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Ex vivo lung perfusion

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https://www.readbyqxmd.com/read/27914896/optimal-ex-vivo-lung-perfusion-techniques-with-oxygenated-perfusate
#1
Kentaro Noda, Shinya Tane, Seok Jin Haam, Awori J Hayanga, Jonathan D'Cunha, James D Luketich, Norihisa Shigemura
BACKGROUND: Accumulating evidence supports an increasing role of ex vivo lung perfusion (EVLP) in clinical lung transplantation. However, EVLP has adverse effects on the quality of lung grafts, which have rarely been discussed. Careful optimization of current EVLP protocols might improve outcomes. This study examined effects of different levels of oxygenation of the perfusate circulated through the lungs during EVLP and the impact on post-transplant functional outcomes. METHODS: We compared results of 4 different oxygenation levels in the perfusate during EVLP: 6% oxygen (O2), 40% O2, 60% O2, and 100% O2...
October 29, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27897967/an-observational-study-of-donor-ex-vivo-lung-perfusion-in-uk-lung-transplantation-develop-uk
#2
Andrew Fisher, Anders Andreasson, Alexandros Chrysos, Joanne Lally, Chrysovalanto Mamasoula, Catherine Exley, Jennifer Wilkinson, Jessica Qian, Gillian Watson, Oli Lewington, Thomas Chadwick, Elaine McColl, Mark Pearce, Kay Mann, Nicola McMeekin, Luke Vale, Steven Tsui, Nizar Yonan, Andre Simon, Nandor Marczin, Jorge Mascaro, John Dark
BACKGROUND: Many patients awaiting lung transplantation die before a donor organ becomes available. Ex vivo lung perfusion (EVLP) allows initially unusable donor lungs to be assessed and reconditioned for clinical use. OBJECTIVE: The objective of the Donor Ex Vivo Lung Perfusion in UK lung transplantation study was to evaluate the clinical effectiveness and cost-effectiveness of EVLP in increasing UK lung transplant activity. DESIGN: A multicentre, unblinded, non-randomised, non-inferiority observational study to compare transplant outcomes between EVLP-assessed and standard donor lungs...
November 2016: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/27866861/outcomes-after-transplantation-of-lungs-preserved-for-more-than-12-h-a-retrospective-study
#3
Jonathan C Yeung, Thorsten Krueger, Kazuhiro Yasufuku, Marc de Perrot, Andrew F Pierre, Thomas K Waddell, Lianne G Singer, Shaf Keshavjee, Marcelo Cypel
BACKGROUND: Ex-vivo lung perfusion (EVLP) can be used to extend overall lung preservation time by splitting one long cold ischaemic time into two shorter ones and interposing an additional EVLP time. We assessed the outcomes after clinical transplantation of lungs with more than 12 h of preservation time. METHODS: For this retrospective study, we searched the Toronto Lung Transplant Program database for patients who had received at least one lung transplant between Jan 1, 2006, and April 30, 2015, at a single hospital in Toronto, Canada...
November 17, 2016: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/27768066/long-term-high-resolution-intravital-microscopy-in-the-lung-with-a-vacuum-stabilized-imaging-window
#4
Carolina Rodriguez-Tirado, Takanori Kitamura, Yu Kato, Jeffery W Pollard, John S Condeelis, David Entenberg
Metastasis to secondary sites such as the lung, liver and bone is a traumatic event with a mortality rate of approximately 90% (1). Of these sites, the lung is the most difficult to assess using intravital optical imaging due to its enclosed position within the body, delicate nature and vital role in sustaining proper physiology. While clinical modalities (positron emission tomography (PET), magnetic resonance imaging (MRI) and computed tomography (CT)) are capable of providing noninvasive images of this tissue, they lack the resolution necessary to visualize the earliest seeding events, with a single pixel consisting of nearly a thousand cells...
October 6, 2016: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/27759556/ex-vivo-lung-perfusion-establishment-and-operationalization-in-iran
#5
Shadi Shafaghi, Azizollah Abbasi Dezfuli, Zahra Ansari Aval, Kambiz Sheikhy, Behrooz Farzanegan, Esmaeil Mortaz, Habib Emami, Clemens Aigner, Fatemeh Sadat Hosseini-Baharanchi, Katayoun Najafizadeh
OBJECTIVES: Although the number of lung transplants is limited because of general shortage of organ donors, ex vivo lung perfusion is a novel method with 2 main benefits, including better evaluation of lung potential and recovery of injured lungs. The main aim of this study was to establish and operationalize ex vivo lung perfusion as the first experience in Iran. MATERIALS AND METHODS: This was a prospective operational research study on 5 cases, including 1 pig from Vienna Medical University and 4 patients from Masih Daneshvari Hospital...
