Prone Positioning During Ex Vivo Lung Perfusion Influences Regional Edema Accumulation

Ordies S1, Frick AE2, Claes S3, Schols D3, Verleden SE4, Van Raemdonck DE5, Neyrinck AP6; Leuven Lung Transplant Group7. Martens A, Verschakelen JA, Verbeken EK, Vanaudenaerde BM, Vos R, Verleden GM. (Leuven, Belg)

J Surg Res. 2019 Jul;239:300-308. doi: 10.1016/j.jss.2019.02.003. Epub 2019 Mar 19.      


Ex vivo lung perfusion (EVLP) is developed to increase the quantity and quality of suitable grafts for lung transplantation. Standardly, lungs are mounted supine with the risk of fluid accumulation in the dorsal regions. Therefore, we investigated the impact of experimental prone position on graft function during EVLP.


Porcine lungs were mounted on a normothermic EVLP for 6 h in supine [S], (n = 7) or prone position [P], (n = 7). Physiology during EVLP was recorded. After EVLP, biopsies were assessed for wet-to-dry weight (W/D) ratios and pathology, broncho-alveolar lavage was measured, and the left lung was computed tomography (CT) scanned.


Physiological parameters were similar between both groups, despite a higher pulmonary vascular resistance in [P] (P = 0.0002). In [S], W/D ratios and CT density of dorsal areas were higher compared to ventral (P = 0.0017 and P = 0.053, respectively). In [P], W/D and CT density between ventral and dorsal regions were similar, meaning that pulmonary edema was distributed more homogeneously throughout the lung. Histology and cytokine levels in perfusate and broncho-alveolar lavage did not differ between both groups.


Prone positioning during EVLP is feasible and leads to more homogenous distribution of interstitial fluid. Supine position resulted in more concentrated edema accumulation in lower dependent regions.

Copyright © 2019. Published by Elsevier Inc.
KEYWORDS: CT imaging; Ex vivo lung perfusion; Ischemia-reperfusion injury; Lung transplantation; Prone position; Supine position
PMID: 30901722 DOI: 10.1016/j.jss.2019.02.003