Technique for xenogeneic cross-circulation to support human donor lungs ex vivo.
| Autor: | Kelly Wu W; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Guenthart BA; Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California., O'Neill JD; Xylyx Bio, Inc., Brooklyn, New York; Department of Cell Biology, State University of New York Downstate Medical Center, Brooklyn, New York., Hozain AE; Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York., Tipograf Y; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Ukita R; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Stokes JW; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Patel YJ; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Pinezich M; Department of Biomedical Engineering, Columbia University, New York, New York., Talackine JR; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Cardwell NL; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Fung K; Perfusion Services, New York - Presbyterian Hospital, New York, New York., Vunjak-Novakovic G; Department of Biomedical Engineering, Columbia University, New York, New York; Department of Medicine, Columbia University Medical Center, New York, New York., Bacchetta M; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee. Electronic address: matthew.bacchetta@vumc.org. |
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| Jazyk: | angličtina |
| Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2023 Mar; Vol. 42 (3), pp. 335-344. Date of Electronic Publication: 2022 Nov 14. |
| DOI: | 10.1016/j.healun.2022.11.002 |
| Abstrakt: | Background: Xenogeneic cross-circulation (XC) is an experimental method for ex vivo organ support and recovery that could expand the pool of donor lungs suitable for transplantation. The objective of this study was to establish and validate a standardized, reproducible, and broadly applicable technique for performing xenogeneic XC to support and recover injured human donor lungs ex vivo. Methods: Human donor lungs (n = 9) declined for transplantation were procured, cannulated, and subjected to 24 hours of xenogeneic XC with anesthetized xeno-support swine (Yorkshire/Landrace) treated with standard immunosuppression (methylprednisolone, mycophenolate mofetil, tacrolimus) and complement-depleting cobra venom factor. Standard lung-protective perfusion and ventilation strategies, including periodic lung recruitment maneuvers, were used throughout xenogeneic XC. Every 6 hours, ex vivo donor lung function (gas exchange, compliance, airway pressures, pulmonary vascular dynamics, lung weight) was evaluated. At the experimental endpoint, comprehensive assessments of the lungs were performed by bronchoscopy, histology, and electron microscopy. Student's t-test and 1-way analysis of variance with Dunnett's post-hoc test was performed, and p < 0.05 was considered significant. Results: After 24 hours of xenogeneic XC, gas exchange (PaO2/FiO2) increased by 158% (endpoint: 364 ± 142 mm Hg; p = 0.06), and dynamic compliance increased by 127% (endpoint: 46 ± 20 ml/cmH Conclusions: Xenogeneic cross-circulation is a robust method for ex vivo support, evaluation, and improvement of injured human donor lungs declined for transplantation. (Copyright © 2022 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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