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Clinical Ex Vivo Lung Perfusion—Pushing the Limits
Article first published online: 28 MAR 2012
DOI: 10.1111/j.1600-6143.2012.04027.x
© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons
Additional Information
How to Cite
Aigner, C., Slama, A., Hötzenecker, K., Scheed, A., Urbanek, B., Schmid, W., Nierscher, F. J., Lang, G. and Klepetko, W. (2012), Clinical Ex Vivo Lung Perfusion—Pushing the Limits. American Journal of Transplantation, 12: 1839–1847. doi: 10.1111/j.1600-6143.2012.04027.x
Publication History
- Issue published online: 28 JUN 2012
- Article first published online: 28 MAR 2012
- Received 25 November 2011, revised 26 January 2012 and accepted for publication 6 February 2012
- Abstract
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Keywords:
- EVLP;
- Ex vivo lung perfusion;
- lung transplantation;
- marginal donors
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 PaO2 at FiO21.0/PEEP5 was 216 mmHg (range 133–271). Four lungs, all with trauma history, showed no improvement and were discarded. Nine lungs improved to a ΔPO2 higher than 350 mmHg. Median PvO2 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.