Ex vivo lung graft perfusion

Abstract This review proposes an update of the state of the art and the ongoing clinical trials of ex vivo lung perfusion for lung transplantation in patients. Ex vivo lung perfusion techniques (EVLP) can be used to evaluate a lung graft outside of the body. The goal of EVLP is to study the function...

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Bibliographic Details
Published in:Anaesthesia critical care & pain medicine 2016-04, Vol.35 (2), p.123-131
Main Authors: Briot, Raphaël, Gennai, Stéphane, Maignan, Maxime, Souilamas, Redha, Pison, Christophe
Format: Article
Language:English
Subjects:
Anesthesia & Perioperative Care
Cardiology and cardiovascular system
Ex vivo lung perfusion
Human health and pathology
Humans
Ischaemia-reperfusion injury
Life Sciences
Lung - physiology
Lung transplantation
Lung Transplantation - methods
Perfusion - methods
Pulmonary Circulation
Pulmonary Edema - etiology
Pulmonary oedema
Reperfusion Injury
Tissue and Organ Procurement
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Summary:Abstract This review proposes an update of the state of the art and the ongoing clinical trials of ex vivo lung perfusion for lung transplantation in patients. Ex vivo lung perfusion techniques (EVLP) can be used to evaluate a lung graft outside of the body. The goal of EVLP is to study the functional status of lung grafts that were first rejected for transplantation because they did not match all criteria for a conventional transplantation. After an EVLP evaluation, some of these lungs may be requalified for a possible transplantation in patients. This article proposes an overview of the developments of EVLP techniques. During EVLP, the perfusion and ventilation of the isolated lung preparation are very progressive in order to avoid oedema due to ischaemia-reperfusion injuries. Lung evaluation is mainly based on gasometric (PaO2 /FiO2 ) and rheological criteria (low pulmonary arterial resistance). Several series of patients transplanted with EVLP evaluated lungs have been recently published with promising results. EVLP preparations also allow a better understanding of the physiopathology and treatments of ischaemia-reperfusion injuries. Organ procurements from “non-heart-beating” donors will probably require a wider application of these ex vivo techniques. The development of semi-automated systems might facilitate the clinical use of EVLP techniques.
ISSN:2352-5568
2352-5568
DOI:10.1016/j.accpm.2015.09.006