Perfusão pulmonar ex vivo: experiência nacional inicial

Pêgo‐Fernandes, Paulo Manuel; Medeiros, Israel Lopes de; Mariani, Alessandro Wasum; Fernandes, Flávio Guimarães; Unterpertinger, Fernando do Valle; Samano, Marcos Naoyuki; Werebe, Eduardo de Campos; Jatene, Fábio Biscegli

doi:10.1590/s1806-37132009001100008

Cited by 8 publications

(2 citation statements)

References 11 publications

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“…It has been shown that reduction of cytokines in lung perfusate did not affect oxygenation, PVR, or oedema formation, demonstrating that factors other than cytokines play a significant role in graft dysfunction [ 67 ]. In addition, EVLP on its own appears to have a positive influence on the injured lungs, which may be related to the optimal oncotic pressure of the perfusion solution [ 68 ]. Future studies are clearly needed to investigate cytokines expression during EVLP in presence of tezosentan and how this combination reduces organ inflammation.…”

Section: Discussionmentioning

confidence: 99%

Endothelin receptor antagonist improves donor lung function in an ex vivo perfusion system

et al. 2020

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Background A lung transplant is the last resort treatment for many patients with advanced lung disease. The majority of donated lungs come from donors following brain death (BD). The endothelin axis is upregulated in the blood and lung of the donor after BD resulting in systemic inflammation, lung damage and poor lung graft outcomes in the recipient. Tezosentan (endothelin receptor blocker) improves the pulmonary haemodynamic profile; however, it induces adverse effects on other organs at high doses. Application of ex vivo lung perfusion (EVLP) allows the development of organ-specific hormone resuscitation, to maximise and optimise the donor pool. Therefore, we investigate whether the combination of EVLP and tezosentan administration could improve the quality of donor lungs in a clinically relevant 6-h ovine model of brain stem death (BSD). Methods After 6 h of BSD, lungs obtained from 12 sheep were divided into two groups, control and tezosentan-treated group, and cannulated for EVLP. The lungs were monitored for 6 h and lung perfusate and tissue samples were processed and analysed. Blood gas variables were measured in perfusate samples as well as total proteins and pro-inflammatory biomarkers, IL-6 and IL-8. Lung tissues were collected at the end of EVLP experiments for histology analysis and wet-dry weight ratio (a measure of oedema). Results Our results showed a significant improvement in gas exchange [elevated partial pressure of oxygen (P = 0.02) and reduced partial pressure of carbon dioxide (P = 0.03)] in tezosentan-treated lungs compared to controls. However, the lungs hematoxylin–eosin staining histology results showed minimum lung injuries and there was no difference between both control and tezosentan-treated lungs. Similarly, IL-6 and IL-8 levels in lung perfusate showed no difference between control and tezosentan-treated lungs throughout the EVLP. Histological and tissue analysis showed a non-significant reduction in wet/dry weight ratio in tezosentan-treated lung tissues (P = 0.09) when compared to control. Conclusions These data indicate that administration of tezosentan could improve pulmonary gas exchange during EVLP.

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Section: Discussionmentioning

confidence: 99%

Endothelin receptor antagonist improves donor lung function in an ex vivo perfusion system

et al. 2020

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“…The system is composed of a heat exchanger and a centrifugal pump (Braile Biomedica, Sao Jose do Rio Preto, Brazil). During our initial experiment, two technical modifications were important for the improvement of the protocol: the use of a pediatric cardiopulmonary bypass system which allowed a considerable reduction in the volume of perfusate, and the use of a centrifugal pump for more precise control of the pulmonary artery flow [ 6].…”

Section: Introductionmentioning

confidence: 99%

Avaliação e recondicionamento pulmonar ex vivo

Pêgo-Fernandes

Mariani

Medeiros

et al. 2010

Rev Bras Cir Cardiovasc

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Objective: Only about 15% of the potential candidates for lung donation are considered suitable for transplantation. A new method for ex vivo lung perfusion (EVLP) has been developed and can be used for evaluation and reconditioning of "marginal" and unacceptable lungs. This is a report of functional evaluation experience with ex vivo perfusion of twelve donor lungs deemed unacceptable in São Paulo, Brazil.Methods: After harvesting, the lungs are perfused ex vivo with Steen Solution, an extra-cellular solution with high colloid osmotic pressure. A membrane oxygenator connected to the circuit receives gas from a mixture of nitrogen and carbon dioxide and maintains a normal mixed venous blood gas level in the perfusate. The lungs are gradually rewarmed, reperfused and ventilated. They are evaluated through analyses of oxygenation capacity, pulmonary vascular resistance (PVR), lung compliance (LC).Results: The arterial oxygen pressure (with inspired oxygen fractions of 100%) increased from a mean of 193.3 mmHg in the organ donor at the referring hospital to a mean of 495.3 mmHg during the ex vivo evaluation. After 1 hour of EVLP, mean PVR was 737.3 dynes/sec/cm 5 , and mean LC was 42.2 ml/cmH 2 O. Conclusions:The ex vivo evaluation model can improve oxygenation capacity of "marginal" lungs rejected for transplantation. It has a great potential to increase lung donor availability and, possibly, to reduce the waiting time on the list. Descriptors: Lung transplantation. Organ preservation. Lung injury.Resumo Objetivo: Apenas 15% dos pulmões doados são aproveitados para transplante. Um novo método de Perfusão Pulmonar Ex Vivo (PPEV) foi desenvolvido e pode ser usado para avaliação e recondicionamento de pulmões "marginais" e rejeitados para o transplante. Esse trabalho relata nossa experiência com a avaliação funcional da PPEV.Métodos: Foram estudados pulmões de 12 doadores considerados inapropriados para transplante pulmonar. Após a captação, os pulmões são perfundidos ex vivo com Steen Solution, uma solução de composição eletrolítica extracelular com alta pressão coloidosmótica. Um oxigenador de membrana ligado ao circuito recebe uma mistura gasosa (nitrogênio e dióxido de carbono) e Bras Cir Cardiovasc 2010; 25(4): 441-446 "desoxigena" o perfusato, mantendo uma concentração de gases semelhante a do sangue venoso. Os pulmões são gradualmente aquecidos, perfundidos e ventilados. A avaliação dos órgãos é feita por gasometrias e medidas como a resistência vascular pulmonar (RVP) e complacência pulmonar (CP). 442 PÊGO-FERNANDES, PM ET AL -Ex vivo lung evaluation and reconditioning RevResultados: A PaO 2 (FiO 2 100%) passou de um valor médio de 193,3 mmHg no doador para 495,3 mmHg durante a PPEV. Após uma hora de PPEV, a RVP média era de 737,3 dinas/seg/ cm 5 e a CP era de 42,2 ml/cmH 2 O.Conclusões: O modelo de avaliação pulmonar ex vivo pode melhorar a capacidade de oxigenação de pulmões "marginais" inicialmente rejeitados para transplante. Isso denota um grande potencial do método para aumentar a disponibili...

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