Toshihiro Okamoto1, David Wheeler2, Qiang Liu3, Cristiano Quintini3, J Steven Hata2, Kenneth R McCurry4. 1. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA; Transplant Center, Cleveland Clinic, Cleveland, Ohio, USA. 2. Department of Outcomes Research, Cardiothoracic Anesthesiology, and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA. 3. Transplant Center, Cleveland Clinic, Cleveland, Ohio, USA. 4. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: mccurrk@ccf.org.
Abstract
BACKGROUND: Ex vivo lung perfusion (EVLP) may be an essential process for the pre-transplant evaluation of the donor lungs. Currently, the partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2, or PF) ratio is the standard in the assessment of lung function in cellular EVLP, whereas other parameters, including airway and vascular parameters, have only been partially utilized. The primary purpose of this study is to assess the potential utility of other parameters as a surrogate of lung function in EVLP. METHODS: Yorkshire swine lungs (n = 12) and rejected human donor lungs (n = 12) were perfused in cellular-based EVLP for 2 hours. PF ratio, airway parameters (peak airway pressure, plateau pressure, dynamic compliance and static compliance) and vascular parameters (pulmonary vascular resistance and pulmonary artery pressure) were measured. The correlations between PF ratio and one of these parameters were analyzed. RESULTS: Correlations were identified in the following combinations: PF ratio and airway parameters (p < 0.05, each); PF ratio and vascular parameters (p < 0.05, each); static compliance and pulmonary vascular resistance in swine lungs (p = 0.0001); and PF ratio and airway parameters in rejected human lungs (p < 0.05, each). There were significant differences in all parameters between suitable cases and non-suitable cases in swine lungs (p < 0.02, each). CONCLUSIONS: Our results show that airway parameters are complementary quantitative indicators of lung function in cellular EVLP, based on the correlations with PF ratio in both swine lungs and human lungs.
BACKGROUND: Ex vivo lung perfusion (EVLP) may be an essential process for the pre-transplant evaluation of the donor lungs. Currently, the partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2, or PF) ratio is the standard in the assessment of lung function in cellular EVLP, whereas other parameters, including airway and vascular parameters, have only been partially utilized. The primary purpose of this study is to assess the potential utility of other parameters as a surrogate of lung function in EVLP. METHODS: Yorkshire swine lungs (n = 12) and rejected humandonor lungs (n = 12) were perfused in cellular-based EVLP for 2 hours. PF ratio, airway parameters (peak airway pressure, plateau pressure, dynamic compliance and static compliance) and vascular parameters (pulmonary vascular resistance and pulmonary artery pressure) were measured. The correlations between PF ratio and one of these parameters were analyzed. RESULTS: Correlations were identified in the following combinations: PF ratio and airway parameters (p < 0.05, each); PF ratio and vascular parameters (p < 0.05, each); static compliance and pulmonary vascular resistance in swine lungs (p = 0.0001); and PF ratio and airway parameters in rejected human lungs (p < 0.05, each). There were significant differences in all parameters between suitable cases and non-suitable cases in swine lungs (p < 0.02, each). CONCLUSIONS: Our results show that airway parameters are complementary quantitative indicators of lung function in cellular EVLP, based on the correlations with PF ratio in both swine lungs and human lungs.
Authors: Toshihiro Okamoto; Hiromichi Niikawa; David Wheeler; Kamal S Ayyat; Soliman Basem; Yoshifumi Itoda; Gengo Sunagawa; Carol F Farver; Kenneth R McCurry Journal: Transplant Direct Date: 2019-04-25