentration of 1 µM. The evaluation included lung graft function, lung compliance and pulmonary vascular resistance as well as biochemical marker measurement in the perfusate at multiple time points. After EVLP, single orthotopic lung transplantation was performed and the grafts were assessed 2 hours after reperfusion.

Lung grafts on EVLP with CyA exhibited significantly better functional and physiological parameters as compared to those without CyA treatment. CyA administration attenuated proinflammatory changes and prohibited glucose consumption during EVLP through mitigating mitochondrial dysfunction in lung grafts. CyA-preconditioned lungs showed better posttransplant lung early graft function and less inflammatory events compared to control.

During EVLP, CyA administration can have a preconditioning effect through both its anti-inflammatory and mitochondrial protective properties leading to improved lung graft preservation which may result in enhanced graft quality after transplantation