Do we need to cool the lung graft after ex vivo lung perfusion? A preliminary study

Stanzi, Alessia; Neyrinck, Arne; Somers, Jana; Cauwenberghs, Hans; Verbeken, Eric; Santambrogio, Luigi; Raemdonck, Dirk Van

doi:10.1016/j.jss.2014.07.068

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…The PaO 2 /FiO 2 quotient showed a slight increase compared to the initial EVLP values in both groups, which was most likely the result of the removal of atelectasis. Traditionally, PaO 2 /FiO 2 quotients as a measure of pulmonary oxygenation capacity have proven to be the most accurate predictors of a successful lung transplant, and our results coincide with those reported by Cypel, et al [ 39 ] and Stanzi, et al [ 40 ].…”

Section: Discussionsupporting

confidence: 91%

Changes in the levels of free sialic acid during ex vivo lung perfusion do not correlate with pulmonary function. Experimental model

Hernández-Jiménez,

Martínez-Cortés,

Olmos-Zuñiga

et al. 2023

BMC Pulm Med

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Background Ex vivo lung perfusion (EVLP) constitutes a tool with great research potential due to its advantages over in vivo and in vitro models. Despite its important contribution to lung reconditioning, this technique has the disadvantage of incurring high costs and can induce pulmonary endothelial injury through perfusion and ventilation. The pulmonary endothelium is made up of endothelial glycocalyx (EG), a coating of proteoglycans (PG) on the luminal surface. PGs are glycoproteins linked to terminal sialic acids (Sia) that can affect homeostasis with responses leading to edema formation. This study evaluated the effect of two ex vivo perfusion solutions on lung function and endothelial injury. Methods We divided ten landrace swine into two groups and subjected them to EVLP for 120 min: Group I (n = 5) was perfused with Steen® solution, and Group II (n = 5) was perfused with low-potassium dextran-albumin solution. Ventilatory mechanics, histology, gravimetry, and sialic acid concentrations were evaluated. Results Both groups showed changes in pulmonary vascular resistance and ventilatory mechanics (p < 0.05, Student’s t-test). In addition, the lung injury severity score was better in Group I than in Group II (p < 0.05, Mann–Whitney U); and both groups exhibited a significant increase in Sia concentrations in the perfusate (p < 0.05 t-Student) and Sia immunohistochemical expression. Conclusions Sia, as a product of EG disruption during EVLP, was found in all samples obtained in the system; however, the changes in its concentration showed no apparent correlation with lung function.

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Section: Discussionsupporting

confidence: 91%

Changes in the levels of free sialic acid during ex vivo lung perfusion do not correlate with pulmonary function. Experimental model

Hernández-Jiménez,

Martínez-Cortés,

Olmos-Zuñiga

et al. 2023

BMC Pulm Med

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“…But in another report, an acellular perfusate and a closed left atrium resulted to a more pronounced lung edema and lower lung compliance [112], confirming a previous thought that alternative perfusion solution might contribute to lung edema formation [113]. [114], various perfusion time [115], cooling or hypothermic preservation [116], as well as alter the work flow of the transplantation, staged model to do liver-after-lung transplantation [117] and split lung transplantation in two centers with a distance of 2250 km by running EVLP [118]. The technique of EVLP-based lung split, preservation and transportation adopted in smaller children, is currently under discussion [119].…”

Section: Anti-pulmonary Edema Performancesupporting

confidence: 53%

Evolving Trend of EVLP: Advancements and Emerging Pathways

Jiao¹

2019

SN Compr. Clin. Med.

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Lung transplant augmentation in the waiting list is impeded by donor lung shortage with a low percentage of procurement. Ex vivo lung perfusion (EVLP) was recognized to have the capacity of providing a platform to preserve, assess, recondition, and even mange existing diseases in rejected donor lungs to expand the donor pool. This review aims to provide the most advanced experimental evidence of EVLP application and perspective as a platform providing qualified donor lungs. Literature review using PubMed, Medscape, Clinical Trials, and Cochrane databases was performed. Data was collected and analyzed. From a view point of publisher, current research centers with their paper contribution volume are also presented to illustrate the future trend of EVLP academically. EVLP incubated donor lungs could have a comparable outcome with conventional transplants. Further interventional studies have shown growing interest in and expectations on EVLP platform as pathways to determine graft quality, to bridge a critical phase of the initial rejected organs and to predict prognosis or complications in an early stage. EVLP is also considered as a tissue regeneration translational research environment with multidisciplinary potential to enhance the recovery and rehabilitation after surgery and advance pulmonary medicine. Ongoing clinical trials and accelerated procedure modulation with commercialization of EVLP are leading to Bcentralization^organ preparation model, opening a new era of lifechange health innovation.

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“…In addition, the use of DCD organs itself seems to be an increased risk factor for PGD. However, similar short‐ and long‐term outcomes between DBD and DCD donors have been reported . Therefore, it is of great interest to limit primary graft dysfunction after lung transplantation with a specific strategy such as steroid administration.…”

Section: Discussionmentioning

confidence: 92%

Steroids can reduce warm ischemic reperfusion injury in a porcine donation after circulatory death model withex vivolung perfusion evaluation

et al. 2016

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Donation after circulatory death (DCD) is being used to increase the number of transplantable organs. The role and timing of steroids in DCD donation and ex vivo lung perfusion (EVLP) has not been thoroughly investigated. In this study, we investigated the effect of steroids on warm ischemic injury in a porcine model (n = 6/group). Following cardiac arrest, grafts were left untouched in the donor (90-min warm ischemia). Graft function was assessed after 6 h of EVLP. In the MP group, 500 mg methylprednisolone was given prior to cardiac arrest and during EVLP. In the CONTR group, no steroids were added. Median lung compliance (13 ml/cmH 0) was significantly better preserved in the CONTR group than in the MP group (30.5 ml/cmH 0). Also, median wet-to-dry weight (6.11 vs. 6.94) and CT density (182.5 vs. 352.9 g/l) were significantly better in the MP group than in the CONTR group, respectively. There was no difference in oxygenation and pulmonary vascular resistance. Perfusate cytokine analysis showed a significant reduction in IL-1β, IL-8, IFN-α, IL-10, TNF-α, and IFN-γ in MP. Cytokines in bronchoalveolar lavage were not decreased except for IFN-gamma. We demonstrated that warm ischemic injury in DCD donation can be attenuated by steroids when given prior to warm ischemia and during EVLP. Ethical context of donor preconditioning should be discussed further.

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Do we need to cool the lung graft after ex vivo lung perfusion? A preliminary study

Cited by 7 publications

References 22 publications

Changes in the levels of free sialic acid during ex vivo lung perfusion do not correlate with pulmonary function. Experimental model

Changes in the levels of free sialic acid during ex vivo lung perfusion do not correlate with pulmonary function. Experimental model

Evolving Trend of EVLP: Advancements and Emerging Pathways

Steroids can reduce warm ischemic reperfusion injury in a porcine donation after circulatory death model withex vivolung perfusion evaluation

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