TY - CHAP M1 - Book, Section TI - Ex Vivo Lung Perfusion A1 - Ceulemans, Laurens J. A1 - Neyrinck, Arne A1 - Van Raemdonck, Dirk A2 - Sugarbaker, David J. A2 - Bueno, Raphael A2 - Burt, Bryan M. A2 - Groth, Shawn S. A2 - Loor, Gabriel A2 - Wolf, Andrea S. A2 - Williams, Marcia A2 - Adams, Ann PY - 2020 T2 - Sugarbaker’s Adult Chest Surgery, 3e AB - Lung transplantation (LTx) is the ultimate therapy for patients suffering from end-stage lung diseases, prolonging survival and improving quality of life.1 However, this treatment remains limited due to the relative shortage of organ donors and acceptable pulmonary grafts (15–30%).2 Therefore, the number of patients waiting for lung transplantation still greatly exceeds the number of donor lungs available, resulting in a current wait list mortality up to 30%.3 Over the last decade several strategies were implemented in transplant centers worldwide to expand the available lung donor pool, including the use of lungs from extended-criteria donors, lobar transplantation, and an increase in the rate of donors after circulatory death (DCD).4 Most of these lung grafts, however, have an increased risk of lung injury that may lead to primary graft dysfunction (PGD) and long-term consequences for LTx recipients. These challenges have prompted clinicians and scientists to grasp the opportunity of the ex situ phase (between procurement and transplantation) for further evaluation and reconditioning of pulmonary grafts. To take advantage of this opportunity, however, it is necessary to preserve donor lungs under safe conditions. One strategy, termed ex vivo lung perfusion (EVLP), attempts to maintain donor lungs in a physiologic state prior to transplantation through ventilation and normothermic perfusion of the graft (Fig. 115-1).5 A major advantage of normothermic preservation, compared with cold storage, is that it maintains lung metabolism and function, resulting in prolonged assessment of the organ, active reconditioning and treatment, and hopefully in the future genetic therapy and immunomodulation. This chapter describes the technical aspects of EVLP, reviews the existing modules currently available, covers the different protocols, and focuses on four potential benefits: organ preservation, assessment, repair, and immunomodulation. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=1170413711 ER -