Kinetics of lactate metabolism during acellular normothermic ex vivo lung perfusion

Terumoto Koike, Jonathan C. Yeung, Marcelo Cypel, Matthew Rubacha, Yasushi Matsuda, Masaaki Sato, Thomas K. Waddell, Mingyao Liu, Shaf Keshavjee

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: Plasma lactate has been used as a marker of poor prognosis in clinical conditions. However, the relationship between lactate production and lung function during acellular normothermic ex vivo lung perfusion (EVLP) is unclear. We investigated the kinetics of lactate metabolism during EVLP and the correlation of this marker with outcomes after transplant. Methods: Human donor lungs in our clinical EVLP trial (CLs; n = 28) and rejected donor lungs for experimental use (Els; n = 8) were perfused ex vivo using the Toronto technique. Lactate level, lactate/pyruvate (L/P) ratio, and glucose level in the perfusate were measured. In CLs, we examined the relationship between lactate metabolism during EVLP and early post-transplant outcomes. The hypoxia-inducible factor 1 sub-unit 1α (HIF-1α) level in lung tissue was examined in ELs. Results: We performed double-lung EVLP in CLs and single-lung EVLP in ELs. In CLs, the lactate and L/P ratios at the end of EVLP had no correlation with early post-transplant outcomes despite lactate elevation during EVLP. Although lactate elevation was also present in all ELs, we were able to identify 2 groups based on L/P ratio at the end of EVLP. The group with the high L/P ratio had higher airway pressure during EVLP and higher HIF-1α in lung tissue at the end of EVLP. Conclusions: Lactate increases seen in the EVLP perfusate most often represent physiologic lactate production by the lung in a setting with reduced lactate clearance. Thus, patients who underwent transplantation after EVLP had good outcomes despite lactate elevation during EVLP.

Original languageEnglish
Pages (from-to)1312-1319
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number12
DOIs
Publication statusPublished - 2011 Dec 1
Externally publishedYes

Keywords

  • ex vivo lung perfusion
  • lactate metabolism
  • lung transplant

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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  • Cite this

    Koike, T., Yeung, J. C., Cypel, M., Rubacha, M., Matsuda, Y., Sato, M., Waddell, T. K., Liu, M., & Keshavjee, S. (2011). Kinetics of lactate metabolism during acellular normothermic ex vivo lung perfusion. Journal of Heart and Lung Transplantation, 30(12), 1312-1319. https://doi.org/10.1016/j.healun.2011.07.014