Delayed EVLP (after cold preservation) as effective as immediate EVLP – but requires fewer resources
A study comparing two EVLP protocols found that EVLP after cold preservation was as effective as immediate EVLP.
The first hard data from an important comparative study of two EVLP protocols was presented last month at the 32nd ESHLT conference in Wengen, Switzerland. The study throws interesting new light on the controversial topic of EVLP protocols – to cool or not to cool – before warm EVLP.
The study from Essen (Olbertz C et al, 2018) compared two EVLP protocols, both of which involve a similar total ischemic time. One group of porcine lungs was subjected to Delayed EVLP ( D-EVLP) involving nine hours of cold preservation, followed by 4 hours of warm EVLP. The second group was subjected to Immediate EVLP ( I-EVLP) whereby the lungs were placed almost immediately on a warm EVLP circuit for 12 hours. Lungs in both groups were perfused with STEEN solution – an extracellular dextran and albumin-containing solution.
Pulmonary gas exchange, biochemical (Lactate dehydrogenase (LDH) and Thiobarbituric acid-reactive substances (TBARS)) and structural parameters were recorded hourly. Although oxygenation, pulmonary vascular resistance and wet-to-dry ratios tended to favour the D-EVLP group, the differences were not statistically significant. After EVLP, however, wet-dry-ratios were significantly lower in the D-EVLP group.
The authors conclude: “Our results suggest that the delayed EVLP protocol is safe and direct EVLP (I-EVLP) is not necessary, especially when the high amount of resources mandatory for direct-mobile clinical EVLP are considered.”
7. Olbertz, Effects of short and long term cold static preservation followed by normothermic ex vivo lung perfusion in a porcine model. Euro HLT meeting, Jan 2018 Wengen. (link to abstract)
Xvivo Insights PB-2018-01-28