In situ lung perfusion is a valuable tool to assess lungs from donation after circulatory death donors category I-II

Wauwer, Caroline Van De; Munneke, Anita J.; Engels, Gerwin E.; Berga, Foke M.; Rakhorst, Gerhard; Nijsten, Maarten W. N.; Mariani, Massimo A.; Erasmus, Michiel E.

doi:10.1111/tri.12068

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…We found that a decrease in compliance and high or increased airway pressure after 2 h of EVLP were the decisive parameters when rejecting lungs, even when they initially met the acceptance criteria for transplantation. This was also demonstrated in our previous animal study of in situ lung perfusion, in which compliance and plateau airway pressures were better in less badly injured donor lungs ( 18 ). Two lungs with a pO 2 above 60 kPa were declined for transplantation due to a decrease in compliance, an increase in plateau airway pressure and pulmonary vascular resistance, and an obvious pulmonary edema upon inspection.…”

Section: Discussionsupporting

confidence: 75%

Is logistically motivated ex vivo lung perfusion a good idea?

Wauwer

Suylen²,

Zhang³

et al. 2022

Front. Transplant.

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Ex vivo lung perfusion (EVLP) is a technique for reconditioning and evaluating lungs. However, the use of EVLP for logistical reasons is still under discussion. In this retrospective study, all EVLPs performed between July 2012 and October 2019 were analyzed for ventilation and perfusion data. After transplantation, primary graft dysfunction (PGD), lung function, chronic lung allograft dysfunction (CLAD)-free survival, and overall survival were analyzed. Fifty EVLPs were performed: seventeen logistic EVLPs led to 15 lung transplantations (LT) and two rejections (LR), and 33 medical EVLPs resulted in 26 lung transplantations (MT) and seven rejections (MR). Pre-EVLP PaO2 was lower for MT than LT (p < 0.05). Dynamic lung compliance remained stable in MT and LT but decreased in MR and LR. Plateau airway pressure started at a higher level in MR (p < 0.05 MT vs. MR at T60) and increased further in LR. After transplantation, there were no differences between MT and LT in PGD, lung function, CLAD-free survival, and overall survival. In addition, the LT group was compared with a cohort group receiving standard donor lungs without EVLP (LTx). There were no significant differences between LT and LTx for PGD, CLAD-free survival, and overall survival. FVC was significantly lower in LT than in LTx after 1 year (p = 0.005). We found that LT lungs appear to perform better than MT lungs on EVLP. In turn, the outcome in the LT group was comparable with the LTx group. Overall, lung transplantation after EVLP for logistic reasons is safe and makes transplantation timing controllable.

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Section: Discussionsupporting

confidence: 75%

Is logistically motivated ex vivo lung perfusion a good idea?

Wauwer

Suylen²,

Zhang³

et al. 2022

Front. Transplant.

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“…It has an internal roller pump to create a continuous flow. The Lung Assist ® is a less robust device with individual components mounted on a frame designed for EVLP and for in situ evaluation of lungs from uncontrolled DCD at the donor site prior to explanting the organs from the body . Finally, the XPS ™ is a fully integrated device that was developed based on the principles of the Toronto technique.…”

Section: Evlp Technology and Devicesmentioning

confidence: 99%

Ex‐vivo lung perfusion

et al. 2014

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Summary This review outlines the new and promising technique of ex vivo lung perfusion and its clinical potential to increase the number of transplantable lungs and to improve the early and late outcome after transplantation. The rationale, the experimental background, the technique and protocols, and available devices for ex vivo lung perfusion are discussed. The current clinical experience worldwide and ongoing clinical trials are reviewed.

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“…Lung Assist® (Organ Assist, Groningen, the Netherlands) is deemed "a less robust device with its individual components fixed on a frame designed for EVLP, and for in situ evaluation of lungs from uncontrolled DCD at the donor site, prior to explanting the organs from the body" [14,35].…”

mentioning

confidence: 99%

Ex-Vivo Lung Perfusion: From Bench to Bedside

Aboelnazar¹,

Himmat²,

Freed³

et al. 2016

Frontiers in Transplantology

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Lung transplantation is an established treatment option for eligible patients with endstage lung disease. Nonetheless, there exists an imbalance between donor lungs considered suitable for transplantation and the ever-growing number of patients dying on the waiting list. This chapter reflects the potential alternative, normothermic exvivo lung perfusion (EVLP), which has emerged to address this issue and how it can expand the currently limited donor pool. Normothermic ex-vivo lung perfusion (EVLP), as a novel preservation technique, is capable of assessing, evaluating, and improving lung function prior to lung transplantation. Here, we (1) contrast the various available commercial EVLP available and used around the world; (2) outline the University of Alberta novel EVLP circuit; (3) discuss the limitations present between clinical and laboratory applications; and (4) present what we are currently working on at the laboratory to further improve the assessment techniques used on EVLP.

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In situ lung perfusion is a valuable tool to assess lungs from donation after circulatory death donors category I-II

Cited by 9 publications

References 28 publications

Is logistically motivated ex vivo lung perfusion a good idea?

Is logistically motivated ex vivo lung perfusion a good idea?

Ex‐vivo lung perfusion

Ex-Vivo Lung Perfusion: From Bench to Bedside

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