Abstract Background While ex vivo lung perfusion (EVLP) extends preservation and enables real-time graft assessment, extended EVLP provokes inflammatory and metabolic imbalances. Given the liver’s central role in systemic metabolism and immune homeostasis, we hypothesized that the Lung Integrated Vital Ex Vivo Support (LIVES), integrating hepatic support, could improve lung graft viability and transplantation outcomes. Methods We established a rat model comparing three preservation strategies: cold storage (CS), EVLP group, and LIVES group. Donor lungs underwent 8 hours of ex vivo perfusion under each condition, followed by orthotopic transplantation and a 24-hour post-transplant evaluation. Physiological parameters, metabolic markers, cytokine profiles, and histological and oxidative stress assessments were performed. Results During the 8-hour perfusion, LIVES lungs maintained higher oxygenation, compliance, stabilized perfusate glucose, and accumulated less lactate compared with EVLP group (all p 0.05). Pro-inflammatory cytokines (TNF-α, IL-6) were suppressed while IL-10 increased under LIVES system. After transplantation, LIVES grafts demonstrated superior oxygenation, reduced alveolar injury on histology, and lower markers of oxidative stress versus CS and SLP (all p 0.05). Conclusions LIVES system provides synergistic metabolic and immunomodulatory support that prolongs the safe duration of lung perfusion and translates into improved post-transplant lung function. The system represents a promising approach to enhancing graft preservation, promoting repair, and optimizing transplant outcomes. This abstract is funded by: Guangzhou National Laboratory
Pan et al. (Fri,) studied this question.