The potential of ex vivo lung perfusion on improving organ quality and ameliorating ischemia reperfusion injury.
Jasper IskeChristopher A HinzeJawad SalmanAxel HaverichStefan G TulliusFabio IusPublished in: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (2021)
Allogeneic lung transplantation (LuTx) is considered the treatment of choice for a broad range of advanced, progressive lung diseases resistant to conventional treatment regimens. Ischemia reperfusion injury (IRI) occurring upon reperfusion of the explanted, ischemic lung during implantation remains a crucial mediator of primary graft dysfunction (PGD) and early allo-immune responses. Ex vivo lung perfusion (EVLP) displays an advanced technique aiming at improving lung procurement and preservation. Indeed, previous clinical trials have demonstrated a reduced incidence of PGD following LuTx utilizing EVLP, while long-term outcomes are yet to be evaluated. Mechanistically, EVLP may alleviate donor lung inflammation through reconditioning the injured lung and diminishing IRI through storing the explanted lung in a non-ischemic, perfused, and ventilated status. In this work, we review potential mechanisms of EVLP that may attenuate IRI and improve organ quality. Moreover, we dissect experimental treatment approaches during EVLP that may further attenuate inflammatory events deriving from tissue ischemia, shear forces or allograft rejection associated with LuTx.
Keyphrases
- ischemia reperfusion injury
- oxidative stress
- clinical trial
- immune response
- multiple sclerosis
- magnetic resonance
- heart failure
- intensive care unit
- randomized controlled trial
- acute respiratory distress syndrome
- bone marrow
- magnetic resonance imaging
- computed tomography
- risk factors
- toll like receptor
- dendritic cells
- inflammatory response
- coronary artery disease
- study protocol
- quality improvement
- climate change
- replacement therapy
- smoking cessation
- kidney transplantation
- phase ii