Comparison of lung preservation solutions in human lungs using an ex vivo lung perfusion experimental model

Abstract

OBJECTIVE:Experimental studies on lung preservation have always been performed using animal models. We present ex vivo lung perfusion as a new model for the study of lung preservation. Using human lungs instead of animal models may bring the results of experimental studies closer to what could be expected in clinical practice.METHOD:Brain-dead donors whose lungs had been declined by transplantation teams were used. The cases were randomized into two groups. In Group 1, Perfadex® was used for pulmonary preservation, and in Group 2, LPDnac, a solution manufactured in Brazil, was used. An ex vivo lung perfusion system was used, and the lungs were ventilated and perfused after 10 hours of cold ischemia. The extent of ischemic-reperfusion injury was measured using functional and histological parameters.RESULTS:After reperfusion, the mean oxygenation capacity was 405.3 mmHg in Group 1 and 406.0 mmHg in Group 2 (p = 0.98). The mean pulmonary vascular resistance values were 697.6 and 378.3 dyn·s·cm-5, respectively (p = 0.035). The mean pulmonary compliance was 46.8 cm H2O in Group 1 and 49.3 ml/cm H2O in Group 2 (p = 0.816). The mean wet/dry weight ratios were 2.06 and 2.02, respectively (p = 0.87). The mean Lung Injury Scores for the biopsy performed after reperfusion were 4.37 and 4.37 in Groups 1 and 2, respectively (p = 1.0), and the apoptotic cell counts were 118.75/mm2 and 137.50/mm2, respectively (p = 0.71).CONCLUSION:The locally produced preservation solution proved to be as good as Perfadex®. The clinical use of LPDnac may reduce costs in our centers. Therefore, it is important to develop new models to study lung preservation.

Methylene blue attenuates ischemia–reperfusion injury in lung transplantation

“…The degree of pulmonary edema is inversely proportional to the quality of lung preservation [19]. Several experimental models have used edema measurement to evaluate the efficacy of protective drugs against IRI after LTx [20,21].…”

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 .…”

Pulmonary reperfusion injury

“…(30) The preservation method is pulmonary artery perfusion with a preservation solution at 4°C, which may cool the tissue evenly and remove blood from the pulmonary vascular bed, preventing thrombosis and attenuating cellular injury caused by macrophages and neutrophils. (31) In a rat model of double lung transplantation, a comparative study of lung preservation solutions revealed low potassium dextran provided superior graft function to Euro-Collins, low potassium Euro-Collins and University of Wisconsin solution after extended ischemia. (32) In a porcine lung transplantation model, after 24 hours of cold ischemia, low potassium dextran or Celsior solution provided safe pulmonary preservation, while surfactant activity was affected to the same extent.…”