title: Ex vivo lung graft perfusion.
abstract: This review proposes an update of the state of the art and the ongoing clinical trials of ex vivo lung perfusion for lung transplantation in patients. Ex vivo lung perfusion techniques (EVLP) can be used to evaluate a lung graft outside of the body. The goal of EVLP is to study the functional status of lung grafts that were first rejected for transplantation because they did not match all criteria for a conventional transplantation. After an EVLP evaluation, some of these lungs may be requalified for a possible transplantation in patients. This article proposes an overview of the developments of EVLP techniques. During EVLP, the perfusion and ventilation of the isolated lung preparation are very progressive in order to avoid oedema due to ischaemia-reperfusion injuries. Lung evaluation is mainly based on gasometric (PaO2/FiO2) and rheological criteria (low pulmonary arterial resistance). Several series of patients transplanted with EVLP evaluated lungs have been recently published with promising results. EVLP preparations also allow a better understanding of the physiopathology and treatments of ischaemia-reperfusion injuries. Organ procurements from "non-heart-beating" donors will probably require a wider application of these ex vivo techniques. The development of semi-automated systems might facilitate the clinical use of EVLP techniques.
authors.affiliation: Pôle urgences médecine aiguë, CHU de Grenoble, laboratoire TIMC, équipe PRETA UMR CNRS 5525, université Joseph-Fourier, 38043 Grenoble cedex 09, France. Electronic address: rbriot@chu-grenoble.fr.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Briot
authors.affiliation: Pôle urgences médecine aiguë, CHU de Grenoble, laboratoire TIMC, équipe PRETA UMR CNRS 5525, université Joseph-Fourier, 38043 Grenoble cedex 09, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Gennai
authors.affiliation: Pôle urgences médecine aiguë, CHU de Grenoble, laboratoire TIMC, équipe PRETA UMR CNRS 5525, université Joseph-Fourier, 38043 Grenoble cedex 09, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Maignan
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
authors.forename: Redha
authors.initials: R
authors.lastname: Souilamas
authors.affiliation: Pôle cardiovasculaire et thoracique, CHU de Grenoble, laboratoire de bioénergétique fondamentale et appliquée, Inserm 1055, université Joseph-Fourier, 38043 Grenoble cedex 09, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
mesh_terms: D006801:Humans; D008168:Lung / Q000502:physiology*; D016040:Lung Transplantation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D011652:Pulmonary Circulation; D011654:Pulmonary Edema / Q000209:etiology; D015427:Reperfusion Injury; D009927:Tissue and Organ Procurement
keywords: Ex vivo lung perfusion; Ischaemia-reperfusion injury; Lung transplantation; Pulmonary oedema