Ex Vivo Lung Perfusion: A Review of Research and Clinical Practices

Abstract

End-stage lung disease is ultimately treated with lung transplantation. However, there is a paucity of organs with an increasing number of patients being diagnosed with end-stage lung disease. Ex vivo lung perfusion has emerged as a potential tool to assess the quality and to recondition marginal donor lungs prior to transplantation with the goal of increasing the donor pool. This technology has shown promise with similar results compared with the conventional technique of cold static preservation in terms of primary graft dysfunction and overall outcomes. This review provides an update on the results and uses of this technology. The review will also summarize clinical studies and techniques in reconditioning and assessing lungs on ex vivo lung perfusion. Last, we discuss how this technology can be applied to fields outside of transplantation such as thoracic oncology and bioengineering.

Ex Vivo Lung Perfusion: A Platform for Donor Lung Assessment, Treatment and Recovery

“…Beyond transplantation, several innovation areas for EVLP have been suggested. First, EVLP provides an excellent and translatable platform for thoracic oncology drug trials [44]. EVLP could be coupled with autotransplantation for the administration of intolerably toxic chemotherapies [44] and antimicrobials [45] in the setting of otherwise incurable malignancies or multi-resistant lung infections.…”

“…First, EVLP provides an excellent and translatable platform for thoracic oncology drug trials [44]. EVLP could be coupled with autotransplantation for the administration of intolerably toxic chemotherapies [44] and antimicrobials [45] in the setting of otherwise incurable malignancies or multi-resistant lung infections. Finally, an area of great future potential lies in bioengineering of lungs, involving decellularization, seeding of the remaining tissue scaffold with multipotent progenitor cells of recipient origin and subsequent recellularization to produce a chimeric organ aimed at circumventing the issue of rejection.…”

Engineered mesenchymal stromal cell therapy during human lung ex vivo lung perfusion is compromised by acidic lung microenvironment

“…In addition, although adenoviral transfection is rapid, it takes up to 8-9 h to achieve measurable therapeutic interleukin-10 (IL-10) protein levels after airway delivery of adenoviral vectors encoding anti-inflammatory IL-10 (AdIL-10) in large-animal 13 and human-rejected lung EVLP experiments, 14 far longer than the 4-to 6-h duration of current standard clinical EVLP. 5 Mesenchymal stromal cells (MSCs) reside in many tissues and participate in repair and immunomodulation primarily through paracrine mechanisms. 15,16 Anti-inflammatory properties of MSCs have made them attractive for various cell-based therapies, 15,17 and phase 1 studies in lung transplant patients with established chronic lung allograft dysfunction have been conducted.…”

“…Normothermic acellular ex vivo lung perfusion (EVLP) is an innovative approach to assess donor lung quality outside the body before transplantation, and it is used to safely increase the number of transplants. 5 , 6 , 7 EVLP can also be used as a platform to apply novel therapeutics during the ex vivo time. 5 Although lungs with specific injury, such as pulmonary embolism, have been successfully repaired during EVLP, 8 more universal lung repair strategies would significantly increase the organ pool for transplantation.…”

Thoracic Transplant Anesthesiology: Keeping Up With Advances and Developments of Allied Specialties

“…14 Chan and colleagues in their review described the history, equipment, and techniques used in ex vivo lung perfusion. 15 They also presented clinical studies showing the benefits of this method and provided future directions. While we attempt to improve the prospects of organ utilization by various methods, understanding the pathogenesis of primary graft dysfunction (PGD) is vital for preservation of organ function after implantation.…”