Reduced-flow ex vivo lung perfusion to rehabilitate lungs donated after circulatory death

Jared P. Beller, Matthew R. Byler, Dustin T. Money, William Z. Chancellor, Aimee Zhang, Yunge Zhao, Mark H. Stoler, Adishesh K. Narahari, Alexander Shannon, J. Hunter Mehaffey, Curtis G. Tribble, Victor E. Laubach, Irving L. Kron, Mark E. Roeser

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

BACKGROUND: Current ex vivo lung perfusion (EVLP) protocols aim to achieve perfusion flows of 40% of cardiac output or more. We hypothesized that a lower target flow rate during EVLP would improve graft function and decrease inflammation of donation after circulatory death (DCD) lungs. METHODS: A porcine DCD and EVLP model was utilized. Two groups (n = 4 per group) of DCD lungs were randomized to target EVLP flows of 40% (high-flow) or 20% (low-flow) predicted cardiac output based on 100 ml/min/kg. At the completion of 4 hours of normothermic EVLP using Steen solution, left lung transplantation was performed, and lungs were monitored during 4 hours of reperfusion. RESULTS: After transplant, left lung–specific pulmonary vein partial pressure of oxygen was significantly higher in the low-flow group at 3 and 4 hours of reperfusion (3-hour: 496.0 ± 87.7 mm Hg vs. 252.7 ± 166.0 mm Hg, p = 0.017; 4-hour: 429.7 ± 93.6 mm Hg vs. 231.5 ± 178 mm Hg, p = 0.048). Compliance was significantly improved at 1 hour of reperfusion (20.8 ± 9.4 ml/cm H2O vs. 10.2 ± 3.5 ml/cm H2O, p = 0.022) and throughout all subsequent time points in the low-flow group. After reperfusion, lung wet-to-dry weight ratio (7.1 ± 0.7 vs. 8.8 ± 1.1, p = 0.040) and interleukin-1β expression (927 ± 300 pg/ng protein vs. 2,070 ± 874 pg/ng protein, p = 0.048) were significantly reduced in the low-flow group. CONCLUSIONS: EVLP of DCD lungs with low-flow targets of 20% predicted cardiac output improves lung function, reduces edema, and attenuates inflammation after transplant. Therefore, EVLP for lung rehabilitation should use reduced flow rates of 20% predicted cardiac output.

Original languageEnglish (US)
Pages (from-to)74-82
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number1
DOIs
StatePublished - Jan 2020

Keywords

  • DCD
  • ex vivo lung perfusion
  • lung preservation
  • lung transplant
  • transplantation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Beller, J. P., Byler, M. R., Money, D. T., Chancellor, W. Z., Zhang, A., Zhao, Y., Stoler, M. H., Narahari, A. K., Shannon, A., Mehaffey, J. H., Tribble, C. G., Laubach, V. E., Kron, I. L., & Roeser, M. E. (2020). Reduced-flow ex vivo lung perfusion to rehabilitate lungs donated after circulatory death. Journal of Heart and Lung Transplantation, 39(1), 74-82. https://doi.org/10.1016/j.healun.2019.09.009