Ex Vivo Lung Perfusion of Cardiac-death Donor Lung in Pigs

Chae Paik Hyo; Jin Haam Seok; Suk Park Moo; Han Song Joo

doi:10.4285/jkstn.2014.28.3.154

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Hyo, Seok, Moo, and Joo: Ex Vivo Lung Perfusion of Cardiac-death Donor Lung in Pigs

Original Article

J Korean Soc Transplant 2014;28(3):154-159.

Published online: 10 September 2014

DOI: https://doi.org/10.4285/jkstn.2014.28.3.154

Ex Vivo Lung Perfusion of Cardiac-death Donor Lung in Pigs

Chae Paik Hyo, M.D.¹, Jin Haam Seok, M.D.², Suk Park Moo, M.D.³, Han Song Joo, M.D.³

¹Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

²Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

³Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Corresponding author: Hyo Chae Paik Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel: 82-2-2228-2140, Fax: 82-2-393-6012 E-mail: hcpaik@yuhs.ac

Received 3 March 2014 Revised 27 June 2014 Accepted 27 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Lung transplantation (LTx) is a life-saving treatment for patients with end-stage lung disease; however, the shortage of donor lungs has been a major limiting factor to increasing the number of LTx. Growing experience following LTx using donor lungs after cardiac death (DCD) has been promising, although concerns remain. The purpose of this study was to develop a DCD lung harvest model using an ex vivo lung perfusion (EVLP) system and to assess the function of presumably damaged lungs harvested from the DCD donor in pigs.

Methods

The 40 kg pigs were randomly divided into the control group with no ischemic lung injury (n=5) and the study group (n=5), which had 1 hour of warm ischemic lung injury after cardiac arrest. Harvested lungs were placed in the EVLP circuit and oxygen capacities (OC), pulmonary vascular resistance (PVR), and peak airway pressure (PAP) were evaluated every hour for 4 hours. At the end of EVLP, specimens were excised for pathologic review and wet/dry ratio.

Results

No statistically significant difference in OC (P=0.353), PVR (P=0.951), and PAP (P=0.651) was observed in both groups. Lung injury severity score (control group vs. study group: 0.700±0.303 vs. 0.870±0.130; P=0.230) and wet/dry ratio (control group vs. study group: 5.89±0.97 vs. 6.20±0.57; P=0.560) also showed no statistically significant difference between the groups. Conclusions: The function of DCD lungs assessed using EVLP showed no difference from that of control lungs without ischemic injury; therefore, utilization of DCD lungs can be a new option to decrease the number of deaths on the waiting list.

Keywords: Lung transplantation, Tissue donors, Organ preservation, Warm ischemia

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Fig. 1.

Schematic diagram of ex vivo lung perfusion (EVLP) model. EVLP system consists of mechanical ventilator, centrifugal pump, heat-exchanger, and the perfusate deo-xygenate as it passes through the membrane gas exchanger. Perfusate is infused into pulmonary artery through leukocyte depletion filter and stored in a hardshell reservior. Perfusate in the reservoir circulates continuously by the centrifugal pump.

Fig. 2.

Comparison of oxygen capacities during 4 hours of ex vivo lung perfusion (EVLP). The level of oxygen capacity was higher in the study group than in the control group during the 4 hours of EVLP.

Fig. 3.

Comparison of pulmonary vascular resistances during 4 hours of ex vivo lung perfusion (EVLP). Pulmonary vascular resistance was higher in the control group, although it did not show statistically significant difference. As the EVLP prolonged, pulmonary vascular resistance slightly increased, which was more apparent in the study group.

Fig. 4.

Comparison of peak airway pressure during 4 hours of ex vivo lung perfusion (EVLP). The peak airway pressure of in the study group was higher during the entire period of EVLP but did not show statistically significant difference. The peak airway pressures in both groups increased sharply after 2 hours, which suggested progression of pulmonary edema.

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