Old and new strategies to preserve the lung before transplantation

Summary - Transplantation is considered a valuable option in the treatment of end-stage lung disease. However, organs from multi-organ donors available for transplantation are far fewer than the number of potential recipients, so that as many as 15 to 20% of them die while on a waitlist. Over the years a number of ways have been explored to overcome the discrepancy between the need and the availability of organs, including the use of lung allocation scores and the implementation of standardized donor management protocols. In the last decade several authors have extended lung donor criteria to increase the pool of organs, unfortunately with controversial results. Recently, the feasibility and safety of transplanting high-risk donor lungs that have undergone ex-vivo lung perfusion (EVLP) have been successfully documented. EVLP allows donor lungs to be evaluated before transplantation when function is doubtful and injured donor lungs can be repaired, thus increasing the number of organs available for transplantation. Although EVLP has opened a new era in lung transplantation, conventional strategies to preserve the lung before transplantation still maintain their importance in the process of organ donation and significantly contribute to the final outcome of transplantation. The purpose of this review is to summarize old and new strategies to preserve the lung before transplantation.