Biomarkers for human donor lung assessment during ex vivo lung perfusion

Lung transplantation remains the only curative treatment option for patients with end-stage lung disease, yet limited donor lung availability and utilization remains a significant obstacle. The ex vivo lung perfusion (EVLP) system allows for the extension of the donor assessment, providing the opportunity to perform advanced assessment on the isolated donor lung under near-physiological conditions. Measuring biomarkers in EVLP perfusate can provide valuable information on the condition of the donor lungs. This review examines biomarkers measured in EVLP perfusate and their ability to predict donor lung utilization and outcomes. Biomarkers in this review can be classified as cytokines, cell death, and endothelial-related molecules, showing potential for clinical application. Some of these biomarkers have also been used to monitor the effects of various therapeutics for donor lung repair or for modification of the EVLP technique. Yet, many limitations persist throughout these studies, which provides the opportunity for extensive future research. The integration of biomarkers with other data collected during EVLP through machine learning and artificial intelligence will lead to automated organ assessment to improve lung transplantation.