Clinical implications

Clinical data and references

Are you a current user of EVLP and want to dive into more information on EVLP? On these pages you will find in depth material on EVLP, recently published articles, news within our medical field and a list of articles.

Introduction to controversies in lung preservation and EVLP

Over the last decade, Ex-Vivo Lung Perfusion (EVLP) has evolved from an experimental lab procedure to become an indispensable semi-elective clinical routine which is revolutionizing donor lung assessment at many leading lung transplant centers.

Initially developed to more reliably and objectively evaluate lung function and thereby assess the Reject/Accept status of donor lungs for transplantation, EVLP is now rapidly emerging as a means of further improving or treating sub-standard/marginal donor lungs to further expand the effective donor lung pool and reduce mortality on the lung transplant waiting list. Not surprisingly, as with most “revolutions-in-progress”, a number of controversies and caveats have arisen over the last few years as to how best to perform and interpret EVLP and associated lung preservation issues.

There are currently 3 principal variants of EVLP. The main differences in protocol are summarized in the following fig (from table 2 Munshi L, Keshavjee S, Cypel M, Lancet, 2013).

Table: Ex vivo lung perfusion protocols

The notes and abstracts below attempt to objectively present recent experimental and clinical findings on some of the recent controversies in the field of lung preservation and ex vivo lung perfusion (EVLP).

(*Peer-reviewed literature from 2012 – 2015 retrieved from the Pubmed/Medline database and presentations to recent ISHLT annual congresses. Review date: Sept 2015. Reviewed for scientific content: P B Buckley, PhC, MRPharmS).

  • Controversy 1

    To cool or not to cool before and/or after warm ex vivo lung perfusion (EVLP)

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  • Controversy 2

    Is addition of RBCs to the STEEN perfusate during EVLP justified?

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  • Controversy 3

    Open or closed left atrium during ex vivo lung perfusion (EVLP)

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