Research Department, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), 90127 Palermo, Italy.
Thoracic Surgery and Lung Transplantation Unit, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), 90127 Palermo, Italy.
Cells. 2022 Feb 27;11(5):826. doi: 10.3390/cells11050826.
Lung transplantation (LTx) has become the gold standard treatment for end-stage respiratory failure. Recently, extended lung donor criteria have been applied to decrease the mortality rate of patients on the waiting list. Moreover, ex vivo lung perfusion (EVLP) has been used to improve the number/quality of previously unacceptable lungs. Despite the above-mentioned progress, the morbidity/mortality of LTx remains high compared to other solid organ transplants. Lungs are particularly susceptible to ischemia-reperfusion injury, which can lead to graft dysfunction. Therefore, the success of LTx is related to the quality/function of the graft, and EVLP represents an opportunity to protect/regenerate the lungs before transplantation. Increasing evidence supports the use of mesenchymal stromal/stem cells (MSCs) as a therapeutic strategy to improve EVLP. The therapeutic properties of MSC are partially mediated by secreted factors. Hence, the strategy of lung perfusion with MSCs and/or their products pave the way for a new innovative approach that further increases the potential for the use of EVLP. This article provides an overview of experimental, preclinical and clinical studies supporting the application of MSCs to improve EVLP, the ultimate goal being efficient organ reconditioning in order to expand the donor lung pool and to improve transplant outcomes.
肺移植（LTx）已成为治疗终末期呼吸衰竭的金标准治疗方法。最近，已经应用了扩展的肺供体标准，以降低等待名单上患者的死亡率。此外，体外肺灌注（EVLP）已被用于改善以前不可接受的肺的数量/质量。尽管取得了上述进展，但与其他实体器官移植相比，LTx 的发病率/死亡率仍然很高。肺特别容易受到缺血再灌注损伤，这可能导致移植物功能障碍。因此，LTx 的成功与移植物的质量/功能有关，EVLP 代表了在移植前保护/再生肺的机会。越来越多的证据支持使用间充质基质/干细胞（MSCs）作为一种治疗策略来改善 EVLP。MSC 的治疗特性部分是通过分泌因子介导的。因此，用 MSCs 及其产物进行肺灌注的策略为新的创新方法铺平了道路，进一步增加了 EVLP 的使用潜力。本文概述了支持将 MSCs 应用于改善 EVLP 的实验、临床前和临床研究，最终目标是有效进行器官再处理，以扩大供肺库并改善移植结果。
