Cold ischemia or topical-ECMO for lung preservation: a randomized experimental study

Area of Science:

• Cardiovascular system and hematology
• Pulmonary medicine
• Transplantation immunology

Background:

• Lung preservation is critical for successful lung transplantation.
• Ex vivo lung perfusion (EVLP) techniques are advancing lung preservation.
• Topical extracorporeal membrane oxygenation (ECMO) is a novel proposed preservation method.

Purpose of the Study:

• To compare the efficacy of topical-ECMO versus traditional cold ischemia (CI) for lung preservation.
• To evaluate functional and histological outcomes of lungs preserved with topical-ECMO and CI.
• To assess the potential of topical-ECMO as an alternative lung preservation strategy.

Main Methods:

• A randomized experimental study using fourteen human donor lungs unsuitable for transplantation.
• Lungs were divided and preserved using either topical-ECMO or CI at 4-7 °C for eight hours.
• Functional (oxygenation capacity, pulmonary artery pressure) and histological (lung injury score, apoptotic cell count) assessments were performed post-preservation via ex vivo perfusion.

Main Results:

• No significant differences were observed in oxygenation capacity (P=0.758) between topical-ECMO and CI groups.
• Pulmonary artery pressure (P=0.285), lung injury score (P=0.367), and apoptotic cell count (P=0.803) were comparable between the two preservation methods.
• Both topical-ECMO and CI demonstrated similar functional and histological preservation up to eight hours.

Conclusions:

• Topical-ECMO is not superior to cold ischemia for lung preservation up to eight hours.
• Current data suggest topical-ECMO does not offer an advantage over established cold ischemia methods for short-term lung preservation.
• Further research may be needed to explore longer preservation times or modified topical-ECMO protocols.