Common Hospital Ingredient Perfusate Equivalent to Standard Krebs–Henseleit Buffer with Serum Albumin Derived Perfusate in Negative Pressure Ventilation Ex Vivo Lung Perfusion

Abstract

Introduction Normothermic ex-vivo lung perfusion (EVLP) using negative pressure ventilation (NPV) and red blood cell-based perfusate solutions have been shown to decrease edema formation and pro-inflammatory cytokine production compared to positive pressure ventilation (PPV). We sought to develop a common hospital ingredient derived perfusate (CHIP) with equivalent functional and inflammatory characteristics to the standard Krebs–Henseleit buffer with 8% serum albumin derived perfusate (KHB-Alb) in order to improve access and reduce costs of ex vivo organ perfusion. Methods Porcine lungs were perfused using NPV-EVLP for 12 hours in a normothermic state, and were allocated to two groups: KHB-Alb (n=8) vs CHIP (n=4). Physiologic parameters, cytokine profiles, and edema formation were compared between treatment groups. Results Perfused lungs in both groups demonstrated equivalent oxygenation (partial pressure of arterial oxygen/ fraction of inspired oxygen ratio >350 mmHg) and physiologic parameters. There was equivalent generation of tumor necrosis factor-α, irrespective of perfusate solution used, when comparing CHIP vs KHB-Alb. Pig lungs developed equivalent edema formation between groups (CHIP: 15.7 ± 5.8%, STEEN 19.5 ± 4.4%, p>0.05). Conclusion A perfusate derived of common hospital ingredients provides equivalent results to standard Krebs–Henseleit buffer with 8% serum albumin based perfusate in NPV-EVLP. Canadian Institutes for Health Research - Canadian National Transplant Research Program (CIHR-CNTRP). University Hospital Foundation (UHF). Mazankowski Alberta Heart Institute - University Hospital Foundation Gerald Averback Award in Cardiovascular Gene Therapy / Genomics and Vascular Biology.