Ex Vivo Lung Perfusion (EVLP) is a novel method of donor lung preservation and treatment developed in Toronto, which allows donor lungs to be treated for at least 12 hours under protective physiological conditions. This essentially creates a critical time window in which donor lungs can be optimally repaired prior to lung transplantation. In Toronto, EVLP has been an integral part of our clinical lung transplant program since 2008. In 2012, Health Canada approved this strategy and subsequently, the Ministry of Health and Long-Term Care started to reimburse our hospital for EVLP costs. In 2013, our lung transplant activities increased by 28% in one year, with EVLP being the major responsible factor for that increase, considering that our multi-organ donor pool number and characteristics did not change. We now have significant experience with over 110 patients that have received EVLP lungs in Toronto. This group of patients enjoys very low rates of severe primary graft dysfunction (PGD), and a 5-year survival of 70% in comparison to 63% in contemporaneous conventional transplants. With the ability to treat infected donor lungs, we are increasing the number of viable transplants.
In Vivo Lung Perfusion (IVLP) is a surgical technique developed to deliver high-dose chemotherapy to the lung, minimizing systemic exposure by selectively delivering an agent though the pulmonary artery and selectively diverting blood. IVLP has the distinct advantage of delivering high-dose drug treatment to the lung while limiting exposure of sensitive critical organs, therefore avoiding severe complications. With In Vivo Lung Perfusion, it is possible to vary parameters such as drug delivery, temperature, ventilation, and other physiological parameters, thus creating a fully customizable environment.
For the liver and kidney transplantation, we’ve developed the
Normothermic Ex Vivo Liver and Kidney perfusion circuits. These maintain the grafts at a physiological temperature (37°C), saturating them with oxygen and a solution that contains blood, minerals, nutrients, amino acids, glucose, antibiotics and drugs. With these techniques, we avoid the negative effects of cold storage, which does not allow graft assessment prior to transplantation and is unsuitable for graft repair strategies.
Using Normothermic perfused preservation, we can reduce preservation injury, and are able to assess liver and kidney function prior to transplantation. In addition, the liver and kidney have a normal function and metabolism during the preservation period, allowing us to apply novel strategies and modify grafts according to the recipient needs. We have already shown that Ex Vivo Liver and Kidney perfusion are safe in our transplantation population, and have performed multiple liver and kidney transplants following Ex Vivo Perfusion.