J Korean Soc Transplant.  2013 Sep;27(3):100-106. 10.4285/jkstn.2013.27.3.100.

Ex vivo Lung Perfusion Model in Lung Transplantation

• Haam SJ
• Paik HC
• Lee DY
• Kim DU
• Kim NY

• KMID: 1495866
• DOI: http://doi.org/10.4285/jkstn.2013.27.3.100

Abstract

BACKGROUND
Lung transplantation (LTx) is an effective treatment for end stage lung disease. However, the shortage of donor lungs has been a major limiting factor to increase the number of LTx. Ex vivo lung perfusion (EVLP) is a currently approved method to evaluate lung function and to repair donor lung with poor function. The purpose of this study was to develop EVLP system in pig model and to maintain lung function during 4 hours of EVLP.
METHODS
Bilateral lung blocks were harvested from five 40 kg pigs. These blocks were applied in EVLP perfused with 37degrees C Steen solution. We performed arterial blood gas (ABG) analyses before death and also every 1 hour for 4 hours after application of EVLP and calculated oxygen capacities (OC) using the results of ABG. We also calculated pulmonary vascular resistance (PVR) and peak airway pressure (PAP) every 1 hour for 4 hours. After EVLP procedure, we excised specimens for pathologic review.
RESULTS
We found that OC gradually decreased during the 4 hour period of EVLP; however, no statistically significant difference was obtained. PVR declined sharply after 1 hour of EVLP (P=0.031) and then remained constant for 3 hours. PAP significantly increased after 3 hours (P<0.0001). Pathologic investigations revealed various findings from normal lung to severe pulmonary edema.
CONCLUSIONS
On the results of this study, we could preserve the lung function for 4 hours using EVLP. We conclude that application of EVLP in clinical setting can make more donor lungs available for LTx. However, we also understand that more studies and training are needed in clinical practice.

Keyword

Lung transplantation; Organ preservation; Unrelated donors

MeSH Terms

Humans
Lung
Lung Diseases
Lung Transplantation
Organ Preservation
Oxygen
Perfusion
Swine
Tissue Donors
Unrelated Donors
Vascular Resistance
Oxygen

Figure

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  Fig. 1. Diagram of ex vivo lung perfusion model. This model con-sists of mechanical ventilator, res-ervoir, centrifugal pump, membrane gas exchanger, and leukocyte filter. A heater-cooler main-tains the perfusate at 37 o C. A mix gas is connected to membrane gas exchanger.

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  Fig. 2. Funnel shaped catheter was sutured to left atrium and pulmonary artery catheter was inserted to main pulmonary artery. Endotracheal intubation tube was inserted to trachea. Donor lung was preserved in dom shaped container during ex vivo lung perfusion.

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  Fig. 3. Oxygen capacity during ex vivo lung perfusion (EVLP). Oxygen capacities gradually decreased after start of EVLP, but these were not statistically significant.

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  Fig. 4. Pulmonary vascular resistance during ex vivo lung perfusion (EVLP). Pulmonary vascular resistance (PVR) declined sharply after 1 hour of EVLP application (P=0.031), and these were consistently maintained for 3 hours.

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  Fig. 5. Peak airway pressure during ex vivo lung perfusion. Peak airway pressure (PAP) significantly increased after 3 hours (P＜0.0001).

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  Fig. 6. (A) Normal alveolar structures were maintained after ex vivo lung perfusion. These findings were shown in anterior part of lungs (HE stain, ×100). (B) Posterior part of lungs revealed severe pulmonary edema and destroyed alveolar structures (HE stain, ×100).

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