Effects of ventilation during warm ischaemia followed by ex-vivo lung perfusion in a sheep model
4 affiliations
- 1Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM-11), Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
- 2Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 3Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 4Department of Thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Abstract
Introduction: Uncontrolled Donation after Circulatory Death (uDCD) has been considered an alternative to expand the lung donor pool. A key variable in these procedures is whether ventilation is maintained during the ischaemic interval. The present study evaluated the impact of ventilation during warm ischaemia in ovine DCD lungs, followed by functional assessment through Ex Vivo Lung Perfusion (EVLP).
Methods: Ovine lungs were procured from a local slaughterhouse and flushed in situ. Lungs were then assigned to two groups: Ventilated (V) or Non-Ventilated (NV) during 120-minutes of warm ischaemia (WI), followed by 120-minutes of cold storage. EVLP was conducted for 240-minutes using a low-flow strategy, pressure-controlled ventilation, and a custom-made perfusion solution. Lung biopsies and perfusate samples were collected. Histopathological evaluation was performed; ventilatory and perfusion parameters were monitored.
Results: After 240-min of EVLP, both groups presented an increase in the compliance (Cdyn) (p = 0.0001), pO2 (p = 0.0047), pCO2 (p = 0.0155), and lactate (p = 0.0001), without differences between the groups. Histopathology analysis indicated that haemorrhage after WI was higher in NV (p < 0.001) than V. Inflammatory cytokines gene expression was increased in V vs. NV at the end-EVLP, but no differences were seen, 24h later.
Discussion: Ventilation did not confer a clear advantage in the functional status of the lungs after EVLP and may even be associated with transient increases in inflammatory and apoptotic responses. These findings suggest that immediate inflation alone may be sufficient to preserve graft quality prior to transplantation, and that preservation strategies should not primarily focus on mechanical ventilation.
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BibTeX
@article{ramos2026effects,
title = {{Effects of ventilation during warm ischaemia followed by ex-vivo lung perfusion in a sheep model}},
author = {Mayara Munhoz de Assis Ramos and Marina Vidal-dos-Santos and Shuqi Yang and Dominique Koerts and Michiel Hu and Roland Hoffmann and Luiz Felipe Pinho Moreira and Michiel Erasmus and Gertrude J. Nieuwenhuijs-Moeke and Ana Cristina Breithaupt-Faloppa and Henri G.D. Leuvenink},
journal = {Clinics},
year = {2026},
month = oct,
doi = {10.1016/j.clinsp.2026.101104},
url = {https://doi.org/10.1016/j.clinsp.2026.101104},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effects of ventilation during warm ischaemia followed by ex-vivo lung perfusion in a sheep model
AU - Mayara Munhoz de Assis Ramos
AU - Marina Vidal-dos-Santos
AU - Shuqi Yang
AU - Dominique Koerts
AU - Michiel Hu
AU - Roland Hoffmann
AU - Luiz Felipe Pinho Moreira
AU - Michiel Erasmus
AU - Gertrude J. Nieuwenhuijs-Moeke
AU - Ana Cristina Breithaupt-Faloppa
AU - Henri G.D. Leuvenink
PY - 2026
DA - 2026/10/23
JO - Clinics
DO - 10.1016/j.clinsp.2026.101104
UR - https://doi.org/10.1016/j.clinsp.2026.101104
AB - Introduction: Uncontrolled Donation after Circulatory Death (uDCD) has been considered an alternative to expand the lung donor pool. A key variable in these procedures is whether ventilation is maintained during the ischaemic interval. The present study evaluated the impact of ventilation during warm ischaemia in ovine DCD lungs, followed by functional assessment through Ex Vivo Lung Perfusion (EVLP). Methods: Ovine lungs were procured from a local slaughterhouse and flushed in situ. Lungs were then assigned to two groups: Ventilated (V) or Non-Ventilated (NV) during 120-minutes of warm ischaemia (WI), followed by 120-minutes of cold storage. EVLP was conducted for 240-minutes using a low-flow strategy, pressure-controlled ventilation, and a custom-made perfusion solution. Lung biopsies and perfusate samples were collected. Histopathological evaluation was performed; ventilatory and perfusion parameters were monitored. Results: After 240-min of EVLP, both groups presented an increase in the compliance (Cdyn) (p = 0.0001), pO2 (p = 0.0047), pCO2 (p = 0.0155), and lactate (p = 0.0001), without differences between the groups. Histopathology analysis indicated that haemorrhage after WI was higher in NV (p < 0.001) than V. Inflammatory cytokines gene expression was increased in V vs. NV at the end-EVLP, but no differences were seen, 24h later. Discussion: Ventilation did not confer a clear advantage in the functional status of the lungs after EVLP and may even be associated with transient increases in inflammatory and apoptotic responses. These findings suggest that immediate inflation alone may be sufficient to preserve graft quality prior to transplantation, and that preservation strategies should not primarily focus on mechanical ventilation.
SN - 1807-5932
SN - 1980-5322
ER -