Use Of Modified Custodiol-N As Perfusion Solution In Ex Vivo Lung Perfusion (Evlp)

Objectives: Ex vivo Lung Perfusion (EVLP) is a promising tool to increase the donor pool for lung transplantation. Custodiol-N solution was originally designed for organ preservation during cold static preservation (CSP) and was successfully used for machine perfusion in kidneys. It was the aim of this study to compare the lungfunctional outcomes after 4 hours of EVLP using modified Custodiol-N or STEEN Solution (TM) as perfusion solution. Methods: In a porcine DCD model, lungs were perfused either with STEEN Solution (TM) (Standard SS, n=8) or modified Custodiol-N with added 1.1 WI glucose monohydrate and 50 WI dextran 40 (CD, n=8). For a third group 7 WI albumin was supplemented to modified Custodiol-N (CDA, n=8). During four hours of EVLP pulmonary gas exchange and activities of lactate dehydrogenase (LDH) and alkaline phosphatase (AP) in perfusate were recorded. Results: Lungs that underwent EVLP with modified Custodiol-N showed significantly higher oxygen capacity (Delta pO(2) averaged over four hours of EVLP: SS: 236.28 +/- 47.26 mmHg, CD: 402.79 +/- 30.33 mmHg, CDA: 414.86 +/- 9.77 mmHg) than lungs perfused with STEEN Solution (TM). The addition of albumin did not have a significant effect on lung function but these lungs showed lower wet/dry ratio. Conclusion: In a porcine DCD model of 9 hours CSP followed by four hours of EVLP the use of modified Custodiol-N as perfusion solution was feasible and associated with higher oxygen capacity than STEEN Solution (TM). The addition of albumin seems to further stabilize lung function.