scholarly journals Ex vivo lung perfusion: how we do it

2021 ◽  
Author(s):  
John Santosh Murala ◽  
William Michael Whited ◽  
Amit Banga ◽  
Robert Castillo ◽  
Matthias Peltz ◽  
...  
Keyword(s):  
Operative Technique ◽  
Lung Transplant ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Fda Approval ◽  
End Stage ◽  
Waitlist Mortality ◽  
Established Treatment

AbstractLung transplantation is an established treatment for patients with end-stage lung disease. However, a shortage of donors, low lung utilization among potential donors, and waitlist mortality continue to be challenges. In the last decade, ex vivo lung perfusion (EVLP) has expanded the donor pool by allowing prolonged evaluation of marginal donor lungs and allowing reparative therapies for lungs, which are otherwise considered not transplantable. In this review, we describe in detail our experience with EVLP including our workflow, setup, operative technique, and protocols. Our multidisciplinary EVLP program functions with the collaboration of surgeons, pulmonologists, and EVLP nurses who run the pump. EVLP program has been a valuable addition to our program. Since Food and Drug Administration (FDA) approval in 2019, we experienced incremental increased lung transplant volume of 12% annually.

Ex vivo lung perfusion for donor lung assessment and repair: a review of translational interspecies models

2020 ◽  
Vol 319 (6) ◽  
pp. L932-L940
Author(s):  
Aizhou Wang ◽  
Aadil Ali ◽  
Shaf Keshavjee ◽  
Mingyao Liu ◽  
Marcelo Cypel
Keyword(s):  
Therapeutic Potential ◽  
Ex Vivo ◽  
Small Animal ◽  
Lung Perfusion ◽  
Contributing Factors ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Advantages And Disadvantages ◽  
Number Of Patients ◽  
End Stage

For patients with end-stage lung disease, lung transplantation is a lifesaving therapy. Currently however, the number of patients who require a transplant exceeds the number of donor lungs available. One of the contributing factors to this is the conservative mindset of physicians who are concerned about transplanting marginal lungs due to the potential risk of primary graft dysfunction. Ex vivo lung perfusion (EVLP) technology has allowed for the expansion of donor pool of organs by enabling assessment and reconditioning of these marginal grafts before transplant. Ongoing efforts to optimize the therapeutic potential of EVLP are underway. Researchers have adopted the use of different large and small animal models to generate translational preclinical data. This includes the use of rejected human lungs, pig lungs, and rat lungs. In this review, we summarize some of the key current literature studies relevant to each of the major EVLP model platforms and identify the advantages and disadvantages of each platform. The review aims to guide investigators in choosing an appropriate species model to suit their specific goals of study, and ultimately aid in translation of therapy to meet the growing needs of the patient population.

Ex vivo lung perfusion made easy

2021 ◽  
Keyword(s):  
Molecular Weight ◽  
Lung Transplant ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Low Molecular Weight ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Transplant Center ◽  
Indispensable Tool

Ex vivo lung perfusion is an indispensable tool in the armamentarium of any lung transplant center. It helps to increase an already shrinking donor pool by offering a chance to assess suboptimal donor lungs in a systematic manner and improve them by treating them with low-molecular-weight perfusate. We offer a stepwise guide to carry out ex vivo lung perfusion on the donor lungs and criteria to accept them for transplants.

Ex Vivo Lung Perfusion: A Review of Research and Clinical Practices

2020 ◽  
Vol 24 (1) ◽  
pp. 34-44 ◽  
Author(s):  
Patrick G. Chan ◽  
Akshay Kumar ◽  
Kathirvel Subramaniam ◽  
Pablo G. Sanchez
Keyword(s):  
Lung Disease ◽  
Ex Vivo ◽  
Conventional Technique ◽  
Lung Perfusion ◽  
Clinical Practices ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Number Of Patients ◽  
End Stage ◽  
Potential Tool

End-stage lung disease is ultimately treated with lung transplantation. However, there is a paucity of organs with an increasing number of patients being diagnosed with end-stage lung disease. Ex vivo lung perfusion has emerged as a potential tool to assess the quality and to recondition marginal donor lungs prior to transplantation with the goal of increasing the donor pool. This technology has shown promise with similar results compared with the conventional technique of cold static preservation in terms of primary graft dysfunction and overall outcomes. This review provides an update on the results and uses of this technology. The review will also summarize clinical studies and techniques in reconditioning and assessing lungs on ex vivo lung perfusion. Last, we discuss how this technology can be applied to fields outside of transplantation such as thoracic oncology and bioengineering.

