Strategies to Improve and Stabilize Extended Ex Vivo Lung Perfusion

Despite the success of lung transplantation to treat end-stage lung diseases, organ shortage remains to be a major limitation. The Toronto Ex vivo lung perfusion (EVLP) protocol has improved assessment of donor lungs and provides an unique platform to repair lungs, with the goal of expanding the organ pool and improving long-term outcomes. However, the use of the technique is limited to ~12h, which limits advances in therapeutic strategies. We sought to determine whether a continuous replacement strategy or a modified feed could be used to operate EVLP to preserve lung integrity for extended perfusion time(24h). During EVLP, pig lungs were subjected to Toronto protocol, continuous perfusate replacement, or modified feed. By using a clinically relevant swine model, here we report the use of continuous perfusate replacement during prolonged EVLP preserved lung integrity for 24h. The application of this operation in EVLP will allow for advanced therapeutic interventions currently not feasible.M.H.Sc