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Ischemia-Reperfusion Injury in Lung Transplantation. Cells 2021; 10:cells10061333. [PMID: 34071255 PMCID: PMC8228304 DOI: 10.3390/cells10061333] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 02/08/2023] Open
Abstract
Lung transplantation has been established worldwide as the last treatment for end-stage respiratory failure. However, ischemia–reperfusion injury (IRI) inevitably occurs after lung transplantation. The most severe form of IRI leads to primary graft failure, which is an important cause of morbidity and mortality after lung transplantation. IRI may also induce rejection, which is the main cause of mortality in recipients. Despite advances in donor management and graft preservation, most donor grafts are still unsuitable for transplantation. Although the pulmonary endothelium is the primary target site of IRI, the pathophysiology of lung IRI remains incompletely understood. It is essential to understand the mechanism of pulmonary IRI to improve the outcomes of lung transplantation. Therefore, we reviewed the state-of-the-art in the management of pulmonary IRI after lung transplantation. Recently, the ex vivo lung perfusion (EVLP) system has been clinically introduced worldwide. Various promising therapeutic strategies for the protection of the endothelium against IRI, including EVLP, inhalation therapy with therapeutic gases and substances, fibrinolytic treatment, and mesenchymal stromal cell therapy, are awaiting clinical application. We herein review the latest advances in the field of pulmonary IRI in lung transplantation.
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Abstract
Because of the high demand of organs, the usage of marginal grafts has increased. These marginal organs have a higher risk of developing ischemia-reperfusion injury, which can lead to posttransplant complications. Ex situ machine perfusion (MP), compared with the traditional static cold storage, may better protect these organs from ischemia-reperfusion injury. In addition, MP can also act as a platform for dynamic administration of pharmacological agents or gene therapy to further improve transplant outcomes. Numerous therapeutic agents have been studied under both hypothermic (1-8°C) and normothermic settings. Here, we review all the therapeutics used during MP in different organ systems (lung, liver, kidney, heart). The major categories of therapeutic agents include vasodilators, mesenchymal stem cells, antiinflammatory agents, antiinfection agents, siRNA, and defatting agents. Numerous animal and clinical studies have examined MP therapeutic agents, some of which have even led to the successful reconditioning of discarded grafts. More clinical studies, especially randomized controlled trials, will need to be conducted in the future to solidify these promising results and to define the role of MP therapeutic agents in solid organ transplantation.
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Jin Z, Suen KC, Wang Z, Ma D. Review 2: Primary graft dysfunction after lung transplant-pathophysiology, clinical considerations and therapeutic targets. J Anesth 2020; 34:729-740. [PMID: 32691226 PMCID: PMC7369472 DOI: 10.1007/s00540-020-02823-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 07/04/2020] [Indexed: 12/13/2022]
Abstract
Primary graft dysfunction (PGD) is one of the most common complications in the early postoperative period and is the most common cause of death in the first postoperative month. The underlying pathophysiology is thought to be the ischaemia–reperfusion injury that occurs during the storage and reperfusion of the lung engraftment; this triggers a cascade of pathological changes, which result in pulmonary vascular dysfunction and loss of the normal alveolar architecture. There are a number of surgical and anaesthetic factors which may be related to the development of PGD. To date, although treatment options for PGD are limited, there are several promising experimental therapeutic targets. In this review, we will discuss the pathophysiology, clinical management and potential therapeutic targets of PGD.
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Affiliation(s)
- Zhaosheng Jin
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Ka Chun Suen
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Zhiping Wang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Daqing Ma
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH, UK.
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Kayawake H, Chen-Yoshikawa TF, Saito M, Yamagishi H, Yoshizawa A, Hirano SI, Kurokawa R, Date H. Protective Effects of a Hydrogen-Rich Preservation Solution in a Canine Lung Transplantation Model. Ann Thorac Surg 2020; 111:246-252. [PMID: 32649946 DOI: 10.1016/j.athoracsur.2020.05.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/17/2020] [Accepted: 05/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Molecular hydrogen (H2) has protective effects against ischemia-reperfusion injury in various organs. Because they are easier to transport and safer to use than inhaled H2, H2-rich solutions are suitable for organ preservation. In this study, we examined the protective effects of an H2-rich solution for lung preservation in a canine left lung transplantation (LTx) model. METHODS Ten beagles underwent orthotopic left LTx after 23 hours of cold ischemia followed by reperfusion for 4 hours. Forty-five minutes after reperfusion, the right main pulmonary artery was clamped to evaluate the function of the implanted graft. The beagles were divided into two groups: control group (n = 5), and H2 group (n = 5). In the control group, the donor lungs were flushed and immersed during cold preservation at 4°C using ET-Kyoto solution, and in the H2 group, these were flushed and immersed using H2-rich ET-Kyoto solution. Physiologic assessments were performed during reperfusion. After reperfusion, the wet-to-dry ratios were determined, and histology examinations were performed. RESULTS Significantly higher partial pressure of arterial oxygen and significantly lower partial pressure of carbon dioxide were observed in the H2 group than in the control group (P = .045 and P < .001, respectively). The wet-to-dry ratio was significantly lower in the H2 group than in the control group (P = .032). Moreover, in histology examination, less lung injury and fewer apoptotic cells were observed in the H2 group (P < .001 and P < .001, respectively). CONCLUSIONS Our results demonstrated that the H2-rich preservation solution attenuated ischemia-reperfusion injury in a canine left LTx model.
