Treatment of transplanted lungs
In conditions of shortage of organs for transplantation, research aimed at improving the quality of donor organs is relevant. In Sweden, almost 70% of donor lungs are unsuitable for transplantation due to acute respiratory distress syndrome developing in them. In addition, the mortality rate is high, and about half of patients die within five years after transplantation.
Researchers from Lund University in Sweden and Skåne University Hospital have tested a new way to improve the quality of donor lungs on large animals. They have also launched a pilot clinical trial.
Acute respiratory distress syndrome (ARDS) is a massive inflammation, one of the links of which is the abundant accumulation of cytokines and other pro-inflammatory proteins in the lungs. In a study on pigs, the group studied the effects of lowering the level of cytokines in the lungs. To do this, scientists induced ARDS of mild and moderate severity in 16 donor pigs. The lungs were then placed in an ex vivo pulmonary perfusion machine (EVLP) with or without cytokine adsorption and/or after transplantation using extracorporeal hemoperfusion.
a. The left lung of each donor animal was removed after ARDS confirmation and then placed in an EVLP machine. The recipient was monitored for 48 hours after the transplantation of the left lung, and after 44 hours the right lung of the recipients was removed for isolated monitoring of the transplanted lung.
b. Adsorption of cytokines during EVLP. The ventilator (a) was connected to the lungs in the dome (b). The perfusate flow was directed to the reservoir (c), which was fed to the cytokine adsorber (d), and then the adsorbed perfusate was fed back to the reservoir. Further, the flow continued in accordance with the established methodology using a pump (e) into a deoxygenator (h), a gas mixture source (f) and a heater (g). After the leukocyte filter (i), the perfusate returned to the lungs.
c. Adjustment of cytokine adsorption after transplantation. A hemodialysis catheter was inserted into the jugular vein of the animals, and the flow passed through the pump (a) and the cytokine adsorber (b), and then returned to the bloodstream.
The researchers noted the restoration of lung function due to a decrease in cytokine levels. In addition, the number of complications during the first 48 hours after transplantation decreased.
From 50 to 60 lung transplants are performed annually at the Skåne University Hospital in Lund and the Salgrenska University Hospital in Gothenburg. It is hoped that this number will increase thanks to a new method of improving the quality of donor organs.
Researchers have launched a pilot clinical trial at the University Hospital of Skåne in Lund. It is planned to perform 20 lung transplants, half of the donor organs will undergo a cytokine reduction procedure, and the rest will be treated in the usual way. In case of a positive result, the study will be expanded to 120 transplants in various institutions in Sweden.
Article by H.Ghaidan et al. Reduction of primary graft dysfunction using cytokine adsorption during organ preservation and after lung transplantation is published in the journal Nature Communications.
Aminat Adzhieva, portal "Eternal Youth" http://vechnayamolodost.ru based on the materials of Lund University: New treatment could result in more donor lungs.