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

Area of Science:

• Transplantation immunology
• Cardiovascular and respiratory systems science

Background:

• Ex vivo lung perfusion (EVLP) protocols aim to improve donor lung availability and protect against primary graft dysfunction.
• Ischemia-reperfusion injury remains a significant challenge after lung transplantation.

Purpose of the Study:

• To investigate the efficacy of perfusate adsorption using a cytokine adsorber during EVLP to recondition lung allografts against ischemia-reperfusion injury.
• To assess the impact of cytokine removal on lung physiology, biochemistry, and inflammatory response during EVLP and post-transplant reperfusion.

Main Methods:

• Donor pig lungs underwent 24-hour cold preservation followed by 6-hour EVLP using the Toronto protocol.
• The treatment group utilized a CytoSorb adsorber for perfusate adsorption, while the control group received standard EVLP.
• Lung function, mechanics, and inflammatory markers were monitored during EVLP and a 4-hour post-transplant reperfusion period.

Main Results:

• The adsorber group exhibited significantly lower perfusate cytokine concentrations, leading to improved EVLP physiology and biochemistry.
• Post-transplant dynamic lung compliance and allograft oxygenation function were markedly superior in the adsorber group.
• A significantly decreased local inflammatory response was observed in the adsorber group during reperfusion.

Conclusions:

• Integrating a cytokine adsorber refines the standard EVLP protocol, enhancing immediate post-transplant graft function.
• Cytokine removal during EVLP mitigates the inflammatory response to reperfusion in a porcine lung transplant model.
• Further clinical studies are warranted to validate the benefits of perfusate adsorption in EVLP.