Experience with the first 50 ex vivo lung perfusions in clinical transplantation

Cypel, Marcelo; Yeung, Jonathan C.; Machuca, Tiago; Chen, Manyin; Singer, Lianne G.; Yasufuku, Kazuhiro; Perrot, Marc de; Pierre, Andrew; Waddell, Thomas K.; Keshavjee, S.

doi:10.1016/j.jtcvs.2012.08.009

Cited by 266 publications

(221 citation statements)

References 29 publications

(31 reference statements)

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“…Subsequently, indications of high-risk DCDD donor lungs that required EVLP included any of the following: (1) last PaO 2 /FiO 2 (P/F) < than 300 mmHg; (2) pulmonary edema detected on chest X-ray or during examination of the lungs at procurement; (3) poor lung compliance during examination of the lungs at procurement; (4) high-risk history (e.g. multiple blood transfusions, questionable history of aspiration) (16,17); (5) interval between WLST and arrest >60 minutes.…”

Section: Donor Selectionmentioning

confidence: 99%

“…Additionally, there should be no worsening x-ray infiltrate and no purulent/frothy secretions on the interval bronchoscopy as well (17).…”

Section: Ex Vivo Lung Perfusion (Evlp)mentioning

confidence: 99%

“…Cypel et al, from the Toronto Lung Transplant Program, further mastered the methodology to allow for prolonged perfusion periods (up to 12 hours) and repeated functional assessments (15). The clinical experience has been repeatedly reported as successful, with high-risk donor lungs presenting similar outcomes to those lungs from standard criteria donors (16,17).…”

Section: Introductionmentioning

confidence: 99%

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Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Machuca

Mercier

Collaud

et al. 2015

American Journal of Transplantation

127

109

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The growing demand for suitable lungs for transplantation drives the quest for alternative strategies to expand the donor pool. The aim of this study is to evaluate the outcomes of lung transplantation (LTx) with donation after circulatory determination of death (DCDD) and the impact of selective ex vivo lung perfusion (EVLP). From 2007 to 2013, 673 LTx were performed, with 62 (9.2%) of them using DCDDs (seven bridged cases). Cases bridged with mechanical ventilation/extracorporeal life support were excluded. From 55 DCDDs, 28 (51%) underwent EVLP. Outcomes for LTx using DCDDs and donation after neurological determination of death (DNDD) donors were similar, with 1 and 5-year survivals of 85% and 54% vs 86% and 62%, respectively (p ¼ 0.43). Although comparison of survival curves between DCDD þ EVLP vs DCDD-no EVLP showed no significant difference, DCDD þ EVLP cases presented shorter hospital stay (median 18 vs. 23 days, p ¼ 0.047) and a trend toward shorter length of mechanical ventilation (2 vs. 3 days, p ¼ 0.059). DCDDs represent a valuable source of lungs for transplantation, providing similar results to DNDDs. EVLP seems an important technique in the armamentarium to safely increase lung utilization from DCDDs; however, further studies are necessary to better define the role of EVLP in this context.

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Section: Donor Selectionmentioning

confidence: 99%

“…Additionally, there should be no worsening x-ray infiltrate and no purulent/frothy secretions on the interval bronchoscopy as well (17).…”

Section: Ex Vivo Lung Perfusion (Evlp)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Machuca

Mercier

Collaud

et al. 2015

American Journal of Transplantation

127

109

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“…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.…”

Section: Stone Et Almentioning

confidence: 99%

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

Stone

Critchley

Major

et al. 2016

American Journal of Transplantation

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Passenger leukocyte transfer from the donor lung to the recipient is intrinsically involved in acute rejection. Direct presentation of alloantigen expressed on donor leukocytes is recognized by recipient T cells, promoting acute cellular rejection. We utilized ex vivo lung perfusion (EVLP) to study passenger leukocyte migration from donor lungs into the recipient and to evaluate the effects of donor leukocyte depletion prior to transplantation. For this purpose, female pigs received male left lungs either following 3 h of EVLP or retrieved using standard protocols. Recipients were monitored for 24 h and sequential samples were collected. EVLPreduced donor leukocyte transfer into the recipient and migration to recipient lymph nodes was markedly reduced. Recipient T cell infiltration of the donor lung was significantly diminished via EVLP. Donor leukocyte removal during EVLP reduces direct allorecognition and T cell priming, diminishing recipient T cell infiltration, the hallmark of acute rejection.

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“…Other therapies such as steroids treatment with methylprednisolone are commonly used in EVLP but their effect on outcomes is still unclear [80,81]. An adenosine A2A agonist has also been shown to improve lung funcion during EVLP [82].…”

Section: J Ventilation and Perfusion Strategies In Evlpmentioning

confidence: 99%

Pulsatile flow does not improve efficacy in ex vivo lung perfusion.

Zoeller¹

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Experience with the first 50 ex vivo lung perfusions in clinical transplantation

Abstract: Transplantation of high-risk donor lungs after 4 to 6 hours of ex vivo lung perfusion is safe, and outcomes are similar to those of conventional transplants. Ex vivo lung perfusion improved our center use of donor lungs, accounting for 20% of our current lung transplant activity.

Cited by 266 publications

References 29 publications

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

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

Pulsatile flow does not improve efficacy in ex vivo lung perfusion.

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