Evaluation of the Effects of the Correction of Hydroelectrolytic Disorders during Prolonged Ex-Vivo Lung Perfusion

Abstract

Purpose During ex-vivo lung perfusion (EVLP), the ionic concentrations and pH of perfusion liquid are modified. In the course of this study, we evaluated whether these ionic disruptions have an impact on the lung graft during 12 hours of EVLP and whether the correction of these disruptions can avoid any lung lesions. If this were confirmed, it would allow longer EVLP time. Methods Twelve pigs' lungs were conventionally retrieved, cold preserved, perfused normothermically ex vivo for 12 hours, cold preserved for a second time and transplanted and reperfused for 4 hours. Ionic analysis and arterial and venous gas analysis were performed every hour during EVLP. Every 2 hours, 100mL of Steen solution were replaced with new Steen solution in the Steen N group and with modified Steen solution in the Steen + group. After 12 hours of EVLP, the right lung was harvested for structural, biological, cellular and histological analysis. The left lung was transplanted to a healthy swine and blood ionic and gas analysis were performed every hour during the left lung reperfusion. Results During EVLP, ∆PO2, compliance and pulmonary vascular resistance were similar in both groups. The ionic concentrations and pH were corrected in the Steen + group. After the left lung transplant, physiological and biological parameters were similar in both groups. Structural analysis by scanning electron microscopy showed a rise of interalveolar pores in the Steen + group. Conclusion The correction of hydroelectrolytic disorders during 12 hours of EVLP is feasible but does not improve lung function during EVLP and after the left lung transplant.