Development of experimental isolated lung perfusion model using surgically resected tumorous human lobes

Ex vivo lung perfusion (EVLP) is a unique platform for lung assessment and preservation. While EVLP has been extensively investigated in donor lungs, its application to translational research is less well-defined. We aimed to evaluate and characterise the EVLP methodology using resected human cancerous lung.

Between January 2021 and March 2023, 216 patients at our Institute underwent eligibility screening for experimental inclusion. Following pneumonectomy or lobectomy, 10 cases were included. The lung specimens were inflated, flushed with Perfadex^®, and connected to an acellular perfusate circuit primed with Steen^® solution. Physiological parameters were monitored at regular intervals with a blood gas analyser.

The median duration of the experiments performed was 159 min, during which the functional parameters remained stable despite the progressive development of oedema. Importantly, elevated lactate levels did not correlate with functional deterioration defined by partial O₂ and CO₂ pressure levels despite a temporal non-significant decline in these parameters. We managed to perfuse pneumonectomy and lobectomy specimens with comparable results regarding the investigated physiological parameters. However, pneumonectomies were associated with shorter median warm ischemic times compared to lobectomies (29.5 min vs. 75 min, respectively).

In this study, we have characterised proof-of-concept EVLP in cancerous human lungs regarding physiological parameters. Oedema management and clearly defined endpoints are essential in its translational application. These preliminary observations are intended to guide future investigators for improved protocols and establish standardised criteria for patient selection.