Current status and future perspective of ex vivo lung perfusion in lung transplantation

Abstract

Brain-dead donor lungs are frequently subjected to injuries acquired during brain death and intensive care unit (ICU) -related complications, which would increase the risk of primary graft dysfunction after lung transplantation. Ex vivo lung perfusion (EVLP), in which donor lungs are ventilated and perfused under normothermic conditions outside the body, enables clinicians to accurately evaluate the donor lung function prior to transplantation. Hence, the EVLP procedure was successfully introduced into clinical practice, expanded the donor lung pool, and showed favorable post-transplant outcomes in a growing number of transplant centers worldwide. The EVLP system and techniques have recently been employed for the assessment of extended criteria donor lungs that were otherwise initially unacceptable in clinical lung transplantation in Japan. The advancement of EVLP from organ assessment to organ treatment or repair will be the next challenging stage toward realizing what we have termed a personalized medicine approach to management of the donor organ.