scholarly journals Impact of Mobile Ex Vivo Lung Perfusion on Lung Transplant Finances

2021 ◽  
Vol 40 (4) ◽  
pp. S309-S310
Author(s):  
M. Urban ◽  
J. Boudreaux ◽  
H.M. Strah ◽  
B. Small ◽  
D. Berkheim ◽  
...  
Keyword(s):  
Lung Transplant ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Ex Vivo Lung Perfusion

scholarly journals Evaluation of the efficacy of a novel perfusion solution for normothermic ex vivo lung perfusion compared with Steen solution™ (animal experimental study)

2021 ◽  
Vol 23 (3) ◽  
pp. 82-89
Author(s):  
S. V. Gautier ◽  
O. M. Tsirulnikova ◽  
I. V. Pashkov ◽  
N. V. Grudinin ◽  
D. O. Oleshkevich ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Lung Diseases ◽  
Ex Vivo ◽  
Infectious Complications ◽  
Lung Perfusion ◽  
Ex Vivo Lung Perfusion ◽  
Perfusion Solution ◽  
Number Of Patients ◽  
Donor Lung ◽  
End Stage

Respiratory diseases, together with infectious complications and hereditary lung diseases, rank third in international mortality statistics. Today, lung transplantation is a recognized method of treating end-stage lung diseases. However, the number of transplant surgeries performed is not much. This is down to the high requirements on the condition of a potential lung donor and directly on the quality of the donor lung. This has significantly limited the number of optimal donors. Rehabilitation of donor lungs to optimal gas exchange indicators can be achieved and objectively assessed in the course of ex vivo lung perfusion (EVLP). The EVLP procedure is widespread in leading transplantation centers in Europe and North America. It allows to significantly expand the pool of donor lungs, thereby serving a greater number of patients in need of lung transplantation. The possibility of EVLP procedure using publicly available perfusion equipment was demonstrated. The optimized protocol fully demonstrated its reliability and efficiency. The developed perfusion solution had no statistically significant differences in comparison with the Steen SolutionTM, which in the future will serve as an alternative for EVLP procedure.

scholarly journals Clinical transplantation using negative pressure ventilation ex situ lung perfusion with extended criteria donor lungs

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Max T. Buchko ◽  
Nasim Boroumand ◽  
Jeffrey C. Cheng ◽  
Alim Hirji ◽  
Kieran Halloran ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Ex Situ ◽  
Positive Pressure ◽  
Ex Vivo Lung Perfusion ◽  
Extended Criteria Donor ◽  
Negative Pressure Ventilation ◽  
Discharge From Hospital ◽  
End Stage

AbstractLung transplantation remains the best treatment option for end-stage lung disease; however, is limited by a shortage of donor grafts. Ex situ lung perfusion, also known as ex vivo lung perfusion, has been shown to allow for the safe evaluation and reconditioning of extended criteria donor lungs, increasing donor utilization. Negative pressure ventilation ex situ lung perfusion has been shown, preclinically, to result in less ventilator-induced lung injury than positive pressure ventilation. Here we demonstrate that, in a single-arm interventional study (ClinicalTrials.gov number NCT03293043) of 12 extended criteria donor human lungs, negative pressure ventilation ex situ lung perfusion allows for preservation and evaluation of donor lungs with all grafts and patients surviving to 30 days and recovered to discharge from hospital. This trial also demonstrates that ex situ lung perfusion is safe and feasible with no patients demonstrating primary graft dysfunction scores grade 3 at 72 h or requiring post-operative extracorporeal membrane oxygenation.

scholarly journals A successful lung transplant from a 3-year-old donor after controlled cardiac death followed by ex vivo lung perfusion: A case report

2019 ◽  
Vol 158 (4) ◽  
pp. e149-e152 ◽  
Author(s):  
Marcos Galasso ◽  
Rachel D. Vanderlaan ◽  
Melinda Solomon ◽  
Christopher Caldarone ◽  
Shaf Keshavjee ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiac Death ◽  
Lung Transplant ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Ex Vivo Lung Perfusion ◽  
Old Donor
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