October 14, 2016: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/27742245/airway-pressure-release-ventilation-during-ex%C3%A2-vivo-lung-perfusion-attenuates-injury
#6
J Hunter Mehaffey, Eric J Charles, Ashish K Sharma, Dustin T Money, Yunge Zhao, Mark H Stoler, Christine L Lau, Curtis G Tribble, Victor E Laubach, Mark E Roeser, Irving L Kron
OBJECTIVE: Critical organ shortages have resulted in ex vivo lung perfusion gaining clinical acceptance for lung evaluation and rehabilitation to expand the use of donation after circulatory death organs for lung transplantation. We hypothesized that an innovative use of airway pressure release ventilation during ex vivo lung perfusion improves lung function after transplantation. METHODS: Two groups (n = 4 animals/group) of porcine donation after circulatory death donor lungs were procured after hypoxic cardiac arrest and a 2-hour period of warm ischemia, followed by a 4-hour period of ex vivo lung perfusion rehabilitation with standard conventional volume-based ventilation or pressure-based airway pressure release ventilation...
September 22, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27737734/bronchodilator-inhalation-during-ex%C3%A2-vivo-lung-perfusion-improves-posttransplant-graft-function-after-warm-ischemia
#7
Kyoko Hijiya, Toyofumi F Chen-Yoshikawa, Takeshi Kondo, Hideki Motoyama, Akihiro Ohsumi, Daisuke Nakajima, Jin Sakamoto, Keiji Ohata, Mamoru Takahashi, Satona Tanaka, Ei Miyamoto, Akihiro Aoyama, Hiroshi Date
BACKGROUND: We hypothesized that an injured lung graft from donation after cardiac death donors could be reconditioned before transplantation using an ex vivo lung perfusion (EVLP) system and ventilation with high-dose short-acting β2-adrenergic receptor agonists. METHODS: Cardiac arrest was induced in a canine model by intravenous potassium chloride injection. Lungs were randomly assigned to two groups after 150 minutes of warm ischemia: inhalation of 1,400 μg of procaterol (BETA group, n = 5) or control group receiving solvent (CON group, n = 5) during EVLP...
October 10, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27728991/contemporary-review-of-the-organ-care-system-in-lung-transplantation-potential-advantages-of-a-portable-ex-vivo-lung-perfusion-system
#8
Bastian Schmack, Alexander Weymann, Prashant Mohite, Diana Garcia Saez, Bartlomiej Zych, Anton Sabashnikov, Mohamed Zeriouh, Joel Schamroth, Achim Koch, Simona Soresi, Olga Ananiadou, Fabio De Robertis, Matthias Karck, Andre Ruediger Simon, Aron Frederik Popov
Lung transplantation remains the definite treatment for various end-stage lung diseases. Cold flush perfusion, the standard method for organ procurement has severe limitations. Organ Care System (OCS; TransMedics, Inc., Andover, USA) is an approved method to preserve hearts for transplantation that allows for greatly reduced cold ischemic time. Consequently, the use of an adapted OCS lung as a portable full ex-vivo lung perfusion system in lung transplantation is currently under close evaluation. Areas covered: The aim of this article is to review the advantages and the role of the OCS in the field of lung transplantation by reviewing the latest literature and evaluating this novel procurement technique in the context of conventional methods like cold flush and regular ex-vivo lung perfusion...
October 11, 2016: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/27727070/correlation-between-pao2-fio2-and-airway-and-vascular-parameters-in-the-assessment-of-cellular-ex-vivo-lung-perfusion-system
#9
Toshihiro Okamoto, David Wheeler, Qiang Liu, Cristiano Quintini, J Steven Hata, Kenneth R McCurry
BACKGROUND: Ex vivo lung perfusion (EVLP) may be an essential process for the pre-transplant evaluation of the donor lungs. Currently, the partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2, or PF) ratio is the standard in the assessment of lung function in cellular EVLP, whereas other parameters, including airway and vascular parameters, have only been partially utilized. The primary purpose of this study is to assess the potential utility of other parameters as a surrogate of lung function in EVLP...
