Transplant Trial Watch

Ex Vivo Perfusion Treatment of Infection in Human Donor Lungs.

Nakajima D, Cypel M, et al.

American Journal of Transplantation 2016; 16(4): 1229-1237.


Aims
To examine the effects of broad-spectrum antibiotic therapy on clinically diagnosed infected human donor lungs during extended ex vivo lung perfusion (EVLP).

Interventions
Lungs were randomly assigned to either receive EVLP performed with high-dose antibiotics (antibiotic group), or EVLP performed without antibiotics (control group).

Participants
15 human donor lungs that were declined for transplantation because of clinical concern regarding infection.

Outcomes
Measured outcomes included donor infections, histological features, EVLP perfusate concentrations, microorganisms, physiological lung function, EVLP perfusate endotoxin levels, and EVLP perfusate levels of cytokines, chemokines, and growth factors correlated with perfusate endotoxin.

Follow-up
12 hours

CET Conclusions
This novel study is one of the first trials attempting to deliver therapeutic intervention to organs during machine perfusion. The authors took 15 discarded lungs and randomised them to ex-vivo perfusion (EVLP) with or without high-dose antibiotics. They were able to demonstrate that antibiotic therapy not only reduced bacterial counts on BAL, but also reduced endotoxin release and improved oxygenation and compliance. These results open the interesting possibility that discarded lungs could be assessed and treated to enable transplantation. The lungs included in this study were not transplanted, meaning that it is uncertain how they would fare post-transplant. As the cold-ischaemic times were long, it is not clear whether similar benefits will be seen in lungs actually being considered for transplant. However, this is an exciting first step in ex-vivo organ manipulation with encouraging results supporting further investigation.

Jadad score
1

Data analysis
Per protocol analysis

Allocation concealment
No

Trial registration
None

Funding source
Non-industry funded