TY - JOUR
T1 - Cellular Ex Vivo Lung Perfusion Beyond 1 H May Improve Marginal Donor Lung Assessment
AU - Niikawa, Hiromichi
AU - Okamoto, Toshihiro
AU - Ayyat, Kamal S.
AU - Itoda, Yoshifumi
AU - Sakanoue, Ichiro
AU - Farver, Carol F.
AU - Yun, James J.
AU - McCurry, Kenneth R.
N1 - Funding Information:
The authors express deepest gratitude to organ donors and their families, as well as the organ procurement organizations Lifebanc and Life Connection of Ohio. The authors wish to acknowledge the efforts of the transplant and organ procurement teams at the Cleveland Clinic. The authors are grateful to XVIVO Perfusion Inc and Maquet for their support. The authors are also grateful to Dr Tracey Bonfield for cytokine analysis and Jennifer Bucey for editorial support. Authors' contributions: H.N. designed research/study, performed research/study, analyzed data, and wrote the paper. T.O. designed research/study, performed research/study, and wrote the paper. K.S.A. and Y.I. performed research/study. I.S. performed research/study. C.F. contributed important reagents and analyzed data. J.J.Y. contributed important reagents, analyzed data, and wrote the paper. K.R.M. designed research/study and contributed important reagents. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/6
Y1 - 2020/6
N2 - Background: Ex vivo lung perfusion (EVLP) permits extended evaluation of donor lungs for transplant. However, the optimal EVLP duration of Lund protocol is unclear. Using human lungs rejected for clinical transplant, we sought to compare the results of 1 versus 2 h of EVLP using the Lund protocol. Methods: Twenty-five pairs of human lungs rejected for clinical transplant were perfused with the Lund EVLP protocol. Blood gas analysis, lung compliance, bronchoscopy assessment, and perfusate cytokine analysis were performed at both 1 and 2 h. Recruitment was performed at both time points. Donor lung transplant suitability was determined at both time points. Results: All cases were divided into four groups based on transplant suitability assessment at 1 h and 2 h of EVLP. In group A (n = 10), lungs were judged suitable for transplant at both 1 and 2 h of EVLP. In group B (n = 6), lungs were suitable at 1 h but nonsuitable at 2 h. In group C (n = 2), lungs were nonsuitable at 1 h but suitable at 2 h. Finally, in group D (n = 7), lungs were nonsuitable for transplant at both time points. In both groups B and C (n = 8), the transplant suitability assessment changed between 1 and 2 h of EVLP. Conclusions: In human lungs rejected for transplant, transplant suitability differed at 1 versus 2 h of EVLP in 32% of lungs studied. Evaluation of lungs with Lund protocol EVLP beyond 1 h may improve donor organ assessment.
AB - Background: Ex vivo lung perfusion (EVLP) permits extended evaluation of donor lungs for transplant. However, the optimal EVLP duration of Lund protocol is unclear. Using human lungs rejected for clinical transplant, we sought to compare the results of 1 versus 2 h of EVLP using the Lund protocol. Methods: Twenty-five pairs of human lungs rejected for clinical transplant were perfused with the Lund EVLP protocol. Blood gas analysis, lung compliance, bronchoscopy assessment, and perfusate cytokine analysis were performed at both 1 and 2 h. Recruitment was performed at both time points. Donor lung transplant suitability was determined at both time points. Results: All cases were divided into four groups based on transplant suitability assessment at 1 h and 2 h of EVLP. In group A (n = 10), lungs were judged suitable for transplant at both 1 and 2 h of EVLP. In group B (n = 6), lungs were suitable at 1 h but nonsuitable at 2 h. In group C (n = 2), lungs were nonsuitable at 1 h but suitable at 2 h. Finally, in group D (n = 7), lungs were nonsuitable for transplant at both time points. In both groups B and C (n = 8), the transplant suitability assessment changed between 1 and 2 h of EVLP. Conclusions: In human lungs rejected for transplant, transplant suitability differed at 1 versus 2 h of EVLP in 32% of lungs studied. Evaluation of lungs with Lund protocol EVLP beyond 1 h may improve donor organ assessment.
KW - Human donor lungs
KW - Ischemia reperfusion injury
KW - Lund protocol
KW - lung transplantation
KW - Perfusion time
KW - Transplant suitability
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U2 - 10.1016/j.jss.2019.09.073
DO - 10.1016/j.jss.2019.09.073
M3 - Article
C2 - 32028151
AN - SCOPUS:85078728133
SN - 0022-4804
VL - 250
SP - 88
EP - 96
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -