Marcelo Cypel1, Shaf Keshavjee. 1. Division Thoracic Surgery, University of Toronto, 200 Elizabeth St, Toronto, Canada.
Abstract
PURPOSE OF REVIEW: The number of patients listed for lung transplantation largely exceeds the number of available transplantable organs because of both a shortage of organ donors and a low utilization rate of lungs from those donors due to injuries acquired during the process of brain death and intensive care unit (ICU) care. A novel strategy for donor lung preservation - ex-vivo lung perfusion (EVLP) - that keeps the organ at physiological protective conditions has shown great promise to increase lung utilization by reassessing, treating, and repairing injured donor lungs prior to transplantation. RECENT FINDINGS: A first clinical trial using EVLP has shown the method to be safe and to allow for reassessment and improvement in function of lungs from high-risk donor lungs prior to transplantation. When these lungs were transplanted, low rates of primary graft dysfunction were achieved, and the early outcomes were similar to those with conventionally selected and transplanted lungs. Preclinical studies have shown a great potential of EVLP as a platform for the delivery of novel simple and advanced therapies to repair injured organs ex vivo and thus further increase the donor lung utilization rate. SUMMARY: EVLP triggers a new era in lung transplantation. This method will allow for more and better organs to become available. Several experimental studies, clinical case reports, and a clinical trial have shown the safety of EVLP and the numerous potentials of EVLP.
PURPOSE OF REVIEW: The number of patients listed for lung transplantation largely exceeds the number of available transplantable organs because of both a shortage of organ donors and a low utilization rate of lungs from those donors due to injuries acquired during the process of brain death and intensive care unit (ICU) care. A novel strategy for donor lung preservation - ex-vivo lung perfusion (EVLP) - that keeps the organ at physiological protective conditions has shown great promise to increase lung utilization by reassessing, treating, and repairing injured donor lungs prior to transplantation. RECENT FINDINGS: A first clinical trial using EVLP has shown the method to be safe and to allow for reassessment and improvement in function of lungs from high-risk donor lungs prior to transplantation. When these lungs were transplanted, low rates of primary graft dysfunction were achieved, and the early outcomes were similar to those with conventionally selected and transplanted lungs. Preclinical studies have shown a great potential of EVLP as a platform for the delivery of novel simple and advanced therapies to repair injured organs ex vivo and thus further increase the donor lung utilization rate. SUMMARY: EVLP triggers a new era in lung transplantation. This method will allow for more and better organs to become available. Several experimental studies, clinical case reports, and a clinical trial have shown the safety of EVLP and the numerous potentials of EVLP.
Authors: Lorraine B Ware; Jason D Christie; Joshua M Diamond; Mary K Porteous; L Jackson Roberts; Nancy Wickersham; Melanie Rushefski; Steven M Kawut; Rupal J Shah; Edward Cantu; David J Lederer; Shampa Chatterjee; Vibha N Lama; Sangeeta Bhorade; Maria Crespo; John McDyer; Keith Wille; Jonathan Orens; Ann Weinacker; Selim Arcasoy; Pali D Shah; David S Wilkes; Chadi Hage; Scott M Palmer; Laurie Snyder; Carolyn S Calfee Journal: J Heart Lung Transplant Date: 2016-01-07 Impact factor: 10.247
Authors: S Shafaghi; K Najafizadeh; K Sheikhy; Z Ansari Aval; B Farzanegan; Y Mafhoomi; Z Faghih Abdollahi; H Emami; E Mortaz; M Porabdollah; A Jahangiri Fard; M Nikobayan Safaei; A Slama; C Aigner; F S Hosseini-Baharanchi; A Abbasi Dezfuli Journal: Int J Organ Transplant Med Date: 2016-11-01