Fig. 1: Experimental overview and technique for cytokine adsorption and lung transplantation.

a Timeline of lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS) lung injury and lung recovery by therapeutic interventions during ex vivo lung perfusion (EVLP) and transplantation (LTx) follow-up. Sample collection, including, plasma, biopsies, bronchoalveolar lavage fluid (BALF), hemodynamic measurements and arterial blood gases (AGB) and differential treatment regimens are indicated. Pulmonary harvest was conducted after confirmation of ARDS and the lungs where then placed on EVLP. The recipient was monitored for 48 hours after left lung transplantation and a mid-sternotomy followed by a right pneumonectomy in the last four hours allowed for isolated monitoring of the transplanted lung. A Swan-Ganz catheter was also placed in this monitoring period. b Setup of cytokine adsorption during EVLP. A mechanical ventilator (a) was connected to the lungs in the dome (b). Flow of perfusate continued into the reservoir (c) which fed into the cytokine adsorber (d) that then directed adsorbed perfusate back into the reservoir. Flow continued as per established methodology using a peristaltic pump (e) into a deoxygenator (h) connected to a gas supply (f) and heater (g). Following the leukocyte filter (i), the perfusate returned to the lungs. c Setup of cytokine adsorption post-transplantation. A veno-venous shunt using a hemodialysis catheter was inserted into the jugular vein. This facilitated flow through a pump (a) that was in line with the cytokine adsorber (b). After adsorption, flow returned to the circulation via the hemodialysis catheter in the jugular vein. Created with BioRender.com.