Due to COVID-19 and a rapidly expanding list of conditions for which lung transplantation can be lifesaving, the need for new organs is growing. However, with a global shortage of donated lungs, some patients die while on the waitlist. Out of all solid organs, lungs have the lowest utilization, with only one in five donated lungs getting transplanted. To help expand the donor pool, transplant surgeons are now using a ex vivo lung perfusion (EVLP) device designed to rescue potentially viable lungs and those initially deemed “unacceptable” for transplant.

XVIVO’s (Gothenburg, Sweden) EVLP device called XPS and nicknamed “lungs in a box” allows transplant surgeons to examine lungs outside the body. XPS is a fully integrated cardiac bypass system that includes all components. The XPS system is based on innovative technology from leading companies and includes a centrifugal pump (MAQUET CardioHelp), heater/cooler and ICU-ventilator (Hamilton). XPS was developed to provide transplantation teams with a consistent and easy-to-use method of performing EVLP in the hospital. The objective was to develop an automated perfusion system that would allow for standardization of EVLP, without interfering with the need for clinical flexibility.

The donor lungs are transported according to individual standard protocol, in a cooler box from the procurement site. The donor lungs are flushed thoroughly in PERFADEX Plus and then placed on the EVLP platform. After warming up according to a detailed protocol, it is up to the EVLP team to set preferred ventilation and perfusion strategies depending on the requirements of each donor lung. Integrated in-line perfusate gas monitors (PGM) enables for real-time trending of pH and pO2 during the entire EVLP procedure. The XPS also enables precise continuous trending of EVLP performance metrics.

The XPS is indicated for use in flushing and temporary continuous normothermic machine perfusion of initially unacceptable excised donor lungs during which time the ex vivo function of the lungs can be reassessed for transplantation. The XVIVO System (XPS) is intended for flushing and temporary continuous normothermic machine perfusion of isolated lungs, during which time the function of the lungs can be assessed for transplantation. The system was developed together with clinicians with extensive experience and knowledge from normothermic EVLP using STEEN Solution. Understanding the clinical needs and challenges transplant teams encounter in daily work, XPS facilitates clinical decision making and offers a flexible comprehensive platform for EVLP. XPS is specifically designed to facilitate X-ray while performing normothermic EVLP. XPS is the first FDA-approved EVLP technology on the market for ex vivo lung perfusion of initially unacceptable donated lungs and is also CE-marked.

“EVLP allows us to take donor lungs outside the body, attach them to a ventilator and make them clinically usable by treating infection, inflammation and edema – it’s visually stunning,” said Ankit Bharat, MD, chief of thoracic surgery at Northwestern Medicine and executive director of the Canning Thoracic Institute, who pioneered COVID-19 lung transplants in the US. “Because we were the first health system in the US to offer lung transplants for COVID-19 patients, our patient volume continues to increase, and we need every tool to help us get more patients transplanted. EVLP will give us the ability to fix lungs that don’t appear usable up front.” 

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