RT Book, Section
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
SR Print(0)
ID 1170413711
T1 Ex Vivo Lung Perfusion
T2 Sugarbaker’s Adult Chest Surgery, 3e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260026931
LK accesssurgery.mhmedical.com/content.aspx?aid=1170413711
RD 2024/04/19
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.