Reconditioning of lungs donated after circulatory death with normothermic ex vivo lung perfusion.
BACKGROUND
The use of donation-after-circulatory-death (DCD) donors for lung transplantation has come into practice. In this study we investigated whether DCD lungs can be resuscitated after warm ischemia with normothermic ex vivo lung perfusion (EVLP).


METHODS
Four hours after cardiac arrest, beagle dogs were divided into two groups (n = 6 each): those with static cold storage (SCS group) and those with normothermic EVLP (EVLP group), for 3.5 hours. Physiologic lung functions were evaluated during EVLP. In both groups, the left lungs were then transplanted and reperfused for 4 hours to evaluate post-transplant lung functions. Lung tissue adenosine triphosphate (ATP) levels were measured at given time-points.


RESULTS
Lung oxygenation was significantly improved with EVLP (p < 0.01), and lung oxygenation at the end of EVLP significantly reflected post-transplant lung oxygenation (r = 0.99, p < 0.01). Post-transplant lung oxygenation was significantly better in the EVLP group than in the SCS group (p < 0.05). Both dynamic pulmonary compliance and wet-to-dry lung weight ratio 4 hours after transplantation were also significantly better in the EVLP group than in the SCS group (p < 0.05). Microthrombi in the donor lungs before transplantation were microscopically detected more often in the SCS group. The lung tissue ATP levels 4 hours after transplantation were significantly higher in the EVLP group compared with the SCS group (p = 0.03).


CONCLUSIONS
Normothermic ex vivo lung perfusion could resuscitate DCD lungs injured by warm ischemia, and may ameliorate ischemia-reperfusion injury.
Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.
Daisuke
D
Nakajima
Fengshi
F
Chen
Tetsu
T
Yamada
Jin
J
Sakamoto
Akihiro
A
Ohsumi
Toru
T
Bando
Hiroshi
H
Date
D000255:Adenosine Triphosphate / Q000097:blood; D000818:Animals; D003994:Bucladesine; D004285:Dogs; D008168:Lung / Q000098:blood supply / Q000502:physiology*; D016040:Lung Transplantation; D023421:Models, Animal; D005996:Nitroglycerin; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010101:Oxygen Consumption / Q000502:physiology*; D015424:Reperfusion / Q000379:methods*; D015427:Reperfusion Injury / Q000517:prevention & control*; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D052096:Warm Ischemia
D019188:Organ Preservation Solutions; D003994:Bucladesine; D000255:Adenosine Triphosphate; D005996:Nitroglycerin