Fig. 3: Improvement of pulmonary function and inflammation following cytokine adsorption during ex vivo lung perfusion (EVLP) treatment.

Donor lungs were connected to an EVLP circuit and assigned to either the non-treated group or treated group which consisted of continuous cytokine adsorption during the four hours of EVLP. a Measures of pulmonary gas exchange including the PaO₂/FiO₂ ratio, the pulmonary vascular resistance (PVR), peak inspiratory pressure (PIP), and dynamic compliance were recorded throughout EVLP. b Gross morphology of the treated lungs (top) and the non-treated lungs (bottom) throughout the 4-hour period. c Cytokines in plasma with samples taken every hour of EVLP, with 1 hour marking the time elapsed since the start of treatment (n = 6 per group). d The bronchoalveolar lavage fluid (BALF) was tested at the end of EVLP for cytokine levels (n = 6 per group). e Cell counts of neutrophils, lymphocytes, and white blood cells were measured every hour. Data is represented as a box-and-whiskers plot with a median line, a plus at the mean, and minimum and maximum values. f The scores of the histologycompare cytokine adsorption groups (left) and the cell counts per mm² after terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining (right). g Images representative of n = 16 samples of hematoxylin and eosin (H&E) histology of non-treated (left) lungs and treated (right) lungs. Scale bar in the larger image represents 0.5 mm. The callout shows a magnified portion of the tissue where the scale bar represents 0.2 mm. h Representative images of n = 5 lungs of TUNEL staining in non-treated (left) and treated lungs (right) with representative black arrows indicating the type of positively stained cell used in the TUNEL score. Scale bars represent 50 µm. All graphs represent data from either the treated donor lungs (n = 6) or non-treated lungs (n = 10 as the one-step group did not receive cytokine adsorption during EVLP), except for the multiplex cytokine and chemokine and the TUNEL analysis (treated donor lungs (n = 6) or non-treated lungs (n = 6)). Statistically significant differences between non-treated and treated groups were tested with two-sided Student’s T-test and within groups with ANOVA when data were normally distributed. The two-sided Mann–Whitney test and the Kruskal–Wallis test were used when data were not normally distributed. *p < 0.05, **p < 0.01, ***p < 0.001, n.s. non significant. All values represent the mean ± standard deviation unless otherwise stated.