Clinical Ex Vivo Lung Perfusion—Pushing the Limits

Abstract

Ex vivo lung perfusion (EVLP) provides the ability to evaluate donor lungs before transplantation. Yet, limited prospective clinical data exist with regard to its potential to recondition unacceptable donor lungs. This paper summarizes the results of a prospective study of lung transplantation using only initially unacceptable donor lungs, which were improved by EVLP for 2-4 h. From March 2010-June 2011, 13 lungs were evaluated ex vivo. Median donor PaO 2 at FiO 2 1.0/PEEP5 was 216 mmHg (range 133-271). Four lungs, all with trauma history, showed no improvement and were discarded. Nine lungs improved to a ΔPO 2 higher than 350 mmHg. Median PvO 2 at final assessment in these lungs was 466 mmHg (range 434-525). These lungs were transplanted with a median total ischemic time of 577 min (range 486-678). None of the patients developed primary graft dysfunction grades 2 or 3 within 72 h after transplantation. One patient with secondary pulmonary hypertension was left on a planned prolonged extracorporeal membrane oxygenation postoperatively. Median intubation time was 2 days. Thirtyday mortality was 0%. During the observation period, 119 patients received standard lung transplantation with comparable perioperative outcome. EVLP has a significant potential to improve the quality of otherwise unacceptable donor lungs.

Altered Immunogenicity of Donor Lungs via Removal of Passenger Leukocytes Using Ex Vivo Lung Perfusion

“…As a significant nonclassical monocyte population was discovered in this study, it is likely that the benefits observed posttransplant will be conferred in human EVLP. Early clinical trial data have indicated equivalence in clinical outcome between standard transplant and EVLP reconditioned lungs, allowing an expanded donor organ pool (20)(21)(22)(23). Although significantly beneficial in itself, there is scope for further improvements in clinical outcome with EVLP via modulation of the donor leukocyte repertoire.…”

Ex vivo lung perfusion in lung transplantation: a case report

“…[8] Aigner ve ark. [9] kullanılamayan akciğerlerin kullanıla-rak standart nakiller ile yakın sonuçlar elde edilmesini enflamatuvar sitokinlerin aselüler perfüzyon ile azaltıl-masına ve hiperonkotik solüsyon ile akciğerin bir nevi dehidratasyonuna bağlamıştır. Sadaria ve ark.…”

International practical guidelines on diagnosis, prevention and treatment of bronchiolitis obliterans syndrome

“…При использовании новых методов улучшения состояния трансплантата, таких как перфузия лег ких ex vivo (EVLP) [168][169][170][171][172], может уменьшиться дисфункция легочного трансплантата, снижаются риск ПДТ, частота и тяжесть СОБ, но данные о вли янии EVLP на риск развития СОБ пока отсутствуют. Усиленная иммуносупрессия с тотальным облучени ем лимфоцитов [173,174] [175,176] могут оказать положительное влияние на снижение легочной функции, обуслов ленное СОБ, но у данных методов, помимо высокой стоимости, имеются значительные побочные эф фекты, поэтому нужны дополнительные клиничес кие исследования для уточнения их эффективности при СОБ.…”