Ex vivo lung perfusion (EVLP) provides a novel approach to lung rehabilitation and assessment following donor organ harvest. EVLP has fostered a renewed hope for donor lung allograft rehabilitation and assessment for transplantation, demonstrating promise within clinical trials utilizing high-risk donor lungs for successful transplantation. The rehabilitation of injured, marginal donor lungs is a principle focus for the advancement of this technology. The use of donation after cardiac death (DCD) lungs remains limited within the United States, accounting for <5% of lung transplants despite the international demonstration of comparable outcomes for DCD and standard brain death donor transplantation. Thus EVLP has inspired renewed interest in the utilization of DCD lungs to significantly increase the donor organ pool size.
One of our current projects, funded by the National Institutes of Health, applies EVLP as a platform for pharmacologic delivery of A2AR agonist to test the hypothesis that EVLP with concomitant A2AR agonist treatment will rehabilitate NHBD lungs for successful transplantation. We are using our pre-clinical porcine lung transplant model to test this hypothesis, and we are also evaluating whether marginal human donor lungs, which are rejected for transplantation, can be rehabilitated in a similar fashion. In addition, we are testing the limits on how long donor lungs can be preserved prior to tranplant. A combination of cold, static preservation with EVLP might extend donor lung preservation up to 24 hours or longs. We believe that these therapeutic applications of A2AR agonist using EVLP could greatly increase the donor lung pool size, thus translating to many lives saved by improving post-transplantation outcomes and reducing donor wait list times.
This video shows a porcine lung undergoing EVLP:
Below are a few photos of our EVLP team harvesting a donor pig lung and preparing it for EVLP:
Lungs undergoing EVLP: