title: Reconditioning of an injured lung graft with intrabronchial surfactant instillation in an ex vivo lung perfusion system followed by transplantation.
abstract: BACKGROUND
  We tested whether an injured lung graft from category-3 donation after cardiac death donor could be reconditioned with an ex vivo lung perfusion (EVLP) system by intrabronchial diluted surfactant lavage before transplantation.
  
  
  METHODS
  In a pig model, cardiac arrest was induced by deconnecting from the ventilator. Left lung injury was done by intrabronchial instillation of 1 mL/kg pepsin + HCl. After retrieval, the heart-lung block was stored at 4°C for 2 h. In the treated group, transplantation was performed after reconditioning with intrabronchial diluted surfactant lavage in EVLP system.
  
  
  RESULTS
  During EVLP, surfactant group showed better oxygenation and lower pulmonary vascular resistance. After transplantation, better oxygenation, lower mean pulmonary artery pressure, and lower lung edema were observed in surfactant group. Lower blood IL-1 beta and IL-6 cytokine levels were measured in the surfactant group. In bronchoalveolar lavage, the percentage of neutrophils, IL-1 beta and IL-6 cytokine levels, amount of protein, and neutrophil infiltration in the lung tissue at the end of the experiment were significantly lower in the surfactant group.
  
  
  CONCLUSIONS
  Our data demonstrate the feasibility of reconditioning and transplantation of an acutely damaged lung graft due to aspiration from a category-3 DCD donor. Implementation of an EVLP system is an efficacious tool to recondition and assess a questionable graft before transplantation.
authors.affiliation: Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland. Electronic address: ilhan.inci@usz.ch.
authors.forename: Ilhan
authors.initials: I
authors.lastname: Inci
authors.forename: Sven
authors.initials: S
authors.lastname: Hillinger
authors.forename: Stephan
authors.initials: S
authors.lastname: Arni
authors.forename: Tevfik
authors.initials: T
authors.lastname: Kaplan
authors.forename: Demet
authors.initials: D
authors.lastname: Inci
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
mesh_terms: D000818:Animals; D021461:Animals, Outbred Strains; D018893:Bronchoalveolar Lavage; D006851:Hydrochloric Acid / Q000494:pharmacology / Q000627:therapeutic use; D053583:Interleukin-1beta / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008168:Lung / Q000187:drug effects / Q000473:pathology* / Q000601:surgery*; D055370:Lung Injury / Q000628:therapy*; D016040:Lung Transplantation; D023421:Models, Animal; D010434:Pepsin A / Q000494:pharmacology / Q000627:therapeutic use; D010477:Perfusion / Q000379:methods*; D013501:Surface-Active Agents / Q000494:pharmacology / Q000627:therapeutic use*; D013552:Swine; D014655:Vascular Resistance / Q000502:physiology
chemical_list: D053583:Interleukin-1beta; D015850:Interleukin-6; D013501:Surface-Active Agents; D010434:Pepsin A; D006851:Hydrochloric Acid
keywords: Aspiration; Donation after cardiac death donor; Ex vivo lung perfusion; Lung transplantation; Porcine; Surfactant