New protocol for ex vivo lung perfusion prior to transplantation

Mohamed S.A. Mohamed, MBBCh, MSc, MD.

Thoracic Transplantation Department, University Clinic Essen, Germany. Hufeland Straße 55. D- 55147 Essen.

E-mail: Mohamed.Shehata@uk-essen.de, mohammed.shehatta1@gmail.com

Accepted 01 October, 2014

Abstract

Normothermic ex vivo lung perfusion (EVLP) is a technique where the retrieved donor lung can be perfused in an ex vivo circuit, providing an opportunity to reassess its function before transplantation. The hyper-oncotic reconditioning fluid helps to mobilize and remove excess interstitial and alveolar fluid. In addition, recruitment of atelectatic areas has an important role. The value of applying EVLP is to widen the range of donation by allowing lungs of brain death victims, which suffers the associated neurogenic edema in addition to possible traumatic contusions and or infections, and the lungs of circulatory death donors, to be reconditioned and reassessed before final decision of acceptance or rejection. EVLP is already applied within different institutions worldwide, using various application protocols. EVLP is an important technology in the practice of lung transplantation. This paper represents a newly suggested EVLP protocol ‘’Shehata Protocol’’ with theoretical proof of its superiority over one of the most successful and applicable protocols nowadays, Toronto Protocol.

Keywords: Ex vivo lung perfusion, lung conditioning, lung preservation, lung repair, lung transplantation and primary graft dysfunction.