A New Lung Preservation Technique through Bronchial Artery Perfusion on Ex-Vivo Lung

Abstract

Purpose Airway hypoxia due to microvascular loss may be a predisposing factor for subsequent fibrotic remodeling in allografts, resulting in suboptimal transplant outcomes in lung transplantation. Ex-vivo lung perfusion (EVLP) is a novel strategy for lung allograft preservation that keeps the organs at physiological protective conditions. Modifying EVLP strategy, we have developed a new lung preservation technique focusing on airway protection through bronchial artery perfusion. Methods and Materials Using heart-lung blocks harvested from Lewis rats, we have developed a model where bronchial circulation (using another cannula from descending aorta, retrogradely) was synchronously perfused in addition to pulmonary circulation with acellular Steen solution on EVLP (the scheme of the model is shown in Fig 1 ). Rat lungs after 1 hour cold preservation, perfused and ventilated on EVLP for 4 hours were evaluated and lungs with bronchial artery perfusion were compared with those without bronchial perfusion on EVLP. The studies were performed based on our rat EVLP protocol that has proven to be reliable with at least 4 hours of duration with stable results. Results At 4 hours on EVLP, bronchial artery perfusion was associated with significantly better preserved oxygenation and better compliance in lung allografts through reduced glucose consumption and increased ATP level as compared to the control group. Conclusions Bronchial artery perfusion on EVLP may be a new lung preservation strategy that breaks through the current major limitation in hypoxic transplant airways after lung transplantation.