EVLP: Expand the Donor Pool and Lead to Better Transplant Outcomes

“Many patients who are waiting for lungs can't get a lung transplant because the donor supply is so limited," Dr. Jonathan D’Cunha said.

Ex vivo lung perfusion (EVLP) has developed as a novel organ preservation method in lung transplantation. EVLP allows physicians to evaluate lung graft function and condition prior to transplantation, leading to the possibility to utilize marginal lung grafts and/or high-risk donor lungs including donation after circulatory death (DCD), atelectasis lung, lung with slight edema and functional problem without other concerns, as well as the lung grafts met to normal criteria. Also, EVLP allows reconditioning of such lung grafts on ex vivo prior to transplantation using various options for treatment including high dose drug administration, stem cell transplantation, gene transfection, ex vivo surgery, and so on.

"Transplants are a very exciting field right now, very exciting time and there's a lot going on," McGowan Institute for Regenerative Medicine affiliated faculty member Jonathan D'Cunha, MD, PhD (pictured), Associate Professor of Cardiothoracic Surgery and Chief of the Lung Transplant Division at the University of Pittsburgh Medical Center, told Andrew Tarantola of Engadget. "It doesn't matter whether it's general urinary transplant or lungs or heart or liver, kidney, they all have different aspects or components to them which we're trying to push the field further and further."

“Many patients who are waiting for lungs can't get a lung transplant because the donor supply is so limited," he said. "So, we're always looking to improve things and expand the donor pool and new technologies are under development by many investigators to try to achieve this goal."

Recently, a modified EVLP system, “Dual EVLP,” where pulmonary artery and bronchial artery are synchronously perfused has been developed and achieved more physiological and therapeutic environment which may be considered to lead better graft recovery. These therapeutic means on EVLP have much possibility to expand the donor pool and lead better transplant outcomes. Therefore, it is important as a translational research to see the beneficial and/or adverse effects of EVLP and the ex vivo pretreatment to high risk donor lungs for further development of lung transplantation. The aims of this study are to test EVLP and Dual EVLP for high risk donor lung and to clarify their effects on the grafts during preservation and after transplantation.

“Having the time to assess [donor organs] properly and make good judgments so you have a good patient outcome is absolutely critical," Dr. D'Cunha said. "Additionally, what the future may hold with things like Ex Vivo Lung Perfusion is the opportunity to even repair or intervene on lungs to make them better."

Illustration: McGowan Institute for Regenerative Medicine.


Engadget (04/26/18)

University of Pittsburgh Department of Cardiothoracic Surgery: Ex vivo lung perfusion prior to lung transplantation for high risk donor lungs

Bio: Dr. Jonathan D’Cunha