Ex Vivo Lung Perfusion (EVLP)

Background

Organ transplantation is one of the most challenging and complex areas of modern medicine. Without effective preservation techniques, it would be virtually impossible to transplant solid organs from the cadaver donor to the recipient because irreversible functional injury often occurs well within the first few hours of donor death. Fortunately, such irreversible injury can generally be prevented or arrested if the organ is rapidly cooled and stored in a uniquely protective preservation solution like Perfadex®.

And in some organs, a marginal functional injury, which can render the organ unacceptable for transplantation, can be improved sufficiently to permit successful transplantation by first perfusing the organ outside the body (ex-vivo organ perfusion) on a closed loop circuit simulating the in-vivo scenario, utilizing a specially developed protective perfusion solution (Steen Solution™)

In the case of lung transplantation, for example, in which effective prolonged cold preservation by Perfadex® has played a significant pioneering role in the development of this procedure, the effective preservation time for lungs has been extended from about 4 hours before the introduction of Perfadex® to well beyond 25 hours today. This major advance has revolutionized access to suitably matched donor lungs where transcontinental transport times have previously restricted utilization, in effect significantly expanding the very restricted donor pool in a scenario where up to 25% of patients still die on the waiting list due to lack of suitable donor organs.

The world´s first successful lung transplantation was performed in Toronto in 1983 and today lung transplantation is a lifesaving operation for patients suffering from end-stage lung diseases.

Even though there have been significant advances since the first transplant there are still major problems to be solved. The demand for acceptable lungs has risen constantly over the years yet the supply of acceptable donor organs has remained almost unchanged.

As a consequence, lung centers around the world are intensively seeking new options to increase the availability of acceptable donor organs, including the use of lungs from older donors, lungs donated after cardiac death (DCD) and other sub-optimal /marginal lungs currently rejected for use. The function of most of these marginal lungs can now be improved by the normothermic ex vivo lung perfusion (EVLP) technique referred to above, thus further expanding the pool of acceptable donor lungs.

The first lung to be successfully transplanted after EVLP was in Sweden in 2001( Steen S et al , 2001). Since then around 200 transplantations have been performed after EVLP worldwide and the number is rapidly increasing.

 

Follow the link to find some of the centers where transplantation has been performed after EVLP. Is your center missing?

The centers in US are part in the trial. STEEN Solution is not FDA cleared.

 

Current problems in lung transplantation

Organ donor shortage

  • High waiting list mortality: 20-25%

Low utilization of lungs

  • Only 15 – 20% of lungs offered used
  • Poor organ function and/or no recipient found (80% non-recovery)

Donor lungs are frequently damaged

  • Field intubation/aspiration
  • Donor management
  • High levels of inflammatory cytokines

In many of the above, ex vivo lung perfusion (EVLP) offers a feasible solution