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Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts
Published on: August 13, 2014
Technique for prolonged normothermic ex vivo lung perfusion
Marcelo Cypel1, Jonathan C Yeung, Shin Hirayama
1Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Summary
Extended 12-hour normothermic ex vivo lung perfusion (EVLP) effectively preserves donor lungs. This technique allows for assessment and maintenance, ensuring excellent post-transplant lung function without significant added injury.
Area of Science:
- Transplantation Science
- Organ Preservation
- Pulmonary Medicine
Background:
- Hypothermia inhibits cellular repair during organ preservation.
- Extended ex vivo lung perfusion (EVLP) at normothermia can potentially improve donor lung assessment and maintenance.
Purpose of the Study:
- To develop and evaluate a 12-hour normothermic EVLP technique for donor lung preservation and assessment.
- To assess the impact of prolonged EVLP on post-transplant lung function.
Main Methods:
- Utilized 12-hour normothermic EVLP with acellular Steen Solution on porcine and human donor lungs.
- Employed protective mechanical ventilation and controlled perfusion during EVLP.
- Evaluated lung oxygenation, pulmonary vascular resistance, and airway pressures; assessed post-transplant function in animal models.
Main Results:
- Donor lung function remained stable throughout 12 hours of normothermic EVLP.
- Achieved excellent post-transplant lung function (Pao(2)/Fio(2): 527 +/- 22 mm Hg) with low edema.
- Preserved lung histology and demonstrated accurate correlation between EVLP assessment and post-transplant graft function.
Conclusions:
- 12-hour EVLP at physiologic temperatures with acellular perfusate is feasible and maintains donor lung viability.
- This EVLP system can be used to assess, maintain, and potentially treat injured donor lungs prior to transplantation.
