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Ex vivo lung perfusion - state of the art in lung donor pool expansion.

Popov AF, Sabashnikov A, Patil NP, Zeriouh M, Mohite PN, Zych B, Saez DG, Schmack B, Ruhparwar A, Dohmen PM, Karck M, Simon AR, Weymann A - Med Sci Monit Basic Res (2015)

Bottom Line: Moreover, lungs from EVLP did not show significantly different postoperative results compared to standard criteria lungs.This could be explained by the reduction of the ischemia-reperfusion injury through EVLP application.The aim of this article is to review technical characteristics and the growing clinical EVLP experience with special attention to EVLP application for donation after cardiac death (DCD) lungs.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.

ABSTRACT
Lung transplantation remains the gold standard for patients with end-stage lung disease. Nevertheless, the number of suitable donor lungs for the increasing number of patients on the waiting list necessitates alternative tools to expand the lung donor pool. Modern preservation and lung assessment techniques could contribute to improved function in previously rejected lungs. Ex vivo lung perfusion (EVLP) already demonstrated its value in identification of transplantable grafts from the higher risk donor pool. Moreover, lungs from EVLP did not show significantly different postoperative results compared to standard criteria lungs. This could be explained by the reduction of the ischemia-reperfusion injury through EVLP application. The aim of this article is to review technical characteristics and the growing clinical EVLP experience with special attention to EVLP application for donation after cardiac death (DCD) lungs.

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Related in: MedlinePlus

Schematic illustration of the EVLP circuit. LA, left atrium; LAP, left atrial pressure; PA, pulmonary artery; PAP, pulmonary artery pressure; CDI, Terumo Cardiovascular Systems Corp, Ann Arbor, MI.
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f4-medscimonitbasicres-21-9: Schematic illustration of the EVLP circuit. LA, left atrium; LAP, left atrial pressure; PA, pulmonary artery; PAP, pulmonary artery pressure; CDI, Terumo Cardiovascular Systems Corp, Ann Arbor, MI.

Mentions: A schematic illustration of the EVLP circuit is shown in Figure 4. The makeup of a dedicated circuit consists of a centrifugal pump, a leukocyte filter, a hollow-fiber oxygenator heat exchanger, and a hardshell reservoir. Perfusate flowing from the left atrium runs into the reservoir, then to the centrifugal pump in order to arrive at the gas exchanger that is linked with the heat and gas cylinder containing a mixture of 6% O2 and 8% CO2 balanced with N2. Here, a deoxygenation and warming process takes place until the fluid reaches the partial gas pressure and temperature of normal venous blood. It is subsequently returned to the pulmonary artery via the leukocyte filter. By gradually augmenting the initial flow of 150 ml/min the target flow of 40% donor calculated cardiac index of 3.0 liters/min/m2 is achieved. Pulmonary artery pressure is maintained ≤15 mm Hg and left atrial pressure ≤5 mm Hg.


Ex vivo lung perfusion - state of the art in lung donor pool expansion.

Popov AF, Sabashnikov A, Patil NP, Zeriouh M, Mohite PN, Zych B, Saez DG, Schmack B, Ruhparwar A, Dohmen PM, Karck M, Simon AR, Weymann A - Med Sci Monit Basic Res (2015)

Schematic illustration of the EVLP circuit. LA, left atrium; LAP, left atrial pressure; PA, pulmonary artery; PAP, pulmonary artery pressure; CDI, Terumo Cardiovascular Systems Corp, Ann Arbor, MI.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4325829&req=5

f4-medscimonitbasicres-21-9: Schematic illustration of the EVLP circuit. LA, left atrium; LAP, left atrial pressure; PA, pulmonary artery; PAP, pulmonary artery pressure; CDI, Terumo Cardiovascular Systems Corp, Ann Arbor, MI.
Mentions: A schematic illustration of the EVLP circuit is shown in Figure 4. The makeup of a dedicated circuit consists of a centrifugal pump, a leukocyte filter, a hollow-fiber oxygenator heat exchanger, and a hardshell reservoir. Perfusate flowing from the left atrium runs into the reservoir, then to the centrifugal pump in order to arrive at the gas exchanger that is linked with the heat and gas cylinder containing a mixture of 6% O2 and 8% CO2 balanced with N2. Here, a deoxygenation and warming process takes place until the fluid reaches the partial gas pressure and temperature of normal venous blood. It is subsequently returned to the pulmonary artery via the leukocyte filter. By gradually augmenting the initial flow of 150 ml/min the target flow of 40% donor calculated cardiac index of 3.0 liters/min/m2 is achieved. Pulmonary artery pressure is maintained ≤15 mm Hg and left atrial pressure ≤5 mm Hg.

Bottom Line: Moreover, lungs from EVLP did not show significantly different postoperative results compared to standard criteria lungs.This could be explained by the reduction of the ischemia-reperfusion injury through EVLP application.The aim of this article is to review technical characteristics and the growing clinical EVLP experience with special attention to EVLP application for donation after cardiac death (DCD) lungs.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.

ABSTRACT
Lung transplantation remains the gold standard for patients with end-stage lung disease. Nevertheless, the number of suitable donor lungs for the increasing number of patients on the waiting list necessitates alternative tools to expand the lung donor pool. Modern preservation and lung assessment techniques could contribute to improved function in previously rejected lungs. Ex vivo lung perfusion (EVLP) already demonstrated its value in identification of transplantable grafts from the higher risk donor pool. Moreover, lungs from EVLP did not show significantly different postoperative results compared to standard criteria lungs. This could be explained by the reduction of the ischemia-reperfusion injury through EVLP application. The aim of this article is to review technical characteristics and the growing clinical EVLP experience with special attention to EVLP application for donation after cardiac death (DCD) lungs.

Show MeSH
Related in: MedlinePlus