Korean J Transplant.  2022 Nov;36(Supple 1):S226. 10.4285/ATW2022.F-3621.

Cost-effective donor lung preservation with high-volume continuous perfusate purification in ex vivo lung perfusion

• Wang Z
• Wei D
• Zhang Y
• Dai Z
• Yang X
• Yue B
• Gao F
• Liu F
• Chen J

• KMID: 2535443
• DOI: http://doi.org/10.4285/ATW2022.F-3621

Abstract

Background
Ex vivo lung perfusion is an ideal platform for donor lung evaluation and preservation. Its application in Asia was limited due to the high running costs and potential lung reperfusion injury. Previous research showed that perfusate purification could maintain perfusate homeostasis during ex vivo lung perfusion and improve the perfuse outcome. However, the optimal purification rate remains unclear.
Methods
A home-designed EVLP system (LuPS-1) which provides the capability of continuous perfusate purification (CPP), was used in this study. Seventeen human donor lungs experienced extended cold ischemia preservation and were perfused by the LuPS-1 system for 12 hours. Five of them were set as the control group. The rest 12 lungs were separated into the low-vol-ume CPP group (LV-CPP, n=6) and the high-volume CPP group (HV-CPP, n=6), the hyperfiltration and replacement volume tar-gets were set at 500 mL/hr for the LV group, and 1500 mL/hr for the HV group. Perfusate electrolyte and lactate profiles were analyzed. Lung function parameters, radiographic, histologic assessment, and weight gain were used for donor graft evalua-tion. Cell apoptosis and tight junction protein levels in the donor graft were investigated.
Results
All the donor lungs from the two CPP groups and two lungs from the control group accomplished 12 hours of EVLP. HV-CPP group showed stable perfusate electrolyte, lactate profile, and significantly decreased lung weight gain compared with the other two groups. High-volume CPP reduced lung reperfusion injury characterized by significantly reduced cell apoptosis and lower microvascular permeability.
Conclusions
High volume CPP improved donor lung function and reduced lung injury during EVLP. Meanwhile, it significantly reduced running costs.