May 20, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27664875/ex-vivo-oxygenated-perfusion-of-free-flaps-during-ischemia-time-a-feasibility-study-in-a-porcine-model-and-preliminary-results
#10
Nicholas J Slater, Her J H Zegers, Benno Küsters, Thimpe Beune, Henri A van Swieten, Dietmar J O Ulrich
BACKGROUND: Under ideal circumstances, creation of the anastomosis during free flap transfer is a routine task and can be performed under short ischemia time. However, vessels may be in suboptimal state due to atherosclerosis, radiotherapy or trauma, increasing difficulties regarding receptor vessel identification, and anastomosis which in turn may lead to lengthening of ischemia time resulting in postoperative wound problems or even flap loss. In the current pilot study, a modified heart-lung machine was assembled to achieve continuous oxygenated extracoporeal perfusion using porcine myocutaneous rectus abdominis flaps, aimed at minimizing tissue damage occurring during ischemia time...
October 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27622532/regenerative-potential-of-human-airway-stem-cells-in-lung-epithelial-engineering
#11
Sarah E Gilpin, Jonathan M Charest, Xi Ren, Luis F Tapias, Tong Wu, Daniele Evangelista-Leite, Douglas J Mathisen, Harald C Ott
Bio-engineered organs for transplantation may ultimately provide a personalized solution for end-stage organ failure, without the risk of rejection. Building upon the process of whole organ perfusion decellularization, we aimed to develop novel, translational methods for the recellularization and regeneration of transplantable lung constructs. We first isolated a proliferative KRT5(+)TP63(+) basal epithelial stem cell population from human lung tissue and demonstrated expansion capacity in conventional 2D culture...
November 2016: Biomaterials
https://www.readbyqxmd.com/read/27614736/donation-after-circulatory-death-lungs-transplantable-up-to-six-hours-after-ex%C3%A2-vivo-lung-perfusion
#12
Eric J Charles, Mary E Huerter, Cynthia E Wagner, Ashish K Sharma, Yunge Zhao, Mark H Stoler, J Hunter Mehaffey, James M Isbell, Christine L Lau, Curtis G Tribble, Victor E Laubach, Irving L Kron
BACKGROUND: Despite the critical need for donor lungs, logistic and geographic barriers hinder lung utilization. We hypothesized that lungs donated after circulatory death subjected to 6 hours of cold preservation after ex vivo lung perfusion (EVLP) would have similar outcomes after transplantation as lungs transplanted immediately after EVLP, and that both would perform superiorly compared with lungs transplanted immediately after procurement. METHODS: Donor porcine lungs were procured after circulatory death and 15 minutes of warm ischemia...
December 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27549543/logistic-ex%C3%A2-vivo-lung-perfusion-for-hyperimmunized-patients
#13
Julien De Wolf, Philippe Puyo, Pierre Bonnette, Antoine Roux, Morgan Le Guen, François Parquin, Alain Chapelier, Edouard Sage
Hyperimmunized patients have restricted access to lung transplantation because of the low rate of donor lung availability. Sensitization to human leukocyte antigen is associated with acute rejection, allograft dysfunction, and decreased survival. Prospective crossmatching could allow matching a lung graft with the recipient; however, such a strategy would increase graft ischemia, with a worse impact on the long-term results of lung transplantation. We used logistic ex vivo lung perfusion for 3 patients at the Foch Hospital while waiting for a negative result of the prospective crossmatching and then moved forward to lung transplantation...
September 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27539097/influence-of-gender-on-ischemia-reperfusion-injury-in-lungs-in-an-animal-model
#14
H Mrazkova, R Lischke, J Herget
As with other organ transplants even lung transplantation raises the question of the possibility of the influence of gender on ischemia-reperfusion injury. This is a current topic especially for increasingly utilized method of lung transplantation from a non-heart-beating donors, where reperfusion preceded by a period of warm and cold ischemia with subsequent treatment options for lung graft reperfusion. For measurements we used our laboratory previously created and validated animal model for ex vivo lung transplantation...
August 19, 2016: Physiological Research
https://www.readbyqxmd.com/read/27526397/finite-element-modeling-of-129-xe-diffusive-gas-exchange-nmr-in-the-human-alveoli
#15
Neil J Stewart, Juan Parra-Robles, Jim M Wild
Existing models of (129)Xe diffusive exchange for lung microstructural modeling with time-resolved MR spectroscopy data have considered analytical solutions to one-dimensional, homogeneous models of the lungs with specific assumptions about the alveolar geometry. In order to establish a model system for simulating the effects of physiologically-realistic changes in physical and microstructural parameters on (129)Xe exchange NMR, we have developed a 3D alveolar capillary model for finite element analysis. To account for the heterogeneity of the alveolar geometry across the lungs, we have derived realistic geometries for finite element analysis based on 2D histological samples and 3D micro-CT image volumes obtained from ex vivo biopsies of lung tissue from normal subjects and patients with interstitial lung disease...
