Ex Vivo Lung Perfusion
Respiratory diseases account for one in five deaths in the UK, and lung transplantation can be the only option for patients with end-stage chronic lung disease – in fact, this is the only option for those with Cystic Fibrosis and end-stage respiratory failure. Currently, only one in five of the potential donor lungs available in the UK are used in lung transplants. Lungs, and other primary organs, are currently evaluated using subjective selection criteria which are poor discriminators of injury and infection, leading to the exclusion of potentially useable lungs.
Ex Vivo Lung Perfusion (EVLP) offers the opportunity to monitor, manipulate and characterise the human lung in an isolated environment and specifically investigate the effect of specific perfusion, ventilation and treatment strategies independently of donor or recipient physiologic variables. EVLP has the potential to increase the donor pool by enabling the assessment and improvement of donor lungs by precisely controlling important variables key to their viability.
EVLP is a novel experimental technique in which donor lungs that can’t be used for transplantation, either because they are functioning poorly or in which function is uncertain, can be assessed objectively with a view to reconditioning them for safe transplantation.
The ENLIGHTEN programme brings together three institutions (Edinburgh, Glasgow and Newcastle) to implement and validate novel real-time optical technologies to image and sense pathology and aberrant physiology in the ex vivo human lung using multiplexed optical endomicroscopy (OEM) and optical sensors (lab-on-a-fibre).
As part of the ENLIGHTEN programme, we aim to retrieve lungs deemed ‘not fit’ for transplant from organ donors whose families authorise their lungs for research in Scotland. The lungs will undergo EVLP and ventilation to enable the team to dynamically interrogate infective, inflammatory and physiological indices in the lungs and the perfusate. As soon as we demonstrate accurate assessment of human lung physiology using our system, we will move forwards with optimisation and the testing of our novel technology to rapidly assess function and infection in lungs that are undergoing EVLP.
We have now obtained all approvals to begin our Scotland wide research programme in February 2017.