Ex vivo lung perfusion and reconditioning

Area of Science:

• Thoracic surgery
• Transplantation immunology
• Cardiopulmonary bypass

Background:

• Donor lung evaluation is critical for successful transplantation.
• Primary graft dysfunction remains a significant challenge in lung transplantation.
• Ex vivo lung perfusion (EVLP) offers a potential solution for assessing and improving donor lung viability.

Purpose of the Study:

• To describe a novel normothermic ex vivo lung perfusion (NEVLP) system for donor lung assessment and repair.
• To detail the technical aspects of the NEVLP circuit, including perfusate composition and gas exchange.
• To highlight the potential of NEVLP to improve donor lung utilization rates.

Main Methods:

• Utilized a normothermic ex vivo lung perfusion system with an acellular hyperosmolar solution.
• Perfused donor lungs anterograde at 40% of estimated cardiac output.
• Employed a hollow fiber oxygenator with hypoxic gas, heat exchanger, and leukocyte filter for circuit completion.

Main Results:

• Lung function was assessed by measuring PO2 differences and physiological parameters.
• The system maintained normothermia and controlled gas exchange.
• Demonstrated a method for evaluating donor lung function ex vivo.

Conclusions:

• Normothermic ex vivo lung perfusion serves as a viable platform for donor lung evaluation and repair.
• This technique has the potential to mitigate concerns regarding primary graft dysfunction.
• Increased utilization of donor lungs is anticipated with the adoption of this EVLP method.