92 Donor Accidental Aspiration Injury – Can We Correct It by Ex-Vivo-Lung-Perfusion (EVLP)?

Purpose After establishing a porcine pulmonary aspiration injury model we evaluated reconditioning/treatment options during ex vivo lung perfusion. Methods and Materials After inducing aspiration injury lungs were perfused for 6 hrs in our ex-vivo lung perfusion circuit (leucocyte filter, heparin coated system, perfusate Steen solution + erythrocytes, Hb5mg/dl) according to standardized protocol. Three groups (n=7 each) were studied: Gr.1 reperfusion only, Gr.2 reperf.+extensive medical treatment incl. NO ventilation, Gr.3 like Gr.2+ATG. Respiratory and hemodynamic parameters were monitored pre-harvest and hourly during reperfusion. Pre- and postreperfusion wet-dry ratio was calculated, histology performed. Judgement of transplantability based on standard donor criteria plus evaluation of pulmonary deflation index (PDI) ≤2 (index grading 1-5; 1=normal to 5=macroscopic frothy edema). Results In Gr.1 one lung failed after 4hrs of reperfusion, while in Gr.2 and 3 all lungs were perfused for 6hrs. Compliance was equal in Gr.2 and 3 (59±8 vs. 59±13 ml/mbar), but significantly better than in Gr.1 (32±16 ml/mbar) at study end-point; PVR was lowest using ATG (1590±412 Gr.1 vs. 585±150 Gr.2 vs. 357±225 Gr.3 dynes). Pulmonary Oxygenation Capacity decreased in Gr.1 and remained stable in Gr.2/3 (172±115 Gr.1 vs. 383±45 Gr.2 vs. 322±57 mmHg Gr.3). Macroscopic evaluation revealed significantly better results in Gr.3 (PDI: 3.8±0.8 Gr.1 vs. 2.3±0.6 Gr.2 vs. 1.6±0.5 Gr.3). Histology and wet-dry ratio confirmed results. In Gr.1 all lungs failed transplantability criteria, in Gr.2 47% were transplantable, in Gr.3 using ATG even 86%. Conclusions Using appropriate medical treatment including ATG administration EVLP allows reversal even of pulmonary aspiration injury. After establishing a porcine pulmonary aspiration injury model we evaluated reconditioning/treatment options during ex vivo lung perfusion. After inducing aspiration injury lungs were perfused for 6 hrs in our ex-vivo lung perfusion circuit (leucocyte filter, heparin coated system, perfusate Steen solution + erythrocytes, Hb5mg/dl) according to standardized protocol. Three groups (n=7 each) were studied: Gr.1 reperfusion only, Gr.2 reperf.+extensive medical treatment incl. NO ventilation, Gr.3 like Gr.2+ATG. Respiratory and hemodynamic parameters were monitored pre-harvest and hourly during reperfusion. Pre- and postreperfusion wet-dry ratio was calculated, histology performed. Judgement of transplantability based on standard donor criteria plus evaluation of pulmonary deflation index (PDI) ≤2 (index grading 1-5; 1=normal to 5=macroscopic frothy edema). In Gr.1 one lung failed after 4hrs of reperfusion, while in Gr.2 and 3 all lungs were perfused for 6hrs. Compliance was equal in Gr.2 and 3 (59±8 vs. 59±13 ml/mbar), but significantly better than in Gr.1 (32±16 ml/mbar) at study end-point; PVR was lowest using ATG (1590±412 Gr.1 vs. 585±150 Gr.2 vs. 357±225 Gr.3 dynes). Pulmonary Oxygenation Capacity decreased in Gr.1 and remained stable in Gr.2/3 (172±115 Gr.1 vs. 383±45 Gr.2 vs. 322±57 mmHg Gr.3). Macroscopic evaluation revealed significantly better results in Gr.3 (PDI: 3.8±0.8 Gr.1 vs. 2.3±0.6 Gr.2 vs. 1.6±0.5 Gr.3). Histology and wet-dry ratio confirmed results. In Gr.1 all lungs failed transplantability criteria, in Gr.2 47% were transplantable, in Gr.3 using ATG even 86%. Using appropriate medical treatment including ATG administration EVLP allows reversal even of pulmonary aspiration injury.