The evolving potential for pediatric <i>ex vivo</i> lung perfusion

Luc, Jessica G.Y.; Nagendran, Jayan

doi:10.1111/petr.12653

Cited by 14 publications

(7 citation statements)

References 61 publications

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“…The evolving potential for EVLP is being investigated at several centers internationally. The potential for EVLP to increase rates of donor lung utilization remains a significant driver to further develop these technologies to address the need for a growing patient population developing end‐stage lung disease . Despite excellent preclinical data using EVLP, there remains discordance between the qualities of results in preclinical EVLP compared to clinical translation.…”

Section: Discussionmentioning

confidence: 99%

A Decrease in Hypoxic Pulmonary Vasoconstriction Correlates With Increased Inflammation During Extended Normothermic Ex Vivo Lung Perfusion

et al. 2017

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Normothermic ex vivo lung perfusion (EVLP) is an evolving technology to evaluate function of donor lungs to determine suitability for transplantation. We hypothesize that hypoxic pulmonary vasoconstriction (HPV) during EVLP will provide a more sensitive parameter of lung function to determine donor lung quality for lung transplantation. Eight porcine lungs were procured, and subsequently underwent EVLP with autologous blood and STEEN solution for 10 h. Standard physiologic parameters including dynamic compliance, peak airway pressure, and pulmonary vascular resistance (PVR) remained stable (P = 0.055), mean oxygenation (PO /FiO ) was 400 ± 18 mm Hg on average throughout perfusion. Response to hypoxia resulted in a robust increase in PVR (ΔPVR) up to 4 h of perfusion, however the HPV response then blunted beyond T6 (P < 0.01). The decrease in HPV response inversely correlated to cytokine concentrations of Interleukin-6 and tumor necrosis factor-α (P < 0.01). Despite acceptable lung oxygenation and standard physiologic parameters during 10 h of EVLP, there is a subclinical deterioration of lung function. HPV challenges can be performed during EVLP as a simple and more sensitive index of pulmonary vascular reactivity.

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Section: Discussionmentioning

confidence: 99%

A Decrease in Hypoxic Pulmonary Vasoconstriction Correlates With Increased Inflammation During Extended Normothermic Ex Vivo Lung Perfusion

et al. 2017

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“…The major limit of lung transplantation is the worldwide lack of suitable donor organs. Strategies to address the shortage of donor lungs include usage of so-called marginal donor organs (or extended criteria donor organs), organ donation after circulatory death with or without ex-vivo lung perfusion as graft preparation preoperatively, and lung graft size reduction (i.e., lobar lung transplants) [19][20][21][22][23]. The latter is of particular interest in pediatric lung transplant candidates because of the shortage of donor organs of smaller children [21].…”

Section: Donor Acceptability Criteria In Pediatric Lung Transplantationmentioning

confidence: 99%

Pediatric lung transplantation: supply and demand

Benoit¹,

Benden

2019

Current Opinion in Organ Transplantation

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Pediatric lung transplantation has been undertaken since the 1980s, and it is today considered an accepted therapy option in carefully selected children with end-stage pulmonary diseases, providing carefully selected children a net survival benefit and improved health-related quality of life. Nowadays, >100 pediatric lung transplants are done worldwide every year. Here, specific pediatric aspects of lung transplantation are reviewed such as the surgical challenge, effects of immunosuppression on the developing pediatric immune system, and typical infections of childhood, as it is vital to comprehend that children undergoing lung transplants present a real challenge as children are not 'just small adults'. Further, an update on the management of the pediatric lung transplant patient is provided in this review, and future challenges outlined. Indications for lung transplantation in children are different compared to adults, the most common being cystic fibrosis (CF). However, the primary diagnoses leading to pediatric lung transplantation vary considerably by age group. Furthermore, there are regional differences regarding the primary indication for lung transplantation in children. Overall, early referral, careful patient selection and appropriate timing of listing are crucial to achieve real survival benefit. Although allograft function is to be preserved, immunosuppressant-related side effects are common in children post-transplantation. Strategies need to be put into practice to reduce drug-related side effects through careful therapeutic drug monitoring and lowering of target levels of immunosuppression, to avoid acute-reversible and chronic-irreversible renal damage. Instead of a "one fits all approach", tailored immunosuppression and a personalized therapy is to be advocated, particularly in children. Further, infectious complications are a common in children of all ages, accounting for almost 50% of death in the first year post-transplantation. However, chronic lung allograft dysfunction (CLAD) remains the major obstacle for improved long-term survival.

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“…[114], various perfusion time [115], cooling or hypothermic preservation [116], as well as alter the work flow of the transplantation, staged model to do liver-after-lung transplantation [117] and split lung transplantation in two centers with a distance of 2250 km by running EVLP [118]. The technique of EVLP-based lung split, preservation and transportation adopted in smaller children, is currently under discussion [119].…”

Section: Anti-pulmonary Edema Performancementioning

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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The evolving potential for pediatric ex vivo lung perfusion

Cited by 14 publications

References 61 publications

A Decrease in Hypoxic Pulmonary Vasoconstriction Correlates With Increased Inflammation During Extended Normothermic Ex Vivo Lung Perfusion

A Decrease in Hypoxic Pulmonary Vasoconstriction Correlates With Increased Inflammation During Extended Normothermic Ex Vivo Lung Perfusion

Pediatric lung transplantation: supply and demand

Evolving Trend of EVLP: Advancements and Emerging Pathways

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