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Affiliation(s)
- Hidenao Kayawake
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Masao Saito
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Thoracic Surgery, Shimada Municipal Hospital, Shimada, Japan
| | - Hiroya Yamagishi
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | | | | | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Spratt JR, Mattison LM, Kerns NK, Huddleston SJ, Meyer L, Iles TL, Loor G, Iaizzo PA. Prolonged extracorporeal preservation and evaluation of human lungs with portable normothermic ex vivo perfusion. Clin Transplant 2020; 34:e13801. [DOI: 10.1111/ctr.13801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/24/2020] [Indexed: 01/16/2023]
Affiliation(s)
- John R. Spratt
- Department of Surgery University of Minnesota Minneapolis Minnesota
| | - Lars M. Mattison
- Department of Surgery University of Minnesota Minneapolis Minnesota
- Department of Biomedical Engineering University of Minnesota Minneapolis Minnesota
| | - Natalie K. Kerns
- Division of Cardiothoracic Surgery Department of Surgery University of Minnesota Minneapolis Minnesota
| | - Stephen J. Huddleston
- Division of Cardiothoracic Surgery Department of Surgery University of Minnesota Minneapolis Minnesota
| | | | - Tinen L. Iles
- Department of Surgery University of Minnesota Minneapolis Minnesota
| | - Gabriel Loor
- Division of Cardiothoracic Surgery Department of Surgery University of Minnesota Minneapolis Minnesota
- Division of Cardiothoracic Transplantation and Circulatory Support Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston Texas
| | - Paul A. Iaizzo
- Department of Surgery University of Minnesota Minneapolis Minnesota
- Department of Biomedical Engineering University of Minnesota Minneapolis Minnesota
- Institute for Engineering in Medicine University of Minnesota Minneapolis Minnesota
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Spratt JR, Mattison LM, Iaizzo PA, Meyer C, Brown RZ, Iles T, Panoskaltsis-Mortari A, Loor G. Lung transplant after prolonged ex vivo
lung perfusion: predictors of allograft function in swine. Transpl Int 2018; 31:1405-1417. [DOI: 10.1111/tri.13315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/06/2018] [Accepted: 07/04/2018] [Indexed: 12/11/2022]
Affiliation(s)
- John R. Spratt
- Department of Surgery; University of Minnesota; Minneapolis MN USA
| | - Lars M. Mattison
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
| | - Paul A. Iaizzo
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
- Department of Integrative Biology and Physiology; University of Minnesota; Minneapolis MN USA
- Institute for Engineering in Medicine; University of Minnesota; Minneapolis MN USA
| | - Carolyn Meyer
- Department of Pediatrics; University of Minnesota; Minneapolis MN USA
- Department of Medicine; University of Minnesota; Minneapolis MN USA
- Masonic Cancer Center; University of Minnesota; Minneapolis MN USA
| | - Roland Z. Brown
- Division of Biostatistics; University of Minnesota; Minneapolis MN USA
| | - Tinen Iles
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
| | - Angela Panoskaltsis-Mortari
- Department of Pediatrics; University of Minnesota; Minneapolis MN USA
- Department of Medicine; University of Minnesota; Minneapolis MN USA
- Masonic Cancer Center; University of Minnesota; Minneapolis MN USA
| | - Gabriel Loor
- Division of Cardiothoracic Surgery; Department of Surgery; University of Minnesota; Minneapolis MN USA
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Rosso L, Zanella A, Righi I, Barilani M, Lazzari L, Scotti E, Gori F, Mendogni P. Lung transplantation, ex-vivo reconditioning and regeneration: state of the art and perspectives. J Thorac Dis 2018; 10:S2423-S2430. [PMID: 30123580 DOI: 10.21037/jtd.2018.04.151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Lung transplantation is the only therapeutic option for end-stage pulmonary failure. Nevertheless, the shortage of donor pool available for transplantation does not allow to satisfy the requests, thus the mortality on the waiting list remains high. One of the tools to overcome the donor pool shortage is the use of ex-vivo lung perfusion (EVLP) to preserve, evaluate and recondition selected lung grafts not otherwise suitable for transplantation. EVLP is nowadays a clinical reality and have several destinations of use. After a narrative review of the literature and looking at our experience we can assume that one of the chances to improve the outcome of lung transplantation and to overcome the donor pool shortage could be the tissue regeneration of the graft during EVLP and the immunomodulation of the recipient. Both these strategies are performed using mesenchymal stem cells (MSC). The results of the models of lung perfusion with MSC-based cell therapy open the way to a new innovative approach that further increases the potential for using of the lung perfusion platform.
