title: A novel dual ex vivo lung perfusion technique improves immediate outcomes in an experimental model of lung transplantation.
abstract: The lungs are dually perfused by the pulmonary artery and the bronchial arteries. This study aimed to test the feasibility of dual-perfusion techniques with the bronchial artery circulation and pulmonary artery circulation synchronously perfused using ex vivo lung perfusion (EVLP) and evaluate the effects of dual-perfusion on posttransplant lung graft function. Using rat heart-lung blocks, we developed a dual-perfusion EVLP circuit (dual-EVLP), and compared cellular metabolism, expression of inflammatory mediators, and posttransplant graft function in lung allografts maintained with dual-EVLP, standard-EVLP, or cold static preservation. The microvasculature in lung grafts after transplant was objectively evaluated using microcomputed tomography angiography. Lung grafts subjected to dual-EVLP exhibited significantly better lung graft function with reduced proinflammatory profiles and more mitochondrial biogenesis, leading to better posttransplant function and compliance, as compared with standard-EVLP or static cold preservation. Interestingly, lung grafts maintained on dual-EVLP exhibited remarkably increased microvasculature and perfusion as compared with lungs maintained on standard-EVLP. Our results suggest that lung grafts can be perfused and preserved using dual-perfusion EVLP techniques that contribute to better graft function by reducing proinflammatory profiles and activating mitochondrial respiration. Dual-EVLP also yields better posttransplant graft function through increased microvasculature and better perfusion of the lung grafts after transplantation.
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.forename: K
authors.initials: K
authors.lastname: Noda
authors.forename: K
authors.initials: K
authors.lastname: Isse
authors.forename: K
authors.initials: K
authors.lastname: Tobita
authors.forename: Y
authors.initials: Y
authors.lastname: Maniwa
authors.forename: J K
authors.initials: JK
authors.lastname: Bhama
authors.forename: J
authors.initials: J
authors.lastname: D'Cunha
authors.forename: C A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: J D
authors.initials: JD
authors.lastname: Luketich
authors.forename: N
authors.initials: N
authors.lastname: Shigemura
mesh_terms: D064591:Allografts; D000792:Angiography; D000818:Animals; D001981:Bronchial Arteries / Q000473:pathology; D006348:Cardiac Surgical Procedures; D006085:Graft Survival; D066298:In Vitro Techniques; D007249:Inflammation; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008833:Microcirculation; D009206:Myocardium / Q000473:pathology; D010477:Perfusion / Q000379:methods*; D011651:Pulmonary Artery / Q000473:pathology; D011652:Pulmonary Circulation; D051381:Rats; D011917:Rats, Inbred Lew; D055114:X-Ray Microtomography