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REVIEW article

Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1513546
This article is part of the Research Topic In-Vitro, In-Vivo, and Ex-Vivo Models of Ischemia-Reperfusion Injury in Lung Transplantation View all 7 articles

Ex Vivo Lung Perfusion: Recent Advancements and Future Directions

Provisionally accepted
Kentaro Nakata Kentaro Nakata 1*Isaac Alderete Isaac Alderete 1Benjamin Hughes Benjamin Hughes 1Matthew Hartwig Matthew Hartwig 1,2
  • 1 Duke Ex Vivo Organ Laboratory, Department of Surgery, Duke University Medical Center, Durham, United States
  • 2 Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, United States

The final, formatted version of the article will be published soon.

    Ex-vivo lung perfusion (EVLP) has emerged as a transformative technique in lung transplantation, offering a solution for evaluating and rehabilitating donor lungs that would otherwise be deemed unsuitable. This review article examines the significant advancements in EVLP technology and its application in clinical practice. We discuss the criteria for selection and rehabilitation of donor lungs, emphasizing the use of EVLP for lungs with compromised function due to factors like prolonged ischemic time and donor smoking history. Further, we elaborate on the technological advancements that have improved the functional assessment of lungs, including the development of more sophisticated perfusion solutions and the integration of artificial intelligence for real-time assessment. Additionally, we discuss the future prospects of EVLP, focusing on potential innovations in perfusion solutions, the integration of regenerative medicine and gene therapy to improve allograft quality. Through this comprehensive review, we aim to provide a clear understanding of the current status of EVLP and its promising future directions, ultimately contributing to improved outcomes in lung transplantation.

    Keywords: Lung Transplantation, Organ Preservation, Machine perfusion, ex-vivo lung perfusion, Donor lung assessment, ischemia-reperfusion injury, Graft rehabilitation

    Received: 18 Oct 2024; Accepted: 05 Feb 2025.

    Copyright: © 2025 Nakata, Alderete, Hughes and Hartwig. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Kentaro Nakata, Duke Ex Vivo Organ Laboratory, Department of Surgery, Duke University Medical Center, Durham, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.