Donation after circulatory death (DCD) is an underused source of donor lungs. Normothermic cellular ex vivo lung perfusion (EVLP) is effective in preserving standard donor lungs but may also be useful in the preservation and assessment of DCD lungs. Using a model of DCD and prolonged EVLP, the effects of donor warm ischemia and postmortem ventilation on graft recovery were evaluated. Adult male swine underwent general anesthesia and heparinization. In the control group (n = 4), cardioplegic arrest was induced and the lungs were procured immediately. In the four treatment groups, a period of agonal hypoxia was followed by either 1 h of warm ischemia with (n = 4) or without (n = 4) ventilation or 2 h of warm ischemia with (n = 4) or without (n = 4) ventilation. All lungs were studied on an EVLP platform for 24 h. Hemodynamic measures, compliance, and oxygenation on EVLP were worse in all DCD lungs compared with controls. Hemodynamics and compliance normalized in all lungs after 24 h of EVLP, but DCD lungs demonstrated impaired oxygenation. Normothermic cellular EVLP is effective in preserving and monitoring of DCD lungs. Early donor postmortem ventilation and timely procurement lead to improved graft function.
Bibliographical noteFunding Information:
This study was funded by grants from United Therapeutics Corporation (Silver Spring, MD, USA); the University of Minnesota's Lillehei Heart Institute, Department of Surgery, and Institute for Engineering in Medicine; and by R01HL108627 awarded to Angela Panoskaltsis-Mortari. These funding organizations did not have any role in collecting, analyzing, or interpreting data or the decision to publish the manuscript. Nonclinical-grade disposable perfusion equipment was provided courtesy of TransMedics. This included the blood collection chambers, four reusable modules for animal work, and OCS Lung solution. Dr. Loor is a co-investigator in the INSPIRE and EXPAND trials and receives grant support for these trials from TransMedics. The authors would like to acknowledge Carolyn Meyer, BS and Andrew Price, BA for technical assistance, Jim Hodges, PhD, for assistance with statistical analysis, and Mary Knatterud, PhD, for assistance with manuscript editing.
© 2017 Steunstichting ESOT
- cellular preservation
- donation after circulatory death
- ex vivo lung perfusion
- lung transplantation