Ex vivo lung perfusion in Brazil

Abdalla, Luís Gustavo; Braga, Karina Andrighetti de Oliveira; Nepomuceno, Natalia Aparecida; Fernandes, Lucas Matos; Samano, Marcos Naoyuki; Pêgo-Fernandes, Paulo Manuel

doi:10.1590/s1806-37562015000000099

Cited by 7 publications

(9 citation statements)

References 13 publications

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“…In Brazil, the technique was applied clinically at the Instituto do Coração (Incor), in the city of São Paulo (State of São Paulo), with results similar to those of this study. ( 4 ) The lungs evaluated remained in physiological conditions of preservation; but the protocol was not effective for promoting improvement in pulmonary function, making the transplant unviable. The authors attributed the result to the use of organs with lesions and pronounced physiological alterations, as well as to the restricted number (n=5) of perfusions conducted.…”

Section: Discussionmentioning

confidence: 99%

“…Ex vivo pulmonary perfusion can be used to recondition high-risk lungs, and is characterized, among other criteria, by the presence of edema and a ratio of partial oxygen pressure/ inspired oxygen fraction (PO 2 /FiO 2 ) 100% <300mmHg. ( 4 – 8 ) Furthermore, by means of this technique, it is possible to evaluate and use lungs from donors after circulatory arrest. ( 3 , 9 – 11 ) In EVLP, the lungs are isolated and submitted to perfusion with a highly oncotic solution, which reduces tissue edema and contributes to the clearance of cells and inflammatory mediators, improving the organ's general condition.…”

Section: Introductionmentioning

confidence: 99%

“…In Brazil, clinical and experimental studies utilized the EVLP technique with the objective of both evaluation and pulmonary reconditioning. ( 4 , 16 – 18 )…”

Section: Introductionmentioning

confidence: 99%

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Evaluation and reconditioning of donor organs for transplantation through ex vivo lung perfusion

Abdalla¹,

Oliveira-Braga²,

Fernandes³

et al. 2019

Einstein (São Paulo)

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Objective: To assess the feasibility and impact of ex vivo lung perfusion with hyperoncotic solution (Steen Solution ™ ) in the utilization of these organs in Brazil. Methods: In this prospective study, we subjected five lungs considered to be high risk for transplantation to 4 hours of ex vivo lung perfusion, with evaluation of oxygenation capacity. High-risk donor lungs were defined by specific criteria, including inflammatory infiltrates, pulmonary edema and partial pressure of arterial oxygen less than 300mmHg (inspired oxygen fraction of 100%). Results: During reperfusion, the mean partial pressure of arterial oxygen (inspired oxygen fraction of 100%) of the lungs did not change significantly (p=0.315). In the first hour, the mean partial pressure of arterial oxygen was 302.7mmHg (±127.66mmHg); in the second hour, 214.2mmHg (±94.12mmHg); in the third hour, 214.4mmHg (±99.70mmHg); and in the fourth hour, 217.7mmHg (±73.93mmHg). Plasma levels of lactate and glucose remained stable during perfusion, with no statistical difference between the moments studied (p=0.216). Conclusion: Ex vivo lung perfusion was reproduced in our center and ensured the preservation of lungs during the study period, which was 4 hours. The technique did not provide enough improvement for indicating organs for transplantation; therefore, it did not impact on use of these organs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation and reconditioning of donor organs for transplantation through ex vivo lung perfusion

Abdalla¹,

Oliveira-Braga²,

Fernandes³

et al. 2019

Einstein (São Paulo)

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“…It has also been shown that administration of nitroglycerin, selective adenosine 2A agonists, and dibutyryl cyclic adeonosine monophosphate in Steen solution lowers the rate of histological graft injury, lowers the levels of inflammatory cytokines, and keeps the microvascular structure of the graft unharmed compared to conventional LTx [22, 23]. It has also been reported that decreasing levels of thyroid stimulating hormone and desmopressin in brain-dead donors might have a role to play in LTx, where administration of such hormone replacements are made possible through EVLP and could improve graft function [24]. EVLP may also play a role in donation after circulatory death (DCD) especially in uncontrolled DCD donors when lung function is often unknown.…”

