Current status and future potential of ex vivo lung perfusion in clinical lung transplantation

Abstract

Lung transplantation is accepted as a well‐established and effective treatment for patients with end‐stage lung disease. While the number of candidates added to the waitlist continues to rise, the number of transplants performed remains limited by the number of suitable organ donors. Ex vivo lung perfusion (EVLP) emerged as a method of addressing the organ shortage by allowing the evaluation and potential reconditioning of marginal donor lungs or minimizing risks of prolonged ischemic time due to logistical challenges. The currently available FDA‐approved EVLP systems have demonstrated excellent outcomes in clinical trials, and retrospective studies have demonstrated similar post‐transplant survival between recipients who received marginal donor lungs perfused using EVLP and recipients who received standard criteria lungs stored using conventional methods. Despite this, widespread utilization has plateaued in the last few years, likely due to the significant costs associated with initiating EVLP programs. Centralized, dedicated EVLP perfusion centers are currently being investigated as a potential method of further expanding utilization of this technology. In the preclinical setting, potential applications of EVLP that are currently being studied include prolongation of organ preservation, reconditioning of unsuitable lungs, and further enhancement of already suitable lungs. As adoption of EVLP technology becomes more widespread, we may begin to see future implementation of these potential applications into the clinical setting.

Is Night Surgery a Nightmare for Lung Transplantation?

“…This strategy is increasingly used in transplant centers. Ex-vivo lung perfusion (EVLP) is a strategy that is also increasingly used worldwide to both increase the graft pool and optimize grafts prior to transplantation [ 24 ]. Although this strategy still needs a great deal of evaluation, EVLP could reasonably be used to optimize grafts at night so that they can be transplanted during the day.…”

Supercooling: a promising technique for prolonged preservation in solid organ transplantation, and early perspectives in vascularized composite allografts

“…Transplantation sciences are rapidly evolving, and modern approaches such as machine perfusion are now used routinely for liver ( 1 , 2 ), kidney ( 3 , 4 ) heart transplants ( 5 , 6 ) and to a lesser extent lungs ( 7 , 8 ). These techniques have progressively supplanted static cold storage and has been shown to be superior in preserving organ function and reducing ischemic injury related to the delay between procurement and revascularization.…”