Normothermic Ex Vivo Lung Perfusion (Novel) as an Assessment of Extended Criteria Donor Lungs: A Prospective Multi-Center Clinical Trial

Sanchez, P.G.; Chan, Ernest G.; Davis, Robert D.; Hartwig, M.; Machuca, Tiago; Whitson, Bryan A.; Daneshmand, Mani A.; Ovidio, F. D; D’Cunha, Jonathan; Weyant, M.; Jessen, M.; Bermúdez, C.; Mulligan, M.S.; Wozniak, Thomas; Lynch, William R.; Nemeh, Hassan; Caldeira, Christiano; Song, Tae Ho; Kreisel, Daniel; Camp, P.; Ramzy, Danny; Griffith, B.; Cantu, Edward

doi:10.1016/j.healun.2022.01.092

Cited by 5 publications

(4 citation statements)

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“…Important EVLP trials, utilizing the above-mentioned EVLP protocols are summarized in Table 1. 12,26,28,30,[32][33][34][35][36][37] In general, the duration of EVLP lasts for 2 to 6 h in clinical settings. Similarities and also important differences exist between the EVLP protocols related to the perfusate composition and circuit, perfusion parameters, ventilation settings, and evaluation of allograft viability, which are summarized in Tables 2 to 5, respectively.…”

Section: Evlp Devices/protocolsmentioning

confidence: 99%

“…Important EVLP trials, utilizing the above-mentioned EVLP protocols are summarized in Table 1. 12,26,28,30,32-37…”

Section: Introductionmentioning

confidence: 99%

“…The device received FDA approval and is remain actively marketed. 28,29 The third EVLP device, the OCS Lung (TransMedics, Andover, MA, United States), runs on a portable platform to initiate EVLP at the donor hospital. This device also received FDA approval.…”

Section: Introductionmentioning

confidence: 99%

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Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

Iskender

2024

Transplantation

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Indications for ex vivo lung perfusion (EVLP) have evolved from assessment of questionable donor lungs to treatment of some pathologies and the logistics. Yet up to 3 quarters of donor lungs remain discarded across the globe. Multiday preservation of discarded human lungs on EVLP platforms would improve donor lung utilization rates via application of sophisticated treatment modalities, which could eventually result in zero waitlist mortality. The purpose of this article is to summarize advances made on the technical aspects of the protocols in achieving a stable multiday preservation of isolated EVLP. Based on the evidence derived from large animal and/or human studies, the following advances have been considered important in achieving this goal: ability to reposition donor lungs during EVLP; perfusate adsorption/filtration modalities; perfusate enrichment with plasma and/or donor whole blood, nutrients, vitamins, and amino acids; low-flow, pulsatile, and subnormothermic perfusion; positive outflow pressure; injury specific personalized ventilation strategies; and negative pressure ventilation. Combination of some of these advances in an automatized EVLP device capable of managing perfusate biochemistry and ventilation would likely speed up the processes of achieving multiday preservation of isolated EVLP.

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Section: Evlp Devices/protocolsmentioning

confidence: 99%

“…Important EVLP trials, utilizing the above-mentioned EVLP protocols are summarized in Table 1. 12,26,28,30,32-37…”

Section: Introductionmentioning

confidence: 99%

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Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

Iskender

2024

Transplantation

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“…[3][4][5] Commercial EVLP devices have been used in a number of multi-center clinical trials and have gained regulatory approval for clinical application. 3,6,7 However, the ability of EVLP to recondition marginal lungs is variable and depends on which criteria are used to select organs for perfusion before transplant. Published studies have shown variation in conversion rates from organs deemed unsuitable to those accepted, with the need remaining to standardize acceptance criteria.…”

Section: Introductionmentioning

confidence: 99%

Modeling the Effects of IL-1β-mediated Inflammation During Ex Vivo Lung Perfusion Using a Split Human Donor Model

et al. 2023

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Background. The association between interleukin-1β (IL-1β) concentrations during ex vivo lung perfusion (EVLP) with donor organ quality and post-lung transplant outcome has been demonstrated in several studies. The mechanism underlying IL-1β-mediated donor lung injury was investigated using a paired single-lung EVLP model. Methods. Human lung pairs were dissected into individual lungs and perfused on identical separate EVLP circuits, with one lung from each pair receiving a bolus of IL-1β. Fluorescently labeled human neutrophils isolated from a healthy volunteer were infused into both circuits and quantified in perfusate at regular timepoints. Perfusates and tissues were subsequently analyzed, with perfusates also used in functional assays. Results. Neutrophil numbers were significantly lower in perfusate samples collected from the IL-1β-stimulated lungs consistent with increased neutrophil adhesion (P = 0.042). Stimulated lungs gained significantly more weight than controls (P = 0.046), which correlated with soluble intercellular adhesion molecule-1 (R2 = 0.71, P = 0.0043) and von-Willebrand factor (R2 = 0.39, P = 0.040) in perfusate. RNA expression patterns for inflammatory genes were differentially regulated via IL-1β. Blockade of IL-1β significantly reduced neutrophil adhesion in vitro (P = 0.025). Conclusion. These data illustrate the proinflammatory functions of IL-1β in the context of EVLP, suggesting this pathway may be susceptible to therapeutic modulation before transplantation.

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A novel modified Steen solution limits inflammatory processes during ex vivo lung perfusion and improves graft function post-transplantation

Gilmour,

Sigvardsson,

Henriksson

et al. 2024

JHLT Open

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Normothermic Ex Vivo Lung Perfusion (Novel) as an Assessment of Extended Criteria Donor Lungs: A Prospective Multi-Center Clinical Trial

Cited by 5 publications

References 0 publications

Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion

Modeling the Effects of IL-1β-mediated Inflammation During Ex Vivo Lung Perfusion Using a Split Human Donor Model

A novel modified Steen solution limits inflammatory processes during ex vivo lung perfusion and improves graft function post-transplantation

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