Normothermic Ex Vivo Lung Perfusion in Clinical Lung Transplantation

Cypel, Marcelo; Yeung, Jonathan C.; Liu, Mingyao; Anraku, Masaki; Chen, Fengshi; Karolak, Wojtek; Sato, Masaaki; Laratta, Jane; Azad, S.; Madonik, M. Mindy; Chow, Chung‐Wai; Chaparro, Cecilia; Hutcheon, Michael; Singer, Lianne G.; Slutsky, Arthur S.; Yasufuku, Kazuhiro; Perrot, Marc de; Pierre, Andrew; Waddell, Thomas K.; Keshavjee, Shaf

doi:10.1056/nejmoa1014597

Cited by 933 publications

(777 citation statements)

References 33 publications

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“…Subsequently, indications of high-risk DCDD donor lungs that required EVLP included any of the following: (1) last PaO 2 /FiO 2 (P/F) < than 300 mmHg; (2) pulmonary edema detected on chest X-ray or during examination of the lungs at procurement; (3) poor lung compliance during examination of the lungs at procurement; (4) high-risk history (e.g. multiple blood transfusions, questionable history of aspiration) (16,17); (5) interval between WLST and arrest >60 minutes.…”

Section: Donor Selectionmentioning

confidence: 99%

“…Cypel et al, from the Toronto Lung Transplant Program, further mastered the methodology to allow for prolonged perfusion periods (up to 12 hours) and repeated functional assessments (15). The clinical experience has been repeatedly reported as successful, with high-risk donor lungs presenting similar outcomes to those lungs from standard criteria donors (16,17).…”

Section: Introductionmentioning

confidence: 99%

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Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Machuca

Mercier

Collaud

et al. 2015

American Journal of Transplantation

130

116

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The growing demand for suitable lungs for transplantation drives the quest for alternative strategies to expand the donor pool. The aim of this study is to evaluate the outcomes of lung transplantation (LTx) with donation after circulatory determination of death (DCDD) and the impact of selective ex vivo lung perfusion (EVLP). From 2007 to 2013, 673 LTx were performed, with 62 (9.2%) of them using DCDDs (seven bridged cases). Cases bridged with mechanical ventilation/extracorporeal life support were excluded. From 55 DCDDs, 28 (51%) underwent EVLP. Outcomes for LTx using DCDDs and donation after neurological determination of death (DNDD) donors were similar, with 1 and 5-year survivals of 85% and 54% vs 86% and 62%, respectively (p ¼ 0.43). Although comparison of survival curves between DCDD þ EVLP vs DCDD-no EVLP showed no significant difference, DCDD þ EVLP cases presented shorter hospital stay (median 18 vs. 23 days, p ¼ 0.047) and a trend toward shorter length of mechanical ventilation (2 vs. 3 days, p ¼ 0.059). DCDDs represent a valuable source of lungs for transplantation, providing similar results to DNDDs. EVLP seems an important technique in the armamentarium to safely increase lung utilization from DCDDs; however, further studies are necessary to better define the role of EVLP in this context.

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Section: Donor Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Machuca

Mercier

Collaud

et al. 2015

American Journal of Transplantation

130

116

View full text Add to dashboard Cite

show abstract

“…As a significant nonclassical monocyte population was discovered in this study, it is likely that the benefits observed posttransplant will be conferred in human EVLP. Early clinical trial data have indicated equivalence in clinical outcome between standard transplant and EVLP reconditioned lungs, allowing an expanded donor organ pool (20)(21)(22)(23). Although significantly beneficial in itself, there is scope for further improvements in clinical outcome with EVLP via modulation of the donor leukocyte repertoire.…”

Section: Stone Et Almentioning

confidence: 99%

Altered Immunogenicity of Donor Lungs via Removal of Passenger Leukocytes Using Ex Vivo Lung Perfusion

Stone

Critchley

Major

et al. 2016

American Journal of Transplantation

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Passenger leukocyte transfer from the donor lung to the recipient is intrinsically involved in acute rejection. Direct presentation of alloantigen expressed on donor leukocytes is recognized by recipient T cells, promoting acute cellular rejection. We utilized ex vivo lung perfusion (EVLP) to study passenger leukocyte migration from donor lungs into the recipient and to evaluate the effects of donor leukocyte depletion prior to transplantation. For this purpose, female pigs received male left lungs either following 3 h of EVLP or retrieved using standard protocols. Recipients were monitored for 24 h and sequential samples were collected. EVLPreduced donor leukocyte transfer into the recipient and migration to recipient lymph nodes was markedly reduced. Recipient T cell infiltration of the donor lung was significantly diminished via EVLP. Donor leukocyte removal during EVLP reduces direct allorecognition and T cell priming, diminishing recipient T cell infiltration, the hallmark of acute rejection.

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“…Significant interest has been generated in allograft optimization through ex vivo lung perfusion (EVLP). Most studies involving EVLP have utilized human lungs (34,35) or large animal (mainly porcine) models (36-39) with or without transplantation. Nonetheless, rodent studies using EVLP and lung transplantation have been performed (40)(41)(42).…”

Section: Introductionmentioning

confidence: 99%

Models of Lung Transplant Research: a consensus statement from the National Heart, Lung, and Blood Institute workshop

Lama¹,

Belperio²,

Christie³

et al. 2017

JCI Insight

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Normothermic Ex Vivo Lung Perfusion in Clinical Lung Transplantation

Abstract: Transplantation of high-risk donor lungs that were physiologically stable during 4 hours of ex vivo perfusion led to results similar to those obtained with conventionally selected lungs. (Funded by Vitrolife; ClinicalTrials.gov number, NCT01190059.).

Cited by 933 publications

References 33 publications

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Altered Immunogenicity of Donor Lungs via Removal of Passenger Leukocytes Using Ex Vivo Lung Perfusion

Models of Lung Transplant Research: a consensus statement from the National Heart, Lung, and Blood Institute workshop

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