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Iskender I. Technical Advances Targeting Multiday Preservation of Isolated Ex Vivo Lung Perfusion. Transplantation 2024; 108:1319-1332. [PMID: 38499501 DOI: 10.1097/tp.0000000000004992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Indications for ex vivo lung perfusion (EVLP) have evolved from assessment of questionable donor lungs to treatment of some pathologies and the logistics. Yet up to 3 quarters of donor lungs remain discarded across the globe. Multiday preservation of discarded human lungs on EVLP platforms would improve donor lung utilization rates via application of sophisticated treatment modalities, which could eventually result in zero waitlist mortality. The purpose of this article is to summarize advances made on the technical aspects of the protocols in achieving a stable multiday preservation of isolated EVLP. Based on the evidence derived from large animal and/or human studies, the following advances have been considered important in achieving this goal: ability to reposition donor lungs during EVLP; perfusate adsorption/filtration modalities; perfusate enrichment with plasma and/or donor whole blood, nutrients, vitamins, and amino acids; low-flow, pulsatile, and subnormothermic perfusion; positive outflow pressure; injury specific personalized ventilation strategies; and negative pressure ventilation. Combination of some of these advances in an automatized EVLP device capable of managing perfusate biochemistry and ventilation would likely speed up the processes of achieving multiday preservation of isolated EVLP.
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Affiliation(s)
- Ilker Iskender
- Department of Cardiac Surgery, East Limburg Hospital, Genk, Belgium
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Ex Vivo Lung Perfusion: A Review of Current and Future Application in Lung Transplantation. Pulm Ther 2022; 8:149-165. [PMID: 35316525 PMCID: PMC9098710 DOI: 10.1007/s41030-022-00185-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/25/2022] [Indexed: 12/23/2022] Open
Abstract
The number of waitlisted lung transplant candidates exceeds the availability of donor organs. Barriers to utilization of donor lungs include suboptimal lung allograft function, long ischemic times due to geographical distance between donor and recipient, and a wide array of other logistical and medical challenges. Ex vivo lung perfusion (EVLP) is a modality that allows donor lungs to be evaluated in a closed circuit outside of the body and extends lung donor assessment prior to final acceptance for transplantation. EVLP was first utilized successfully in 2001 in Lund, Sweden. Since its initial use, EVLP has facilitated hundreds of lung transplants that would not have otherwise happened. EVLP technology continues to evolve and improve, and currently there are multiple commercially available systems, and more under investigation worldwide. Although barriers to universal utilization of EVLP exist, the possibility for more widespread adaptation of this technology abounds. Not only does EVLP have diagnostic capabilities as an organ monitoring device but also the therapeutic potential to improve lung allograft quality when specific issues are encountered. Expanded treatment potential includes the use of immunomodulatory treatment to reduce primary graft dysfunction, as well as targeted antimicrobial therapy to treat infection. In this review, we will highlight the historical development, the current state of utilization/capability, and the future promise of this technology.
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Mercier O, Laverdure F, Filaire L, Mal H, Bunel V, Deblauwe D, Wemeau L, Dauriat G, Fadel E, Vincentelli A. Fatal Covid-19 vasoplegic shock in a recipient few hours before double lung transplantation in high emergency. Transpl Infect Dis 2020; 23:e13445. [PMID: 32785961 PMCID: PMC7435541 DOI: 10.1111/tid.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Olaf Mercier
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Pulmonary Hypertension National Referral Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Florent Laverdure
- Department of Anesthesiology and Intensive Care, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Laura Filaire
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Pulmonary Hypertension National Referral Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Hervé Mal
- Service de Pneumologie B et Transplantation Pulmonaire, Centre Hospitalier Universitaire Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Bunel
- Service de Pneumologie B et Transplantation Pulmonaire, Centre Hospitalier Universitaire Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Gaëlle Dauriat
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Pulmonary Hypertension National Referral Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Elie Fadel
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Pulmonary Hypertension National Referral Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France.,INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
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Introducing the concept of semielective lung transplantation through the use of ex vivo lung perfusion. J Thorac Cardiovasc Surg 2018; 156:2350-2352. [PMID: 29961586 DOI: 10.1016/j.jtcvs.2018.05.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/13/2018] [Accepted: 05/16/2018] [Indexed: 12/16/2022]
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Application and interpretation of histocompatibility data in thoracic (heart and lung) transplantation. Curr Opin Organ Transplant 2017; 22:421-425. [PMID: 28654443 DOI: 10.1097/mot.0000000000000424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of the review is to update our current understanding and utilization of immunogenetic tools in heart and lung transplant. RECENT FINDINGS Increasingly, complex patients have been managed perioperatively for heart and lung transplant using a variety of tests and techniques. Recent treatment regimens and listing strategies have exploited recent laboratory advances. However, the better characterization has led to an even more complex description of sensitized heart and lung candidates. Several recent studies have examined antibody strengths and behavior to guide clinical decision-making and examine postoperative outcomes. Finally, non-human leukocyte antigen antibodies have emerged as possible determinants of allograft outcome in heart and lung transplant. SUMMARY Heart and lung transplant candidates with preformed and de-novo posttransplant antibodies continue to represent a challenging and high-risk group of patients. Modern immunogenetic techniques have broadened our understanding and have revealed an even more complex relationship between antibodies, allografts, and outcomes.
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Comprendre le poumon agressé. Actes du séminaire de recherche translationnelle de la Société de Réanimation de Langue Française (6 décembre 2016). MEDECINE INTENSIVE REANIMATION 2017. [PMCID: PMC7149235 DOI: 10.1007/s13546-017-1279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Le séminaire de recherche translationnelle 2016 organisé par la Société de Réanimation de Langue Française s’est focalisé sur les mécanismes de réponse à l’agression et de réparation pulmonaire. Le poumon représente une interface essentielle entre l’hôte et son environnement et est à ce titre soumis à des agressions constantes et multiples. La réanimation s’est en grande partie construite autour de la prise en charge de la défaillance respiratoire. Au-delà du traitement étiologique et du support ventilatoire, se pose la problématique récurrente du développement de thérapeutiques adjuvantes à visée immunomodulatrice. Le développement de telles thérapeutiques innovantes est conditionné par les avancées dans la compréhension de la physiopathologie de l’agression pulmonaire aiguë, ainsi que par la validation au lit du patient d’outils d’évaluation permettant de quantifier l’effet des interventions thérapeutiques.
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