Safe lung preservation for twenty-four hours with perfadex

Passenger leukocyte transfer from the donor lung to the recipient is intrinsically involved in acute rejection. Direct presentation of alloantigen expressed on donor leukocytes is recognized by recipient T cells, promoting acute cellular rejection. We utilized ex vivo lung perfusion (EVLP) to study passenger leukocyte migration from donor lungs into the recipient and to evaluate the effects of donor leukocyte depletion prior to transplantation. For this purpose, female pigs received male left lungs either following 3 h of EVLP or retrieved using standard protocols. Recipients were monitored for 24 h and sequential samples were collected. EVLPreduced donor leukocyte transfer into the recipient and migration to recipient lymph nodes was markedly reduced. Recipient T cell infiltration of the donor lung was significantly diminished via EVLP. Donor leukocyte removal during EVLP reduces direct allorecognition and T cell priming, diminishing recipient T cell infiltration, the hallmark of acute rejection.

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“…Recipients were followed for 24 h. A detailed description of our porcine lung transplantation procedure is given elsewhere (12).…”

Section: Lung Transplantationmentioning

confidence: 99%

Altered Immunogenicity of Donor Lungs via Removal of Passenger Leukocytes Using Ex Vivo Lung Perfusion

Stone

Critchley

Major

et al. 2016

American Journal of Transplantation

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“…A recent clinical report by Kshettry et al [18] has shown that patients who received lung grafts with ischemic time 16 h achieved acceptable survival rates after transplantation. However, Snell et al [19] reported that the survival of the patients was significantly reduced receiving a graft with an ischemic time beyond 5 h. Several animal studies have demonstrated that low-potassium dextran solutions were significantly superior to the EC solution [20,21] and provided extended pulmonary preservation with satisfactory results [22]. In the current study, we intended to compare the recently improved ET-K solution with the clinical standard EC solution and a low-potassium solution, since ET-K is also a potassium-reduced solution.…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, we intended to compare the recently improved ET-K solution with the clinical standard EC solution and a low-potassium solution, since ET-K is also a potassium-reduced solution. As a representative, we chose Perfadex because of its proven beneficial effects in recent experimental trials [21,22].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Euro-Collins Solution, Low-Potassium Dextran Solution Containing Glucose, and ET-Kyoto Solution for Lung Preservation in an Extracorporeal Rat Lung Perfusion Model

et al. 1998

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We have recently developed a modified ET-Kyoto solution by adding N-acetylcysteine, nitroglycerin, and dibutyryl cyclic adenosine monophosphate to the previously reported ET-Kyoto solution. The purpose of this study was to compare the new ET-Kyoto solution with the regular Euro-Collins solution and a low-potassium dextran solution containing glucose (Perfadex^®) in an isolated rat lung perfusion model. Rat lung blocks were preserved with ET-Kyoto solution, with Euro-Collins solution, or with Perfadex for 4 h. Arterial oxygen tension, shunt fraction, peak inspiratory pressure, mean pulmonary arterial pressure, and pulmonary vascular resistance were assessed up to 50 min after reperfusion. ET-Kyoto solution provided a significantly better lung function after reperfusion than Euro-Collins solution and Perfadex, while Perfadex was also superior to the Euro-Collins solution. We conclude that lung preservation with ET-Kyoto solution is significantly superior to Euro-Collins solution and to Perfadex in an isolated rat lung perfusion model.

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“…After extensive experimental investigation, (9,13,14) the use of lungs obtained from non-heart-beating donors has become a clinical reality. Recently, the survival of recipients of lungs obtained from non-heart-beating donors was found to be somewhat lower than that of recipients of lungs from brain-dead donors, although within acceptable levels, the one-year and two-year survival rates being 78% and 69% in the former group, respectively, compared with…”

Section: Discussionmentioning

confidence: 99%

Influência da estratégia ventilatória no desempenho funcional de enxertos pulmonares em um modelo experimental de transplante pulmonar unilateral de doadores após parada cardiocirculatória

et al. 2010

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Objective: To compare the influence of two different ventilation strategies-volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV)-on the functional performance of lung grafts in a canine model of unilateral left lung transplantation using donor lungs harvested after three hours of normothermic cardiocirculatory arrest under mechanical ventilation. Methods: The study comprised 40 mongrel dogs, randomized into two groups: VCV and PCV. Of the 20 recipients, 5 did not survive the transplant, and 5 died before the end of the post-transplant assessment period. The remaining 10 survivors (5 in each group) were evaluated for 360 min after lung transplantation. The functional performance of the grafts was evaluated regarding respiratory mechanics, gas exchange, and lung graft histology. Results: There were no significant differences between the groups regarding respiratory mechanics (peak inspiratory pressure, plateau pressure, mean airway pressure, dynamic compliance, and static compliance) or gas exchange variables (PaO 2 , venous oxygen tension, PaCO 2 , venous carbon dioxide tension, and the arterial-venous oxygen content difference). The histopathological findings were consistent with nonspecific acute lung injury and did not differ between the groups. Conclusions: This model of lung transplantation showed that the functional performance of lung grafts was not influenced by the ventilation strategy employed during the first six hours after reperfusion.Keywords: Pulmonary ventilation; Respiration, artificial; Lung transplantation; Dogs; Organ preservation. ResumoObjetivo: Comparar a influência de duas estratégias ventilatórias -ventilação controlada a volume (VCV) e ventilação controlada a pressão (VCP) -no desempenho funcional de enxertos pulmonares em um modelo canino de transplante pulmonar unilateral esquerdo, utilizando-se doadores cujos pulmões foram captados após três horas de parada cardiocirculatória em temperatura ambiente e sob ventilação mecânica. Métodos: O estudo incluiu 40 cães mestiços randomizados nos grupos VCV e VCP. Dos 20 receptores, 5 não sobreviveram ao transplante, e 5 não sobreviveram ao período de avaliação pós-transplante. Os 10 receptores sobreviventes (5 em cada grupo) foram avaliados durante 360 min após o término do transplante pulmonar. O desempenho funcional dos enxertos foi estudado através da avaliação da mecânica respiratória, trocas gasosas e histologia do enxerto. Resultados: Não houve diferenças significativas entre os grupos quanto às variáveis de mecânica respiratória (pressão de pico inspiratória, pressão de platô, pressão média de vias aéreas, complacência dinâmica e complacência estática) e de trocas gasosas (PaO 2 , pressão venosa mista de oxigênio, PaCO 2 , pressão venosa mista de CO 2 e diferença arteriovenosa de oxigênio). As alterações histopatológicas foram compatíveis com o padrão de lesão pulmonar aguda não específica e não diferiram entre os grupos. Conclusões: Este modelo de transplante pulmonar mostrou que o desempenho funcional do...

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Safe lung preservation for twenty-four hours with perfadex

Cited by 99 publications

References 12 publications

Altered Immunogenicity of Donor Lungs via Removal of Passenger Leukocytes Using Ex Vivo Lung Perfusion

Altered Immunogenicity of Donor Lungs via Removal of Passenger Leukocytes Using Ex Vivo Lung Perfusion

Comparison of Euro-Collins Solution, Low-Potassium Dextran Solution Containing Glucose, and ET-Kyoto Solution for Lung Preservation in an Extracorporeal Rat Lung Perfusion Model

Influência da estratégia ventilatória no desempenho funcional de enxertos pulmonares em um modelo experimental de transplante pulmonar unilateral de doadores após parada cardiocirculatória

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