Fisher Shane, O'Connor James, Redmond Karen
Department of Medicine, St James's Hospital Dublin, Dublin, Ireland.
Royal College of Surgeons Ireland, Dublin, Ireland.
JHLT Open. 2025 Jul 29;10:100356. doi: 10.1016/j.jhlto.2025.100356. eCollection 2025 Nov.
A major challenge in lung transplantation is the shortage of viable donor lungs. Ex vivo lung perfusion (EVLP) has emerged as an effective assessment and conditioning tool to expand the donor lung pool. This systematic review sought to establish the contribution of large animal models to EVLP development and application, particularly focusing on assessing the risk of bias and the certainty of evidence.
A strategic literature search was conducted using a predefined pro forma. Relevant data were extracted, and thematic analysis was applied for qualitative synthesis of key measures. Methodological quality and bias risk were assessed using systematic review centre for laboratory animal experimentation's risk of bias tool, and certainty of evidence was evaluated using the grading of recommendations assessment, development and evaluation Framework.
A total of 32 studies met the inclusion criteria, using porcine, ovine, rabbit, and canine models. Key themes included EVLP's role in donor lung assessment and preservation, marginal donor lung repair, and as an experimental translational platform. All studies were assessed with the systematic review centre for laboratory animal experimentation tool and had a high or unclear risk of bias. Twenty-eight (87.5%) showed low certainty of evidence, 2 (6.25%) very low, and 2 (6.25%) moderate, raising concerns about overall evidence strength.
Large animal EVLP models have significantly advanced donor lung preservation, reconditioning, and therapeutic intervention. However, methodological bias remains a concern due to inconsistent adherence to reporting and procedural standards. Greater conformity to standardized protocols is pivotal to improve the reliability, reproducibility, and translational value of future EVLP research.
肺移植的一个主要挑战是可用于移植的供体肺短缺。体外肺灌注（EVLP）已成为一种有效的评估和处理工具，可扩大供体肺库。本系统评价旨在确定大型动物模型对EVLP发展和应用的贡献，尤其侧重于评估偏倚风险和证据的确定性。
使用预先定义的格式进行策略性文献检索。提取相关数据，并应用主题分析对关键指标进行定性综合。使用实验动物系统评价中心的偏倚风险工具评估方法学质量和偏倚风险，并使用推荐分级评估、制定和评价框架评估证据的确定性。
共有32项研究符合纳入标准，使用了猪、羊、兔和犬模型。关键主题包括EVLP在供体肺评估和保存、边缘供体肺修复以及作为实验性转化平台方面的作用。所有研究均使用实验动物系统评价中心工具进行评估，偏倚风险高或不明确。28项（87.5%）研究证据确定性低，2项（6.25%）极低，2项（6.25%）中等，这引发了对总体证据强度的担忧。
大型动物EVLP模型在供体肺保存、修复和治疗干预方面取得了显著进展。然而，由于对报告和程序标准的遵守不一致，方法学偏倚仍然是一个问题。更严格地遵循标准化方案对于提高未来EVLP研究的可靠性、可重复性和转化价值至关重要。
