Toronto Lung Transplant Program and Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, ON, Canada.
J Heart Lung Transplant. 2021 Jul;40(7):687-695. doi: 10.1016/j.healun.2021.03.002. Epub 2021 Mar 5.
Ex vivo lung perfusion (EVLP) is an isolated organ assessment technique that has revolutionized the field of lung transplantation and enabled a safe increase in the number of organs transplanted. The objective of this study was to develop a protein-based assay that would provide a precision medicine approach to lung injury assessment during EVLP.
Perfusate samples collected from clinical EVLP cases performed from 2009 to 2019 were separated into development (n = 281) and validation (n = 57) sets to derive and validate an inflammation score based on IL-6 and IL-8 protein levels in perfusate. The ability of an inflammation score to predict lungs suitable for transplantation and likely to produce excellent recipient outcomes (time on ventilator ≤ 3 days) was assessed. Inflammation scores were compared to conventional clinical EVLP assessment parameters and associated with outcomes, including primary graft dysfunction and patient care in the ICU.
An inflammation score accurately predicted the decision to transplant (AUROC 68% [95% CI 62-74]) at the end of EVLP and those transplants associated with short ventilator times (AUROC 73% [95% CI 66-80]). The score identified lungs more likely to develop primary graft dysfunction at 72-hours post-transplant (OR 4.0, p = 0.03). A model comprised of the inflammation score and ∆PO was able to determine EVLP transplants that were likely to have excellent recipient outcomes, with an accuracy of 87% [95% CI 83-92].
The adoption of an inflammation score will improve accuracy of EVLP decision-making and increase confidence of surgical teams to determine lungs that are suitable for transplantation, thereby improving organ utilization rates and patient outcomes.
离体肺灌注（EVLP）是一种评估器官的技术，它彻底改变了肺移植领域，使可移植器官的数量安全增加。本研究的目的是开发一种基于蛋白质的检测方法，为 EVLP 期间的肺损伤评估提供精准医疗方法。
将 2009 年至 2019 年进行的临床 EVLP 病例中的灌流液样本分为开发（n=281）和验证（n=57）两组，以得出并验证基于灌流液中白细胞介素-6（IL-6）和白细胞介素-8（IL-8）蛋白水平的炎症评分。评估炎症评分预测适合移植的肺和可能产生良好受者结局（呼吸机使用时间≤3 天）的能力。将炎症评分与传统的 EVLP 临床评估参数进行比较，并与包括原发性移植物功能障碍和 ICU 内患者护理在内的结局相关联。
炎症评分准确预测了 EVLP 结束时的移植决策（AUROC 68%[95%CI 62-74%]）和与呼吸机使用时间短相关的移植（AUROC 73%[95%CI 66-80%]）。该评分识别出更有可能在移植后 72 小时发生原发性移植物功能障碍的肺（OR 4.0，p=0.03）。由炎症评分和∆PO 组成的模型能够确定 EVLP 移植后受者具有良好结局的可能性，准确率为 87%[95%CI 83-92%]。
采用炎症评分将提高 EVLP 决策的准确性，并增强手术团队确定适合移植的肺的信心，从而提高器官利用率和患者结局。
