Original articleGeneral thoracicCytokine Expression Profile in Human Lungs Undergoing Normothermic Ex-Vivo Lung Perfusion
Section snippets
Human Lung Procurement and Preparation for EVLP
Single human lungs from organ donors deemed unacceptable for transplantation after thorough evaluation for a variety of reasons, such as poor oxygenation, pulmonary contusion or consolidation, patient history of asthma, and donor-recipient size mismatch, were used for this study. A waiver for the use of these human lungs was obtained from the Colorado Multiple Institutional Review Board. Before procurement, the PaO2 was recorded with the FiO2 set at 100%. Single donor lungs were procured using
Oxygenation and Pulmonary Function Improve Significantly With EVLP
After 12 hours of EVLP, all lungs met transplant criteria for oxygenation. The PaO2 on 100% FiO2 improved significantly by more than 35% during the first 2 hours of perfusion compared with the donor's last-recorded PaO2 on 100% FiO2 (p < 0.05; Fig 1). The PVR also significantly improved at hours 7, 9, 10, 11, and 12 of EVLP compared with early perfusion (p < 0.05; Fig 2).
No Pulmonary Edema Formation During EVLP
Over the course of the 12-hour EVLP, no pulmonary edema formation was noted in the single human lung as calculated by the wet
Comment
Ex-vivo lung perfusion is emerging as a powerful method to expand the current donor pool for lung transplantation. The technique of normothermic EVLP has the ability to recondition lungs normally thought to be unacceptable for transplantation [6, 8]. This technique also provides more time to evaluate lungs outside the donor body, possibly identifying additional acceptable lungs merely by being able to monitor them under more stringent, controllable conditions than are allowed in the donor body.
References (21)
- et al.
Ex vivo lung perfusion: early report of Brazilian experience
Transplant Proc
(2010) - et al.
Organ donation and utilization in the United States, 1996-2005
Am J Transplant
(2007) - et al.
Technique for prolonged normothermic ex vivo lung perfusion
J Heart Lung Transplant
(2008) - et al.
Guidelines for donor lung selection: time for revision?
Ann Thorac Surg
(2010) Lung transplantation outcomes: the importance and inadequacies of assessing survival
Am J Transplant
(2009)- et al.
Transplantation of lungs from a non-heart-beating donor
Lancet
(2001) - et al.
Ex vivo evaluation of nonacceptable donor lungs
Ann Thorac Surg
(2006) - et al.
Clinical transplantation of initially rejected donor lungs after reconditioning ex vivo
Ann Thorac Surg
(2009) - et al.
Primary graft failure following lung transplantation
Chest
(1998) - et al.
First human transplantation of a nonacceptable donor lung after reconditioning ex vivo
Ann Thorac Surg
(2007)
Cited by (68)
A radiographic score for human donor lungs on ex vivo lung perfusion predicts transplant outcomes
2024, Journal of Heart and Lung TransplantationRecovery of extracorporeal lungs using cross-circulation with injured recipient swine
2023, Journal of Thoracic and Cardiovascular SurgerySubnormothermic ex vivo lung perfusion attenuates graft inflammation in a rat transplant model
2022, Journal of Thoracic and Cardiovascular SurgeryEffects of cold or warm ischemia and ex-vivo lung perfusion on the release of damage associated molecular patterns and inflammatory cytokines in experimental lung transplantation
2021, Journal of Heart and Lung TransplantationPerfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function
2021, Journal of Thoracic and Cardiovascular SurgeryImpact of triptolide during ex vivo lung perfusion on grafts after transplantation in a rat model
2021, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :For example, grafts undergoing EVLP have been found to demonstrate a heightened proinflammatory state. It was reported that perfusate cytokine levels such as IL-6, IL-8, and MCP-1 significantly increased with time during EVLP.2 Also, the DEVELOP-UK trial found that increased IL-1β perfusate levels were found to be a potential predictive biomarker for post-transplant outcomes.22
- *
Both authors contributed equally.