Ex vivo lung perfusion to improve donor lung function and increase the number of organs available for transplantation

Franco Valenza, Lorenzo Rosso, Silvia Coppola, Sara Froio, Alessandro Palleschi, Davide Tosi, Paolo Mendogni, Valentina Salice, Giulia M Ruggeri, Jacopo Fumagalli, Alessandro Villa, Mario Nosotti, Luigi Santambrogio, Luciano Gattinoni, Franco Valenza, Lorenzo Rosso, Silvia Coppola, Sara Froio, Alessandro Palleschi, Davide Tosi, Paolo Mendogni, Valentina Salice, Giulia M Ruggeri, Jacopo Fumagalli, Alessandro Villa, Mario Nosotti, Luigi Santambrogio, Luciano Gattinoni

Abstract

This paper describes the initial clinical experience of ex vivo lung perfusion (EVLP) at the Fondazione Ca' Granda in Milan between January 2011 and May 2013. EVLP was considered if donor PaO2 /FiO2 was below 300 mmHg or if lung function was doubtful. Donors with massive lung contusion, aspiration, purulent secretions, pneumonia, or sepsis were excluded. EVLP was run with a low-flow, open atrium and low hematocrit technique. Thirty-five lung transplants from brain death donors were performed, seven of which after EVLP. EVLP donors were older (54 ± 9 years vs. 40 ± 15 years, EVLP versus Standard, P < 0.05), had lower PaO2 /FiO2 (264 ± 78 mmHg vs. 453 ± 119 mmHg, P < 0.05), and more chest X-ray abnormalities (P < 0.05). EVLP recipients were more often admitted to intensive care unit as urgent cases (57% vs. 18%, P = 0.05); lung allocation score at transplantation was higher (79 [40-84] vs. 39 [36-46], P < 0.05). After transplantation, primary graft dysfunction (PGD72 grade 3, 32% vs. 28%, EVLP versus Standard, P = 1), mortality at 30 days (0% vs. 0%, P = 1), and overall survival (71% vs. 86%, EVLP versus Standard P = 0.27) were not different between groups. EVLP enabled a 20% increase in available donor organs and resulted in successful transplants with lungs that would have otherwise been rejected (ClinicalTrials.gov number: NCT01967953).

Keywords: brain death; ex vivo lung perfusion organ regeneration; lung transplantation; marginal donor criteria; outcome.

© 2014 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT.

Figures

Figure 1
Figure 1
Disposition of donor lungs.
Figure 2
Figure 2
Donor oxygenation stratified by studied groups. Arterial partial pressure of oxygen (PaO2) was measured at 5 cmH2O of positive end-expiratory pressure, and with an inspiratory fraction of oxygen (FiO2) of 1. “Best” represents the best PaO2/FiO2 recorded during the entire process of brain death determination; “Last” represents the last PaO2/FiO2 value recorded before the recovery of lungs. *P < 0.05. Best versus Last, #P < 0.05 Standard versus EVLP, One-way anova.
Figure 3
Figure 3
Kaplan–Meier curves show that overall survival after transplantation was similar between groups (86% vs. 71%, P = 0.27).

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Source: PubMed

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