Literature Database
Reduction of primary graft dysfunction using cytokine adsorption during organ preservation and after lung transplantation
Ghaidan H, Stenli M, Niroomand A, Mittendorfer M, Hirdman G, Gvazava N, Edström D, Silva IAN, Broberg E, Hallgren O, Olm F, Wagner DE, Pierre L, Hyllén S, Lindstedt S. Nature Communications 2022; 13:4173
07/27/2022
New!Peer Reviewed Published DataSafetyTransplantImprov. resp functionAnimal modelsARDSExperimental setupInflammatory parameters
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Summary
Despite improvements, lung transplantation for end-stage disease remains hampered by both a scarcity of donor organs and by mortality following primary graft dysfunction (PGD). Since acute respiratory distress syndrome (ARDS) limits donor lung utilization, this study investigated the use of CytoSorb cytokine adsorption as a means of treating ARDS donor lungs. Ex-vivo lung perfusion (EVLP) was used to assess the donor lungs. Mild to moderate ARDS was induced via lipopolysaccharide (LPS) in 16 donor pigs. The non-treated group received EVLP and underwent transplantation without cytokine adsorption. The treated groups were subdivided between a ‘two step’ group (lungs were treated with CytoSorb both during EVLP (4 hours) and for 12 hours post transplantation) and a ‘one step’ group (use of CytoSorb only for 12 hrs postop). The primary endpoint of lung function was the PaO2/FiO2 ratio. Results showed that treatment with CytoSorb significantly decreased cytokine levels during EVLP and decreased levels of immune cells post-transplantation. Histology demonstrated fewer signs of lung injury across both treatment periods and the incidence of PGD was significantly reduced among treated animals. The effects of CytoSorb seemed to increase when used at two times points. In summary, CytoSorb cytokine adsorption in the context of ARDS injured lungs (i) reduced inflammation and restored pulmonary function during EVLP, (ii) restored pulmonary function and decreased inflammation following transplantation, and (iii) reduced the incidence of PGD in transplanted recipients. The authors suggest this treatment will increase the availability of donor lungs and increase the tolerability of donor lungs in the recipient.
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