The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026
Pulmonary-abdominal normothermic regional perfusion enables in situ lung evaluation in donation after circulatory death: A comparative study with conventional abdominal normothermic regional perfusion.
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Umeda Masashi, Tanaka Shin, Kondo Kaoru, Ryuko Tsuyoshi, Ujike Hiroyuki, Choshi Haruki, Kawana Shinichi, Yamamoto Haruchika, Nakajima Kumi, Torigoe Hidejiro, Mejía Lucas Hoyos, Campo-Cañaveral de la Cruz Jose Luis, Shien Kazuhiko, Suzawa Ken, Miyoshi Kentaroh, Ohara Toshiaki, Gómez-de-Antonio David, Okazaki Mikio, Sugimoto Seiichiro, Matsukawa Akihiro, Toyooka Shinichi
Аннотация
OBJECTIVE: In controlled donation after circulatory death (cDCD), normothermic regional perfusion (NRP) enables in situ assessment of abdominal organs, whereas donor lung evaluation remains limited and often relies on ex vivo lung perfusion. We developed a pulmonary-abdominal normothermic regional perfusion (PA-NRP) circuit that allows controlled pulmonary perfusion and ventilation during NRP. This study aimed to determine whether PA-NRP permits in situ lung assessment without compromising post-transplant lung function or abdominal organ integrity.
METHODS: Using a porcine cDCD model, donor-recipient pairs were assigned to PA-NRP (n = 5) or conventional abdominal NRP (A-NRP; n = 4). After 30 min of warm ischemia, NRP was maintained for 2 hours. In the PA-NRP group, lungs were ventilated and perfused during NRP, whereas in the A-NRP group, lungs were retrieved without pulmonary reperfusion. Orthotopic single left lung transplantation was performed, followed by a 4-hour post-transplant evaluation. Hepatic and renal injury during NRP was evaluated histologically using Suzuki and EGTI scoring systems.
RESULTS: Post-transplant oxygenation, dynamic lung compliance, pulmonary vascular resistance, and wet-to-dry weight ratios were comparable between the PA-NRP and A-NRP groups. Histological lung injury scores did not differ between groups. Hepatic and renal histological injury scores were similar between groups.
CONCLUSIONS: PA-NRP enables controlled in situ lung perfusion and assessment while preserving abdominal organ integrity and achieving post-transplant lung outcomes comparable to conventional recovery. This integrated approach may provide an in situ lung evaluation platform during cDCD procurement, particularly in settings where ex vivo lung perfusion is unavailable or logistically impractical.
METHODS: Using a porcine cDCD model, donor-recipient pairs were assigned to PA-NRP (n = 5) or conventional abdominal NRP (A-NRP; n = 4). After 30 min of warm ischemia, NRP was maintained for 2 hours. In the PA-NRP group, lungs were ventilated and perfused during NRP, whereas in the A-NRP group, lungs were retrieved without pulmonary reperfusion. Orthotopic single left lung transplantation was performed, followed by a 4-hour post-transplant evaluation. Hepatic and renal injury during NRP was evaluated histologically using Suzuki and EGTI scoring systems.
RESULTS: Post-transplant oxygenation, dynamic lung compliance, pulmonary vascular resistance, and wet-to-dry weight ratios were comparable between the PA-NRP and A-NRP groups. Histological lung injury scores did not differ between groups. Hepatic and renal histological injury scores were similar between groups.
CONCLUSIONS: PA-NRP enables controlled in situ lung perfusion and assessment while preserving abdominal organ integrity and achieving post-transplant lung outcomes comparable to conventional recovery. This integrated approach may provide an in situ lung evaluation platform during cDCD procurement, particularly in settings where ex vivo lung perfusion is unavailable or logistically impractical.