Current Methodological Procedures in Rat Models After Circulatory Death

Lung transplantation continues to face significant hurdles, mainly regarding graft preservation and minimizing ischemia-reperfusion injury (IRI). Conventional preservation techniques like static cold storage often lead to complications, stimulating the development of ex vivo lung perfusion (EVLP) as a more effective alternative. EVLP offers the advantage of evaluating and treating the graft prior to transplantation, thereby improving the use of extended-criteria donors and donation after circulatory death (DCD). Recent findings demonstrate the potential of normothermic EVLP in reducing IRI damage. Additionally, the application of various temperature settings for EVLP-hypothermic, subnormothermic, and normothermic-shows promise in better preserving lung function. Ventilation strategies also influence graft viability, with negative-pressure ventilation emerging as a potential method to decrease inflammation and damage relative to traditional positive-pressure methods. Furthermore, gas treatments during perfusion, such as hydrogen sulfide, carbon monoxide, and nitric oxide, offer promising avenues to enhance lung graft preservation. Despite the advantages, widespread adoption of EVLP faces challenges, especially related to highlighting the need for cost-effective preservation techniques. Future investigations should focus on deepening our understanding of graft injury mechanisms, especially in DCD models, and refining preservation protocols. Developing more reliable small animal models and aligning studies with the Maastricht classification will help bridge the gap between preclinical research and clinical application, ultimately expanding the donor pool and improving transplantation outcomes.