Transplantation after ex vivo lung perfusion: A midterm follow-up

Wallinder, Andreas; Riise, Gerdt C.; Ricksten, Sven‐Erik; Silverborn, Martin; Dellgren, Göran

doi:10.1016/j.healun.2016.05.021

Cited by 57 publications

(63 citation statements)

References 20 publications

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“…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%

“…Standard transplant protocols developed and refined since the 1960's involve infusion of the donor lung with a specially formulated perfusate before inflation of the lung, stapling of the trachea, and cold preservation until transplantation (7). In contrast, ex-vivo lung perfusion (EVLP) involves continuous ventilation and perfusion of donor lungs, offering the potential to both extend the ability to functionally assess grafts, as well as recondition them to a transplant-suitable standard, thereby expanding the available pool of grafts (8). EVLP can be administered via several different established protocols which vary perfusate composition, flow, temperature, pressure, and ventilation, with off-the-shelf EVLP equipment such as the "XVIVO Perfusion System (XPS)", "Organ Care System (OCS)", and "Vivoline LS-1" now on the market (1).…”

Section: Introductionmentioning

confidence: 99%

“…While extended-criteria lungs have been shown to have comparable follow-up survival outcomes to standard criteria lungs using standard lung transplant methods, the use of EVLP to further expand the donor pool raises the question of EVLP recipient long-term outcomes (3,8,9). The objective of this meta-analysis was to aggregate midto long-term survival data and available post-operative outcomes from studies comparing LTx recipients who received EVLP treated grafts to those receiving standard protocol (cold-preservation) grafts.…”

Section: Introductionmentioning

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: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

show abstract

“…As it enables the use of lungs that were previously not considered for transplantation, this valuable procedure significantly contributes to the expansion of the donor pool (3). Numerous studies indicate that short-term clinical outcome of extended-criteria donor lungs subjected to EVLP is similar to that of standard donor organs (4)(5)(6)(7)(8)(9).…”

mentioning

confidence: 99%

Influence of ex vivo perfusion on the biomolecular profile of rat lungs

et al. 2018

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Despite increasing clinical adoption, biologic influences of ex vivo lung perfusion (EVLP) remain insufficiently elucidated. The aim of the current study was to investigate biomolecular changes induced by EVLP in rat lungs. EVLP was maintained for 180 min. Hyaluronan, mediators, and cells were assessed in the perfusate. Gene expression, signaling pathways, and ATP content were investigated in lung tissue. EVLP induced the release of medium-high molecular weight hyaluronan and transcription of hyaluronan synthases ( P< 0.001). Increasing concentrations of inflammatory mediators were detected in the perfusate ( P < 0.001). Perfused lungs exhibited a distinctive transcriptional signature compared with organs examined before or after surgery/procurement ( P = 0.003). Up-regulated genes were involved in inflammation and its regulation, apoptosis/survival, heat shock, and oxidative stress response ( q = 0). Down-regulated genes were related to lymphocyte function ( q = 0). The NF-κB, signal transducer and activator of transcription 3, ERK1/2, p38, Akt, and stress-activated protein kinase/JNK signaling pathways were modulated by EVLP ( P < 0.05). Most of these biomolecular changes were examined and confirmed in additional experiments that were performed in lungs procured from donation after cardiocirculatory death after 180 min of warm ischemia. The current study demonstrates that EVLP broadly affects the lung biomolecular phenotype. These findings improve our comprehension of the effects exerted by the procedure and encourage additional research in preclinical models to implement therapeutic interventions.-Lonati, C., Bassani, G. A., Brambilla, D., Leonardi, P., Carlin, A., Faversani, A., Gatti, S., Valenza, F. Influence of ex vivo perfusion on the biomolecular profile of rat lungs.

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“…These studies specified that selected donor lungs rejected for transplantation can be used after EVLP, and short-term and mid-term results of transplantation after EVLP and without EVLP groups were comparable (17,18). As a consequence of these studies, the interest of the industry in related technology increased, and many current studies from different companies producing devices for lung perfusion are underway.…”

Section: Clinical Experiencesmentioning

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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Transplantation after ex vivo lung perfusion: A midterm follow-up

Cited by 57 publications

References 20 publications

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

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

Influence of ex vivo perfusion on the biomolecular profile of rat lungs

Ex-vivo Lung Perfusion and Its Role in Experimental Studies

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