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Clinical Ex Vivo Lung Perfusion—Pushing the Limits
Author(s) -
Aigner C.,
Slama A.,
Hötzenecker K.,
Scheed A.,
Urbanek B.,
Schmid W.,
Nierscher F. J.,
Lang G.,
Klepetko W.
Publication year - 2012
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2012.04027.x
Subject(s) - medicine , extracorporeal membrane oxygenation , transplantation , lung transplantation , lung , surgery , ex vivo , perioperative , perfusion , anesthesia , in vivo , microbiology and biotechnology , biology
Ex vivo lung perfusion (EVLP) provides the ability to evaluate donor lungs before transplantation. Yet, limited prospective clinical data exist with regard to its potential to recondition unacceptable donor lungs. This paper summarizes the results of a prospective study of lung transplantation using only initially unacceptable donor lungs, which were improved by EVLP for 2–4 h. From March 2010–June 2011, 13 lungs were evaluated ex vivo . Median donor PaO 2 at FiO 2 1.0/PEEP5 was 216 mmHg (range 133–271). Four lungs, all with trauma history, showed no improvement and were discarded. Nine lungs improved to a ΔPO 2 higher than 350 mmHg. Median PvO 2 at final assessment in these lungs was 466 mmHg (range 434–525). These lungs were transplanted with a median total ischemic time of 577 min (range 486–678). None of the patients developed primary graft dysfunction grades 2 or 3 within 72 h after transplantation. One patient with secondary pulmonary hypertension was left on a planned prolonged extracorporeal membrane oxygenation postoperatively. Median intubation time was 2 days. Thirty‐day mortality was 0%. During the observation period, 119 patients received standard lung transplantation with comparable perioperative outcome. EVLP has a significant potential to improve the quality of otherwise unacceptable donor lungs.