Extension of Donor Lung Preservation With Hypothermic Storage After Normothermic Ex Vivo Lung Perfusion

Michael Kuan Yew Hsin, Ilker Iskender, Daisuke Nakajima, Manyin Chen, Hyunhee Kim, Pedro Reck Dos Santos, JinSakamoto, Jingu Lee, Kohei Hashimoto, Constantine Harmantas, David Hwang, Tom Waddell, Mingyao Liu, Shaf Keshavjee, Marcelo Cypel

J Heart Lung Transplant. 2016 Jan;35(1):130-136. doi: 10.1016/j.healun.2015.05.017. Epub 2015 Jun 10.  

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.

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.

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).

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.

ex vivo lung perfusion; lung evaluation; lung physiology; lung preservation; lung resuscitation; lung transplantation.
Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

PMID: 26227444 DOI: 10.1016/j.healun.2015.05.017