Ex Vivo Lung Perfusion

Transplant

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As one of the leading transplantation centers in the country, UT Southwestern Medical Center is at the forefront of research and clinical care for people who need lung transplants. Our specialists have extensive expertise in ex vivo lung perfusion, a technology that assesses, prepares, repairs, and restores donor lungs for successful transplantation.

Expertise in Ex Vivo Lung Perfusion

For some patients with certain serious lung diseases, lung transplantation is the only treatment that can save their lives. However, patients often must wait for weeks or months for transplant because only about 20 to 30 percent of donor lungs are usable. 

Ex vivo lung perfusion (EVLP) is technology that helps to assess and possibly repair and restore lungs that are damaged at the time of the donor’s death. By repairing lungs that might have previously been considered too damaged for transplant, EVLP helps expand the pool of healthy donor lungs – and helps us save additional lives.

UT Southwestern’s lung transplant team performs more than 60 lung transplantations each year and is one of fewer than two dozen U.S. centers using EVLP. Our team consists of pulmonologists, surgeons, cardiologists, transplant coordinators, nurses, dietitians, social workers, and pharmacists – providing a multidisciplinary approach to caring for patients with end-stage lung disease who need transplantation. Our multidisciplinary approach helps us deliver a personalized treatment plan for each patient that includes postoperative and long-term care.

Conditions We Treat

Lung transplantation is a treatment for people with end-stage lung disease for whom other treatments have failed. Our lung transplant specialists typically recommend transplantation for people with severe lung diseases such as:

Treatment With Ex Vivo Lung Perfusion

At UT Southwestern, we use the EVLP system as part of our lung transplantation process. The system helps our transplant team more thoroughly evaluate donor lungs and improves the quality of donor lungs as they are being considered for transplantation. 

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Donor lungs being connected to the ex-vivo lung perfusion pump after cannulation by Dr. John Murala, Surgical Director of the EVLP program.

If the lungs aren’t suitable for direct transplantation in the donor operating room, but are potentially repairable, we consider EVLP technology. The process takes about 6 to 8 hours and involves these steps:

  • Specially designed canulas (tubings) that mimic the connections in the human body are attached to the donor lungs.
  • The lungs are placed inside a sterile environment and connected to an EVLP pump and a ventilator.
  • The lungs are ventilated, kept at normal body temperature, and treated with a solution containing nutrients, proteins, antibiotics, and oxygen.
  • The pump circulates the solution through the blood vessels and the lung tissue, flushing the remaining donor blood and helping to repair the damaged lungs.
  • Breathing tubes in the lungs are cleaned using bronchoscopy.
  • Lungs are evaluated using a combination of physiological variables, including pressure in the blood vessels and breathing tubes; elasticity and recoil of the lung tissue and ability to transfer oxygen; radiography (X-ray of the lungs); and direct assessment of the organ.
  • A dedicated and experienced team consisting of a surgeon, nurse perfusionists, and a pulmonologist closely monitor this data and eventually determine whether the lungs are suitable for transplantation.

Typically, without EVLP, once a donor lung or pair of lungs are found, the donor lungs need to be transplanted within six hours. However, use of EVLP technology allows us to support and evaluate the donor lungs outside of the human body for well in excess of six hours.

Ex vivo lung perfusion offers key benefits for people awaiting lung transplants:

  • Less time on the lung transplant waiting list because more healthy donor lungs are available
  • Lower risk of organ dysfunction early after transplantation
  • Possible improvement in long-term survival of the graft  
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Donor lungs on the ex-vivo lung perfusion pump are perfused through the pulmonary artery cannula and the left atrial cannula. The lungs are inflated via the endotracheal tube connected to a mechanical ventilator.

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