J Korean Soc Transplant.  2014 Sep;28(3):154-159. 10.4285/jkstn.2014.28.3.154.

Ex Vivo Lung Perfusion of Cardiac-death Donor Lung in Pigs

• Paik HC
• Haam SJ
• Park MS
• Song JH

• KMID: 1727519
• DOI: http://doi.org/10.4285/jkstn.2014.28.3.154

Abstract

BACKGROUND
Lung transplantation (LTx) is a life-saving treatment for patients with end-stage lung disease; however, the shortage of donor lungs has been a major limiting factor to increasing the number of LTx. Growing experience following LTx using donor lungs after cardiac death (DCD) has been promising, although concerns remain. The purpose of this study was to develop a DCD lung harvest model using an ex vivo lung perfusion (EVLP) system and to assess the function of presumably damaged lungs harvested from the DCD donor in pigs.
METHODS
The 40 kg pigs were randomly divided into the control group with no ischemic lung injury (n=5) and the study group (n=5), which had 1 hour of warm ischemic lung injury after cardiac arrest. Harvested lungs were placed in the EVLP circuit and oxygen capacities (OC), pulmonary vascular resistance (PVR), and peak airway pressure (PAP) were evaluated every hour for 4 hours. At the end of EVLP, specimens were excised for pathologic review and wet/dry ratio.
RESULTS
No statistically significant difference in OC (P=0.353), PVR (P=0.951), and PAP (P=0.651) was observed in both groups. Lung injury severity score (control group vs. study group: 0.700+/-0.303 vs. 0.870+/-0.130; P=0.230) and wet/dry ratio (control group vs. study group: 5.89+/-0.97 vs. 6.20+/-0.57; P=0.560) also showed no statistically significant difference between the groups.
CONCLUSIONS
The function of DCD lungs assessed using EVLP showed no difference from that of control lungs without ischemic injury; therefore, utilization of DCD lungs can be a new option to decrease the number of deaths on the waiting list.

Keyword

Lung transplantation; Tissue donors; Organ preservation; Warm ischemia

MeSH Terms

Death
Heart Arrest
Humans
Lung Diseases
Lung Injury
Lung Transplantation
Lung*
Organ Preservation
Oxygen
Perfusion*
Swine*
Tissue Donors*
Vascular Resistance
Waiting Lists
Warm Ischemia
Oxygen

Figure

• 

  Fig. 1. Schematic diagram of ex vivo lung perfusion (EVLP) model. EVLP system consists of mechanical ventilator, centrifugal pump, heat-exchanger, and the perfusate deo-xygenate as it passes through the membrane gas exchanger. Perfusate is infused into pulmonary artery through leukocyte depletion filter and stored in a hardshell reservior. Perfusate in the reservoir circulates continuously by the centrifugal pump.

• 

  Fig. 2. Comparison of oxygen capacities during 4 hours of ex vivo lung perfusion (EVLP). The level of oxygen capacity was higher in the study group than in the control group during the 4 hours of EVLP.

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  Fig. 3. Comparison of pulmonary vascular resistances during 4 hours of ex vivo lung perfusion (EVLP). Pulmonary vascular resistance was higher in the control group, although it did not show statistically significant difference. As the EVLP prolonged, pulmonary vascular resistance slightly increased, which was more apparent in the study group.

• 

  Fig. 4. Comparison of peak airway pressure during 4 hours of ex vivo lung perfusion (EVLP). The peak airway pressure of in the study group was higher during the entire period of EVLP but did not show statistically significant difference. The peak airway pressures in both groups increased sharply after 2 hours, which suggested progression of pulmonary edema.

Reference

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