Comparison of Celsior and Perfadex lung preservation solutions in rat lungs subjected to 6 and 12 hours of ischemia using an ex-vivo lung perfusion system

Abstract

OBJECTIVE:This study evaluated the performance of lungs that were preserved with different solutions (Celsior, Perfadex or saline) in an ex vivo rat lung perfusion system.METHODS:Sixty Wistar rats were anesthetized, anticoagulated and randomized into three groups (n = 20). The rats were subjected to antegrade perfusion via the pulmonary artery with Perfadex, Celsior, or saline, followed by 6 or 12 hours of ischemia (4°C, n = 10 in each group). Respiratory mechanics, gas exchange and hemodynamics were measured at 10-minute intervals during the reperfusion of heart-lung blocks in an ex vivo system (IL2-Isolated Perfused Rat or Guinea Pig Lung System, Harvard Apparatus, Holliston, Massachusetts, USA; Hugo Sachs Elektronik, Germany) for 60 minutes. The lungs were prepared for histopathology and evaluated for edema following reperfusion. Group comparisons were performed using ANOVA and the Kruskal-Wallis test with a 5% level of significance.RESULTS:Gas exchange was not significantly different between lungs perfused with either Perfadex or Celsior at the same ischemic times, but it was very low in lungs that were preserved with saline. Airway resistance was greater in the lungs that were preserved for 12 hours. Celsior lungs that were preserved for 6 and 12 hours exhibited lower airway resistance (p = 0.01) compared to Perfadex lungs. Pulmonary artery pressure was not different between the groups, and no significant differences in histopathology and apoptosis were observed between the groups.CONCLUSIONS:Lungs that were preserved with Celsior or Perfadex exhibited similar gas exchange and histopathological findings. Airway resistance was slightly lower in the Celsior-preserved lungs compared with the Perfadex-preserved lungs.

Tips for optimizing organ preservation solutions

“…Few cells have been observed to have chromatin condensation, which may suggest an early stage of apoptosis. The basement membrane thickness was comparable in both groups (Menezes et al, 2012). However, clinical studies by Gohrbandt et al demonstrated that Celsior protected lungs during transplantation better than Perfadex.…”

Animal models of ex vivo lung perfusion as a platform for transplantation research

“…The Pego-Fernandes group reported that their solution, low potassium dextran-glucose (LPDnac) was comparable to Perfadex (Vitrolife, Goteborg, Germany) but found saline to be inadequate [13,14] . Menezes et al [15] also compared Perfadex to Celsior and found lungs perfused with either exhibited similar gas exchange and histopathological findings.…”

“…Basic properties, such as the optimal electrolyte composition of the perfusate itself are not agreed upon. Current data are unclear as to which currently available solutions perform best [15] . Perfadex, a solution developed specifically for lung preservation, may not offer better preservation than Celsior, a heart preservation solution [15,25] .…”

A cocktail solution for the ex vivo preservation and perfusion of the lung; Shehata solution

“…Although 2 studies have confirmed Celsior's ability to provide similar clinical results to those of the Perfadex solution, with additional trends towards better survival and less incidence of chronic lung allograft dysfunction, especially with longer ischemic periods, Perfadex remains the most widely used preservation solution in most lung transplant centers [6,7].…”