Ex vivo lung perfusion prior to lung transplantation for high risk donor lungs

Ex vivo lung perfusion (EVLP) has developed as a novel organ preservation method in lung transplantation. EVLP allows us to evaluate lung graft function and condition prior to transplantation, leading to a possibility to utilize marginal lung grafts and/or high risk donor lungs including donation after circulatory death (DCD), atelectasis lung, lung with slight edema and functional problem without other concerns, as well as the lung grafts met to normal criteria. Also, EVLP allows us to recondition such lung grafts on ex vivo prior to transplantation using various options for treatment including high dose drug administration, stem cell transplantation, gene transfection, ex vivo surgery, and so on. Recently, we have developed a modified EVLP system “Dual EVLP” where pulmonary artery and bronchial artery are synchronously perfused, and achieved more physiological and therapeutic environment which may be considered to lead better graft recovery. These therapeutic means on EVLP have a much possibility to expand donor pool and lead better transplant outcomes. Therefore, it is important as a translational research to see the beneficial and/or adverse effects of EVLP and the ex vivo pretreatment to high risk donor lungs for further development of lung transplantation. The aims of this study are to test EVLP and Dual EVLP for high risk donor lung and to clarify their effects on the grafts during preservation and after transplantation.

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