Marcelo Cypel1, Shaf Keshavjee. 1. Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, UHN, University of Toronto, Toronto, Ontario, 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. A novel strategy of donor lung management, ex-vivo lung perfusion (EVLP), that keeps the organ at physiological protective conditions has shown great promise to increase lung utilization by re-evaluating, treating, and repairing donor lungs prior to transplantation. RECENT FINDINGS: Clinical trials using EVLP have shown the method to be well tolerated and it allows for reassessment and improvement in function from high-risk donor lungs from both brain death and cardiac death donors 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 also shown a great potential of EVLP as a platform for the delivery of novel therapies to repair injured organs ex vivo and thus further increase the donor lung utilization rate. SUMMARY: Development of an ex-vivo treatment arsenal ranging in complexity from pharmacologic to gene and cellular therapies will soon allow clinicians to utilize the full potential of the donor organ pool improving outcomes of lung transplantation.
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. A novel strategy of donor lung management, ex-vivo lung perfusion (EVLP), that keeps the organ at physiological protective conditions has shown great promise to increase lung utilization by re-evaluating, treating, and repairing donor lungs prior to transplantation. RECENT FINDINGS: Clinical trials using EVLP have shown the method to be well tolerated and it allows for reassessment and improvement in function from high-risk donor lungs from both brain death and cardiac death donors 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 also shown a great potential of EVLP as a platform for the delivery of novel therapies to repair injured organs ex vivo and thus further increase the donor lung utilization rate. SUMMARY: Development of an ex-vivo treatment arsenal ranging in complexity from pharmacologic to gene and cellular therapies will soon allow clinicians to utilize the full potential of the donor organ pool improving outcomes of lung transplantation.
Authors: K Walweel; K Skeggs; A C Boon; L E See Hoe; M Bouquet; N G Obonyo; S E Pedersen; S D Diab; M R Passmore; K Hyslop; E S Wood; J Reid; S M Colombo; N J Bartnikowski; M A Wells; D Black; L P Pimenta; A K Stevenson; K Bisht; L Marshall; D A Prabhu; L James; D G Platts; P S Macdonald; D C McGiffin; J Y Suen; J F Fraser Journal: J Biomed Sci Date: 2020-10-02 Impact factor: 8.410
Authors: Nathan Haywood; Matthew R Byler; Aimee Zhang; Mark E Roeser; Irving L Kron; Victor E Laubach Journal: Int J Mol Sci Date: 2020-09-17 Impact factor: 5.923