Physiologic assessment of the ex vivo donor lung for transplantation

Yeung, Jonathan C.; Cypel, Marcelo; Machuca, Tiago; Koike, Terumoto; Cook, Douglas J.; Bonato, Riccardo; Chen, Manyin; Sato, Masaaki; Waddell, Thomas K.; Liu, Mingyao; Slutsky, Arthur S.; Keshavjee, Shaf

doi:10.1016/j.healun.2012.08.016

Cited by 113 publications

(91 citation statements)

References 17 publications

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“…Since EVLP principles are based on protective ventilation (tidal volume of 7 mL/kg) and perfusion (40% cardiac output flow, dedicated solution with optimal colloidosmotic pressure), it is conceivable that lungs presenting with physiological deterioration ex vivo would have presented poor functional outcomes in the recipient. Although these lungs failing EVLP physiological criteria have not been transplanted and therefore the posttransplantation function is unknown, preclinical experimental evidence suggests a high risk of severe graft dysfunction (26). In this sense, utilization of EVLP introduced more objectivity to donor lung assessment and resulted in a striking donor lung utilization of up to 43% of kidney DCDD donors.…”

Section: Dcdd-no Evlp Vs Dcdd þ Evlpmentioning

confidence: 99%

“…While we recognize that this analysis does not account for recipient derived contributions to PGD that clearly exist (38), we also acknowledge that the decision making process during EVLP needs to be made more precise. Currently, decision making during EVLP is largely based on physiologic parameters (26). We have been studying potential biomarker strategies to further refine this process (39)(40)(41)(42).…”

Section: Dcdd-no Evlp Vs Dcdd þ Evlpmentioning

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

128

116

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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: Dcdd-no Evlp Vs Dcdd þ Evlpmentioning

confidence: 99%

Section: Dcdd-no Evlp Vs Dcdd þ Evlpmentioning

confidence: 99%

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

128

116

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“…Yeung et al demonstrated that ex vivo PO 2 may not be the first indication of lung injury. In this study, pulmonary edema was associated with a decrease in compliance and an increase in airway pressure before a decrease in PO 2 [16].…”

Section: Discussionmentioning

confidence: 55%

In situ lung perfusion is a valuable tool to assess lungs from donation after circulatory death donors category I-II

et al. 2013

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SummaryDonations after circulatory death (DCD) lung grafts are an alternative to extend the donor pool in lung transplantation. This study investigates the use of an in situ lung perfusion system (ISLP) in the donor to evaluate category I-II lungs. Pigs were sacrificed by ventricular fibrillation. All animals underwent 20 min of cardiopulmonary resuscitation and 5 min hands-off period after which heparin was administered. In group [WI-1], this was followed by 1 h of warm ischemia (WI) and 2 h of topical cooling (TC). In group [WI-2], 2 h of WI was followed by 1 h of TC. In group [WI-0], there was a minimal period of WI and no TC. In all three groups, the lungs were then evaluated during 60 min with ISLP. A high W/D weight ratio was correlated with a lower compliance, higher lactate production, and a higher PaCO 2 . ISLP is an effective way to assess the quality of lungs from category I-II DCD donors.

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“…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). Partial oxygen pressures are recorded, and delta values of pulmonary artery and left atrium oxygenation are evaluated.…”

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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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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Physiologic assessment of the ex vivo donor lung for transplantation

Cited by 113 publications

References 17 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

In situ lung perfusion is a valuable tool to assess lungs from donation after circulatory death donors category I-II

Ex-vivo Lung Perfusion and Its Role in Experimental Studies

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