Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Ex Vivo Lung Perfusion in Lung Transplantation

  • Haam, Seokjin (Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine)
  • Received : 2022.07.11
  • Accepted : 2022.07.21
  • Published : 2022.08.05
Download PDF
⟨ Previous Next ⟩

Abstract

Ex vivo lung perfusion (EVLP) is a technique that enables active metabolism of the lung by creating an environment similar to that inside the body, even though the explanted lungs are outside the body. The EVLP system enables the use of lung grafts that do not satisfy the acceptance criteria for lung transplantation (LTx) by making it possible to evaluate the function of the lung grafts and repair lungs in poor condition, thereby reducing the waiting time of patients requiring LTx and consequently mortality.

Keywords

Acknowledgement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

  1. Valapour M, Lehr CJ, Skeans MA, et al. OPTN/SRTR 2018 annual data report: lung. Am J Transplant 2020;20 Suppl s1:427-508. https://doi.org/10.1111/ajt.15677
  2. Van Raemdonck D, Neyrinck A, Verleden GM, et al. Lung donor selection and management. Proc Am Thorac Soc 2009;6:28-38. https://doi.org/10.1513/pats.200808-098GO
  3. Steen S, Liao Q, Wierup PN, Bolys R, Pierre L, Sjoberg T. Transplantation of lungs from non-heart-beating donors after functional assessment ex vivo. Ann Thorac Surg 2003;76:244-52. https://doi.org/10.1016/S0003-4975(03)00191-7
  4. Cypel M, Rubacha M, Yeung J, et al. Normothermic ex vivo perfusion prevents lung injury compared to extended cold preservation for transplantation. Am J Transplant 2009;9:2262-9. https://doi.org/10.1111/j.1600-6143.2009.02775.x
  5. de Perrot M, Bonser RS, Dark J, et al. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part III: donor-related risk factors and markers. J Heart Lung Transplant 2005;24:1460-7. https://doi.org/10.1016/j.healun.2005.02.017
  6. Weeder PD, van Rijn R, Porte RJ. Machine perfusion in liver transplantation as a tool to prevent non-anastomotic biliary strictures: rationale, current evidence and future directions. J Hepatol 2015;63:265-75. https://doi.org/10.1016/j.jhep.2015.03.008
  7. Wierup P, Haraldsson A, Nilsson F, et al. Ex vivo evaluation of nonacceptable donor lungs. Ann Thorac Surg 2006;81:460-6. https://doi.org/10.1016/j.athoracsur.2005.08.015
  8. Cypel M, Sato M, Yildirim E, et al. Initial experience with lung donation after cardiocirculatory death in Canada. J Heart Lung Transplant 2009;28:753-8. https://doi.org/10.1016/j.healun.2009.05.009
  9. Snell GI, Levvey BJ, Oto T, et al. Early lung transplantation success utilizing controlled donation after cardiac death donors. Am J Transplant 2008;8:1282-9. https://doi.org/10.1111/j.1600-6143.2008.02231.x
  10. Cypel M, Yeung JC, Liu M, et al. Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med 2011;364:1431-40. https://doi.org/10.1056/NEJMoa1014597
  11. Rega FR, Vanaudenaerde BM, Wuyts WA, et al. IL-1beta in bronchial lavage fluid is a non-invasive marker that predicts the viability of the pulmonary graft from the non-heart-beating donor. J Heart Lung Transplant 2005;24:20-8. https://doi.org/10.1016/j.healun.2003.10.004
  12. Kaneda H, Waddell TK, de Perrot M, et al. Pre-implantation multiple cytokine mRNA expression analysis of donor lung grafts predicts survival after lung transplantation in humans. Am J Transplant 2006;6:544-51. https://doi.org/10.1111/j.1600-6143.2005.01204.x
  13. De Perrot M, Sekine Y, Fischer S, et al. Interleukin-8 release during early reperfusion predicts graft function in human lung transplantation. Am J Respir Crit Care Med 2002;165:211-5. https://doi.org/10.1164/ajrccm.165.2.2011151
  14. George TJ, Arnaoutakis GJ, Beaty CA, et al. A physiologic and biochemical profile of clinically rejected lungs on a normothermic ex vivo lung perfusion platform. J Surg Res 2013;183:75-83. https://doi.org/10.1016/j.jss.2012.11.012
  15. Nakajima D, Liu M, Ohsumi A, et al. Lung lavage and surfactant replacement during ex vivo lung perfusion for treatment of gastric acid aspiration-induced donor lung injury. J Heart Lung Transplant 2017;36:577-85. https://doi.org/10.1016/j.healun.2016.11.010
  16. Inci I, Yamada Y, Hillinger S, Jungraithmayr W, Trinkwitz M, Weder W. Successful lung transplantation after donor lung reconditioning with urokinase in ex vivo lung perfusion system. Ann Thorac Surg 2014;98:1837-8. https://doi.org/10.1016/j.athoracsur.2014.01.076
  17. Dong B, Stewart PW, Egan TM. Postmortem and ex vivo carbon monoxide ventilation reduces injury in rat lungs transplanted from non-heart-beating donors. J Thorac Cardiovasc Surg 2013;146:429-36. https://doi.org/10.1016/j.jtcvs.2012.11.005
  18. Haam S, Lee JG, Paik HC, Park MS, Lim BJ. Hydrogen gas inhalation during ex vivo lung perfusion of donor lungs recovered after cardiac death. J Heart Lung Transplant 2018;37:1271-8. https://doi.org/10.1016/j.healun.2018.06.007
  19. Grimm JC, Zhang F, Magruder JT, et al. Accumulation and cellular localization of nanoparticles in an ex vivo model of acute lung injury. J Surg Res 2017;210:78-85. https://doi.org/10.1016/j.jss.2016.11.007
  20. Machuca TN, Cypel M, Bonato R, et al. Safety and efficacy of ex vivo donor lung adenoviral IL-10 gene therapy in a large animal lung transplant survival model. Hum Gene Ther 2017;28:757-65. https://doi.org/10.1089/hum.2016.070
  21. Niikawa H, Okamoto T, Ayyat KS, et al. Prone ex vivo lung perfusion protects human lungs from reperfusion injury. Artif Organs 2022 Jun 3 [Epub]. https://doi.org/10.1111/aor.14328.
  22. Nakajima D, Watanabe Y, Ohsumi A, et al. Mesenchymal stromal cell therapy during ex vivo lung perfusion ameliorates ischemia-reperfusion injury in lung transplantation. J Heart Lung Transplant 2019;38:1214-23. https://doi.org/10.1016/j.healun.2019.07.006
  23. Cypel M, Yeung JC, Donahoe L, et al. Normothermic ex vivo lung perfusion: does the indication impact organ utilization and patient outcomes after transplantation? J Thorac Cardiovasc Surg 2020;159:P346-55.
  24. Andreasson AS, Dark JH, Fisher AJ. Ex vivo lung perfusion in clinical lung transplantation: state of the art. Eur J Cardiothorac Surg 2014;46:779-88. https://doi.org/10.1093/ejcts/ezu228