Section: Discussionmentioning

confidence: 99%

Ten year follow-up of lung transplantations using initially rejected donor lungs after reconditioning using ex vivo lung perfusion

Ghaidan

Fakhro

Andréasson

et al. 2019

J Cardiothorac Surg

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Background In 2006 and 2007 we performed double lung transplantation with marginal donor lungs assessed and reconditioned by Ex Vivo Lung Perfusion (EVLP), using a technique developed by Professor Stig Steen. Here we present a 10-year follow-up comparing the outcomes of lung transplantations performed at our clinic using EVLP lungs vs. conventional lungs. Method Between 2006 and 2007, 21 patients (6 EVLP, 15 conventional) underwent double lung transplantation (LTx) with follow-up on May 2017 at Lund University Hospital, Sweden. Pulmonary function was measured at 3/6/12 months, and annually thereafter for a period of 10 years in addition to survival and freedom from chronic lung allograft dysfunction (CLAD) being analyzed. Results Regarding Forced Expiratory Volume in 1 s (FEV1) and 6MWT at 3, 6, and 12 months and annually thereafter, no difference in median FEV1 nor 6MWT was found for EVLP-LTx vs. conventional-LTx ( p > 0.05). No difference was shown in post-operative survival between EVLP-LTx vs. conventional LTx for patients with an overall survival up to 10-years (p > 0.05). The same pattern was shown in sub analyses for patients with a limited survival up to 1 and 5 years (p > 0.05). Conclusion No superiority was found in conventional-LTx over EVLP-LTx, neither in long-term survival nor pulmonary function. No difference in CLAD-free survival was seen between the two groups. We believe that EVLP is a safe and effective method to use in LTx, greatly increasing the donor pool by improving marginal lungs and providing an objective assessment of the viability of marginal donor lungs.

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“…A report from Brazil showed that 4 h EVLP on extended-criteria donor lungs could recover the mean PaO 2 and oxygenation capacity, and static compliance improved especially in the first 2 h but failed in next 2 h. No change in pulmonary vascular resistance was observed. Thus these lungs were precluded transplantation due to complex physical conditions [27].…”

Section: Early Human Reports With Long-term Follow-up Of Evlp Incubatmentioning

confidence: 99%

Evolving Trend of EVLP: Advancements and Emerging Pathways

Jiao¹

2019

SN Compr. Clin. Med.

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Lung transplant augmentation in the waiting list is impeded by donor lung shortage with a low percentage of procurement. Ex vivo lung perfusion (EVLP) was recognized to have the capacity of providing a platform to preserve, assess, recondition, and even mange existing diseases in rejected donor lungs to expand the donor pool. This review aims to provide the most advanced experimental evidence of EVLP application and perspective as a platform providing qualified donor lungs. Literature review using PubMed, Medscape, Clinical Trials, and Cochrane databases was performed. Data was collected and analyzed. From a view point of publisher, current research centers with their paper contribution volume are also presented to illustrate the future trend of EVLP academically. EVLP incubated donor lungs could have a comparable outcome with conventional transplants. Further interventional studies have shown growing interest in and expectations on EVLP platform as pathways to determine graft quality, to bridge a critical phase of the initial rejected organs and to predict prognosis or complications in an early stage. EVLP is also considered as a tissue regeneration translational research environment with multidisciplinary potential to enhance the recovery and rehabilitation after surgery and advance pulmonary medicine. Ongoing clinical trials and accelerated procedure modulation with commercialization of EVLP are leading to Bcentralization^organ preparation model, opening a new era of lifechange health innovation.

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Ex vivo lung perfusion in Brazil

Cited by 7 publications

References 13 publications

Evaluation and reconditioning of donor organs for transplantation through ex vivo lung perfusion

Evaluation and reconditioning of donor organs for transplantation through ex vivo lung perfusion

Ten year follow-up of lung transplantations using initially rejected donor lungs after reconditioning using ex vivo lung perfusion

Evolving Trend of EVLP: Advancements and Emerging Pathways

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