A Low-Cost Perfusate Alternative for Ex Vivo Lung Perfusion

Buchko, Max; Himmat, Sayed; Aboelnazar, N.; Stewart, Catherine J.; Hatami, Sanaz; Dromparis, Peter; Adam, Benjamin; Freed, Darren H.; Nagendran, Jayan

doi:10.1016/j.transproceed.2020.05.007

Cited by 5 publications

(6 citation statements)

References 24 publications

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“…77 Because of the high costs of Steen, lowcost alternatives, such as Krebs-Henseleit-Albumin, the Papworth-Blood, and Custadiol-MP solutions have been successfully used in EVLP settings. [78][79][80] Krebs-Henseleit-Albumin solution contains electrolytes similar to human The Lund protocol is the first EVLP protocol that aims to assess questionable donor lungs for a short period of time at full perfusion flow. The Toronto protocol is the most widely accepted protocol that endorses protective ventilation/perfusion strategies using closed left atrium strategy.…”

Section: Perfusate Basementioning

confidence: 99%

“…77 Because of the high costs of Steen, low-cost alternatives, such as Krebs-Henseleit-Albumin, the Papworth-Blood, and Custadiol-MP solutions have been successfully used in EVLP settings. 78-80 Krebs-Henseleit-Albumin solution contains electrolytes similar to human plasma but differs from Steen with the absence of dextran. 78 The Papworth-Blood solution, which used to preserve donor lungs, is an extracellular-type solution like Steen and contains Ringer’s lactate solution, albumin, mannitol, and leukocyte-depleted blood.…”

Section: Introductionmentioning

confidence: 99%

“…78-80 Krebs-Henseleit-Albumin solution contains electrolytes similar to human plasma but differs from Steen with the absence of dextran. 78 The Papworth-Blood solution, which used to preserve donor lungs, is an extracellular-type solution like Steen and contains Ringer’s lactate solution, albumin, mannitol, and leukocyte-depleted blood. 79 Custodiol-MP solution, which is specifically designed for machine perfusion, composed of histidine-tryptophan-ketoglutarate solution, iron chelators, deferoxamine, and amino acids supplemented with Dextran, human albumin, and glucose.…”

Section: Introductionmentioning

confidence: 99%

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Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

Iskender

2024

Transplantation

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Indications for ex vivo lung perfusion (EVLP) have evolved from assessment of questionable donor lungs to treatment of some pathologies and the logistics. Yet up to 3 quarters of donor lungs remain discarded across the globe. Multiday preservation of discarded human lungs on EVLP platforms would improve donor lung utilization rates via application of sophisticated treatment modalities, which could eventually result in zero waitlist mortality. The purpose of this article is to summarize advances made on the technical aspects of the protocols in achieving a stable multiday preservation of isolated EVLP. Based on the evidence derived from large animal and/or human studies, the following advances have been considered important in achieving this goal: ability to reposition donor lungs during EVLP; perfusate adsorption/filtration modalities; perfusate enrichment with plasma and/or donor whole blood, nutrients, vitamins, and amino acids; low-flow, pulsatile, and subnormothermic perfusion; positive outflow pressure; injury specific personalized ventilation strategies; and negative pressure ventilation. Combination of some of these advances in an automatized EVLP device capable of managing perfusate biochemistry and ventilation would likely speed up the processes of achieving multiday preservation of isolated EVLP.

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Section: Perfusate Basementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

Iskender

2024

Transplantation

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“…The pulmonary trunk is cannulated and perfused with a solution to assist in preservation and reconditioning. The perfusate solution supports metabolism with varying compositions depending on the specific protocol being followed [134,[142][143][144][145][146][147]. The perfusate drains from the left atrium into a circuit for filtration and deoxygenation before returning to the pulmonary artery to complete its course.…”

Section: Overview Of Eslpmentioning

confidence: 99%

Lung Transplantation, Pulmonary Endothelial Inflammation, and Ex-Situ Lung Perfusion: A Review

Forgie

Fialka

Freed

et al. 2021

Cells

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Lung transplantation (LTx) is the gold standard treatment for end-stage lung disease; however, waitlist mortality remains high due to a shortage of suitable donor lungs. Organ quality can be compromised by lung ischemic reperfusion injury (LIRI). LIRI causes pulmonary endothelial inflammation and may lead to primary graft dysfunction (PGD). PGD is a significant cause of morbidity and mortality post-LTx. Research into preservation strategies that decrease the risk of LIRI and PGD is needed, and ex-situ lung perfusion (ESLP) is the foremost technological advancement in this field. This review addresses three major topics in the field of LTx: first, we review the clinical manifestation of LIRI post-LTx; second, we discuss the pathophysiology of LIRI that leads to pulmonary endothelial inflammation and PGD; and third, we present the role of ESLP as a therapeutic vehicle to mitigate this physiologic insult, increase the rates of donor organ utilization, and improve patient outcomes.

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“…Others have shown that a cellular perfusate may lead to better maintenance of the lungs on EVLP, and so these findings may not be universally applicable to other perfusion systems. 26 Nonetheless, these new iterations to the Toronto Protocol refine the practice of EVLP and bring us closer toward a physiologic perfusion platform to support novel organ rehabilitation strategies.…”

mentioning

confidence: 99%

Commentary: Making lungs great again—introducing new modifications to the Toronto ex vivo lung perfusion protocol

Kesseli

Davis

Hartwig

2021

The Journal of Thoracic and Cardiovascular Surgery

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A Low-Cost Perfusate Alternative for Ex Vivo Lung Perfusion

Cited by 5 publications

References 24 publications

Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

Lung Transplantation, Pulmonary Endothelial Inflammation, and Ex-Situ Lung Perfusion: A Review

Commentary: Making lungs great again—introducing new modifications to the Toronto ex vivo lung perfusion protocol

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