How to Recondition<i>Ex Vivo</i>Initially Rejected Donor Lungs for Clinical Transplantation: Clinical Experience from Lund University Hospital

Lindstedt, Sandra; Eyjolfsson, Atli; Koul, Bansi; Wierup, Per; Pierre, Leif; Gustafsson, Ronny; Ingemansson, Richard

doi:10.1155/2011/754383

Cited by 28 publications

(24 citation statements)

References 15 publications

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“…Flow is also increased step-by-step and the pulmonary arterial pressure is adjusted to be less than 20 mmHg. Tidal volume was traditionally adjusted to 100 mL/kg/min, positive-end expiratory pressure (PEEP) to 5 cmH 2 O, and respiratory frequency is 16 per minute (25,26).…”

Section: Techniquesmentioning

confidence: 99%

“…Depending on the practice of different centers, some maneuvers are undertaken 5-10 minutes prior to evaluation. Tidal volume is adjusted to 10 mL/kg, respiratory frequency to 10, and FiO 2 to 1.0 (16,26,32). Pulmonary artery pressure, left atrium pressure, peak airway pressure, and dynamic and static compliance parameters are recorded (33).…”

Section: Physiological Parametersmentioning

confidence: 99%

See 1 more Smart Citation

Ex-vivo Lung Perfusion and Its Role in Experimental Studies

Cosgun¹,

Dabak²,

Şenbaklavacı³

2017

Eurasian J Pulmonol

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To date, lung transplantation is an accepted and a preferred treatment modality for end-stage lung diseases (1-3). But ischemia reperfusion--related injury, allograft rejection, bronchiolitis obliterans, and chronic graft rejection are still important and detrimental problems in lung transplant medicine (2). The gap between the limited number of donor organs and the increase in the number of patients on the waiting list is increasing rapidly. The acceptance of lung donors is still 20%-30% so far. The scarcity of appropriate organs leads to improper utilization of marginal donors. One of the solutions to increase the number of donor organs is the meticulous evaluation of donor organs after cardiac death (2-4). This is why a method called ex-vivo lung perfusion (EVLP) was developed. The usefulness of EVLP on lung transplantation is firstly because this model makes it possible to evaluate the lung perfusion and functions of the body in the pre transplant period in marginal organs. By this method, we can make the right decision to implant. Second area of utilization is by preserving the graft after harvesting over long time intervals. Third area provides a platform for the development of additional therapies especially decreasing ischemia reperfusion (IRI). In this review, we aimed to provide the usage of EVLP on the development of treatment strategies in experimental studies and share our experiences with colleagues in the related field (5). General Perspective of Organ Culture SystemsThe experimental sciences have routinely used in-vivo and in-vitro models for stimulation of physiology and diseases. As a result of integration of physics and chemistry into in-vitro and in-vivo biomedicine, study on cell cultures and analyzing them at the molecular level became possible. The aim of ex-vivo experimental studies of organs is to create a system to stimulate human pathophysiology. Sys- Review Ex-vivo Lung Perfusion and Its Role in Experimental StudiesTuğba Coşgun AbstractLung transplantation is an accepted treatment modality for end-stage lung diseases. However, the donor pool is not getting larger in comparison to the number of patients on the waiting list. Of the patients on the waiting list for lung transplant, more than a quarter dies while waiting. Utilization of marginal donors became an issue, and ex-vivo lung perfusion (EVLP) was started to be performed to solve this problem. Besides that, success in lung transplantation has not reached a satisfactory level for various reasons including ischemia reperfusion injury. Treatment options against these reasons that cause low success of lung transplantations are being investigated by many centers. Nowadays, EVLP that was initially developed to re-evaluate marginal donors has become a method for studies in experimental models. In our article, we want to review EVLP models in experimental studies.

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Section: Techniquesmentioning

confidence: 99%

Section: Physiological Parametersmentioning

confidence: 99%

Ex-vivo Lung Perfusion and Its Role in Experimental Studies

Cosgun¹,

Dabak²,

Şenbaklavacı³

2017

Eurasian J Pulmonol

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“…However, in some cases (e.g. in brain dead donors) the lungs may become oedematous due to prolonged infusion and, therefore, unsuitable for transplantation [41]. Lung ''reconditioning'' by ex vivo lung perfusion (EVLP) is now possible, leading to an increase in the number and quality of the available donor pool [42].…”

Section: Pah and Lung Transplantationmentioning

confidence: 99%

Severe pulmonary arterial hypertension: treatment options and the bridge to transplantation

Corris

Degano

2014

Eur Respir Rev

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Pulmonary arterial hypertension (PAH) is a rare disease leading to right heart failure and death. Prognosis remains poor, particularly for patients with severe disease, i.e. World Health Organization functional class IV. There have been significant improvements in treatment options. Several agents are available that target the three main established PAH disease pathways, and can be combined sequentially or upfront. Strong scientific evidence supports the use of intravenous epoprostenol in severe PAH; however, despite recommendations, many patients do not receive parenteral prostanoids and there is a lack of evidence from randomised clinical trials supporting the value of other PAH medications alone in severe PAH.Lung transplantation is an important option in patients with severe PAH who have not responded sufficiently to therapy, or who have worsened despite maximal treatment. Bridging techniques are available for patients who worsen while awaiting transplantation. The type of bridging technique used depends on various factors including patient illness severity, physician experience and the anticipated waiting time for transplantation. With the aim to facilitate the treatment decision-making process, herein we review the medical treatment options available for patients with severe PAH, and the bridging techniques that may be used to sustain patients awaiting transplantation. @ERSpublications Current options for treatment and bridging to lung transplantation in patients with severe PAH

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“…The concept has been extended to include assessment and management of ''borderline'' DCD lungs [44,45] with lungs previously thought to be unusable being successfully transplanted [46]. One estimate is that 46% of lungs may be ''converted'' by ex vivo perfusion and management [47].…”

Section: Ex Vivo Perfusionmentioning

confidence: 99%