Strategies to prolong homeostasis of ex vivo perfused lungs
| Autor: | Marcelo Cypel, Yohei Taniguchi, Manyin Chen, Shaf Keshavjee, Ricardo Zamel, Tatsuaki Watanabe, L. Caldarone, Constantine Harmantas, H. Gokhale, Hei Yu Andrew Cheung, Mamoru Takahashi, Yui Watanabe, R. Qaqish, Mingyao Liu, Z. Guan |
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| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male Swine Transplants 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine medicine.artery Fraction of inspired oxygen Medicine Animals Homeostasis Lung business.industry Organ Preservation respiratory system respiratory tract diseases 3. Good health Donor lungs Perfusion medicine.anatomical_structure Parenteral nutrition 030228 respiratory system Anesthesia Pulmonary artery Surgery Parenteral Nutrition Total Cardiology and Cardiovascular Medicine business Ex vivo Lung Transplantation |
| Zdroj: | The Journal of thoracic and cardiovascular surgery. 161(6) |
| ISSN: | 1097-685X |
| Popis: | Objectives Ex vivo lung perfusion provides an innovative method to assess and repair donor lungs. The current Toronto ex vivo lung perfusion protocol can reliably and reproducibly preserve lungs for 12 hours. A longer ex vivo lung perfusion preservation time could enable the application of more advanced repair therapies and the rescue of more donor lungs for lung transplant. Our objective was to achieve stable 24-hour normothermic ex vivo lung perfusion. Methods We systematically examined 3 modifications of ex vivo lung perfusion perfusate administration in a large animal 24-hour ex vivo lung perfusion model. Pig lungs were assigned to 4 groups (n = 5 per group): (1) control; (2) continuous replacement of ex vivo lung perfusion perfusate; (3) modified feed, which used a modified solution to maintain perfusate osmolality by adjusting glucose and sodium levels; and (4) total parenteral nutrition, in which we added parenteral nutrition to the perfusate. Results Only 1 lung in the control group completed 24-hour ex vivo lung perfusion. However, 24-hour perfusion was achieved in 4 lungs in the continuous replacement group, 3 lungs in the modified feed group, and 4 lungs in the total parenteral nutrition group. The total parenteral nutrition group achieved significantly longer stable perfusion time compared with control (P = .03). Lung function was significantly improved and inflammatory cytokine production was reduced in the continuous replacement and total parenteral nutrition groups compared with control. Conclusions Modifications of ex vivo lung perfusion perfusate toward achieving a stable homeostatic state can extend perfusion time for up to 24 hours. Although these modifications allow for prolonged ex vivo lung perfusion, further research will be required to develop stable lung support beyond 24 hours. |
| Databáze: | OpenAIRE |
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