Department of Thoracic and Cardiovascular Surgery, Division of Thoracic Transplantation, West German Heart Center, University Hospital Essen, Essen, Germany.
Department of Cardiothoracic Surgery, Center of Cardiology, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany.
Int J Artif Organs. 2022 Feb;45(2):162-173. doi: 10.1177/0391398821990663. Epub 2021 Feb 2.
Ex vivo lung perfusion (EVLP) is an established technique to evaluate and eventually recondition lungs prior to transplantation. Custodiol-MP (C-MP) solution is a new solution, designed for clinical machine perfusion, that has been used for kidneys. The aim of this study was to compare the effects of EVLP with Custodiol-MP on lung functional outcomes to the gold standard of EVLP with Steen Solution™.
In a porcine EVLP model of DCDD (Donation after Circulatory Determination of Death), lungs were perfused with Steen Solution™ (SS, = 7) or Custodiol-MP solution supplemented with 55 g/l albumin (C-MP, = 8). Lungs were stored cold for 4 h in low potassium dextran solution and subsequently perfused ex vivo for 4 h. During EVLP pulmonary gas exchange, activities of lactate dehydrogenase (LDH) and alkaline phosphatase (AP) as well as levels of lactate in the perfusate were recorded hourly.
Oxygenation capacity differed significantly between groups (averaged over 4 h: SS 274 ± 178 mmHg; C-MP 284 ± 151 mmHg = 0.025). Lactate dehydrogenase activities and lactate concentrations were significantly lower in Custodiol-MP perfused lungs.In a porcine model of DCDD with 4 h of EVLP the use of modified Custodiol-MP as perfusion solution was feasible. The use of C-MP showed at least comparable lung functional outcomes to the use of Steen Solution. Furthermore C-MP perfusion resulted in significantly lower lactate dehydrogenase activity and lactate levels in the perfusate and higher oxygenation capacity.
体外肺灌注（EVLP）是一种评估肺脏并在移植前对其进行再处理的成熟技术。Custodiol-MP（C-MP）溶液是一种新的用于临床机器灌注的溶液，已用于肾脏。本研究的目的是比较 EVLP 中使用 Custodiol-MP 与使用 Steen Solution™的 EVLP 对肺功能结果的影响，Steen Solution™是金标准。
在 DCDD（循环确定死亡后的捐赠）的猪 EVLP 模型中，用 Steen Solution™（SS，n=7）或添加 55g/l 白蛋白的 Custodiol-MP 溶液（C-MP，n=8）进行灌注。肺在低钾右旋糖酐溶液中冷储存 4 小时，然后进行体外灌注 4 小时。在 EVLP 期间，每小时记录肺气体交换、乳酸脱氢酶（LDH）和碱性磷酸酶（AP）的活性以及灌流液中的乳酸水平。
两组间氧合能力有显著差异（4 小时平均值：SS 274±178mmHg；C-MP 284±151mmHg = 0.025）。Custodiol-MP 灌注肺中乳酸脱氢酶活性和乳酸浓度明显较低。在 4 小时 EVLP 的 DCDD 猪模型中，使用改良的 Custodiol-MP 作为灌注溶液是可行的。C-MP 的使用显示出至少与 Steen Solution 相当的肺功能结果。此外，C-MP 灌注导致灌流液中的乳酸脱氢酶活性和乳酸水平显著降低，氧合能力更高。
