Lung Transplantation and the Blood–Gas Barrier

Schnapper, Anke; Ochs, Matthias

doi:10.1007/978-3-319-18392-3_9

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“…The condition of the alveolar septum is of particular importance during lung transplantation. A good condition at the time of implantation is a prerequisite for sustained organ performance in the immediate post-transplant period as well as for long-term success [ 2 , 24 , 43 ]. In our model, alveolar septum integrity was preserved well in all groups.…”

Section: Discussionmentioning

confidence: 99%

Cellular and acellular ex vivo lung perfusion preserve functional lung ultrastructure in a large animal model: a stereological study

et al. 2018

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BackgroundEx vivo lung perfusion (EVLP) is used by an increasing number of transplant centres. It is still controversial whether an acellular or cellular (erythrocyte enriched) perfusate is preferable. The aim of this paper was to evaluate whether acellular (aEVLP) or cellular EVLP (cEVLP) preserves functional lung ultrastructure better and to generate a hypothesis regarding possible underlying mechanisms.MethodsLungs of 20 pigs were assigned to 4 groups: control, ischaemia (24 h), aEVLP and cEVLP (both EVLP groups: 24 h ischaemia + 12 h EVLP). After experimental procedures, whole lungs were perfusion fixed, samples for light and electron microscopic stereology were taken, and ventilation, diffusion and perfusion related parameters were estimated.ResultsLung structure was well preserved in all groups. Lungs had less atelectasis and higher air content after EVLP. No significant group differences were found in alveolar septum composition or blood-air barrier thickness. Small amounts of intraalveolar oedema were detected in both EVLP groups but significantly more in aEVLP than in cEVLP.ConclusionsBoth EVLP protocols supported lungs well for up to 12 h and could largely prevent ischaemia ex vivo reperfusion associated lung injury. In both EVLP groups, oedema volume remained below the level of functional relevance. The group difference in oedema formation was possibly due to inferior septal perfusion in aEVLP.Electronic supplementary materialThe online version of this article (10.1186/s12931-018-0942-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%