Ex Vivo Reconditioning of Marginal Donor Lungs Injured by Acid Aspiration

İnci, İlhan; Ampollini, Luca; Arni, Stephan; Jungraithmayr, Wolfgang; Inci, Demet; Hillinger, Sven; Leskosek, B.; Vogt, Peter R.; Weder, Walter

doi:10.1016/j.healun.2008.07.027

Cited by 78 publications

(54 citation statements)

References 36 publications

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“…Especially for assessing the consequences of heterogeneous pulmonary microcirculation and the ability to reabsorb fluid from peripheral airspaces, it is necessary to restart the pulmonary circulation. For this purpose, some investigating groups showed that an extracorporeal circuit was useful as a tool for assessment and maintenance of lung block quality [19,20,21,22]. It has been clearly established in numerous experimental models that heparin and different vasodilators can ameliorate reperfusion injury.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Instability of Central Airways and Peripheral Airspace in Rat Lungs Perfused with Cold Preservation Solutions

Hamakawa

Sakai²,

Takahashi³

et al. 2011

Eur Surg Res

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Background/Aims: For lung preservation, one of two types of solutions is commonly employed: Euro-Collins (EC) or low potassium dextran glucose (LPDG). These two solutions have been compared regarding biological, morphometrical and physiological outcomes in many experiments. However, the dynamic mechanics of perfused lung are not well understood because the dynamic characteristics cannot be assessed under static conditions; hence, the primary goal of the present study was to assess this in perfused rat lungs during the preservation period, comparing EC with LPDG at 0 or 9 h at 4°C. Methods: Lung impedance was measured using a forced oscillation technique. Lung resistance and elastance values were obtained by the fast Fourier transform algorithm. The instability of central airways and heterogeneity of ventilation were estimated. Results: In the EC group, airway resistance and instability were high after perfusion, and the lung elastance was high and more heterogeneous after cold storage. In contrast, those parameters were stable in the LPDG group during cold storage. Conclusion: Such dynamic stability might facilitate the handling of lung grafts and eliminate injurious cyclic ventilation stress after reperfusion. Thus, we conclude that the impedance frequency characteristic represents a novel informative parameter for investigating lung preservation techniques.

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Section: Discussionmentioning

confidence: 99%

Dynamic Instability of Central Airways and Peripheral Airspace in Rat Lungs Perfused with Cold Preservation Solutions

Hamakawa

Sakai²,

Takahashi³

et al. 2011

Eur Surg Res

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“…4 You follow the PICOT format, which serves as the starting point for identification of important key words used in the search process: 5 • Population: heart transplant patients • Intervention: heart transplantation with ex-vivo perfusion • Comparison: heart transplantation with cold storage • Outcome: patient survival and graft survival • Time horizon: 30 days after transplant You then conduct a literature search in PubMed Clinical Queries using the search terms "heart transplantation" AND "ex-vivo perfusion" AND "cold storage," using the "Therapy" and "Broad" filters. You identify 10 articles: 7 ex-vivo human/animal studies, [6][7][8][9][10][11][12] 1 nonrandomized clinical study, 13 1 review 14 and 1 RCT. 15 The RCT addresses your research question and has the benefit of being level-I evidence.…”

Section: Finding the Evidencementioning

confidence: 99%

Users’ guide to the surgical literature: how to assess a noninferiority trial

Thoma

Farrokhyar

Waltho

et al. 2017

CJS

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DISCUSSIONS IN SURGERY • DISCUSSIONS EN CHIRURGIEUsers' guide to the surgical literature: how to assess a noninferiority trial A well-planned randomized controlled trial (RCT) is the most optimal study design to determine if a novel surgical intervention is any different than a prevailing one. Traditionally, when we want to show that a new surgical intervention is superior to a standard one, we analyze data from an RCT to see if the null hypothesis of "no difference" can be rejected (i.e., the 2 surgical interventions have the same effect).1,2 Let's consider a hypothetical RCT that compares laparoscopic to open appendectomy and the outcome meas ured is a pain score based on a Likert scale from 0 to 10. Suppose it was found that the mean pain score following laparoscopic appendectomy was 7 points and that following open appendectomy was 8 points, and that this 1-point difference was statistically significant. Such a result would be uncommon because it would require a large sample size, but let's accept this for now. Although statistically the result is significant, we do not consider this 1-point difference to have clinical relevance. This type of thinking addresses the concept of minimum clinically important difference (MCID), which describes a threshold that might persuade us to change our surgical practice. The meaningful MCID is usually based on the available best evidence derived from previous systematic reviews, pilot/feasibility studies or clinical judgment based on discussion with experts in the field.In another hypothetical RCT, the length of stay (LOS) after laparoscopic appendectomy was observed to be 24 hours versus 30 hours after open appendectomy, with a p < 0.05. It would be meaningless to conclude that the observed difference of 6 hours is the truth without reporting a confidence interval (CI), as a p value alone does not provide information on the degree of uncertainty (variation) applied in measuring the difference in hospital stay. Briefly, a CI provides information regarding the degree of uncertainty associated with the observed difference of 6 hours in hospital stay. It is within the CI that the true difference will likely lie. Let's say that in our hypothetical example the 95% CI for hospitalization time difference of 6 hours was 1-11 hours in favour of the laparoscopic approach. This means we are 95% confident that the true difference lies somewhere between 1 and 11 hours, A well-planned randomized controlled trial (RCT) is the most optimal study design to determine if a novel surgical intervention is any different than a prevailing one. Traditionally, when we want to show that a new surgical intervention is superior to a standard one, we analyze data from an RCT to see if the null hypothesis of "no difference" can be rejected (i.e., the 2 surgical interventions have the same effect). A noninferiority RCT design seeks to determine whether a new intervention is not worse than a prevailing (standard) one within an acceptable margin of risk or benefit, referred to as the "noninferiority margin...

