Alternative solution for ex vivo lung perfusion, experimental study on donated human lungs non-accepted for transplantation

Abstract

PURPOSE:To evaluate a new perfusate solution to be used for ex vivo lung perfusion. METHODS:Randomized experimental study using lungs from rejected brain-dead donors harvested and submitted to 1 hour of ex vivo lung perfusion (EVLP) using mainstream solution or the alternative. RESULTS: From 16 lungs blocs tested, we found no difference on weight after EVLP: Steen group (SG) = 1,097±526g; Alternative Perfusion Solution (APS) = 743±248g, p=0.163. Edema formation, assessed by Wet/dry weigh ratio, was statistically higher on the Alternative Perfusion Solution group (APS = 3.63 ± 1.26; SG = 2.06 ± 0.28; p = 0.009). No difference on PaO2 after EVLP (SG = 498±37.53mmHg; APS = 521±55.43mmHg, p=0.348, nor on histological analyses: pulmonary injury score: SG = 4.38±1.51; APS = 4.50±1.77, p=0.881; apoptotic cells count after perfusion: SG = 2.4 ± 2.0 cells/mm 2 ; APS = 4.8 ± 6.9 cells/mm 2 ; p = 0.361). CONCLUSION:The ex vivo lung perfusion using the alternative perfusion solution showed no functional or histological differences, except for a higher edema formation, from the EVLP using Steen Solution ® on lungs from rejected brain-dead donors.

In vivo lung perfusion rehabilitates sepsis-induced lung injury

“…12, 25, 26 Several groups have demonstrated that perfusion with Steen solution can reduce pulmonary edema in ex vivo perfused lungs. 23, 27, 28 Our LPS-induced model of porcine ARDS simulates the increased vascular permeability observed during sepsis. This injury is ameliorated with 4 hours of IVLP perfusion, and these data demonstrate enduring edema reduction even after 4 hours of reperfusion.…”

Human Pulmonary 3D Models For Translational Research

“…A small number of groups investigated isolated, ex vivo perfused, and ventilated human lungs or lobes . In these models, lung tissue was perfused via the cannulated pulmonary artery with cell free perfusion media, with cell‐containing (e.g., diluted whole human blood preparations) solutions, or solutions for lung preservation during transport before transplantation .…”

“…A small number of groups investigated isolated, ex vivo perfused, and ventilated human lungs or lobes . In these models, lung tissue was perfused via the cannulated pulmonary artery with cell free perfusion media, with cell‐containing (e.g., diluted whole human blood preparations) solutions, or solutions for lung preservation during transport before transplantation . The lungs were ventilated via the natural airways for up to 24 h. Such limited available and technically elaborated models allow for the investigation of lung edema formation, oxygenation capacity, vascular reactivity, bacterial infection, and innovative therapeutic approaches such as stem cell therapies .…”

Evolving Trend of EVLP: Advancements and Emerging Pathways

“…Several open atrium cases got severe pulmonary edema in 7 h EVLP; however, the closed atrial technique leads to significantly less edema and superior lung physiology [111]. But in another report, an acellular perfusate and a closed left atrium resulted to a more pronounced lung edema and lower lung compliance [112], confirming a previous thought that alternative perfusion solution might contribute to lung edema formation [113]. [114], various perfusion time [115], cooling or hypothermic preservation [116], as well as alter the work flow of the transplantation, staged model to do liver-after-lung transplantation [117] and split lung transplantation in two centers with a distance of 2250 km by running EVLP [118].…”