Keep your lungs warm
The cooled donor lungs were offered to be warmed up by six degrees
Anastasia Kuznetsova-Fantoni, N+1
Canadian transplant specialists suggested storing donor lungs at a temperature of 10 degrees Celsius, rather than according to the standard protocol at 4 degrees Celsius. Doctors conducted experiments with the lungs of pigs and it turned out that the organs that were stored at a higher temperature are more elastic and provide better oxygenation. Also, the lungs that were at a temperature of 10 degrees Celsius before transplantation were successfully transplanted to five patients. The work was published in Science Translational Medicine (Ali et al., Static lung storage at 10°C maintains mitochondrial health and preserves donor organ function).
Donor organs are stored in a preservative solution at a temperature of 4 degrees Celsius until the moment of transplantation. During such hypothermia, the metabolic rate of cells decreases, but at the same time the function of mitochondria suffers. Transplantologists strive to maintain a balance between slow metabolism and maintaining mitochondrial function, so they considered 4 degrees the optimal temperature.
Thirty years ago, scientists proposed to increase the storage temperature of donor lungs to 10 degrees Celsius, but this method was not used in clinical practice due to the fear of doctors to harm the organs. In addition, previous studies could not explain why the lungs are stored better at 10 degrees Celsius than at 4 degrees Celsius.
Transplantologists led by Marcelo Cypel from The University of Toronto decided to repeat the experiments of their colleagues. At first, they observed how pig lungs are stored at different temperatures. In the first group, the lungs were at 4 degrees Celsius, and in the second – at 10 degrees Celsius. After 36 hours, the scientists assessed the condition of the organs using a standard procedure used by surgeons to look at the condition of the lungs before transplantation. It turned out that organs that were stored at a higher temperature were more elastic (p<0.0001) and provided better oxygenation (p<0.0001).
To assess the function of mitochondria, doctors used PCR to calculate the amount of extracellular mitochondrial DNA that is released from cells under stressful conditions. In the lungs stored at 4 degrees Celsius, the amount of extracellular mitochondrial DNA was much higher than in the lungs stored at 10 degrees Celsius (p<0.05). In addition, in the lungs stored at a lower temperature, the concentration of pro-inflammatory cytokines was increased: interleukin-1-beta and interleukin-8 (p<0.05).
Drawings from the article by Ali et al.
After experimenting with the lungs of pigs, doctors received permission to transplant donor lungs stored at 10 degrees Celsius until the moment of transplantation. Transplantation was performed on five patients. At 10 degrees Celsius, the lungs were on average for 10.4 hours. After the operation, the patients had no serious complications, and on average they were discharged home after 17 days. The average discharge time after a lung transplant at the University of Toronto Hospital before that was more – 26 days.
Transplantologists concluded that finding the lungs at 10 degrees until the moment of transplantation, apparently, is more beneficial for the preservation of their functions. The doctors also added that the new technique can allow even organs in an imperfect condition to be transplanted, which previously would have been regarded as unsuitable for transplantation.
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