Delayed EVLP (after cold preservation) as effective as immediate EVLP – but requires fewer resources

The first hard data from an important comparative study of two EVLP protocols was presented last month at the 32^nd 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.”

Reference:

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