Addition of Dialysis to Ex-Vivo Lung Perfusion Maintains Homeostasis and Stability of Donor Lungs: A Proof of Concept Study

2021 
Purpose Ex-vivo lung perfusion (EVLP) maintains marginal donor lungs at body temperature with ventilation and circulating perfusate, allowing for functional assessment prior to transplantation. Prolonged EVLP would allow for advanced time-dependent therapies for donor lung repair and reconditioning. We hypothesized that the addition of a dialysis machine to the EVLP circuit (dEVLP) would maintain homeostasis of the donor lung and prolong EVLP duration. Methods Porcine donor lungs (n=6) were extracted and placed on the EVLP platform for 36 hours or until termination criteria (dynamic compliance Results EVLP was prolonged in the dialysis group with a mean duration of EVLP reaching 30.83±0.57 h in the dEVLP group compared to 19.6±2.61 h in the historical control group (Fig 1D). Percent lung survival at 24h of perfusion was 100% in the dEVLP group, while only 20% was seen in historical controls (Fig 1B). Dialysis successfully prevented an increase in electrolyte levels (Fig 1C), maintained glucose and lactate levels at baseline (1C), and maintained physiological parameters (Fig 1D). Both lungs which survived to 36h of EVLP presented excellent lung function based on assessment by EVLP. Conclusion Dialysis may preserve lung function and length of EVLP by maintaining homeostasis of the lung. Following the results of this encouraging proof of concept study, a formal blinded experiment is underway.
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