Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Front Immunol. 2024 Mar 6;15:1358153. doi: 10.3389/fimmu.2024.1358153. eCollection 2024.
Primary graft dysfunction (PGD) is a common complication after lung transplantation. A plethora of contributing factors are known and assessment of donor lung function prior to organ retrieval is mandatory for determination of lung quality. Specialized centers increasingly perform ex vivo lung perfusion (EVLP) to further assess lung functionality and improve and extend lung preservation with the aim to increase lung utilization. EVLP can be performed following different protocols. The impact of the individual EVLP parameters on PGD development, organ function and postoperative outcome remains to be fully investigated. The variables relate to the engineering and function of the respective perfusion devices, such as the type of pump used, functional, like ventilation modes or physiological (e.g. perfusion solutions). This review reflects on the individual technical and fluid components relevant to EVLP and their respective impact on inflammatory response and outcome. We discuss key components of EVLP protocols and options for further improvement of EVLP in regard to PGD. This review offers an overview of available options for centers establishing an EVLP program and for researchers looking for ways to adapt existing protocols.
原发性移植物功能障碍（PGD）是肺移植后的常见并发症。已知有许多致病因素，在获取器官前必须评估供肺的功能，以确定肺的质量。专门的中心越来越多地进行离体肺灌注（EVLP），以进一步评估肺功能，并通过提高和延长肺保存来改善肺功能，目的是增加肺的利用率。EVLP 可以按照不同的方案进行。个体 EVLP 参数对 PGD 发展、器官功能和术后结果的影响仍有待充分研究。这些变量与各自灌注设备的工程和功能有关，例如使用的泵的类型、功能，如通气模式或生理（例如灌注溶液）。这篇综述反映了与 EVLP 相关的各个技术和液体成分及其对炎症反应和结果的各自影响。我们讨论了 EVLP 方案的关键组成部分以及进一步改善 EVLP 治疗 PGD 的选择。这篇综述为建立 EVLP 计划的中心和寻找适应现有方案的方法的研究人员提供了现有选择的概述。
