Abstract
BackgroundEx vivo lung perfusion (EVLP) is a widespread accepted platform for preservation and evaluation of donor lungs prior to lung transplantation (LTx). Standard lungs are ventilated using volume-controlled ventilation (VCV). We investigated the effects of flow-controlled ventilation (FCV) in a large animal EVLP model.Fourteen porcine lungs were mounted on EVLP after a warm ischemic interval of 2 h and randomized in two groups (n = 7/group). In VCV, 7 grafts were conventionally ventilated and in FCV, 7 grafts were ventilated by flow-controlled ventilation. EVLP physiologic parameters (compliance, pulmonary vascular resistance and oxygenation) were recorded hourly. After 6 h of EVLP, broncho-alveolar lavage (BAL) was performed and biopsies for wet-to-dry weight (W/D) ratio and histology were taken. The left lung was inflated, frozen in liquid nitrogen vapors and scanned with computed tomography (CT) to assess regional distribution of Hounsfield units (HU).ResultsAll lungs endured 6 h of EVLP. Oxygenation was better in FCV compared to VCV (p = 0.01) and the decrease in lung compliance was less in FCV (p = 0.03). W/D ratio, pathology and BAL samples did not differ between both groups (p = 0.16, p = 0.55 and p = 0.62). Overall, CT densities tended to be less pronounced in FCV (p = 0.05). Distribution of CT densities revealed a higher proportion of well-aerated lung parts in FCV compared to VCV (p = 0.01).ConclusionsFCV in pulmonary grafts mounted on EVLP is feasible and leads to improved oxygenation and alveolar recruitment. This ventilation strategy might prolong EVLP over time, with less risk for volutrauma and atelectrauma.
Highlights
Ex vivo lung perfusion (EVLP) is a widespread accepted platform for preservation and evaluation of donor lungs prior to lung transplantation (LTx)
Oxygenation was better in flow-controlled ventilation (FCV) compared to volume-controlled ventilation (VCV) (p = 0.01) and the decrease in lung compliance was less in FCV (p = 0.03)
FCV in pulmonary grafts mounted on EVLP is feasible and leads to improved oxygenation and alveolar recruitment
Summary
Ex vivo lung perfusion (EVLP) is a widespread accepted platform for preservation and evaluation of donor lungs prior to lung transplantation (LTx). EVLP physiologic parameters (compliance, pulmonary vascular resistance and oxygenation) were recorded hourly. Ex vivo lung perfusion (EVLP) is a form of machine perfusion and has been introduced in the field of LTx to evaluate graft function outside the body [2]. During EVLP, the lungs are perfused with a normothermic solution and at the same time ventilated with positive pressure. Graft function is mainly monitored using standard physiological variables including compliance, pulmonary vascular resistance (PVR) and oxygenation. EVLP has the potential to assess organs physiologically and biologically prior to transplantation and facilitates longer preservation times compared to conventional hypothermic storage on ice [3]. Active resuscitation of injured grafts by EVLP might be possible, but search of adequate therapeutic strategies is still ongoing [4]
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