Korean J Transplant.  2022 Nov;36(Supple 1):S167. 10.4285/ATW2022.F-2926.

Beating heart and breathing lungs in the box: future of transplant and beyond

• Lesbekov T
• Nurmykhametova Z
• Kaliyev R
• Faizov L
• Medressova A
• Aripov M
• Zuparov E
• Kaliyev B
• Pya Y

• KMID: 2535683
• DOI: http://doi.org/10.4285/ATW2022.F-2926

Abstract

Background
Continuous ex situ machine perfusion of the donor heart and lung has been proposed as an alternative and superior method of donor heart preservation compared to cold static storage especially during the transport time. The ex situ heart and lungs perfusion opens new horizons in the transplant field, and beyond for isolated organs treatment including gen and cell ther-apies, surgical corrections, diagnostics, pharmacokinetics, resuscitation and transportation.
Methods
Twenty-five domestic adult pigs, weighing 93.1±13.1 kg were selected for this study. Until cardiectomy, all pigs received Principles of Laboratory Animal Care. The pig heart and lung were cannulated, and then connected to the portable system for normothermic ex situ heart/lung preservation. In the heart preservation system (HPS), oxygenated blood is perfused by a centrifugal pump into the aorta, perfusing the coronary arteries. In the lung preservation system (LPS) oxygenated blood is perfused by centrifugal pump into the pulmonary artery and ventilation occurs. After the end of experiment (6 hours), pig heart is arrested with normothermic blood cardioplegia and is disconnected. The pig isolated heart was conditioned with levosimendan while in the system and hemofiltration was applied in the HPS in order to protect and improve donor heart function. Ex situ heart and lungs perfusion process was accompanied with echocardiographic, computerized tomography, and contrast-enhanced magnet-ic resonance assessment.
Results
Mean±SD ischemic time was 19.2±3.3 minutes. Mean ex vivo perfusion time was 360±0.7 minutes. Time of sinus rhythm restoration was 2.3±5.7 minutes. All isolated lungs had normal ventilation parameters. All isolated hearts and lung had stable perfusion, biochemical and histological characteristics in the perfusion system. Mean venous lactate trend are with normal levels at the end of perfusion. Figure 1 simplified schema of the experimental design and protocol.
Conclusions
Normothermic ex situ heart and lungs perfusion provides more physiologic and reproducible approach to sustain the isolated organs.