Development of a Novel Optimized BioEnvironment for proLonged (NOBEL) ex vivo lung preservation.

Current Ex Vivo Lung Perfusion (EVLP) systems are designed to support lungs outside of the body for up to 12 hours, allowing clinicians limited opportunity to assess organ function and viability prior to transplant. However, prolonged EVLP would allow for advanced time-dependent therapies such as immunomodulation, cell-based therapies and gene editing for donor lung repair and reconditioning. Therefore, we have developed a novel optimized bioenvironment for prolonged (NOBEL) EVLP to preserve a donor lung up to 30 hours. Three healthy swine donor lungs were used to optimize our NOBEL EVLP system. Several improvements over conventional blood-based EVLP protocols were used to prolong preservation including the following: (a) hypothermia to reduce metabolic waste and hemolysis, (b) dialysis to maintain pH, glucose and electrolyte levels at normal values, (c) proning using a biocompatible soft net lung support with axial lung rotation to reduce positional lung tissue damage, and (d) total parenteral nutrition to provide vital nutrients for cellular recovery. Our preliminary results show that these interventions were associated with improved lung oxygenation and gross morphology over that seen with a conventional EVLP protocol.