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Case Reports
. 2024 Dec 5;13(23):7412.
doi: 10.3390/jcm13237412.

Beyond the Barriers of Ex Vivo Lung Perfusion Through an Emblematic Case: A New Way Forward to Expand the Donor Pool

Eleonora Faccioli  1 , Vincenzo Verzeletti  1 , Marco Mammana  1 , Andrea Dell'Amore  1 , Luca Melan  1 , Fares Shamshoum  1 , Edoardo Rosellini  2 , Annalisa Boscolo  2   3   4 , Federica Pezzuto  5 , Paolo Navalesi  2   3 , Fiorella Calabrese  5 , Federico Rea  1 , Marco Schiavon  1
Affiliations
Case Reports

Beyond the Barriers of Ex Vivo Lung Perfusion Through an Emblematic Case: A New Way Forward to Expand the Donor Pool

Eleonora Faccioli et al. J Clin Med. .

Abstract

Background: Lung transplantation is the most effective treatment for end-stage respiratory diseases, but its application is limited by the shortage of organs. Ex vivo lung perfusion (EVLP) has emerged as a promising technique to evaluate and recondition donor lungs previously deemed unsuitable for transplantation. However, limitations such as lung contusions, air leaks, and perfusate extravasation, especially in portable EVLP systems, hinder the procedure. Despite prolonged perfusions that can result in blood pooling at the lung bases due to fixed lung positioning and diminished oncotic pressure, in some cases, extending perfusion time beyond the typical 5-6 h could benefit extended-criteria lungs, addressing factors such as edema or logistical complications. Methods: We present an innovative protocol involving prolonged EVLP, pronation of the graft, and the addition of anti-edematous drugs to the perfusate. Results: This novel approach, previously tested in animal models, enhances lung reconditioning and expands the donor pool. Conclusions: Our findings suggest that this strategy overcomes key limitations of standard EVLP, offering a valuable solution for improving the availability of transplantable lungs.

Keywords: EVLP; PGD; lung transplant; machine perfusion; marginal donor.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) pronated lungs; (B) supinated lungs during EVLP.
Figure 2
Figure 2
(A) OCS lung parameters during normothermic perfusion showing an increase in the PaO2/FiO2 ratio, a reduction in vascular resistance trend, and stability of peak airway pressure and pulmonary pressure; (B) histological examination of the pre-reperfusion biopsy (hematoxylin and eosin, scale bar: 600 µm); (C) higher magnification of the histological examination of the pre-reperfusion biopsy (hematoxylin and eosin, scale bar: 300 μm. Arrowhead on lymphocytes); (D) histological examination of the post-reperfusion biopsy (hematoxylin and eosin, scale bar: 500 μm); (E) higher magnification of the histological examination of the post-reperfusion biopsy (hematoxylin and eosin, scale bar: 300 µm. Arrows on neutrophilic margination).
See this image and copyright information in PMC

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