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Affiliation(s)
- Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alberto Zanella
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Righi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mario Barilani
- Unit of Regenerative Medicine-Cell Factory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,EPIGET LAB, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Lorenza Lazzari
- Unit of Regenerative Medicine-Cell Factory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Scotti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesca Gori
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Spratt JR, Mattison LM, Iaizzo PA, Brown RZ, Helms H, Iles TL, Howard B, Panoskaltsis-Mortari A, Loor G. An experimental study of the recovery of injured porcine lungs with prolonged normothermic cellularex vivolung perfusion following donation after circulatory death. Transpl Int 2017; 30:932-944. [DOI: 10.1111/tri.12981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/31/2017] [Accepted: 05/05/2017] [Indexed: 12/14/2022]
Affiliation(s)
- John R. Spratt
- Department of Surgery; University of Minnesota; Minneapolis MN USA
| | - Lars M. Mattison
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
| | - Paul A. Iaizzo
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
- Department of Integrative Biology and Physiology; University of Minnesota; Minneapolis MN USA
- Institute for Engineering in Medicine; University of Minnesota; Minneapolis MN USA
| | - Roland Z. Brown
- Division of Biostatistics; University of Minnesota; Minneapolis MN USA
| | - Haylie Helms
- Department of Pediatrics; University of Minnesota; Minneapolis MN USA
- Department of Medicine; University of Minnesota; Minneapolis MN USA
- Masonic Cancer Center; University of Minnesota; Minneapolis MN USA
| | - Tinen L. Iles
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
| | - Brian Howard
- Department of Surgery; University of Minnesota; Minneapolis MN USA
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
| | - Angela Panoskaltsis-Mortari
- Department of Pediatrics; University of Minnesota; Minneapolis MN USA
- Department of Medicine; University of Minnesota; Minneapolis MN USA
- Masonic Cancer Center; University of Minnesota; Minneapolis MN USA
| | - Gabriel Loor
- Division of Cardiothoracic Surgery; Department of Surgery; University of Minnesota; Minneapolis MN USA
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β2-Adrenoreceptor Agonist Inhalation During Ex Vivo Lung Perfusion Attenuates Lung Injury. Ann Thorac Surg 2015; 100:480-6. [DOI: 10.1016/j.athoracsur.2015.02.136] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 01/30/2015] [Accepted: 02/10/2015] [Indexed: 11/22/2022]
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Protective effect of surfactant inhalation against warm ischemic injury in an isolated rat lung ventilation model. PLoS One 2013; 8:e72574. [PMID: 24009692 PMCID: PMC3757025 DOI: 10.1371/journal.pone.0072574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/09/2013] [Indexed: 12/29/2022] Open
Abstract
Warm ischemia-reperfusion injury remains a crucial issue in transplantation following the cardiac death of donors. Previously, we showed that surfactant inhalation during warm ischemia mitigated ischemia-reperfusion injury. This study investigated the mechanisms of surfactant inhalation protection of the warm ischemic lung after reoxygenation with ventilation alone. In an isolated rat lung ventilation model, cardiac arrest was induced in the CTRL (control) and SURF (surfactant treatment) groups by ventricular fibrillation. Ventilation was restarted 110 min later; the lungs were flushed, and a heart and lung block was procured. In the SURF group, a natural bovine surfactant (Surfacten®) was inhaled for 3 min at the end of warm ischemia. In the Sham (no ischemia) group, lungs were flushed, procured, and ventilated in the same way. Afterwards, the lungs were ventilated with room air without reperfusion for 60 min. Surfactant inhalation significantly improved dynamic compliance and airway resistance. Moreover, surfactant inhalation significantly decreased inducible nitric oxide synthase and caspase-3 transcript levels, and increased those of Bcl-2 and surfactant protein-C. Immunohistochemically, lungs in the SURF group showed weaker staining for 8-hydroxy-2′-deoxyguanosine, inducible nitric oxide synthase, and apoptosis, and stronger staining for Bcl-2 and surfactant protein-C. Our results indicate that surfactant inhalation in the last phase of warm ischemia mitigated the injury resulting from reoxygenation after warm ischemia. The reduction in oxidative damage and the inhibition of apoptosis might contribute to the protection of the warm ischemic lungs.
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Current world literature. Curr Opin Allergy Clin Immunol 2013; 13:119-24. [PMID: 23242117 DOI: 10.1097/aci.0b013e32835cb509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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