Dong Wei1,2, Fei Gao3, Zhenkun Yang2, Wei Wang2, Yinglun Chen1, Yan Lu4, Jingyu Chen1,2,5. 1. Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China. 2. Jiangsu Engineering Research Center of Organ Lung Preservation, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China. 3. Department of Emergency, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China. 4. Guangdong Shunde Innovative Design Institute, Shunde 528311, China. 5. Lung Transplant Group, China-Japan Friendship Hospital, Beijing 100029, China.
Abstract
BACKGROUND: Ex vivo lung perfusion (EVLP) has developed as the most effective technique for estimating marginal donor lungs. This study attempted to extend the EVLP running time to 12 hours with a dialyzer rather than periodically replacing the perfusate. METHODS: Human donor lungs rejected by the clinical lung transplantation (LTx) team were obtained. After cold storage lasting 18-24 hours, lungs were randomly assigned to 2 groups: a control group and a perfusate purification (PP) group. The control group underwent EVLP in the traditional way, while a dialyzer was added into the circuit as a bypass in the PP group. The effects on lung function, microenvironment, inflammatory response, and cell death were evaluated. RESULTS: A total of 8 rejected donor lungs were obtained and each group was assigned to 4 cases of EVLP. Three cases were prematurely terminated because of serious lung edema and decreased lung function. There were no significant differences in airway pressure, pulmonary artery pressure, and oxygen concentration between the two groups in the first 8 hours. The pH in the control group was significantly lower than that in the PP group, and the levels of potassium and lactate were significantly higher than those in the PP group. Inflammatory markers increased in both groups, while IL-6 and IL-10 were higher in the PP group in the first 6 hours. Hematoxylin and eosin (HE) staining revealed lung injuries in both groups, but no significant difference was noted in the HE-stained slides. There were significantly more TUNEL-positive cells in the control group (69.5%±4.0%) than in the PP group (47.5%±3.9%) (P=0.000). CONCLUSIONS: Using the modified method of EVLP reduces the high cost caused by exchanging perfusion fluid per hour and could prolong the normothermic preservation time of donor lungs. 2020 Annals of Translational Medicine. All rights reserved.
BACKGROUND: Ex vivo lung perfusion (EVLP) has developed as the most effective technique for estimating marginal donor lungs. This study attempted to extend the EVLP running time to 12 hours with a dialyzer rather than periodically replacing the perfusate. METHODS: Human donor lungs rejected by the clinical lung transplantation (LTx) team were obtained. After cold storage lasting 18-24 hours, lungs were randomly assigned to 2 groups: a control group and a perfusate purification (PP) group. The control group underwent EVLP in the traditional way, while a dialyzer was added into the circuit as a bypass in the PP group. The effects on lung function, microenvironment, inflammatory response, and cell death were evaluated. RESULTS: A total of 8 rejected donor lungs were obtained and each group was assigned to 4 cases of EVLP. Three cases were prematurely terminated because of serious lung edema and decreased lung function. There were no significant differences in airway pressure, pulmonary artery pressure, and oxygen concentration between the two groups in the first 8 hours. The pH in the control group was significantly lower than that in the PP group, and the levels of potassium and lactate were significantly higher than those in the PP group. Inflammatory markers increased in both groups, while IL-6 and IL-10 were higher in the PP group in the first 6 hours. Hematoxylin and eosin (HE) staining revealed lung injuries in both groups, but no significant difference was noted in the HE-stained slides. There were significantly more TUNEL-positive cells in the control group (69.5%±4.0%) than in the PP group (47.5%±3.9%) (P=0.000). CONCLUSIONS: Using the modified method of EVLP reduces the high cost caused by exchanging perfusion fluid per hour and could prolong the normothermic preservation time of donor lungs. 2020 Annals of Translational Medicine. All rights reserved.
Entities:
Keywords:
Ex vivo lung perfusion (EVLP); dialyzer; lactate; lung injury
Authors: Marcelo Cypel; Jonathan C Yeung; Mingyao Liu; Masaki Anraku; Fengshi Chen; Wojtek Karolak; Masaaki Sato; Jane Laratta; Sassan Azad; Mindy Madonik; Chung-Wai Chow; Cecilia Chaparro; Michael Hutcheon; Lianne G Singer; Arthur S Slutsky; Kazuhiro Yasufuku; Marc de Perrot; Andrew F Pierre; Thomas K Waddell; Shaf Keshavjee Journal: N Engl J Med Date: 2011-04-14 Impact factor: 91.245
Authors: Ilhan Inci; Yoshito Yamada; Sven Hillinger; Wolfgang Jungraithmayr; Michael Trinkwitz; Walter Weder Journal: Ann Thorac Surg Date: 2014-10-30 Impact factor: 4.330
Authors: Ilker Iskender; Tugba Cosgun; Stephan Arni; Michael Trinkwitz; Stefan Fehlings; Yoshito Yamada; Nikola Cesarovic; Keke Yu; Thomas Frauenfelder; Wolfgang Jungraithmayr; Walter Weder; Ilhan Inci Journal: J Heart Lung Transplant Date: 2017-05-20 Impact factor: 10.247
Authors: Andrew Fisher; Anders Andreasson; Alexandros Chrysos; Joanne Lally; Chrysovalanto Mamasoula; Catherine Exley; Jennifer Wilkinson; Jessica Qian; Gillian Watson; Oli Lewington; Thomas Chadwick; Elaine McColl; Mark Pearce; Kay Mann; Nicola McMeekin; Luke Vale; Steven Tsui; Nizar Yonan; Andre Simon; Nandor Marczin; Jorge Mascaro; John Dark Journal: Health Technol Assess Date: 2016-11 Impact factor: 4.014
Authors: Miral R Sadaria; Phillip D Smith; David A Fullerton; George A Justison; Joon H Lee; Ferenc Puskas; Frederick L Grover; Joseph C Cleveland; T Brett Reece; Michael J Weyant Journal: Ann Thorac Surg Date: 2011-06-25 Impact factor: 4.330
Authors: Matthew R Byler; Nathan S Haywood; Dustin T Money; Aimee Zhang; Jared P Beller; Eric J Charles; William Z Chancellor; Huy Q Ta; Mark H Stoler; J Hunter Mehaffey; Victor E Laubach; Irving L Kron; Mark E Roeser Journal: Semin Thorac Cardiovasc Surg Date: 2021-03-11