One-year experience with ex vivo lung perfusion: Preliminary results from a single center

2018 ◽  
Vol 41 (8) ◽  
pp. 460-466 ◽  
Author(s):  
Achim Koch ◽  
Nikolaus Pizanis ◽  
Carolin Olbertz ◽  
Omar Abou-Issa ◽  
Christian Taube ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Lung Perfusion ◽  
Smoking History ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Extended Criteria Donor ◽  
Ventilation Time ◽  
Postoperative Ventilation ◽  
Lung Transplants ◽  
One Year

Objective: To enlarge the donor pool for lung transplantation, an increasing number of extended criteria donor lungs are used. However, in more than 50% of multi-organ donors the lungs are not used. Ex vivo lung perfusion offers a unique possibility to evaluate and eventually recondition the injured donor lungs. The aim of our study was to assess the enlargement of the donor pool and the outcome with extended criteria donor lungs after ex vivo lung perfusion. Patients and Methods: Data were prospectively collected in our lung transplant database. We compared the results of lung transplants after ex vivo lung perfusion with those after conventional cold static preservation. In total, 11 extended criteria donor lungs processed with ex vivo lung perfusion and 41 cold static preservation lungs transplanted consecutively between May 2016 and May 2017 were evaluated. Normothermic ex vivo lung perfusion was performed according to the Toronto protocol for 4 h. Cold static preservation lungs were stored in low-potassium dextran solution. Results: Ex vivo lung perfusion lungs before procurement had significantly lower PaO2/FiO2 (P/F) ratios and more X-ray abnormalities. There were no statistically significant differences for pre-donation ventilation time, smoking history, or sex. After reconditioning with ex vivo lung perfusion, 9 out of 11 processed lungs were considered suitable and successfully transplanted. The mean postoperative ventilation time and in-hospital stay were not significantly different in ex vivo lung perfusion and cold static preservation recipients. Conclusion: Ex vivo lung perfusion can safely be used in the evaluation of lungs initially considered not suitable for transplantation. The primary outcome was not negatively affected and normothermic ex vivo lung perfusion is a useful tool to increase the usage of potentially transplantable lungs.

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.

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.

Ex-Vivo Lung Perfusion Results In a 5% Increase in Lung Transplants

2017 ◽  
Vol 101 ◽  
pp. S84
Author(s):  
Richard Hasz ◽  
Sharon M. West ◽  
Howard M. Nathan
Keyword(s):  
Ex Vivo ◽  
Lung Perfusion ◽  
Ex Vivo Lung Perfusion ◽  
Lung Transplants

In lung transplantation, are pulmonary grafts from donors deceased from hanging as suitable as grafts from donors deceased from other causes?

2019 ◽  
Vol 30 (1) ◽  
pp. 30-32
Author(s):  
João Santos Silva ◽  
Anne Olland ◽  
Gilbert Massard ◽  
Pierre-Emmanuel Falcoz
Keyword(s):  
Lung Transplantation ◽  
Observational Studies ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Graft Dysfunction ◽  
Post Transplantation ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Study Type

Abstract A best evidence topic was constructed according to a structured protocol. The question addressed was whether pulmonary grafts from donors deceased from hanging offer the same benefit as grafts from donors deceased from other causes in lung transplantation. Of the 17 papers found, 4 provided the best evidence to answer the question. The authors, date, journal, country of publication, study type, group studied, relevant outcomes and results of these papers are tabulated. One study reported a large cohort of donors and analysed the outcomes by cause of death, reporting no differences in survival. The remaining 3 papers analysed observational studies on the outcomes of lung transplantation using pulmonary grafts from donors deceased from hanging, compared with donors deceased from other causes. No differences in the rates of post-transplantation pulmonary graft dysfunction and long-term overall survival were reported. Although the cohort of donors deceased from hanging is small, we conclude that these donors are an important contribution to the donor pool. Ex vivo lung perfusion may have a role in assessing graft viability in this scenario.

1 One Year Survival and Functional Status of Patients from the Human Ex Vivo Lung Perfusion (HELP) Trial

2011 ◽  
Vol 30 (4) ◽  
pp. S8 ◽  
Author(s):  
M. Cypel ◽  
M. Sato ◽  
J.C. Yeung ◽  
M. Liu ◽  
M. Anraku ◽  
...  
Keyword(s):  
Functional Status ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Ex Vivo Lung Perfusion ◽  
One Year
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