The only curative therapy for terminal lung disease is allogeneic lung transplantation (LuTx), which is reserved for a small group of needy individuals due to the increasing disparity between the number of patients on the waiting list versus the smaller number of organ donors. However, LuTx itself is also fraught with some side effects, some of which are life-threatening - including what is known as ischemia-reperfusion injury (IRI), which occurs when the explanted lung is re-perfused during implantation into the organ recipient. IRI is a critical cause of primary graft dysfunction (PGD) and early allo-immune reactions that can lead to lung failure after transplantation.
Compared to the current gold standard, static cold storage, the so-called ex vivo lung perfusion (EVLP) represents a highly innovative technique to perfuse the lung at body temperature and thereby preserve it with nutrients and oxygen. International studies have shown that the use of this novel lung preservation technique (period from organ removal to implantation in the organ recipient) leads to a lower incidence of IRI and thus PGD after LuTx and significantly improves the overall outcome after LuTx. This is due to the fact that EVLP alleviates the inflammation of the lung, the IRI, by allowing the removed lung to perform its anatomical-physiological functions (including gas exchange) in the EVLP under a near-physiological milieu.
In recent years, DZL scientists in the ELD disease area have been investigating potential mechanisms of EVLP that may attenuate IRI and improve organ quality. In addition, they analyzed experimental treatment approaches during EVLP to further attenuate inflammatory events associated with LuTx such as tissue ischemia, the effect of gravity, or allograft rejection. Based on these data, EVLP has now become a globally established procedure for donor lung preservation that has led to significant reduction in the prevalence of primary PGD after LuTx. These data have now been summarized and related to the international literature in a recent review paper in the American Journal of Transplantation.
Original publication: Iske et al., 2021 / American Journal of Transplantation