Fibrinolytic Treatment Improves the Quality of Lungs Retrieved From Non-Heart-Beating Donors

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

“…Firstly, the refinement of donor selection was illustrated by the study of Sanchez et al, which showed that, despite similar clinical characteristics and alveolocapillary barrier properties after the period of cardiac arrest and warm ischemia, donor lungs that did not receive prearrest heparinization had significantly worse physiological performance on EVLP compared to lungs from donors that received pre-arrest heparin (32). Secondly, the normothermic and metabolically active environment restored by EVLP provides an ideal platform for therapeutic manipulation of the DCDD organ (33)(34)(35)(36). EVLP-treated lungs showed better posttransplant lung function and less microthrombi formation compared to no-EVLP lungs in a DCDD experimental study (37).…”

State of Art: Clinical ex vivo lung perfusion: Rationale, current status, and future directions

“…These positive results stimulated several investigators to use animal models to identify therapies that could be used to recondition lungs before implantation. Inci et al 68 reported that the addition of urokinase to the perfusate during EVLP improved graft quality in a swine DCD model by reducing PVR, most likely by thrombus degradation, leading to better oxygenation. Dong et al 69,70 demonstrated that ventilation before and during ex vivo perfusion with nitric oxide or carbon monoxide improved lung function by reducing the effects of ischemia-reperfusion injury in a DCD rat model.…”

Ex Vivo Reconditioning of Marginal Donor Lungs Injured by Acid Aspiration

“…Technical details of ex vivo perfusion have been reported previously. 14 Pulmonary artery pressure (PAP) and temperature of the oxygenated inflowing perfusate were gradually increased. Ventilation was started when the outflow temperature reached 32°C.…”