Ex vivo rehabilitation of non–heart-beating donor lungs in preclinical porcine model: Delayed perfusion results in superior lung function Daniel P. Mulloy,

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Presentation transcript:

Ex vivo rehabilitation of non–heart-beating donor lungs in preclinical porcine model: Delayed perfusion results in superior lung function Daniel P. Mulloy, MD, Matthew L. Stone, MD, Ivan K. Crosby, MBBS, Damien J. LaPar, MD, Ashish K. Sharma, MBBS, David V. Webb, MD, Christine L. Lau, MD, Victor E. Laubach, PhD, Irving L. Kron, MD The Journal of Thoracic and Cardiovascular Surgery Volume 144, Issue 5, Pages 1208-1216 (November 2012) DOI: 10.1016/j.jtcvs.2012.07.056 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Non–heart-beating donor lung harvest and ex vivo lung perfusion (EVLP) procedures. A, Fresh clot removed from donor left atrium and pulmonary veins during antegrade lung flush. B, Donor lungs during EVLP with pulmonary artery cannula, left atrial cannula, and endotracheal tube secured in place. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 1208-1216DOI: (10.1016/j.jtcvs.2012.07.056) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Lung physiology after 4 hours of reperfusion. A, Mean airway pressure. B, Mean pulmonary artery pressure. C, Oxygenation, represented by partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio measured at 4 points: donor arterial blood oxygenation before death, ex vivo lung perfusion (EVLP)-perfusate oxygenation at 1 hour, EVLP-perfusate oxygenation at 4 hours, and recipient arterial blood oxygenation at end of transplantation. CSP, Cold static preservation; I-EVLP, immediate EVLP; and D-EVLP, delayed EVLP. A and B, *P < .05 versus CSP; #P < .05 versus CSP and I-EVLP. C, *P < .05 versus I-EVLP; #P < .05 versus CSP and I-EVLP. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 1208-1216DOI: (10.1016/j.jtcvs.2012.07.056) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Mean proinflammatory cytokine levels in bronchoalveolar lavage fluid at end of 4 hours of reperfusion. CSP, Cold static preservation; I-EVLP, immediate ex vivo lung perfusion; D-EVLP, delayed ex vivo lung perfusion. *P < .05 versus CSP; #P < .05 versus CSP and I-EVLP. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 1208-1216DOI: (10.1016/j.jtcvs.2012.07.056) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Representative histologic (Top, hematoxylin-eosin sections, ×20) and gross (Bottom) appearance of lungs after 4 hours of reperfusion. CSP, Cold static preservation; I-EVLP, immediate ex vivo lung perfusion; D-EVLP, delayed ex vivo lung perfusion. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 1208-1216DOI: (10.1016/j.jtcvs.2012.07.056) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Mean lung injury severity scores stratified by histologic feature. See text for details of assigned scores. CSP, Cold static preservation; I-EVLP, immediate ex vivo lung perfusion; D-EVLP, delayed ex vivo lung perfusion; PMN, polymorphonuclear leukocytes; HPF, high power field. *P < .05 versus CSP; #P < .05 versus I-EVLP. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 1208-1216DOI: (10.1016/j.jtcvs.2012.07.056) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions