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Ex vivo lung perfusion with adenosine A2A receptor agonist allows prolonged cold preservation of lungs donated after cardiac death  Cynthia E. Wagner,

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Presentation on theme: "Ex vivo lung perfusion with adenosine A2A receptor agonist allows prolonged cold preservation of lungs donated after cardiac death  Cynthia E. Wagner,"— Presentation transcript:

1 Ex vivo lung perfusion with adenosine A2A receptor agonist allows prolonged cold preservation of lungs donated after cardiac death  Cynthia E. Wagner, MD, Nicolas H. Pope, MD, Eric J. Charles, MD, Mary E. Huerter, MD, Ashish K. Sharma, MBBS, PhD, Morgan D. Salmon, PhD, Benjamin T. Carter, BS, Mark H. Stoler, MD, Christine L. Lau, MD, MBA, Victor E. Laubach, PhD, Irving L. Kron, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 151, Issue 2, Pages (February 2016) DOI: /j.jtcvs Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Comparison of initial and final Pao2/Fio2 ratios among groups. Initial donor Pao2/Fio2 ratios were obtained before procurement. Final Pao2/Fio2 ratios of donor lungs were determined from samples obtained from the left superior and inferior pulmonary veins after 4 hours of reperfusion. *P < .0001 versus DMSO. Pao2/Fio2, Arterial oxygen partial pressure/fraction of inspired oxygen; DMSO, dimethyl sulfoxide; ATL-E, A2AR agonist administration during EVLP; ATL-E/R, A2AR agonist administration during EVLP and reperfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Trends in Po2 gradients throughout 4 hours of EVLP in DMSO, ATL-E, and ATL-E/R groups. The red line represents the 350 mm Hg threshold for clinical lung transplantation. Po2, Oxygen tension; EVLP, ex vivo lung perfusion; DMSO, dimethyl sulfoxide; ATL-E, A2AR agonist administration during EVLP; ATL-E/R, A2AR agonist administration during EVLP and reperfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Changes in physiologic parameters throughout 4 hours of EVLP. Peak airway pressure, dynamic compliance, and PVR in the DMSO, ATL-E, and ATL-E/R groups. EVLP, Ex vivo lung perfusion; DMSO, dimethyl sulfoxide; ATL-E, A2AR agonist administration during EVLP; ATL-E/R, A2AR agonist administration during EVLP and reperfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Percent change in peak airway pressure, dynamic compliance, and PVR between the first hour and the fourth hour of EVLP among groups. The red line represents the 15% threshold for clinical lung transplantation. EVLP, Ex vivo lung perfusion; DMSO, dimethyl sulfoxide; ATL-E, A2AR agonist administration during EVLP; ATL-E/R, A2AR agonist administration during EVLP and reperfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 Proinflammatory cytokine levels in lung tissue after 4 hours of reperfusion. IL, Interleukin; IFN-γ, interferon gamma; DMSO, dimethyl sulfoxide; ATL-E, A2AR agonist administration during EVLP; ATL-E/R, A2AR agonist administration during EVLP and reperfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

7 Figure 6 Pulmonary edema after 4 hours of reperfusion as measured by total protein concentration in BAL fluid and lung wet-to-dry weight ratios. BAL, Bronchoalveolar lavage; DMSO, dimethyl sulfoxide; ATL-E, A2AR agonist administration during EVLP; ATL-E/R, A2AR agonist administration during EVLP and reperfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

8 Figure 7 Top, Representative lung histology (hematoxylin and eosin stain at 20× magnification) after 4 hours of reperfusion in DMSO, ATL-E, and ATL-E/R groups. Bottom, Comparison of mean lung injury severity scores among groups as determined from histology. DMSO, Dimethyl sulfoxide; ATL-E, A2AR agonist administration during EVLP; ATL-E/R, A2AR agonist administration during EVLP and reperfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

9 The treated groups (ATL-E and ATL-E/R) had higher final Pao2/Fio2 ratios than the DMSO group.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

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