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“…The EVLP circuit is composed of one reservoir, one centrifugal pump, membrane oxygenator (exchanger), and leukocyte filter ( Figure 1) (24). Steen solution which is the most important part of the circuit contains human albumin and dextran.…”

Section: Techniquesmentioning

confidence: 99%

“…Inci et al used acid aspiration to promote lung injury and studied the effect of surfactants. For this procedure, 5 mL/ kg betaine HCL/pepsin was bronchoscopically instilled (24). Another application of EVLP is to assess organs of NHBD (30,31).…”

Section: Injurymentioning

confidence: 99%

Ex-vivo Lung Perfusion and Its Role in Experimental Studies

Cosgun¹,

Dabak²,

Şenbaklavacı³

2017

Eurasian J Pulmonol

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To date, lung transplantation is an accepted and a preferred treatment modality for end-stage lung diseases (1-3). But ischemia reperfusion--related injury, allograft rejection, bronchiolitis obliterans, and chronic graft rejection are still important and detrimental problems in lung transplant medicine (2). The gap between the limited number of donor organs and the increase in the number of patients on the waiting list is increasing rapidly. The acceptance of lung donors is still 20%-30% so far. The scarcity of appropriate organs leads to improper utilization of marginal donors. One of the solutions to increase the number of donor organs is the meticulous evaluation of donor organs after cardiac death (2-4). This is why a method called ex-vivo lung perfusion (EVLP) was developed. The usefulness of EVLP on lung transplantation is firstly because this model makes it possible to evaluate the lung perfusion and functions of the body in the pre transplant period in marginal organs. By this method, we can make the right decision to implant. Second area of utilization is by preserving the graft after harvesting over long time intervals. Third area provides a platform for the development of additional therapies especially decreasing ischemia reperfusion (IRI). In this review, we aimed to provide the usage of EVLP on the development of treatment strategies in experimental studies and share our experiences with colleagues in the related field (5). General Perspective of Organ Culture SystemsThe experimental sciences have routinely used in-vivo and in-vitro models for stimulation of physiology and diseases. As a result of integration of physics and chemistry into in-vitro and in-vivo biomedicine, study on cell cultures and analyzing them at the molecular level became possible. The aim of ex-vivo experimental studies of organs is to create a system to stimulate human pathophysiology. Sys- Review Ex-vivo Lung Perfusion and Its Role in Experimental StudiesTuğba Coşgun AbstractLung transplantation is an accepted treatment modality for end-stage lung diseases. However, the donor pool is not getting larger in comparison to the number of patients on the waiting list. Of the patients on the waiting list for lung transplant, more than a quarter dies while waiting. Utilization of marginal donors became an issue, and ex-vivo lung perfusion (EVLP) was started to be performed to solve this problem. Besides that, success in lung transplantation has not reached a satisfactory level for various reasons including ischemia reperfusion injury. Treatment options against these reasons that cause low success of lung transplantations are being investigated by many centers. Nowadays, EVLP that was initially developed to re-evaluate marginal donors has become a method for studies in experimental models. In our article, we want to review EVLP models in experimental studies.

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Ex Vivo Reconditioning of Marginal Donor Lungs Injured by Acid Aspiration

Cited by 78 publications

References 36 publications

Dynamic Instability of Central Airways and Peripheral Airspace in Rat Lungs Perfused with Cold Preservation Solutions

Dynamic Instability of Central Airways and Peripheral Airspace in Rat Lungs Perfused with Cold Preservation Solutions

Users’ guide to the surgical literature: how to assess a noninferiority trial

Ex-vivo Lung Perfusion and Its Role in Experimental Studies

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