Cold ischemia or topical-ECMO for lung preservation: a randomized experimental study.
OBJECTIVE
Lung preservation remains a challenging issue for lung transplantation groups. Along with the development of ex vivo lung perfusion, a new preservation method known as topical-ECMO (extracorporal membrane oxygenation) has been proposed. The present study compared topical-ECMO with cold ischemia (CI) for lung preservation in an ex vivo experimental model.


METHODS
Randomized experimental study, conducted at a public medical school.


METHODS
Fourteen human lungs were retrieved from seven brain-dead donors that were considered unsuitable for transplantation. The lung bloc was divided and each lung was randomized to be preserved by means of topical-ECMO or CI (4-7 °C) for eight hours. These lungs were then reconnected to an ex vivo perfusion system for functional evaluation. Lung biopsies were obtained at three times. The functional variables assessed were oxygenation capacity (OC) and pulmonary artery pressure (PAP); and the histological variables were lung injury score (LIS) and apoptotic cell count (ACC).


RESULTS
The mean OC was 468 mmHg (± 81.6) in the topical-ECMO group and 455.8 (± 54) for CI (P = 0.758). The median PAP was 140 mmHg (120-160) in the topical-ECMO group and 140 mmHg (140-150) for CI (P = 0.285). The mean LIS was 35.57 (± 4.5) in the topical-ECMO group and 33.86 (± 6.1) for CI (P = 0.367). The ACC was 25.00 (± 9.34) in the topical-ECMO group and 24.86 (± 10.374) for CI (P = 0.803).


CONCLUSIONS
The present study showed that topical-ECMO was not superior to cold ischemia for up to eight hours of lung preservation.
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Alessandro Wasum
AW
Mariani
Department of Thoracic Surgery, Hospital de Messejana, Fortaleza, Brazil, MD, PhD. Attending Physician, Department of Thoracic Surgery, Hospital de Messejana, Fortaleza, Brazil.
Israel Lopes
IL
Medeiros
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD, PhD. Full Professor of Thoracic Surgery, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Paulo Manuel
PM
Pêgo-Fernandes
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, Medical Student, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Flavio Guimarães
FG
Fernandes
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, Medical Student, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Fernando Do Vale
Fdo V
Unterpertinguer
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD. Attending Physician, Department of Thoracic and Cardiovascular Surgery, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Lucas Matos
LM
Fernandes
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD, PhD. Professor, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Paulo Francisco
PF
Cardoso
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD, PhD. Attending Physician, Department of Pathology, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina de Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Mauro
M
Canzian
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, MD, PhD. Full Professor of Cardiovascular Surgery, Head of Thoracic and Cardiovascular Surgery Departament, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Fabio Biscegli
FB
Jatene
D000328:Adult; D000368:Aged; D002452:Cell Count; D050377:Cold Ischemia / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D010477:Perfusion / Q000379:methods*; D015427:Reperfusion Injury; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013997:Time Factors; D014019:Tissue Donors
D019188:Organ Preservation Solutions