First experience with ex vivo lung perfusion for initially discarded donor lungs in the Netherlands: a single-centre study

Zhang, Zhang L; Suylen, Vincent van; Zanden, Judith E. van; Wauwer, Caroline Van De; Verschuuren, Erik; Bij, Wim van der; Erasmus, Michiel E.

doi:10.1093/ejcts/ezy373

Cited by 28 publications

(28 citation statements)

References 25 publications

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“…Using marginal lungs under extended-criteria for standard protocol lung transplant has been reported as doubling utilization rates to around 30-40% (30,31). Using EVLP however, studies in the present analysis reported conversion rates from EVLP evaluated lungs to transplant ranging from 34% to 97% (8,20,21,23,24,26). This allowed increased donor utilization, ranging from 33% to 50% (8,22,23).…”

Section: Discussionmentioning

confidence: 58%

“…This was in contrast to the other included studies, where EVLP was used for reconditioning grafts with poorer pre-EVLP PaO 2 /FiO 2 ratios. PGD3 at 72 hours has been found to correlate with increased 30-day, 90-day, and 1-year mortality (26,28), as well as chronic lung allograft dysfunction (27). While the reduction in PGD3 at 72 h was only significant in the INSPIRE RCT, a reduced incidence of PGD3 at 72 h in EVLP transplant recipients was a finding shared by several other included studies (5,18,26).…”

Section: Discussionmentioning

confidence: 90%

“…In all, 13 studies were included for analysis (PRISMA diagram provided in Figure S1) (4,5,8,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). One randomized controlled trial (RCT) was included (27), while four studies were prospective, non-randomized trials (18,(20)(21)(22), six were retrospective series (4,5,8,23,25,26), and two were series with their design not fully described (19,24). One study was rated as standard quality, four as moderate quality, and eight as high quality ( Table S2).…”

Section: Resultsmentioning

confidence: 99%

“…PGD3 at 72 hours has been found to correlate with increased 30-day, 90-day, and 1-year mortality (26,28), as well as chronic lung allograft dysfunction (27). While the reduction in PGD3 at 72 h was only significant in the INSPIRE RCT, a reduced incidence of PGD3 at 72 h in EVLP transplant recipients was a finding shared by several other included studies (5,18,26). Though these studies' findings on PGD3 did not reach significance and had smaller cohorts than the RCT, they all noted an absence of PGD3 events in their EVLP recipients, and other nonzero event studies similarly noted non-significant lower incidences.…”

Section: Discussionmentioning

confidence: 99%

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Ex-vivo lung perfusion versus standard protocol lung transplantation—mid-term survival and meta-analysis

Chakos

Ferret

Muston

et al. 2020

Ann Cardiothorac Surg

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Background: While extended criteria lung donation has helped expand the lung donor pool, utilization of lungs from donors of at least one other solid organ is still limited to around 15-30%. Ex-vivo lung perfusion (EVLP) offers the ability to expand the number of useable lung grafts through assessment and reconditioning of explanted lungs, particularly those not initially meeting criteria for transplantation. This meta-analysis aimed to examine the mid-to long-term survival and other short-term outcomes of patients transplanted with EVLP-treated lungs versus standard/cold-storage protocol lungs.Methods: Literature search of ten medical databases was conducted for original studies involving "ex-vivo lung perfusion" and "EVLP". Included articles were assessed by two independent researchers, survival data from Kaplan-Meier curves digitized, and individual patient data imputed to conduct aggregated survival analysis. Meta-analyses of suitably reported outcomes were conducted using a random-effects model. Results: Thirteen studies met inclusion criteria, with a total of 407 EVLP lung transplants and 1,765 as per standard/cold storage protocol. One study was a randomized controlled trial while the remainder were single-institution cohort series of varying design. The majority of donor lungs were from brain death donors, with EVLP lungs having significantly worse PaO 2 /FiO 2 ratio and significantly greater rate of abnormal chest X-ray. Aggregated survival analysis of all included studies revealed no significant survival difference for EVLP or standard protocol lungs (hazard ratio 1.00; 95% confidence interval: 0.79-1.27, P=0.981). Survival at 12, 24, and 36 months for the EVLP cohort was 84%, 79%, and 74%, respectively. Survival at 12, 24, and 36 months for the standard protocol cohort was 85%, 79%, and 73%, respectively. Meta-analysis did not find a significant difference in risk of 30-day mortality or primary graft dysfunction grade 3 at 72 hours between cohorts. Conclusions:There was no significant difference in mid-to long-term survival of EVLP lung transplant patients when compared to standard protocol donor lungs. The incidence of 30-day mortality and primary graft dysfunction grade 3 at 72 hours did not differ significantly between groups. EVLP offers the potential to increase lung donor utilization while providing similar short-term outcomes and mid-to long-term survival.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Ex-vivo lung perfusion versus standard protocol lung transplantation—mid-term survival and meta-analysis

Chakos

Ferret

Muston

et al. 2020

Ann Cardiothorac Surg

View full text Add to dashboard Cite

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“…More importantly, which should not be omitted, rodent models we used in frontier researches, having their inherent limitation when imitating human condition, such as lower perfusion flow in rat, are hypersensitive to perfusate. Thus we should find more efficient way to use declined human lungs [130] or lungs from cadavers for research upon overcoming the ethical barriers by organ procurement organizations with cross-border multi-center cooperation.…”

Section: Evlp-based Bready-to-use^organ Transplant Era Openingmentioning

confidence: 99%

Evolving Trend of EVLP: Advancements and Emerging Pathways

Jiao¹

2019

SN Compr. Clin. Med.

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Lung transplant augmentation in the waiting list is impeded by donor lung shortage with a low percentage of procurement. Ex vivo lung perfusion (EVLP) was recognized to have the capacity of providing a platform to preserve, assess, recondition, and even mange existing diseases in rejected donor lungs to expand the donor pool. This review aims to provide the most advanced experimental evidence of EVLP application and perspective as a platform providing qualified donor lungs. Literature review using PubMed, Medscape, Clinical Trials, and Cochrane databases was performed. Data was collected and analyzed. From a view point of publisher, current research centers with their paper contribution volume are also presented to illustrate the future trend of EVLP academically. EVLP incubated donor lungs could have a comparable outcome with conventional transplants. Further interventional studies have shown growing interest in and expectations on EVLP platform as pathways to determine graft quality, to bridge a critical phase of the initial rejected organs and to predict prognosis or complications in an early stage. EVLP is also considered as a tissue regeneration translational research environment with multidisciplinary potential to enhance the recovery and rehabilitation after surgery and advance pulmonary medicine. Ongoing clinical trials and accelerated procedure modulation with commercialization of EVLP are leading to Bcentralization^organ preparation model, opening a new era of lifechange health innovation.

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