Neutrophil extracellular traps in ex vivo lung perfusion perfusate predict the clinical outcome of lung transplant recipients

Lung transplantation is lifesaving for patients with end-stage lung diseases. However, a scarcity of donor lungs suitable for transplantation limits the number of procedures that can be performed. Furthermore, major obstacles to successful lung transplantation still exist; primary graft dysfunction (PGD), the leading cause of early morbidity and mortality post-lung transplant, develops in approximately 15–30% of recipients [1]. Normothermic ex vivo lung perfusion (EVLP) maintains donor lungs in a physiological state through perfusion and ventilation, so that the lungs can be assessed, treated, and accepted for transplantation, thereby increasing the donor pool and alleviating the severe shortage of viable donor lungs [2]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Miss Caldarone has nothing to disclose. Conflict of interest: Dr. Mariscal has nothing to disclose. Conflict of interest: Dr. Zamel has nothing to disclose. Conflict of interest: Conflict of Interest Statement Perfusix Canada (PXCA): Dr Cypel is a founder of Perfusix Canada. This company provided ex vivo lung perfusion (EVLP) services to University Health Network in the past. Due to conflict of interest relative to EVLP activities as lung transplant surgeons in the institution, Dr. Cypel did not receive any payments from PXCA. Furthermore with respect to the provision of EVLP services, PXCA is a non-profit company that does not generate profit from EVLP activities provided for UHN patients. XOR Labs Toronto (XOR): Dr Cypel of XOR, a company dedicated to development of EVLP machines. The XOR EVLP machine is in development phase and was not used in the performance of this study.Lung Bioengineering (LBI): LBI acquired Perfusix USA in 2015, a company that was co-founded by Dr Cypel. Currently Dr. Cypel is a paid consultants for LBI. They give strategic advice to LBI lung perfusion center as members of its Scientific Advisory Board. The samples obtained in the current study were collected from consented UHN patients with a major aim to develop biomarkers to predict donor lung quality so that safer transplantation can be performed. Conflict of interest: Dr. Palaniyar reports grants from Cystic Fibrosis Canada (3180), grants from Canadian Institutes of Health Research ( MOP-2 111012), during the conduct of the study. Conflict of interest: Dr. Keshavjee reports other from Perfusix Canada Inc, other from XOR Labs Toronto Inc, grants from XVIVO Perfusion, personal fees from Lung Bioengineering, United Therapeutics, outside the submitted work; and Conflict of Interest Statement Conflict of interest: Dr. Khan reports grants from Cystic Fibrosis Canada (3180), grants from Mitacs, during the conduct of the study. Mingyao Liu Conflict of interest: Dr. Sage has nothing to disclose. Conflict of interest: Dr. Juvet has nothing to disclose. Conflict of interest: Dr. Martinu has nothing to disclose.