Ex-vivo lung perfusion and ventilation: where to from here?
Ex-vivo lung perfusion and ventilation: where to from here? Curr Opin Organ Transplant. 2019 Jun;24(3):297-304 Authors: Ali A, Cypel M Abstract PURPOSE OF REVIEW: Within the last decade, ex-vivo lung perfusion (EVLP) has become a widespread technology used for organ assessment and reconditioning within clinical transplantation. This review aims to offer insights toward future applications and developments in regards to its utility. RECENT FINDINGS: The intervention of EVLP is a well-tolerated method to effectively allow for extended preservation periods. The thoughtful usage of EVLP can therefore be used to optimize operating room logistics and progress lung transplantation toward becoming a more elective procedure. EVLP has also demonstrated itself as an excellent platform for targeted therapies. Prolonged perfusion achieved through further platform stability will allow for time-dependent molecular therapies. Lastly, EVLP allows for the opportunity to perform advanced diagnostics within an isolated setting. Sophistication of point-of-care technologies will allow for accurate predictive measures of transplant outcomes within the platform. SUMMARY: The future of EVLP involves usage of the system as a preservation modality, utilizing advanced diagnostics to predict transplant outcome, and performing therapeutic interventions to optimize organ quality. The generation of clinical data to facilitate and validate these approaches should be performed ...
Publication date: Available online 9 October 2019Source: The Lancet Respiratory MedicineAuthor(s): Marcelo Cypel, Jordan J Feld, Marcos Galasso, Rafaela V Pinto Ribeiro, Nikki Marks, Magdalena Kuczynski, Deepali Kumar, Ilona Bahinskaya, Vanderlei S Bagnato, Cristina Kurachi, Arthur S S.sky, Jonathan C Yeung, Laura Donahoe, Marc de Perrot, Kazuhiro Yasufuku, Andrew Pierre, Matthew Binnie, Cecilia Chaparro, Tereza Martinu, Manyin ChenSummaryBackgroundA substantial proportion of organ donors test positive for hepatitis C virus (HCV) infection. To date, only a few studies have evaluated the safety of using lungs from these don...
This cohort study assesses the long-term outcomes of transplant recipients of donor lungs treated with ex vivo lung perfusion.
Limited donor lung availability and prolonged wait times remain substantial barriers to lung transplant. According to the Scientific Registry of Transplant Recipients, 11% of patients were removed from the wait-list in 2017 because of death or clinical deterioration and 40% of patients waited longer than 1 year before transplant. Ex vivo lung perfusion (EVLP) provides the opportunity to expand the donor pool, but despite encouraging early posttransplant outcomes, the long-term effect of EVLP remains unclear. In this issue of JAMA Surgery, Divithotawela et al present 10-year outcomes of the Toronto Lung Transplant Group &rs...
Current ex vivo lung perfusion (EVLP) protocols aim to achieve perfusion flows of 40% of cardiac output or more. We hypothesized that a lower target flow rate during EVLP would improve graft function and decrease inflammation of donation after circulatory death (DCD) lungs.
We present two cases of circulatory death donor (DCD) hearts recovered using NMP.
We examined these outcomes in a large-cohort, single-center series of clinical EVLP cases.
We examined these outcomes in a large cohort, single center experience of clinical EVLP cases.
I read with great interest the article “Outcomes of Marginal Donors for Lung Transplantation After Ex Vivo Lung Perfusion: A Systematic Review And Meta-analysis,” published by Nakajima and colleagues1 in this issue of the Journal. It provides a summary of published evidence comparing outcomes of marginal donor lungs pretreated by ex vivo lung perfusion (EVLP) to outcomes of standard donor lungs preserved by static cold storage. A total of 8 studies with nearly 1200 patients met the inclusion criteria and served as the basis for a meta-analysis.
The article in this issue of the Journal by Cypel and colleagues1 of Toronto presents a large cohort single-center experience with clinical ex vivo lung perfusion (EVLP). Previous studies have shown promising outcomes for EVLP to evaluate and treat donor lungs, but there has been limited worldwide experience with this relatively new technology.2-5 Most studies have had small sample sizes and have failed to answer the question of when EVL P is clinically indicated. Cypel and colleagues1 evaluated 262 lung transplants performed after EVLP and focused on the impact of indication for EVLP on lung utilization rates and transplant outcomes.
We describe a novel circuit which allows safe and easy switch between modalities without prolonged interruption of flow. This circuit offers a safety net during surgery to minimise the risks influencing the use of extracorporeal membrane oxygenation. PMID: 31480930 [PubMed - as supplied by publisher]