Ex Vivo Lung Perfusion: A Review of Current and Future Application in Lung Transplantation

Ahmad, Kareem; Pluhacek, Jennifer L; Brown, Anne

doi:10.1007/s41030-022-00185-w

Cited by 30 publications

(24 citation statements)

References 73 publications

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“…As a learning curve of EVLP has been mentioned before, 26–28 a peak of 33.1% of EVLP use in DCD transplants was identified in 2019 in our analysis with a declined thereafter. This may be the result of increasing familiarity within the transplant community DCD 26–28 and DCD practices. Currently, centers seem to rely on prewithdrawal data to define the quality of DCD lungs and successfully transplant them without the use of EVLP for secondary assesment 7–9 …”

Section: Discussionsupporting

confidence: 66%

“…During the EVLP clinical trial era of 2011–2018, more DCDs were procured and evaluated on EVLP 9,10,25 . As a learning curve of EVLP has been mentioned before, 26–28 a peak of 33.1% of EVLP use in DCD transplants was identified in 2019 in our analysis with a declined thereafter. This may be the result of increasing familiarity within the transplant community DCD 26–28 and DCD practices.…”

Section: Discussionmentioning

confidence: 66%

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Lung transplantation from donation after circulatory death, evolution, and current status in the United States

Furukawa

Noda

Chan

et al. 2023

Clinical Transplantation

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Background:The number of lung transplants from donors after circulatory death has increased over the last decade. This study aimed to describe the evolution and outcomes following lung transplantation donation after circulatory death (DCD) and report the practices and outcomes of ex vivo lung perfusion (EVLP) in this donor population. Methods:This was a retrospective study using a prospectively collected national registry. The United Network for Organ Sharing (UNOS) database was queried to identify adult patients who underwent lung transplantation between May 1, 2005, and December 31, 2021. Kaplan-Meier analysis and Weibull regression were used to compare survival in four cohorts (donation after brain death [DBD] with or without EVLP, and DCD with or without EVLP). The primary outcome of interest was patient survival. Results:Of the 21 356 recipients who underwent lung transplantation, 20 380 (95.4%) were from brain death donors and 976 (4.6%) from donors after circulatory death.Kaplan-Meier analysis showed no difference in the survival time between the two groups. In a multivariable analysis that controlled for baseline differences in donor and recipient characteristics, recipients who received lungs from cardiac death donors after EVLP had 28% shorter survival time relative to donor lungs after brain death without EVLP (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.10-2.15, p = .01). Conclusions:The early survival differences observed after lung transplants from donors after circulatory death in lungs evaluated with EVLP deserves further investigation.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 66%

Lung transplantation from donation after circulatory death, evolution, and current status in the United States

Furukawa

Noda

Chan

et al. 2023

Clinical Transplantation

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“…Currently, EVLP and DCD are not legal in Korea, and the use of marginal donors has increased by more than 50% [ 6 , 8 ]. EVLP is actively used in the United States and Canada to increase organ availability, and in some cases, organ quality is improved by using the prone position [ 12 - 14 ]. EVLP should be introduced to expand the pool of suitable donor lungs and reduce the average wait time of transplant candidates [ 15 ].…”

Section: Donor Shortages and Increased Use Of Marginal Donorsmentioning

confidence: 99%

Allocation of Donor Lungs in Korea

Yeo

2022

J Chest Surg

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The expansion of indications for lung transplantation, the growth of the waiting list, and donor shortages are increasing the waiting list mortality rate in Korea. The current lung allocation system in Korea is based mainly on urgency, but outcomes should also be considered to avoid futile transplantation. This review describes the current status of, and issues with, the lung allocation system in Korea including donors, the waiting list, and transplant outcomes in the context of an aging society, in which the frequency of end-stage pulmonary disease is increasing.

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“…Currently, in the United States, EVLP screening is used prior to 5%-10% of all lung transplants. 2 Additionally, preconditioning of lung grafts during EVLP evaluation has often been discussed as a way to improve posttransplant outcomes. 3,4 In addition to physiologic assessment, continuous ventilation, perfusion, and therapeutic interventions in an active metabolic environment may resuscitate the graft, improve graft quality, and result in better posttransplant outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Various single‐ and multi‐center clinical studies have confirmed the safety of EVLP to screen lungs from the high‐risk donor pool. Currently, in the United States, EVLP screening is used prior to 5%–10% of all lung transplants 2 . Additionally, preconditioning of lung grafts during EVLP evaluation has often been discussed as a way to improve posttransplant outcomes 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Single‐center experience of ex vivo lung perfusion and subsequent lung transplantation

Noda

Chan

Furukawa

et al. 2023

Clinical Transplantation

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Background The safety of lung transplantation using ex vivo lung perfusion (EVLP) has been confirmed in multiple clinical studies; however, limited evidence is currently available regarding the potential effects of EVLP on posttransplant graft complications and survival with mid‐ to long‐term follow‐up. In this study, we reviewed our institutional data to better understand the impact of EVLP. Methods Lungs placed on EVLP from 2014 through 2020 and transplant outcomes were retrospectively analyzed. Data were compared between lungs transplanted and declined after EVLP, between patients with severe primary graft dysfunction (PGD3) and no PGD3 after EVLP, and between matched patients with lungs transplanted with and without EVLP. Results In total, 98 EVLP cases were performed. Changes in metabolic indicators during EVLP were correlated with graft quality and transplantability, but not changes in physiological parameters. Among 58 transplanted lungs after EVLP, PGD3 at 72 h occurred in 36.9% and was associated with preservation time, mechanical support prior to transplant, and intraoperative transfusion volume. Compared with patients without EVLP, patients who received lungs screened with EVLP had a higher incidence of PGD3 and longer ICU and hospital stays. Lung grafts placed on EVLP exhibited a significantly higher chance of developing airway anastomotic ischemic injury by 30 days posttransplant. Acute and chronic graft rejection, pulmonary function, and posttransplant survival were not different between patients with lungs screened on EVLP versus lungs with no EVLP. Conclusion EVLP use is associated with an increase of early posttransplant adverse events, but graft functional outcomes and patient survival are preserved.

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Ex Vivo Lung Perfusion: A Review of Current and Future Application in Lung Transplantation

Cited by 30 publications

References 73 publications

Lung transplantation from donation after circulatory death, evolution, and current status in the United States

Lung transplantation from donation after circulatory death, evolution, and current status in the United States

Allocation of Donor Lungs in Korea

Single‐center experience of ex vivo lung perfusion and subsequent lung transplantation

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