Extracorporeal lung perfusion (ex-vivo lung perfusion)

Abstract

Development of an ex-vivo treatment arsenal ranging in complexity from pharmacologic to gene and cellular therapies will soon allow clinicians to utilize the full potential of the donor organ pool improving outcomes of lung transplantation.

Pyrrolidine dithiocarbamate administered during ex-vivo lung perfusion promotes rehabilitation of injured donor rat lungs obtained after prolonged warm ischemia

“…In this context, assessment and ex vivo treatment of such damaged lungs using EVLP clearly represents a breakthrough to increase the pool of suitable donor lungs [15]. EVLP may notably be of major interest for the evaluation of lungs obtained after cardiac arrest (DCD lungs), which are at higher risk of injury and deterioration [6]. Interestingly, EVLP on its own appears to have a positive influence on the outcome of transplanted DCD lungs, as indicated by shorter hospital stay and trends towards reduced PGD in human recipients of DCD lungs with EVLP vs no EVLP [15].…”

“…Interestingly, EVLP on its own appears to have a positive influence on the outcome of transplanted DCD lungs, as indicated by shorter hospital stay and trends towards reduced PGD in human recipients of DCD lungs with EVLP vs no EVLP [15]. This effect may be related to the optimal oncotic pressure of the perfusion solution, which might reduce the development of pulmonary edema during reperfusion [6]. …”

“…EVLP was initially developed to assess the function and the potential for transplantation of DCD lungs [4, 5], and its use has been then extended to other forms of “non standard” donor lungs [3]. EVLP has also been proposed as a platform to deliver drugs ex vivo (concept of pharmacological reconditioning) [6], in order to improve the status of the donor lung and to reduce the risk of primary graft dysfunction (PGD), a severe form of lung ischemia and reperfusion injury (LIR) which may develop early after transplantation [7]. In line with this concept, we recently provided evidence, in an experimental model of EVLP of DCD lungs, that such lungs could be significantly reconditioned by the ex vivo administration of drugs interfering with oxidative processes associated with LIR [8].…”

Treatment with 3-aminobenzamide during ex vivo lung perfusion of damaged rat lungs reduces graft injury and dysfunction after transplantation

“…A major limitation to lung transplantation (LTx) is the lack of available organs, due to the limited number of donors and the high proportion of organs deemed unsuitable for transplantation . In recent years, ex vivo lung perfusion (EVLP) has been developed to increase donor lung utilization, representing a breakthrough in clinical LTx .…”

“…In recent years, ex vivo lung perfusion (EVLP) has been developed to increase donor lung utilization, representing a breakthrough in clinical LTx . EVLP allows the assessment of a donor graft in optimal conditions, and may serve as a platform to deliver therapies for the repair of damaged organs (concept of reconditioning, or rehabilitation) …”