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A miracle in surgical medicine: What is ex vivo lung perfusion (EVLP) technology?
Ex vivo lung perfusion (EVLP) is an advanced medical preservation technique whose goal is to support donated lungs to maintain their active cellular metabolism prior to transplantation. This technology uses specially designed machines to simulate the environment of the natural circulatory system, restoring the nutrients and oxygen needed by the lungs to enhance their function. In this way, previously rejected donated lungs have the opportunity to be re-evaluated and repaired, thereby expanding the pool of lungs available for transplantation.
Ex vivo lung perfusion is not only a technological innovation, but also a life saver.
Physiological Background
The main function of the lungs is to facilitate gas exchange, supplying oxygen to the blood while removing carbon dioxide. This process takes place in the alveoli, which are tiny air sacs where oxygen and carbon dioxide are exchanged across a thin barrier. Pulmonary perfusion refers to the process of blood circulation through the lungs, and the efficiency of this process is affected by the distribution and adequacy of blood flow. In a healthy lung, perfusion should be optimally balanced with ventilation to ensure efficient gas exchange.
Historical BackgroundThe concept of ex vivo perfusion was first proposed by Alexis Carrel and Charles Lindbergh in the 1930s, when their experiments involved perfusion techniques of various organs. As the research progressed, Stig Steen and his team first applied ex vivo lung perfusion technology clinically in 2001, successfully re-evaluating and repairing the originally rejected lungs to make them meet the standards for transplantation.
Common Protocols for Ex Vivo Lung Perfusion Techniques
Currently, there are three main EVLP protocols: the Toronto protocol, the Lund protocol, and the Organ Care System protocol. These protocols use different procedures and standards to make otherwise unsuitable donated lungs suitable for transplantation.
Toronto Agreement
As one of the most commonly used EVLP protocols, the implementation of the Toronto protocol includes strict screening of donated lungs to ensure that only lungs that meet the standards can receive further processing. Central to this protocol is a low-flow strategy designed to prevent fluid accumulation.
Lend Agreement
The Lund protocol was the first efficient EVLP protocol introduced by Sting in 2000. The protocol focuses on re-evaluating lungs that were originally deemed substandard, with improvements in lung function being made during the process.
Organ Care System Protocol
The Organ Care System (OCS protocol) is a portable EVLP system that allows the functional evaluation of the donated lungs during transportation, further reducing the cold ischemia time of the donor lungs and reducing the impact of this process on the transplantation. impact.
The advent of EVLP not only revives rejected donated lungs, it may also change the entire landscape of lung transplantation.
Advantages and significance
The emergence of EVLP technology has given many donated lungs that were once deemed unsuitable an opportunity to be reconsidered. Through this technology, doctors can effectively repair lungs damaged by fluid buildup or infection and make previously unsuitable lungs suitable for transplantation. Furthermore, patients who underwent EVLP demonstrated good survival and graft function following lung transplantation.
Risks and Challenges
Although EVLP has significant potential, the procedure is associated with several risks, such as inflammatory response and possible ventilator injury. In addition, the high cost of EVLP is also a challenge that discourages many clinical institutions.
Looking to the future
With the advancement of science and technological development, EVLP technology is bound to play a greater role in the field of lung transplantation and help more patients gain new life. In the future, can we completely improve the risks and economic burden of this technology and make it a more popular transplant method?
