7. Effects of short and long term cold static preservation followed by normothermic ex vivo lung perfusion in a porcine model
EHLT Jan 2018 Wengen. (presentation)
Olbertz Ca,c, Koch Aa, Pizanis Na, Bäumker Ha, Rauen Ub, Nolte Ic, Kamler Ma
aThoracic Transplantation, West German Heart Center, University Hospital Essen, Essen, Germany,
Ex Vivo Lung Perfusion (EVLP) is a promising tool for evaluation and reconditioning of marginal donor lungs. However, the optimal treatment protocol is discussed controversially. After lung harvest EVLP can be performed immediately or after a prolonged cold ischemic time. We hypothesize, that lung functional parameters are better preserved after prolonged cold static preservation followed by EVLP compared to immediate EVLP.
Following cardiac arrest and 30 min of no-touch warm ischemia porcine lungs were harvested, flushed and stored in cold low potassium dextran solution. Group 1 was prepared for immediate long EVLP (I-EVLP) and group 2 for delayed short EVLP (D-EVLP) after 9 hours of cold storage (D-EVLP). TheI-EVLP protocol was 12 hours and D-EVLP protocol 4 hours. Lungs were perfused in an acellular dextran and albumin containing solution. Pulmonary gas exchange, biochemical (Lactate dehydrogenase (LDH) and Thiobarbituric acid-reactive substances (TBARS)) and structural parameters were recorded hourly.
∆ pO2 (pulmonary venous – pulmonary arterial pO2) tended to be higher in D-EVLP group, especially in hour 1: I-EVLP: 259 ± 132, D-EVLP: 291 ± 96 and hour 2: I-EVLP: 228 ± 125, D-EVLP: 252 ± 116 (n.s.), pulmonary vascular resistance and wet-dry-ratio to be lower in the D-EVLP group (n.s.). No significant differences were noticed in LDH release and TBARS level. Wet-dry-ratio after D-EVLP was significantly lower than after I-EVLP (p<0.05).
In a non-heart beating porcine lung donor model with relevant ischemic tissue damage, cold static preservation (CSP) and delayed EVLP results in similar lung function compared to direct EVLP. Our results suggest that the delayed EVLP protocol is save and direct EVLP is not necessary, especially when the high amount of resources mandatory for direct-mobile clinical EVLP are considered.