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Optimal ex vivo lung perfusion techniques with oxygenated perfusate
Kentaro Noda1, Shinya Tane1, Seok Jin Haam1
1Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Summary
Optimizing oxygen levels during ex vivo lung perfusion (EVLP) improves lung graft quality and post-transplant outcomes. Moderate oxygenation (40%) reduced inflammation and oxidative damage, enhancing lung function after transplantation.
Area of Science:
- Transplantation immunology
- Organ preservation
- Pulmonary medicine
Background:
- Ex vivo lung perfusion (EVLP) is increasingly used in lung transplantation.
- EVLP can negatively impact lung graft quality, necessitating protocol optimization.
- The effects of perfusate oxygenation during EVLP on graft outcomes require further investigation.
Purpose of the Study:
- To investigate the impact of varying perfusate oxygenation levels during EVLP on lung graft quality and post-transplant function.
- To determine the optimal oxygen concentration for EVLP to minimize adverse effects and improve outcomes.
Main Methods:
- Four oxygenation levels (6%, 40%, 60%, 100% O2) were tested during EVLP in a rat model.
- Lung function, compliance, vascular resistance, and perfusate markers were assessed.
- Graft function was evaluated after transplantation.
Main Results:
- Perfusion with 40% oxygen showed the lowest glucose consumption.
- 40% and 60% oxygenation significantly reduced inflammatory markers and oxidative damage compared to 6% and 100% oxygen.
- Lungs treated with 40% oxygen during EVLP demonstrated superior post-transplant functional outcomes.
Conclusions:
- Optimizing perfusate oxygen levels during EVLP can enhance lung graft quality and improve post-transplant outcomes.
- Current deoxygenated EVLP protocols may lead to increased inflammation and compromised cellular metabolism.
- Moderate oxygenation (e.g., 40%) appears beneficial for EVLP protocols.
