title: Extension of donor lung preservation with hypothermic storage after normothermic ex vivo lung perfusion.
abstract: BACKGROUND
  Ex vivo lung perfusion (EVLP) allows normothermic evaluation and treatment of donor lungs not currently acceptable for transplant and improves organ use. Donor lungs undergo a period of cold preservation before (cold ischemic time [CIT]-1) and after (CIT-2) EVLP. We investigated the effect of an extended CIT-2 on lung function after transplantation.
  
  
  METHODS
  Explanted pig lungs, preserved in low-potassium dextran flush (Perfadex) at 4°C for 10 hours, were subjected to 6 hours of EVLP. They were subsequently allocated to 2 groups: short CIT-2 (CIT-2 = 2 hours; n = 5), and long CIT-2 (CIT-2 = 10 hours; n = 5). In a control group (n = 6), explanted lungs were placed in cold static preservation for 24 hours without EVLP. After the total preservation period, the left lung was transplanted in all groups.
  
  
  RESULTS
  After 4 hours of reperfusion, oxygenation function, acute lung injury score, inflammatory markers, and cell death pathway markers were similar between short and long CIT-2 groups. Both EVLP groups fared significantly better than the control group in oxygenation function (p < 0.05).
  
  
  CONCLUSIONS
  The intervention of EVLP improved lung function after transplantation, and this was not affected by a prolonged cold static preservation time after EVLP. These results provide the basis for a practical prolonged lung preservation strategy using a combination of cold and warm preservation techniques, which may improve lung transplantation logistics and outcomes.
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael Kuan Yew
authors.initials: MKY
authors.lastname: Hsin
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ilker
authors.initials: I
authors.lastname: Iskender
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakajima
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Manyin
authors.initials: M
authors.lastname: Chen
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Hyunhee
authors.initials: H
authors.lastname: Kim
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Pedro Reck
authors.initials: PR
authors.lastname: Dos Santos
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jin
authors.initials: J
authors.lastname: Sakamoto
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jingu
authors.initials: J
authors.lastname: Lee
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Constantine
authors.initials: C
authors.lastname: Harmantas
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Hwang
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tom
authors.initials: T
authors.lastname: Waddell
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mingyao
authors.initials: M
authors.lastname: Liu
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.affiliation: Latner Thoracic Surgery Laboratories, Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: Marcelo.cypel@uhn.ca.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cypel
mesh_terms: D000818:Animals; D050377:Cold Ischemia / Q000379:methods*; D004195:Disease Models, Animal; D005112:Extracorporeal Circulation; D005500:Follow-Up Studies; D016040:Lung Transplantation; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D010477:Perfusion / Q000379:methods*; D015427:Reperfusion Injury; D013552:Swine; D013997:Time Factors
chemical_list: D019188:Organ Preservation Solutions
keywords: ex vivo lung perfusion; lung evaluation; lung physiology; lung preservation; lung resuscitation; lung transplantation