TY  - CHAP
M1  - Book, Section
TI  - Ex Vivo Lung Perfusion
A1  - Cypel, Marcelo
A1  - Keshavjee, Shaf
A2  - Sugarbaker, David J.
A2  - Bueno, Raphael
A2  - Colson, Yolonda L.
A2  - Jaklitsch, Michael T.
A2  - Krasna, Mark J.
A2  - Mentzer, Steven J.
A2  - Williams, Marcia
A2  - Adams, Ann
PY  - 2015
T2  - Adult Chest Surgery, 2e
AB  - Lung  transplantation  is  a  life-saving  therapy  for  patients  suffering  from  end-stage  lung  diseases.  The  number  of  patients  waiting  for  lung  transplantation,  however,  greatly  exceeds  the  number  of  donor  lungs  available.  Moreover,  only  about  15%  of  lungs  from  multiorgan  donors  are  deemed  usable  for  transplantation.1  Most  potential  lungs  are  considered  unsuitable  as  the  result  of  injury  that  occurs  with  brain  death  and  ICU-related  complications  (i.e.,  barotrauma  or  lung  edema  associated  with  fluid  resuscitation).  Since  primary  graft  dysfunction  leads  to  severe  early  and  long-term  consequences  for  lung  transplant  recipients,  transplant  teams  tend  to  be  very  conservative  in  their  selection  of  donor  lungs.  As  a  result,  fewer  organs  are  selected  and  the  wait  list  mortality  may  climb  as  high  as  30%  to  40%.2,3  While  the  current  cornerstone  of  clinical  lung  preservation  is  to  limit  the  metabolic  rate  of  the  donor  lung  by  hypothermia,  this  strategy  best  serves  lungs  meeting  ideal  acceptance  criteria.  The  current  donor  organ  shortage  has  prompted  most  donor  programs  to  use  increasing  numbers  of  extended  criteria  organs,  where  lung  function  is  not  as  assured  as  with  an  ideal  lung.  The  ex  vivo  phase  of  organ  preservation,  prior  transplantation  into  the  recipient,  provides  a  window  of  opportunity  for  further  evaluation  and  even  resuscitation  of  these  compromised  lungs.  To  take  advantage  of  this  opportunity,  however,  it  is  necessary  to  preserve  the  donor  organs  under  normothermic  or  near-normothermic  conditions.  One  strategy,  termed  ex  vivo  lung  perfusion  (EVLP),  attempts  to  simulate  in  vivo  conditions  through  ventilation  and  perfusion  of  the  donor  lung  graft.  One  important  advantage  of  normothermic  perfusion  is  that  it  maintains  the  active  metabolic  functions  of  the  lung,  providing  an  opportunity  for  continued  assessment  of  the  organ  during  the  ex  vivo  phase  of  organ  preservation,  active  treatments,  and  restoration  of  normal  function.  This  chapter  focuses  on  the  resurgence  of  EVLP,  important  technical  aspects,  clinical  outcomes,  and  future  perspectives.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1105848140
ER  -