Lung Transplantation: When Innovation Expands Access and Improves Outcomes
Seance of wednesday 05 november 2025 (Progrès et Innovations en Chirurgie Thoracique)
DOI number : 10.26299/c8kx-pt81/emem.2025.45.03
Abstract
Lung transplantation remains a treatment of last resort, constrained by donor organ shortages and the variability in initial graft quality. The emergence of ex vivo lung perfusion (EVLP) represents a major breakthrough for optimizing donor utilization and refining perioperative management.
Indeed, EVLP allows for preservation, functional assessment, and reconditioning of the graft in a normothermic and physiological environment, reproducing in situ ventilation and perfusion conditions. This technology enables an objective evaluation of lung function while allowing targeted therapeutic interventions—anti-infective and anti-inflammatory—applied directly to the isolated organ.
EVLP programs have demonstrated, across several leading transplant centers, a 20–30% increase in the number of feasible lung transplants, without any deterioration in early postoperative outcomes or increase in the incidence of primary graft dysfunction (PGD). On the contrary, the observed reduction in PGD tends to confirm the protective effect of ex vivo reconditioning on the pulmonary endothelium, thereby contributing to improved overall outcomes.
Beyond merely broadening donor acceptance criteria, EVLP paves the way—through new organizational models—for a shared therapeutic platform, capable of addressing the challenges inherent to this highly specialized, time-intensive, and frequently nocturnal activity.
Indeed, EVLP allows for preservation, functional assessment, and reconditioning of the graft in a normothermic and physiological environment, reproducing in situ ventilation and perfusion conditions. This technology enables an objective evaluation of lung function while allowing targeted therapeutic interventions—anti-infective and anti-inflammatory—applied directly to the isolated organ.
EVLP programs have demonstrated, across several leading transplant centers, a 20–30% increase in the number of feasible lung transplants, without any deterioration in early postoperative outcomes or increase in the incidence of primary graft dysfunction (PGD). On the contrary, the observed reduction in PGD tends to confirm the protective effect of ex vivo reconditioning on the pulmonary endothelium, thereby contributing to improved overall outcomes.
Beyond merely broadening donor acceptance criteria, EVLP paves the way—through new organizational models—for a shared therapeutic platform, capable of addressing the challenges inherent to this highly specialized, time-intensive, and frequently nocturnal activity.