Post-Ex Vivo Lung Perfusion Hypothermic Storage Limits Inflammation and Endothelial Dysfunction

Area of Science:

• Transplantation immunology
• Organ preservation
• Pulmonary medicine

Background:

• Ex vivo lung perfusion (EVLP) involves significant temperature shifts from static cold storage (4°C) to warm reperfusion (37°C).
• The impact of these temperature fluctuations on lung graft quality, specifically inflammation and endothelial function, remains unexplored.

Purpose of the Study:

• To investigate the effects of temperature variations during EVLP on inflammatory markers and endothelial dysfunction in donor lung grafts.
• To assess the association between changes in specific biomarkers and the development of primary graft dysfunction.

Main Methods:

• A prospective, observational study was conducted at a single university hospital.
• Twenty donor lungs were evaluated using EVLP.
• Pro- and anti-inflammatory cytokines (IL-1β, IL-8, IL-6, TNF-α, IL-10), glycocalyx biomarkers (HS, SD1), and endothelin-1 (ET-1) were measured at key time points during and after EVLP.

Main Results:

• EVLP significantly increased levels of IL-1β, IL-6, IL-8, IL-10, TNF-α, and ET-1.
• Post-EVLP hypothermic storage led to increased IL-10 and TNF-α compared to the first graft.
• Variations in IL-8, TNF-α, and ET-1 during hypothermic storage were associated with severe primary graft dysfunction at 72 hours.

Conclusions:

• Post-EVLP hypothermic storage might attenuate inflammatory responses and endothelial dysfunction before lung transplantation.
• The statistical significance of some observed differences was limited, warranting cautious interpretation.
• Further studies are necessary to validate these findings and their clinical implications.