Is perfusate exchange during ex vivo lung perfusion beneficial?

Lung transplantation is a therapeutic option for patients with end-stage lung disease. The number of lung transplantations worldwide has been increasing since 2012 and has almost doubled over the last decade (1). Despite the increase in lung transplant rates, 326 patients died on the waitlist or became too sick to undergo transplant in 2017, and the overall waitlist mortality rate was 17.2 per 100 waitlist-years (2). Shortage of acceptable donor lungs remains a major limitation to lung transplantation. Ex vivo lung perfusion (EVLP) is an increasingly utilized technology to assess and recondition donor organs that are otherwise marginal for transplantation and may be used to expand the donor pool.