October 2016: Journal of Magnetic Resonance
https://www.readbyqxmd.com/read/27514498/steroids-can-reduce-warm-ischemic-reperfusion-injury-in-a-porcine-dcd-model-with-evlp-evaluation
#16
An Martens, Marc Boada, Bart M Vanaudenaerde, Stijn E Verleden, Robin Vos, Geert M Verleden, Eric K Verbeken, Dirk Van Raemdonck, Dominique Schols, Sandra Claes, Arne P Neyrinck
Donation after circulatory death (DCD) is being used to increase the number of transplantable organs. The role and timing of steroids in DCD donation and ex-vivo lung perfusion (EVLP) has not been thoroughly investigated. In this study, we investigated the effect of steroids on warm-ischemic injury in a porcine model (n=6/group). Following cardiac arrest, grafts were left untouched in the donor (90 minutes warm ischemia). Graft function was assessed after 6 hours of EVLP. In MP-group, 500 mg methylprednisolone was given prior to cardiac arrest and during EVLP...
August 12, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/27476670/nlrp3-protects-alveolar-barrier-integrity-by-an-inflammasome-independent-increase-of-epithelial-cell-adherence
#17
Elena Kostadinova, Catherine Chaput, Birgitt Gutbier, Juliane Lippmann, Leif E Sander, Timothy J Mitchell, Norbert Suttorp, Martin Witzenrath, Bastian Opitz
Bacterial pneumonia is a major cause of acute lung injury and acute respiratory distress syndrome, characterized by alveolar barrier disruption. NLRP3 is best known for its ability to form inflammasomes and to regulate IL-1β and IL-18 production in myeloid cells. Here we show that NLRP3 protects the integrity of the alveolar barrier in a mouse model of Streptococcus pneumoniae-induced pneumonia, and ex vivo upon treatment of isolated perfused and ventilated lungs with the purified bacterial toxin, pneumolysin...
2016: Scientific Reports
https://www.readbyqxmd.com/read/27444694/mesenchymal-stem-cell-treatment-is-associated-with-decreased-perfusate-concentration-of-interleukin-8-during-ex-vivo-perfusion-of-donor-lungs-after-18-hour-preservation
#18
Pierre Mordant, Daisuke Nakajima, Ricardo Kalaf, Ilker Iskender, Lucas Maahs, Paula Behrens, Rafael Coutinho, Rohin K Iyer, John E Davies, Marcelo Cypel, Mingyao Liu, Thomas K Waddell, Shaf Keshavjee
BACKGROUND: Ex vivo lung perfusion (EVLP) presents a unique therapeutic opportunity to administer mesenchymal stromal cells (MSCs) to lung grafts before transplantation. We sought to determine the optimal route and dose of viable human umbilical cord-derived MSCs to be delivered into ex vivo-perfused damaged swine lungs, and to measure their effect on concentration of growth factors and inflammatory mediators. METHODS: Pig lungs were conventionally retrieved, cold preserved for 18 hours, and perfused normothermically ex vivo for 12 hours...
May 6, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27424500/improving-donor-lung-suitability-from-protective-strategies-to-ex-vivo-reconditioning
#19
Paolo Solidoro, Annia Schreiber, Massimo Boffini, Fulvio Braido, Fabiano DI Marco
Lung transplant is a therapeutic option for end stage lung diseases, but only a limited number of lung grafts is considered suitable for transplantation. It has been recently suggested an approach to improve and maximize donor lung suitability, namely ventilation strategies to prevent lung damage and preserve function before transplantation. In potential lung donor patients, the use of lung-protective ventilatory strategies may protect against and at least partially reverse some conditions, such as ventilator-induced lung injury, atelectasis and neurogenic pulmonary edema, resulting in improved donor organ procurement...
June 2016: Minerva Medica
https://www.readbyqxmd.com/read/27381674/transplantation-after-ex-vivo-lung-perfusion-a-midterm-follow-up
#20
Andreas Wallinder, Gerdt C Riise, Sven-Erik Ricksten, Martin Silverborn, Göran Dellgren
BACKGROUND: A large proportion of donor lungs are discarded due to known or presumed organ dysfunction. Ex vivo lung perfusion (EVLP) has proven its value as a tool for discrimination between reversible and irreversible donor lung pathology. However, the long-term outcome after transplantation of lungs after EVLP is essentially unknown. We report short-term and midterm outcomes of recipients who received transplants of EVLP-evaluated lungs. METHODS: Single-center results of recipients of lungs with prior EVLP were compared with consecutive recipients of non-EVLP lungs (controls) during the same period...
May 31, 2016: Journal of Heart and Lung Transplantation
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