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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

Chest x-ray at the beginning of EVLP (A) and at the end of assessment (B). It is clearly visible that EVLP ameliorates congestion of the lungs.
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f5-medscimonitbasicres-21-9: Chest x-ray at the beginning of EVLP (A) and at the end of assessment (B). It is clearly visible that EVLP ameliorates congestion of the lungs.

Mentions: Gas exchange is evaluated after full flow has been obtained. Therefore, for 5 minutes the FiO2 supply on the ventilator is enhanced to 100%, by reporting arterial blood gases (ABGs) from perfusate of the left atrial cannula and separately from each pulmonary vein. At the start of ventilation, a flexible bronchoscopy with bronchoalveolar lavage for urgent Gram stain and culture is sampled. Both ABGs and flexible bronchoscopy are repeated every hour. At the beginning as well as the end of EVLP a chest x-ray (CRX) is performed (Figure 5). In difficult cases a CT scan can also be implemented (Figure 6). Condition of the lungs is assessed at arrival, after that every hour by visual and manual evaluation for atelectasis, consolidation, and pulmonary edema. After each evaluation a pulmonary recruitment is conducted every 30 minutes by raising the tidal volume with ensuing inspiratory hold maneuvers up to 25 cm H2O for ten seconds. At the start of ventilation a deflation test for compliance is conducted, which is repeated hourly. In due consideration of all parameters observed the decision to implant the lungs is made.


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)

Chest x-ray at the beginning of EVLP (A) and at the end of assessment (B). It is clearly visible that EVLP ameliorates congestion of the lungs.
© Copyright Policy
Related In: Results  -  Collection

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

f5-medscimonitbasicres-21-9: Chest x-ray at the beginning of EVLP (A) and at the end of assessment (B). It is clearly visible that EVLP ameliorates congestion of the lungs.
Mentions: Gas exchange is evaluated after full flow has been obtained. Therefore, for 5 minutes the FiO2 supply on the ventilator is enhanced to 100%, by reporting arterial blood gases (ABGs) from perfusate of the left atrial cannula and separately from each pulmonary vein. At the start of ventilation, a flexible bronchoscopy with bronchoalveolar lavage for urgent Gram stain and culture is sampled. Both ABGs and flexible bronchoscopy are repeated every hour. At the beginning as well as the end of EVLP a chest x-ray (CRX) is performed (Figure 5). In difficult cases a CT scan can also be implemented (Figure 6). Condition of the lungs is assessed at arrival, after that every hour by visual and manual evaluation for atelectasis, consolidation, and pulmonary edema. After each evaluation a pulmonary recruitment is conducted every 30 minutes by raising the tidal volume with ensuing inspiratory hold maneuvers up to 25 cm H2O for ten seconds. At the start of ventilation a deflation test for compliance is conducted, which is repeated hourly. In due consideration of all parameters observed the decision to implant the lungs is made.

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