Optimal ex vivo lung perfusion techniques with oxygenated perfusate

Noda, Kentaro; Tane, Shinya; Haam, Seokjin; Hayanga, Awori J.; D’Cunha, Jonathan; Luketich, James D.; Shigemura, Norihisa

doi:10.1016/j.healun.2016.10.014

Cited by 27 publications

(23 citation statements)

References 41 publications

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“…To our knowledge, EVLP for more than 12h has not been reported so far using the three widely used EVLP protocols in the clinical setting. Several studies have been performed to optimize the EVLP protocols looking at the roles of atrial pressure, 9 synchronous bronchial artery circulation, 10 cellular and acellular perfusates, 11 continued perfusate exchange, 12 negative pressure ventilation, 13 perfusate oxygen concentration, 14 continuous perfusate adsorption, 15 and positioning of donor lungs. 16 Combination of these strategies may result in prolonged EVLP times.…”

Section: Glossary Of Abbreviationsmentioning

confidence: 99%

Perfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function

Arni

Maeyashiki

Çıtak

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Improvement in ex vivo lung perfusion (EVLP) protocols could increase the number of donors available for transplantation and protect the lungs from primary graft dysfunction. We hypothesize that perfusate adsorption during EVLP reconditions the allograft to ischemia-reperfusion injury after lung transplantation. Methods: Donor pig lungs were preserved for 24h at 4°C, followed by 6h of EVLP according to the Toronto protocol. The perfusate was additionally adsorbed through a CytoSorb adsorber in the treatment group, whereas control lungs were perfused according to the standard protocol (n = 5, each). EVLP physiology and biochemistry were monitored. Upon completion of EVLP, a left single lung transplantation was performed. Oxygenation function and lung mechanics were assessed during a 4-hour reperfusion period. The inflammatory response was determined during EVLP and reperfusion. Results: The cytokine concentrations in the perfusate were markedly lower with the adsorber, resulting in improved EVLP physiology and biochemistry during the 6-hour perfusion period. Post-transplant dynamic lung compliance was markedly better during the 4-hour reperfusion period in the treatment group. Isolated allograft oxygenation function and dynamic compliance were continued to be superior in the adsorber group at the end of reperfusion accompanied by a markedly decreased local inflammatory response. Conclusions: Implementation of an additional cytokine adsorber has refined the standard EVLP protocol. Furthermore, cytokine removal during EVLP improved immediate post-transplant graft function together with a less intense inflammatory response to reperfusion in pigs. Further studies are warranted to understand the beneficial effects of perfusate adsorption during EVLP in the clinical setting.

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Section: Glossary Of Abbreviationsmentioning

confidence: 99%

Perfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function

Arni

Maeyashiki

Çıtak

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Debate continues about the best conditions for EVLP with regards to cellular versus acellular composition of the perfusate (138)(139)(140)(141), the importance of left atrial pressure (138,142), positive versus negative pressure ventilation (143), the use of leucocyte (144) or cytokine filters (145,146) in the circuit, the oxygenation level of the perfusate (147), and the role of hemofiltration (148). Research is ongoing to identify clinical biomarkers in the perfusate such as cytokines (149), endothelial markers (150), adhesion molecules (151), metabolomics (152) and to investigate imaging techniques (153,154) before and after EVLP that may be predictive of graft function after transplantation.…”

Section: Lungmentioning

confidence: 99%

Machine perfusion of thoracic organs

Raemdonck¹,

Rega²,

Rex³

et al. 2018

J. Thorac. Dis.

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This article summarizes recent knowledge and clinical advances in machine perfusion (MP) of thoracic organs. MP of thoracic organs has gained much attention during the last decade. Clinical studies are investigating the role of MP to preserve, resuscitate, and assess heart and lungs prior to transplantation. Currently, MP of the cardiac allograft is essential in all type DCD heart transplantation while MP of the pulmonary allograft is mandatory in uncontrolled DCD lung transplantation. MP of thoracic organs also offers an exciting platform to further investigate downregulation of the innate and adaptive immunity prior to reperfusion of the allograft in recipients. MP provides a promising technology that allows pre-transplant preservation, resuscitation, assessment, repair, and conditioning of cardiac and pulmonary allografts outside the body in a near physiologic state prior to planned transplantation. Results of ongoing clinical trials are awaited to estimate the true clinical value of this new technology in advancing the field of heart and lung transplantation by increasing the total number and the quality of available organs and by further improving recipient early and long-term outcome.

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“…Removed passenger leukocytes could reduce pyroptotic reactions [85] and pro-inflammatory cytokines [86]. Another way to modify EVLP in order to reach a better post-transplant functional outcome is to optimize the level of perfusate oxygenation, such as 40% O 2 [87] or ventilated with 2% hydrogen [88,89], through upregulation of heme oxygenase-1 and promoting mitochondrial biogenesis [90] and innate mechanisms of repair [91]. NPV could also reduce lung edema and lower composite acute lung injury [92].…”

Section: Anti-inflammatory Strategymentioning

confidence: 99%

Evolving Trend of EVLP: Advancements and Emerging Pathways

Jiao¹

2019

SN Compr. Clin. Med.

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Lung transplant augmentation in the waiting list is impeded by donor lung shortage with a low percentage of procurement. Ex vivo lung perfusion (EVLP) was recognized to have the capacity of providing a platform to preserve, assess, recondition, and even mange existing diseases in rejected donor lungs to expand the donor pool. This review aims to provide the most advanced experimental evidence of EVLP application and perspective as a platform providing qualified donor lungs. Literature review using PubMed, Medscape, Clinical Trials, and Cochrane databases was performed. Data was collected and analyzed. From a view point of publisher, current research centers with their paper contribution volume are also presented to illustrate the future trend of EVLP academically. EVLP incubated donor lungs could have a comparable outcome with conventional transplants. Further interventional studies have shown growing interest in and expectations on EVLP platform as pathways to determine graft quality, to bridge a critical phase of the initial rejected organs and to predict prognosis or complications in an early stage. EVLP is also considered as a tissue regeneration translational research environment with multidisciplinary potential to enhance the recovery and rehabilitation after surgery and advance pulmonary medicine. Ongoing clinical trials and accelerated procedure modulation with commercialization of EVLP are leading to Bcentralization^organ preparation model, opening a new era of lifechange health innovation.

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Optimal ex vivo lung perfusion techniques with oxygenated perfusate

Cited by 27 publications

References 41 publications

Perfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function

Perfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function

Machine perfusion of thoracic organs

Evolving Trend of EVLP: Advancements and Emerging Pathways

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