Ex vivo lung perfusion review of a revolutionary technology

Makdisi, George; Makdisi, Tony; Jarmi, Tambi; Caldeira, Christiano

doi:10.21037/atm.2017.07.17

Cited by 29 publications

(21 citation statements)

References 47 publications

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“…Over the last two decades, however, because of progressive organ shortage and a higher proportion of extended criteria donors (ECD), machine perfusion has re‐emerged. Now, systems for both hypo‐ and normothermic machine perfusion are commercially available for heart , lung , liver and kidney grafts . Most available systems are oxygenated and either preservation solutions or diluted blood serve as perfusate .…”

Section: Advances In Organ and Tissue Preservationmentioning

confidence: 99%

“…Because of the large number of perfusion systems and preclinical and clinical trials, we exemplarily discuss the potential of machine perfusion in the setting of liver perfusion in the following section. Various reviews and reports on perfusion systems for the heart , lung , kidney , and initial studies in pancreas and VCA are available elsewhere.…”

Section: Advances In Organ and Tissue Preservationmentioning

confidence: 99%

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Emerging technologies in organ preservation, tissue engineering and regenerative medicine: a blessing or curse for transplantation?

et al. 2019

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Summary Since the beginning of transplant medicine in the 1950s, advances in surgical technique and immunosuppressive therapy have created the success story of modern organ transplantation. However, today more than ever, we are facing a huge discrepancy between organ supply and demand, limiting the potential for transplantation to save and improve the lives of millions. To address the current limitations and shortcomings, a variety of emerging new technologies focusing on either maximizing the availability of organs or on generating new organs and organ sources hold great potential to eventully overcoming these hurdles. These advances are mainly in the field of regenerative medicine and tissue engineering. This review gives an overview of this emerging field and its multiple sub‐disciplines and highlights recent advances and existing limitations for widespread clinical application and potential impact on the future of transplantation.

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Section: Advances In Organ and Tissue Preservationmentioning

confidence: 99%

Section: Advances In Organ and Tissue Preservationmentioning

confidence: 99%

Emerging technologies in organ preservation, tissue engineering and regenerative medicine: a blessing or curse for transplantation?

et al. 2019

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“…Due to a rising number of patients awaiting lung transplantation on one hand, and an increasing shortage of donor lungs on the other hand, about 50% of listed patients die while waiting for a transplantation [1][2][3]. Moreover, many donor lungs deteriorate following explantation and only 15-20% of donated lungs fulfill the functional requirements for lung transplantation [2,4,5]. To increase the number of transplantations, the quality of explanted donor lungs must be enhanced [2].…”

Section: Introductionmentioning

confidence: 99%

Temperature Controlled and Monitored Ex Vivo Lung Perfusion System for Research and Training Purposes

Pongratz

Ziegle

Boese

et al. 2019

Current Directions in Biomedical Engineering

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Ex vivo lung perfusion (EVLP) is a preservation method for donor lungs, which keep lungs viable in a physiological environment outside of a body for a short period of time. EVLP is established clinically for lung transplantation. Experimental applications for EVLP are e.g. lung cancer research or medical device development and testing. For preservation, a lung is ventilated artificially in an organ chamber and perfused antegrade through the pulmonary artery. Here we introduce a thermoregulation system for an experimental EVLP system to be used for translational research approaches as well as for training medical staff. To implement physiological culture conditions that are a prerequisite for lung preservation and tissue homeostasis, a thermoregulation is needed to rewarm the explanted lung tissue (storage temperature 4°C). Technically, the EVLP system must be thermally insulated, so loss of caloric is avoided. For monitoring, temperature sensors are integrated within the lung, in the organ chamber and in the afferent perfusate tube, whereby the measured values determine the thermoregulation. Initial tests using thermal packs (cooled to 4-6°C) placed on a heating mat, as a part of the perfusion circuit, showed that the perfusate temperature falls to 34°C, but restores after approximately 60 minutes (36.5°C), whereby the thermal pack is warmed. With this setup longer perfusion times should be obtained rather than without thermoregulation due to normothermic perfusion of the lung.

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“…4,5 Ex vivo lung perfusion (EVLP) aims to address these limitations by providing initially unacceptable donor lungs with physiologic conditions-normothermia, perfusion, ventilation-to recover function outside the body to a level acceptable for transplantation. 6,7 Since the introduction of EVLP by Steen and colleagues in 2001, 8 EVLP platforms have demonstrated short-term support and recovery of marginal quality donor lungs in preclinical and clinical settings. [8][9][10][11] However, EVLP has been unable to recover the majority of unusable donor lungs, likely due to the inability of an isolated single-organ support system to provide an appropriate physiologic milieu that enables endogenous repair.…”

mentioning

confidence: 99%

Multiday maintenance of extracorporeal lungs using cross-circulation with conscious swine

Hozain¹,

Tipograf²,

Pinezich³

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: Lung remains the least-utilized solid organ for transplantation. Efforts to recover donor lungs with reversible injuries using ex vivo perfusion systems are limited to<24 hours of support. Here, we demonstrate the feasibility of extending normothermic extracorporeal lung support to 4 days using crosscirculation with conscious swine.Methods: A swine behavioral training program and custom enclosure were developed to enable multiday cross-circulation between extracorporeal lungs and recipient swine. Lungs were ventilated and perfused in a normothermic chamber for 4 days. Longitudinal analyses of extracorporeal lungs (ie, functional assessments, multiscale imaging, cytokine quantification, and cellular assays) and recipient swine (eg, vital signs and blood and tissue analyses) were performed.

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Ex vivo lung perfusion review of a revolutionary technology

Cited by 29 publications

References 47 publications

Emerging technologies in organ preservation, tissue engineering and regenerative medicine: a blessing or curse for transplantation?

Emerging technologies in organ preservation, tissue engineering and regenerative medicine: a blessing or curse for transplantation?

Temperature Controlled and Monitored Ex Vivo Lung Perfusion System for Research and Training Purposes

Multiday maintenance of extracorporeal lungs using cross-circulation with conscious swine

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