Thoracic organs: current preservation technology and future prospects; part 1: lung.

Area of Science:

• Transplantation immunology
• Cardiothoracic surgery
• Organ preservation

Background:

• Critical organ shortages necessitate expanded donor criteria for lung transplantation.
• Extended donor criteria can compromise early recipient outcomes.
• Primary graft dysfunction remains a significant challenge in lung transplantation.

Purpose of the Study:

• To review advancements in lung preservation solutions and ex-vivo techniques.
• To assess strategies for improving early outcomes in lung transplant recipients.
• To explore methods for increasing the availability of pulmonary grafts.

Main Methods:

• Review of clinical and experimental evidence on preservation solutions.
• Analysis of current practices in pulmonary flush, reperfusion, and ventilation control.
• Evaluation of ex-vivo lung perfusion (EVLP) studies.

Main Results:

• Extracellular preservation solutions are the current standard for lung preservation.
• Combined antegrade and retrograde pulmonary flush techniques are common but lack strong evidence.
• Ex-vivo lung perfusion has shown promise in small clinical series for lung assessment and reconditioning.

Conclusions:

• Extracellular solutions have reduced primary graft dysfunction, enabling broader donor criteria and longer ischemic times.
• Ex-vivo lung perfusion is emerging as a method to extend preservation and improve the quality of marginal lungs.