Continuous Hemodialysis Does Not Improve Graft Function During Ex Vivo Lung Perfusion Over 24 Hours |
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| Affiliation: | 1. Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada;2. Mazankowski Alberta Heart Institute, Edmonton, AB, Canada;3. Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada;4. Alberta Transplant Institute, Edmonton, AB, Canada;5. Canadian National Transplant Research Program, Edmonton, AB, Canada;1. Department of Surgery, University of Virginia, Charlottesville, Virginia;2. Department of Pathology, University of Virginia, Charlottesville, Virginia;1. Department of Thoracic and Cardiovascular Surgery, Lerner Research Institute, Cleveland, Ohio;2. Department of Respiratory Medicine, Lerner Research Institute, Cleveland, Ohio;3. Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, Ohio;4. Transplant Center, Cleveland Clinic, Cleveland, Ohio;1. Department of Cardiothoracic Surgery, Sahlgrenska University Hospital;2. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy;3. Transplant Institute, Gothenburg, Sweden;4. Department of Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden;1. Department of Cardiovascular Sciences, Unit of Anesthesiology and Algology, Katholieke Universiteit Leuven, Leuven, Belgium;2. Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium;3. Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium;4. Department of Microbiology and Immunology, Unit of Virology and Chemotherapy (Rega Institute), Katholieke Universiteit Leuven, Leuven, Belgium;5. Department of Chronic Diseases, Metabolism and Ageing, Unit of Pneumology, Katholieke Universiteit Leuven, Leuven, Belgium;6. Department of Chronic Diseases, Metabolism and Ageing, Unit of Experimental Thoracic Surgery, Katholieke Universiteit Leuven, Leuven, Belgium;7. Leuven Lung Transplant Unit, Katholieke Universiteit Leuven, Leuven, Belgium;1. Department of Surgery, University of Virginia Health System, Charlottesville, Virginia;2. Department of Pathology, University of Virginia Health System, Charlottesville, Virginia;1. Laboratory for Experimental Thoracic Surgery, Department of Clinical and Experimental Medicine, KU Leuven University, Leuven, Belgium;2. Department of Thoracic Surgery, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy;3. Department of Anesthesia, University Hospitals Leuven, Leuven, Belgium;4. Department of Pathology, University Hospitals Leuven, Leuven, Belgium;5. Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium |
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| Abstract: | ![]()
BackgroundExtended periods of ex vivo lung perfusion (EVLP) lead to several inadvertent consequences including accumulation of lactate and increasing electrolyte concentrations in the perfusate. We sought to determine whether continuous hemodialysis (CHD) of the perfusate would be a suitable modality for improving ionic homeostasis in extended EVLP without compromising functional outcomes.MethodsTwelve porcine lungs were perfused using EVLP for 24 hours. All lungs were ventilated with negative pressure ventilation. Lungs in the treatment group (n = 6) underwent continuous hemodialysis of the perfusate. Functional parameters, edema formation, and histopathologic analysis were used to assess graft function. Electrolyte and lactate profiles were also followed to assess the efficiency of hemodialysis.ResultsLungs in both treatment and control groups demonstrated stable and acceptable oxygenation to 24 hours. Lungs demonstrated a decrease in compliance over time. There was no difference in oxygenation and compliance between groups. CHD-EVLP lungs had higher pulmonary vascular resistance and pulmonary artery pressures. Despite increased perfusion pressures, weight gain at both 11 and 23 hours was not different between groups. Perfusate sodium and lactate concentrations were significantly lower in the CHD-EVLP group.ConclusionThe addition of continuous hemodialysis to EVLP did not improve graft function up to 24 hours despite improved maintenance of perfusate composition. |
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