Prone Positioning During Ex Vivo Lung Perfusion Influences Regional Edema Accumulation

Ordies, Sofie; Frick, Anna Elisabeth; Claes, Sandra; Schols, Dominique; Verleden, Stijn E.; Raemdonck, Dirk Van; Neyrinck, Arne; Martens, A; Verschakelen, Johny; Verbeken, Eric; Vanaudenaerde, Bart M.; Vos, Robin; Verleden, Geert M.

doi:10.1016/j.jss.2019.02.003

Cited by 28 publications

(24 citation statements)

References 28 publications

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“…Several studies have been performed to optimize the EVLP protocols looking at the roles of atrial pressure, 9 synchronous bronchial artery circulation, 10 cellular and acellular perfusates, 11 continued perfusate exchange, 12 negative pressure ventilation, 13 perfusate oxygen concentration, 14 continuous perfusate adsorption, 15 and positioning of donor lungs. 16 Combination of these strategies may result in prolonged EVLP times.…”

Section: Glossary Of Abbreviationsmentioning

confidence: 99%

Perfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function

Arni

Maeyashiki

Çıtak

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Improvement in ex vivo lung perfusion (EVLP) protocols could increase the number of donors available for transplantation and protect the lungs from primary graft dysfunction. We hypothesize that perfusate adsorption during EVLP reconditions the allograft to ischemia-reperfusion injury after lung transplantation. Methods: Donor pig lungs were preserved for 24h at 4°C, followed by 6h of EVLP according to the Toronto protocol. The perfusate was additionally adsorbed through a CytoSorb adsorber in the treatment group, whereas control lungs were perfused according to the standard protocol (n = 5, each). EVLP physiology and biochemistry were monitored. Upon completion of EVLP, a left single lung transplantation was performed. Oxygenation function and lung mechanics were assessed during a 4-hour reperfusion period. The inflammatory response was determined during EVLP and reperfusion. Results: The cytokine concentrations in the perfusate were markedly lower with the adsorber, resulting in improved EVLP physiology and biochemistry during the 6-hour perfusion period. Post-transplant dynamic lung compliance was markedly better during the 4-hour reperfusion period in the treatment group. Isolated allograft oxygenation function and dynamic compliance were continued to be superior in the adsorber group at the end of reperfusion accompanied by a markedly decreased local inflammatory response. Conclusions: Implementation of an additional cytokine adsorber has refined the standard EVLP protocol. Furthermore, cytokine removal during EVLP improved immediate post-transplant graft function together with a less intense inflammatory response to reperfusion in pigs. Further studies are warranted to understand the beneficial effects of perfusate adsorption during EVLP in the clinical setting.

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Section: Glossary Of Abbreviationsmentioning

confidence: 99%

Perfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function

Arni

Maeyashiki

Çıtak

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Animals were sedated and anaesthetized as previously described [9]. Baseline venous and arterial blood samples were taken at 100% fraction of inspiratory oxygen (FiO 2 ).…”

Section: Injury Model and Evlp Setupmentioning

confidence: 99%

“…Our EVLP setup was as follows: acellular perfusate, closed atrium and flow calculated as 40% of cardiac output. A centrifugal pump, heat exchanger, gas exchanger, and reservoir enabled normothermic (37 °C), double-lung EVLP during 6 h as previously reported [9]. Briefly, the lungs were cannulated with XVIVO ™ Lung Cannula Set (XVIVO Perfusion ™ , Göteborg, Sweden).…”

Section: Injury Model and Evlp Setupmentioning

confidence: 99%

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Flow-controlled ventilation during EVLP improves oxygenation and preserves alveolar recruitment

Ordies

Orlitová

Heigl

et al. 2020

ICMx

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Background Ex vivo lung perfusion (EVLP) is a widespread accepted platform for preservation and evaluation of donor lungs prior to lung transplantation (LTx). Standard lungs are ventilated using volume-controlled ventilation (VCV). We investigated the effects of flow-controlled ventilation (FCV) in a large animal EVLP model. Fourteen porcine lungs were mounted on EVLP after a warm ischemic interval of 2 h and randomized in two groups (n = 7/group). In VCV, 7 grafts were conventionally ventilated and in FCV, 7 grafts were ventilated by flow-controlled ventilation. EVLP physiologic parameters (compliance, pulmonary vascular resistance and oxygenation) were recorded hourly. After 6 h of EVLP, broncho-alveolar lavage (BAL) was performed and biopsies for wet-to-dry weight (W/D) ratio and histology were taken. The left lung was inflated, frozen in liquid nitrogen vapors and scanned with computed tomography (CT) to assess regional distribution of Hounsfield units (HU). Results All lungs endured 6 h of EVLP. Oxygenation was better in FCV compared to VCV (p = 0.01) and the decrease in lung compliance was less in FCV (p = 0.03). W/D ratio, pathology and BAL samples did not differ between both groups (p = 0.16, p = 0.55 and p = 0.62). Overall, CT densities tended to be less pronounced in FCV (p = 0.05). Distribution of CT densities revealed a higher proportion of well-aerated lung parts in FCV compared to VCV (p = 0.01). Conclusions FCV in pulmonary grafts mounted on EVLP is feasible and leads to improved oxygenation and alveolar recruitment. This ventilation strategy might prolong EVLP over time, with less risk for volutrauma and atelectrauma.

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“…Lower flows (especially nonpulsatile) during EVLP might result in lower vascular recruitment and simply exclude perfusion of injured regions, thereby falsely increasing P/F ratios [16,17]. Our group recently demonstrated that also the impact of flow distribution during EVLP by prone positioning might affect physiological parameters and extravascular lung water content [18].…”

mentioning

confidence: 99%

Measuring physiologic shunt fraction during normothermic ex‐vivo lung perfusion to assess transplantability of questionable donor lungs

Raemdonck

Neyrinck

2019

Transpl Int

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Prone Positioning During Ex Vivo Lung Perfusion Influences Regional Edema Accumulation

Cited by 28 publications

References 28 publications

Perfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function

Perfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function

Flow-controlled ventilation during EVLP improves oxygenation and preserves alveolar recruitment

Measuring physiologic shunt fraction during normothermic ex‐vivo lung perfusion to assess transplantability of questionable donor lungs

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