Ex Vivo Lung Perfusion is a way to test and examine donated lungs outside the body before transplantation

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Find out how our services aim to increase the number of donor lungs available for transplant.

WHAT IS EVLP?

EVLP stands for ex-vivo lung perfusion. This means that donor lungs are removed from the donor's body (“ex-vivo" is Latin for "outside that which is living”) and put onto a special device that keeps them at the same conditions as in the body.

While on this device, the lungs are also filled (“perfused”) with a nutrient-rich solution that helps prevent them from being damaged.

This gives doctors the chance to look closely at the condition of the lungs, and decide if they can be used for transplantation.

HOW CAN EVLP HELP?
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EVLP gives the transplant team more time to evaluate whether the lungs can be used for a transplant.

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The EVLP system attempts to mimic the functionality of the body. The donor lungs are attached to a ventilator, pump, and filters. The donor lungs are kept at normal body temperature and perfused.

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EVLP makes it possible for organs to be transported over greater distances. This may help hospitals in procuring lungs from donors that are farther away.

WHY IS EVLP NEEDED?

SHORTAGE OF ORGANS THAT MEET "IDEAL" SPECIFICATIONS

Historically, the number of people on the transplant waiting list continues to be much larger than the number of acceptable donors.

Though the number of donors is rising, many donor organs are still not used because they are considered unacceptable.

Statistics Graph

Data from optn.transplant.hrsa.gov and OPTN/SRTR Annual Report.

LUNGS VERSUS OTHER TRANSPLANTED ORGANS

Lung Utilization Chart

ONLY 20%

OF AVAILABLE DONOR LUNGS ARE USED FOR TRANSPLANTATION*

*Each year this percentage is increasing due to technological advancements

80%

ARE NOT USED

BY COMPARISON:

  • Comparison 0

    70%-80%

    of available donor kidneys are used for transplantation

  • Comparison 1

    75%

    of available donor livers are used for transplantation

  • Comparison 2

    30%

    of available donor hearts are used for transplantation

WHY ARE ONLY 20% OF DONOR LUNGS USED?

  • CONDITION OF DONOR LUNGS
    LUNGS ARE VULNERABLE AND MAY BECOME DAMAGED

    Lungs may become damaged as a result of the donor’s death due to many factors, including:

    • ISCHEMIA
      ABSENT OR INSUFFICIENT BLOOD SUPPLY TO LUNGS
    • EDEMA
      EXCESS FLUID IN THE LUNGS
    • PNEUMONIA
      INFLAMMATION OF THE LUNGS CAUSED BY INFECTION
    • TRAUMA
      DIRECT INJURY TO THE LUNGS
  • LOGISTICAL CHALLENGES
    LUNGS HAVE SHORT PRESERVATION AND TRANSPORT TIMES

    Donated lungs have a short preservation time (the time between lung removal and transplantation) to remain viable. This limits the distance they can be transported for transplantation.

    LUNG PRESERVATION TIME
    Lung Transportation Time
    4 hr - 6 hr
    Lung Transportation time Icon
    Common maximum adult organ preservation times
    • KIDNEY
      Ambulance Green - Kidney
      24 hr - 36 hr
      Kidney time
    • LIVER
      Ambulance Green - Liver
      8 hr - 12 hr
      Liver time
    • HEART
      Ambulance Green - Heart
      4 hr - 6 hr
      Heart time
  • DONOR MEDICAL HISTORY
    ONLY A LIMITED NUMBER OF ORGAN DONORS MEET LUNG ACCEPTANCE CRITERIA

    Below are some of the characteristics of an ideal donor:

    • Donor Medical History Image 0
      YOUNG DONORS
    • Donor Medical History Image 1
      NO SIGNIFICANT MEDICAL HISTORY
    • Donor Medical History Image 2
      MINIMAL SMOKING HISTORY
    • Donor Medical History Image 3
      GOOD LUNG FUNCTION
  • ORGAN MATCHING
    INABILITY TO FIND RECIPIENT

    Factors that affect the allocation of every donated organ include:

    • Organ Matching Image 0
      BLOOD TYPE
    • Organ Matching Image 1
      SIZE
    • Organ Matching Image 2
      TIME LIMITATIONS
    • Organ Matching Image 3
      DISTANCE FROM DONOR HOSPITAL

EVLP POTENTIAL

Discover the many benefits that EVLP can offer the field of lung transplantation:

Evlp Potential

“ [With EVLP] we have been able to utilize some lungs that otherwise would not have been used for transplant.”

