Abstract
BackgroundEx vivo lung perfusion (EVLP) is used by an increasing number of transplant centres. It is still controversial whether an acellular or cellular (erythrocyte enriched) perfusate is preferable. The aim of this paper was to evaluate whether acellular (aEVLP) or cellular EVLP (cEVLP) preserves functional lung ultrastructure better and to generate a hypothesis regarding possible underlying mechanisms.MethodsLungs of 20 pigs were assigned to 4 groups: control, ischaemia (24 h), aEVLP and cEVLP (both EVLP groups: 24 h ischaemia + 12 h EVLP). After experimental procedures, whole lungs were perfusion fixed, samples for light and electron microscopic stereology were taken, and ventilation, diffusion and perfusion related parameters were estimated.ResultsLung structure was well preserved in all groups. Lungs had less atelectasis and higher air content after EVLP. No significant group differences were found in alveolar septum composition or blood-air barrier thickness. Small amounts of intraalveolar oedema were detected in both EVLP groups but significantly more in aEVLP than in cEVLP.ConclusionsBoth EVLP protocols supported lungs well for up to 12 h and could largely prevent ischaemia ex vivo reperfusion associated lung injury. In both EVLP groups, oedema volume remained below the level of functional relevance. The group difference in oedema formation was possibly due to inferior septal perfusion in aEVLP.
Highlights
Ex vivo lung perfusion (EVLP) is used by an increasing number of transplant centres
Ventilation-related parameters All lungs were well inflated. The volume of both lungs was significantly greater in groups Acellular ex vivo lung perfusion (aEVLP) and cellular EVLP (cEVLP) compared to control group (p = 0.004 and 0.047, respectively) and ischaemia group (p = 0.004 and 0.042, respectively) (Fig. 1a)
Alltogether, we deduct that the main effect of erythrocyte addition to perfusate is its impact on capillary pressure which, in turn, is responsible for the differences we found between aEVLP and cEVLP
Summary
Ex vivo lung perfusion (EVLP) is used by an increasing number of transplant centres. It is still controversial whether an acellular or cellular (erythrocyte enriched) perfusate is preferable. The aim of this paper was to evaluate whether acellular (aEVLP) or cellular EVLP (cEVLP) preserves functional lung ultrastructure better and to generate a hypothesis regarding possible underlying mechanisms. Donor organ shortage is a main factor that limits the number of lung transplantations in patients with end-stage lung disease [1]. Ex vivo lung perfusion (EVLP) offers the possibility to evaluate marginal lungs after procurement but before transplantation and to include suitable organs in the donor pool. One of the controversies centres on using acellular (aEVLP) or cellular perfusate in EVLP (cEVLP), i.e. erythrocyte addition to perfusate. Uncertainties about preferable strategies limit further expansion of EVLP usage
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