Cardiothoracic transplantation
Transplantation of initially rejected donor lungs after ex vivo lung perfusion

Read at the 38th Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 27-30, 2012.
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Objective

Ex vivo lung perfusion has the potential to increase the number of patients treated with lung transplantation. Our initial clinical experience with ex vivo lung perfusion is reviewed as well as early clinical outcome in patients transplanted with reconditioned lungs.

Methods

Six pairs of donor lungs deemed unsuitable for transplantation underwent ex vivo lung perfusion with Steen solution mixed with red blood cells to a hematocrit of 10% to 15%. After reconditioning, lung function was evaluated and acceptable lungs were transplanted. Technical experience with ex vivo lung perfusion as well as clinical outcome for patients transplanted with ex vivo lung perfusion-treated lungs were evaluated.

Results

Donor lungs initially rejected either as a result of an inferior partial pressure of arterial oxygen/ fraction of inspired oxygen (n = 5; mean, 20.5 kPa; range, 9.1-29.9 kPa) or infiltrate on chest radiograph (n = 1) improved their oxygenation capacity to a mean partial pressure of arterial oxygen/fraction of inspired oxygen of 57 ± 10 kPa during the ex vivo lung perfusion (mean improvement, 33.6 kPa; range, 21-51 kPa; P < .01). During evaluation, hemodynamic (flow, vascular resistance, pressure) and respiratory (peak airway pressure, compliance) parameters were stable. Two single lungs were not used for lung transplantation because of subpleural hematoma or edema. Six recipients from the regular waiting list underwent single (n = 2) or double (n = 4) lung transplantation. One patient had primary graft dysfunction grade 2 at 72 hours. Median time to extubation was 7 hours. All patients survived 30 days and were discharged in good condition from the hospital.

Conclusions

The use of ex vivo lung perfusion seems safe and indicates that some lungs otherwise refused for lung transplantation can be recovered and transplanted with acceptable short-term results.

CTSNet classification

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Abbreviations and Acronyms

CO2
carbon dioxide
EVLP
ex vivo lung perfusion
FiO2
fraction of inspired oxygen
LTx
lung transplantation
PA
pulmonary artery
PaO2
partial pressure of arterial oxygen
PEEP
positive end-expiratory pressure
P/F
ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen
PO2
partial pressure of oxygen
PVR
pulmonary vascular resistance

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This work was supported by grants from the Swedish Heart and Lung Foundation, the Jan Elgqvist Foundation, and an ALF/LUA research grant from Sahlgrenska University Hospital.

Disclosure: Authors have nothing to disclose with regard to commercial support.