Successful Transplantation of Porcine Lungs Following 3 Days of Preservation Using a Modified Cold Static Method Paired with Intermittent Normothermic Ex Vivo Lung Perfusion (EVLP)
PURPOSE We have recently showed the superiority of 10degC cold static preservation (CSP) compared to standard 4degC. Despite that, CSP cannot be prolonged unlimited. Here, we hypothesized that combining CSP at 10degC with 2 short cycles of normothermic EVLP (a "recharge" period) would further extend donor lung preservation. METHODS Donor lungs (n=3) from Yorkshire pigs (28 35kg) were flushed with 4degC LPD and subsequently preserved using 10degC CSP and intermittent normothermic EVLP (Fig 1A) After a total of 72h of preservation, a left lung transplant was performed followed by 4h of reperfusion. At 4h of reperfusion, isolated graft assessment was performed by clamping the contralateral pulmonary artery and bronchus. To evaluate the contribution of the EVLP recharge periods, 2 control lungs were preserved solely with 10degC CSP for 72h and assessed using normothermic EVLP. RESULTS After 3 days of preservation, post transplant graft function was excellent. Systemic P/F ratio after excluding the contra lateral lung was 430 57 mmHg. Lung function was also stable during the intermittent EVLP periods (Fig 1B) and after transplantation (Fig 1C) No pulmonary edema was observed in the bronchoscopic assessment after transplant. Lungs preserved purely in CSP for 72h were assessed on EVLP and failed immediately with the development of massive pulmonary edema. CONCLUSION We demonstrate for the first time the feasibility of 3 day lung preservation leading to excellent early post transplant outcomes. Further experiments are being performed to confirm these positive findings and underlying mechanisms. The combination of a modified CSP method (10degC) and intermittent EVLP can open new opportunities to further prolong organ preservation and provide time for advanced lung treatments and repair.
The Journal of heart and lung transplantation the official publication of the International Society for Heart Transplantation