An extracellular oxygen carrier during prolonged pulmonary preservation improves post-transplant lung function

Aadil Ali, Yui Watanabe, Marcos Galasso, Tatsuaki Watanabe, Manyin Chen, Eddy Fan, Laurent Brochard, Khaled Ramadan, Rafaela Vanin Pinto Ribeiro, William Stansfield, Hemant Gokhale, Anajara Gazzalle, Thomas Waddell, Mingyao Liu, Shaf Keshavjee, Marcelo Cypel

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background: The use of a novel extracellular oxygen carrier (EOC) preservation additive known as HEMO2Life has recently been shown to lead to a superior preservation of different types of solid organs. Our study aimed to investigate the effect of this EOC on extending lung preservation time and its mechanism of action. Methods: Donor pigs were randomly allocated to either of the following 2 groups (n = 6 per group): (1) 36 hours cold preservation or (2) 36 hours cold preservation with 1 g/liter of EOC. The lungs were evaluated through 12 hours of normothermic ex vivo lung perfusion (EVLP) followed by a left-single lung transplant into a recipient pig. Grafts were reperfused for 4 hours, followed by right pulmonary artery clamping to assess graft oxygenation function. Results: During EVLP assessment, EOC-treated lungs showed improvements in physiologic parameters, whereas the control lungs deteriorated. After a total of 48 hours of preservation (36 hours cold + 12 hours normothermic EVLP), transplanted grafts in the treatment group displayed significantly better oxygenation than in the controls (PaO2/FiO2: 437 ± 36 mm Hg vs 343 ± 27 mm Hg, p = 0.041). In addition, the use of EOC led to significantly less edema formation (wet-to-dry ratio: 4.95 ± 0.29 vs 6.05 ± 0.33, p = 0.026), less apoptotic cell death (p = 0.041), improved tight junction preservation (p = 0.002), and lower levels of circulating IL-6 within recipient plasma (p = 0.004) compared with non-use of EOC in the control group after transplantation. Conclusion: The use of an EOC during an extended pulmonary preservation period led to significantly superior early post-transplant lung function.

Original languageEnglish
Pages (from-to)595-603
Number of pages9
JournalJournal of Heart and Lung Transplantation
Issue number6
Publication statusPublished - 2020 Jun


  • ex vivo lung perfusion
  • lung preservation
  • lung transplantation
  • oxygen carriers
  • prolonged preservation


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