Dr. Matthew Hartwig
Transplant Surgeon, Duke University

EVLP TIMELINE

The idea of ex vivo organ perfusion started over 50 years ago. Transplant programs around the world have contributed to advancing the technology to what is being used today.

2001

FIRST EVLP TRANSPLANT

In Sweden, EVLP is carried out for the first time on a human donor lung. The results of this procedure guide the first successful clinical lung transplantation from a non-heart-beating donor.

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2007

INITIALLY REJECTED LUNG

First transplant of a nonacceptable donor lung following EVLP.

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2011

TORONTO CLINICAL EXPERIENCE

Clinical trial concludes that transplantation of high-risk donor lungs that are physiologically stable during 4 hours of ex vivo perfusion lead to results similar to those obtained conventionally.

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2011

FIRST EVLP TRANSPLANT IN UNITED STATES

First lung transplantation with the application of remote EVLP, wherein the donor lungs are transported from the donor hospital to a center for EVLP and then transported to another hospital for transplantation into the recipient. It is also the first case of lung transplantation in the United States utilizing EVLP for functional optimization leading to successful transplantation.

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FUTURE DIRECTION FOR EVLP1

  • NEAR-TERM
    • Further optimization of EVLP
    • EVLP used for scheduling lung transplantations during business hours
    • Adaptation for pediatric lung transplantation
  • MID-TERM
    • EVLP performed in centralized hubs
    • Decrease in costs
  • LONG-TERM
    • EVLP used to enhance donor lungs

EVLP IMPACT

IMPACT OF EVLP ON ORGAN UTILIZATION

EVLP HAS INCREASED THE NUMBER OF TRANSPLANTABLE LUNGS BY 15-20% AT SOME TRANSPLANT CENTERS 2

Evlp Impact
IMPACT OF EVLP ON PATIENT OUTCOMES3

Review and analysis was performed to evaluate the outcomes of EVLP.

Analysis of
  • 1191 PATIENTS
  • 8 STUDIES

2 Groups:
16% were patients with EVLP
84% were patients without EVLP

Findings & conclusions

POST TRANSPLANT OUTCOMES WERE SIMILAR

Between EVLP-treated and Standard Lung Transplants

Even though the initial donor lung quality was worse in the EVLP-treated group, there were no significant differences in outcomes between EVLP and non-EVLP groups with respect to:

  • amount of time patients were connected to a ventilator after surgery
  • extent of artificial life support use
  • amount of time patients had to stay in the intensive care unit
  • amount of time patients had to stay in the hospital
  • 72-hour serious primary graft dysfunction
  • 30-day survival
  • 1-year survival

REFERENCES:

  1. Artificial Organs, Volume: 44, Issue: 1, Pages: 12-15, First published: 24 October 2019, DOI: (10.1111/aor.13571).
  2. Ex Vivo Lung Perfusion: A Key Tool for Translational Science in the Lungs. Tane S., Noda K., Shigemura N. (2017) Chest, 151 (6), pp. 1220-1228.
  3. Outcomes of marginal donors for lung transplantation after ex vivo lung perfusion: A systematic review and meta-analysis. Tian, Dong et al. The Journal of Thoracic and Cardiovascular Surgery, Volume 159, Issue 2, 720 – 730.e6

TALK WITH YOUR DOCTOR

If you have been diagnosed with an end-stage lung disease and are considering a lung transplant, talk with your doctor about whether EVLP might be possible through your transplant center.