Ex-vivo perfusion of lung autotransplants as a last-resort therapy for multidrug resistant lung infections.
A new ingenious application of ex-vivo lung perfusion (EVLP) was recently reported by Zinne et al(6). Multidrug-resistant bacteria have emerged as an ominous threat to the treatment of severe lung infections, where normal therapeutic doses of antibiotics are no longer effective. Higher, more effective doses are often too toxic to use systemically. One last-resort solution is to explant the infected lung, subject it to warm EVLP with much higher doses of antibiotics and then return the treated autotransplant to the patient.
This concept was recently tested by Zinne et al who subjected porcine lungs infected with severe pneumonia to 2 hours of ex-vivo perfusion using very high doses of antibiotic (colistin) in the STEEN solution perfusate. The ex-vivo lungs were then immediately re-implanted into the donors. After 5 days, mortality rates in the high dose EVLP group were only half those in the standard dose group.
A similar strategy has previously been used with some success by other groups (Toronto, Antwerp, etc) to treat lung cancer with high (systemically) toxic levels of cytostatics whereby the lung circulation has first been isolated in-vivo by ligation from the systemic circulation.
References:
6. Zinne N et al, Treatment of infected lungs by ex vivo perfusion with high dose antibiotics and autotransplantation: A pilot study in pigs. PLoS One. 2018 Mar 5;13(3):e0193168 (link to abstract)
Xvivo Insights PB-2018-11-07
