Comparing Gas and Inhaled Pharmacologic Interventions During Ex Vivo Lung Perfusion: A Systematic Review.

Background: Ex vivo lung perfusion (EVLP) has expanded the use of donor lungs by enabling ex vivo assessment, preservation, and rehabilitation before transplantation. Despite these advances, ischemia-reperfusion injury, inflammatory activation, pulmonary edema, and impaired lung mechanics continue to compromise graft quality and contribute to primary graft dysfunction. Inhaled and gaseous interventions have emerged as potential adjunctive therapies to improve donor lung preservation during EVLP; however, a standardized protocol has not yet been established. Methods: PubMed and Embase were used to search human and animal studies evaluating inhaled and gaseous interventions administered during and after EVLP. Articles published from the database's inception to September 22, 2025, were analyzed. Results: , and liquid ventilation demonstrated minimal benefit. Conclusions: . Future research should prioritize standardizing protocols, optimizing gas composition and timing, and assessing long-term posttransplant outcomes to translate these findings into clinical practice.