Prolonged extracorporeal preservation and evaluation of human lungs with portable normothermic ex vivo perfusion

Spratt, John R.; Mattison, Lars M.; Kerns, N.K.; Huddleston, Stephen J.; Meyer, Linette; Iles, Tinen L.; Loor, Gabriel; Iaizzo, Paul A.

doi:10.1111/ctr.13801

Cited by 6 publications

(5 citation statements)

References 39 publications

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“…When analyzing donor lung quality, oxygenation capacity was long seen as the most important parameter for assessing lungs before and during EVLP. There is increasing evidence that overall graft performance during EVLP is more important for evaluation ( 7 , 13 , 15 , 16 ). A study by Yeung et al, in which an acellular perfusate was used, demonstrated that while compliance and airway pressure deteriorated, oxygenation remained stable.…”

Section: Discussionmentioning

confidence: 99%

Is logistically motivated ex vivo lung perfusion a good idea?

Wauwer

Suylen²,

Zhang³

et al. 2022

Front. Transplant.

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Ex vivo lung perfusion (EVLP) is a technique for reconditioning and evaluating lungs. However, the use of EVLP for logistical reasons is still under discussion. In this retrospective study, all EVLPs performed between July 2012 and October 2019 were analyzed for ventilation and perfusion data. After transplantation, primary graft dysfunction (PGD), lung function, chronic lung allograft dysfunction (CLAD)-free survival, and overall survival were analyzed. Fifty EVLPs were performed: seventeen logistic EVLPs led to 15 lung transplantations (LT) and two rejections (LR), and 33 medical EVLPs resulted in 26 lung transplantations (MT) and seven rejections (MR). Pre-EVLP PaO2 was lower for MT than LT (p < 0.05). Dynamic lung compliance remained stable in MT and LT but decreased in MR and LR. Plateau airway pressure started at a higher level in MR (p < 0.05 MT vs. MR at T60) and increased further in LR. After transplantation, there were no differences between MT and LT in PGD, lung function, CLAD-free survival, and overall survival. In addition, the LT group was compared with a cohort group receiving standard donor lungs without EVLP (LTx). There were no significant differences between LT and LTx for PGD, CLAD-free survival, and overall survival. FVC was significantly lower in LT than in LTx after 1 year (p = 0.005). We found that LT lungs appear to perform better than MT lungs on EVLP. In turn, the outcome in the LT group was comparable with the LTx group. Overall, lung transplantation after EVLP for logistic reasons is safe and makes transplantation timing controllable.

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Section: Discussionmentioning

confidence: 99%

Is logistically motivated ex vivo lung perfusion a good idea?

Wauwer

Suylen²,

Zhang³

et al. 2022

Front. Transplant.

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“…Plasma component of ADWB might alleviate IR injury through antifibrinolytic mechanisms during EVLP. 93,94 Inventors later described a technique to collect ADWB during multiorgan procurement surgery. 95 ADWB-based perfusate and plasma exchange have also been shown to provide optimal conditions for ex vivo heart perfusion.…”

Section: Blood (Cellular Versus Acellular Perfusate)mentioning

confidence: 99%

Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

Iskender

2024

Transplantation

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Indications for ex vivo lung perfusion (EVLP) have evolved from assessment of questionable donor lungs to treatment of some pathologies and the logistics. Yet up to 3 quarters of donor lungs remain discarded across the globe. Multiday preservation of discarded human lungs on EVLP platforms would improve donor lung utilization rates via application of sophisticated treatment modalities, which could eventually result in zero waitlist mortality. The purpose of this article is to summarize advances made on the technical aspects of the protocols in achieving a stable multiday preservation of isolated EVLP. Based on the evidence derived from large animal and/or human studies, the following advances have been considered important in achieving this goal: ability to reposition donor lungs during EVLP; perfusate adsorption/filtration modalities; perfusate enrichment with plasma and/or donor whole blood, nutrients, vitamins, and amino acids; low-flow, pulsatile, and subnormothermic perfusion; positive outflow pressure; injury specific personalized ventilation strategies; and negative pressure ventilation. Combination of some of these advances in an automatized EVLP device capable of managing perfusate biochemistry and ventilation would likely speed up the processes of achieving multiday preservation of isolated EVLP.

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“…At current, experimental, mostly porcine, setups report stable EVLP for up to 72 hours ( 5 , 7 ). Clinical implementation of these prolonged protocols is still lacking.…”

Section: Introductionmentioning

confidence: 99%

The impact and relevance of techniques and fluids on lung injury in machine perfusion of lungs

Ponholzer,

Dumfarth,

Krapf

et al. 2024

Front. Immunol.

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Primary graft dysfunction (PGD) is a common complication after lung transplantation. A plethora of contributing factors are known and assessment of donor lung function prior to organ retrieval is mandatory for determination of lung quality. Specialized centers increasingly perform ex vivo lung perfusion (EVLP) to further assess lung functionality and improve and extend lung preservation with the aim to increase lung utilization. EVLP can be performed following different protocols. The impact of the individual EVLP parameters on PGD development, organ function and postoperative outcome remains to be fully investigated. The variables relate to the engineering and function of the respective perfusion devices, such as the type of pump used, functional, like ventilation modes or physiological (e.g. perfusion solutions). This review reflects on the individual technical and fluid components relevant to EVLP and their respective impact on inflammatory response and outcome. We discuss key components of EVLP protocols and options for further improvement of EVLP in regard to PGD. This review offers an overview of available options for centers establishing an EVLP program and for researchers looking for ways to adapt existing protocols.

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Prolonged extracorporeal preservation and evaluation of human lungs with portable normothermic ex vivo perfusion

Cited by 6 publications

References 39 publications

Is logistically motivated ex vivo lung perfusion a good idea?

Is logistically motivated ex vivo lung perfusion a good idea?

Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

The impact and relevance of techniques and fluids on lung injury in machine perfusion of lungs

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