Innovations in EVLP: A recent development in donor lung assessment

A recent clinical study suggests that a biomarker of tissue injury, cell-free DNA, in the EVLP perfusate can predict primary graft dysfunction (PGD) in lung transplantation.

Cell-free DNA (cfDNA), released from the mitochondria and nuclei of injured cells, has been explored as a biomarker for tissue injury in various clinical settings. A recent study from Toronto⁽¹⁾ investigated whether monitoring cell-free DNA in the perfusate during Ex Vivo Lung Perfusion (EVLP) could predict the risk of primary graft dysfunction (PGD) after transplantation.

Of the 62 patients who received lungs subjected to EVLP, 14 developed PGD grade 3 within 72 hours of transplantation. Samples of perfusate DNA were taken at one and four hours during EVLP.

Concentrations of mitochondrial DNA in the perfusate of the PGD3 group were significantly higher than those in non-PGD group at 1 hour of EVLP (P = .011). The perfusate of the PGD3 group also had significantly higher levels of nuclear DNA compared with the non-PGD group at 1 hour (P = .008) and this difference remained significant at 4 hours too (P = .001).

Interestingly, these differences were particularly evident in DCD lungs donated after cardiac death, but were not significant in lungs donated after brain death (DBD). This study thus suggests, at least for DCD lungs, that cell-free DNA can help estimate damage to the donor lungs before implantation.

References:

1. Kanou T, Nakahira K, Choi A M, Cypel M, et al. Cell-free DNA in human ex vivo lung perfusate as a potential biomarker to predict the risk of primary graft dysfunction in lung transplantation. J Thoracic Cardiovasc Surg, Aug 10 , 2020 (in press) (link to abstract)

XVIVO Insights PB-2020-10-28