Ex Vivo Lung Perfusion (EVLP)
Ex Vivo Lung Perfusion (EVLP) has become a key strategy to assess, recondition, and safely transplant lungs from DCD (Donation after Circulatory Death) donors, particularly because of warm ischemia exposure. Below is a practical, clinically oriented guide focused on how to use EVLP after DCD, with protocols and critical parameters that transplant teams monitor.
DCD lungs are exposed to:
•Agonal phase hypoperfusion
•Warm ischemic injury
•Higher risk of primary graft dysfunction (PGD)
EVLP allows:
•Functional assessment under near-physiologic conditions
•Reversal of atelectasis and pulmonary edema
•Controlled reperfusion before implantation
•Objective go / no-go decision
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2. Timing and Donor Considerations …
6.Decision Criteria: Transplant vs Decline
Proceed to transplant if:
•PaO₂/FiO₂ improves to >400
•Stable hemodynamics on EVLP
•No worsening pulmonary edema
•Good compliance and uniform inflation
Decline if:
•Progressive edema
•Rising PVR
•Poor oxygenation despite optimization
•Severe contusion or infection
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7. DCD-Specific Considerations
•Avoid overperfusion → worsens reperfusion injury
•Use low FiO₂ during EVLP to limit oxidative stress
•EVLP mitigates:
•Endothelial dysfunction
•Capillary leak
•Particularly valuable when:
•Uncontrolled DCD
•Prolonged agonal phase
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8. Post-EVLP Handling
•Cold flush with Perfadex
•Standard cold storage
•Implantation with:
•Controlled reperfusion
•Low pulmonary artery pressures
•Early protective ventilation
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9. Outcomes
•Multiple studies show DCD lungs assessed with EVLP have outcomes comparable to DBD lungs
•Reduced PGD rates
•Expanded donor pool by 20–30%
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10. Future Directions
•EVLP as a therapeutic platform:
•Fibrinolytics
•Gene therapy
•IL-10 / anti-inflammatory agents
•Prolonged EVLP (>12 hours)
Dr.Sam Zeraatian Nejad Davani, Cardiovascular and Transplant surgeon. Advanced Fellow of Thoracic Organs Transplantation Chicago Illinois.