# Enhanced Donor Lung Viability During Prolonged Ex Vivo Lung Perfusion Using ECMO Technology

## TL;DR

This study explores using ECMO technology to improve donor lung viability during extended ex vivo perfusion, with promising results.

## Contribution

A mobile EVLP system using ECMO technology was developed and tested for prolonged lung preservation.

## Key findings

- Whole blood-based perfusate with ultrafiltration is efficient for lung preservation up to 24 hours.
- Cytokine removal significantly improved organ quality during prolonged EVLP.
- Bronchodilator application showed potential for enhancing lung function during perfusion.

## Abstract

The shortage of donor organs remains a significant obstacle to addressing the growing demand for lung transplantation. We have developed a mobile EVLP circuit utilizing extracorporeal membrane oxygenation (ECMO) technology. The goals of our study was to evaluate the safety of a cellular-based EVLP system and to assess the efficacy of continuous cytokine removal and the application of bronchodilators during prolonged EVLP. A total of 29 pigs, aged 6–18 months and weighing 93 ± 13.1 kg (mean ± SD), were used in the study. The lungs were randomly allocated into the following groups: Cytosorb group (n = 12), were perfused with an EVLP circuit containing a Cytosorb cartridge, and Control group (n = 12), where lungs were perfused with an EVLP circuit without a Cytosorb cartridge, Bronchodilator group (n = 5) consisted of lungs that were nebulized with a combined bronchodilator every 4 h after the initiation of ventilation and Control group (n = 5) inhaled the control solvent under the same settings. Our study demonstrates that whole blood based perfusate with continuous ultrafiltration for functioning lung in machine perfusion can be straightforward and efficient for at least 24 h. Additional cytokine removal had led to significant improvement of organ quality over 24 h of EVLP.

Diagram illustrating enhanced donor lung viability during prolonged ex vivo lung perfusion using ECMO technology. It shows four pig groups for various experiments, a ventilator system with reservoirs and oxygenators, and equipment like gas cylinders and hemofilters. Evaluations include CT scans, histology, and lung weight. Arrows indicate the process flow from lung procurement to organ evaluation.