Clin Transplant Res.  2024 Mar;38(1):23-36. 10.4285/ctr.23.0057.

Ex vivo lung perfusion and the Organ Care System: a review

• M M
• Attawar S
• BN M
• Tisekar O
• Mohandas A

• KMID: 2555994
• DOI: http://doi.org/10.4285/ctr.23.0057

Abstract

With the increasing prevalence of heart failure and end-stage lung disease, there is a sustained interest in expanding the donor pool to alleviate the thoracic organ shortage crisis. Efforts to extend the standard donor criteria and to include donation after circulatory death have been made to increase the availability of suitable organs. Studies have demonstrated that outcomes with extended-criteria donors are comparable to those with standard-criteria donors. Another promising approach to augment the donor pool is the improvement of organ preservation techniques. Both Ex vivo lung perfusion (EVLP) for the lungs and the Organ Care System (OCS, TransMedics) for the heart have shown encouraging results in preserving organs and extending ischemia time through the application of normothermic regional perfusion. EVLP has been effective in improving marginal or borderline lungs by preserving and reconditioning them. The use of OCS is associated with excellent short-term outcomes for cardiac allografts and has improved utilization rates of hearts from extended-criteria donors. While both EVLP and OCS have successfully transitioned from research to clinical practice, the costs associated with commercially available systems and consumables must be considered. The Ex vivo perfusion platform, which includes both EVLP and OCS, holds the potential for diverse and innovative therapies, thereby transforming the landscape of thoracic organ transplantation.

Keyword

Ex vivo lung perfusion; Heart failure; Heart and lung transplantation

Figure

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  Fig. 1 Schematic representation of an ex vivo lung perfusion (EVLP) circuit. PA, pulmonary artery; LA, left atrium.

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  Fig. 2 Ex vivo lung perfusion cannulation: green cannula in the left atrium, yellow cannula in the pulmonary artery, and endotracheal tube in trachea.

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  Fig. 3 Manual ex vivo lung perfusion circuit. The lung within the dome is within the in-line sensors.

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  Fig. 4 Schematic diagram of an Organ Care System circuit. AO, aorta; PA, pulmonary artery; LV, left ventricle; RV, right ventricle; LA, left atrium.

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