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Contributions, bias, and research gaps in large animal ex vivo lung perfusion models: A systematic review

  • 0Department of Medicine, St James's Hospital Dublin, Dublin, Ireland.
Jhlt Open +

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August 21, 2025

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August 21, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Large animal models significantly advanced ex vivo lung perfusion (EVLP) for donor lungs. However, high risk of bias and low certainty of evidence necessitate standardized protocols for reliable research.

Area Of Science

  • Transplantation research
  • Medical innovation
  • Animal models in research

Background

  • Donor lung shortage is a major hurdle in lung transplantation.
  • Ex vivo lung perfusion (EVLP) is a key technique to expand the donor lung pool.
  • Large animal models are crucial for EVLP development and application.

Purpose Of The Study

  • To assess the contribution of large animal models to EVLP development.
  • To evaluate the risk of bias in EVLP studies using animal models.
  • To determine the certainty of evidence for EVLP techniques.

Main Methods

  • Systematic literature search using a predefined pro forma.
  • Thematic analysis for qualitative synthesis of key EVLP measures.
  • Risk of bias assessment using the Systematic Review Centre for Laboratory Animal Experimentation tool.
  • Certainty of evidence evaluation using the GRADE framework.

Main Results

  • 32 studies using porcine, ovine, rabbit, and canine models were included.
  • EVLP models are vital for donor lung assessment, preservation, repair, and as translational platforms.
  • All studies exhibited a high or unclear risk of bias.
  • 28 studies (87.5%) showed low certainty of evidence, with 2 (6.25%) very low and 2 (6.25%) moderate.

Conclusions

  • Large animal EVLP models have advanced lung preservation and therapeutic interventions.
  • Methodological bias due to inconsistent standards is a significant concern.
  • Standardized protocols are essential to enhance the reliability and translational value of EVLP research.

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