More on additives to the EVLP perfusate: The intriguing role of hydrogen

A study from Japan underlines the beneficial effects of adding hydrogen during EVLP.

The benefits of hydrogen reconditioning during EVLP were first reported by Noda et al(6) in rat lungs in 2014. The significance of their results was highlighted in the same issue of Transplantation(7) in an editorial by Dark: “The effects of hydrogen as an antioxidant, anti-inflammatory, and antiapoptotic agent are only just now being realized.”

More recently Haam et al(8) found that hydrogen gas inhalation during EVLP improved donation after cardiac death (DCD) lung function via reduction of inflammation and apoptosis, and this effect persisted after transplantation, as reported in XVIVO INSIGHTS November 2018(9).

This year a group in Japan(10) has just published further work on the protective effects of a hydrogen-rich preservation solution in a canine (beagle) lung transplant model. Two groups of lungs were subjected to 23 hours of cold ischemic preservation, with or without the addition of a hydrogen-rich solution. Thereafter orthotopic left lung transplantation was performed followed by reperfusion for four hours.

Significantly improved gaseous exchange and lower wet-to-dry ratios were reported in the hydrogen group than in the control group. In addition, histology revealed less lung injury and fewer apoptotic cells in the hydrogen group (P < .001 and P < .001, respectively). The authors conclude that their results demonstrate that use of a hydrogen-enriched preservation solution attenuates ischemia-reperfusion injury in a canine left lung transplant model.

This work repeats, for the lung, what has been shown for other organs with a hydrogen enhanced solution. The next obvious step is to combine inhaled hydrogen during EVLP in a larger animal model.

XVIVO Insights PB-2021-04-20


6. Noda K, et al: Hydrogen preconditioning during ex vivo lung perfusion improves the quality of lung grafts in rats. Transplantation. 2014 Sep 15;98(5):499-506
7. Dark J: Hydrogen in lung reconditioning–more than just inflation. Transplantation. 2014 Sep 15;98(5):497-8.
8. Haam, et al: Hydrogen gas inhalation during ex vivo lung perfusion of donor lungs recovered after cardiac death. J Heart Lung 2018 Oct; 37(10): 1271-1278 (link to existing Abstract)
9. XVIVO INSIGHTS Nov 2018: Hydrogen gas inhalation during ex-vivo lung perfusion improves transplant outcomes (link to existing Insight)
10. H Kayawake, et al: Protective Effects of a Hydrogen-Rich Preservation Solution in a Canine Lung Transplantation Model. Ann Thorac Surg . 2021 Jan;111(1):246-252. doi: 10.1016/j.athoracsur.2020.05.076. PMID: 32649946 (link to Abstract)