(111) - Primary Graft Dysfunction Is Related To Extravascular Lung Water During Ex Vivo Lung Perfusion

Abstract

s S47 Methods: Lungs from uDCDDs < 66 years old were obtained after failed CPR (Category 1). If there was state ID indicating consent for organ donation, EMS facilitated identity of next-of-kin (NOK). NOK were contacted by the OPO for assent to recover lungs for assessment and possible transplant. Deceased donors were ventilated with O2 and transported to an operating room. The OPO then obtained a detailed medical/social donor history from NOK. Lungs were flushed antegrade with cold PerfadexTM (with Alprostadil and heparin) and retrograde. Blood was sent for serologies. Lungs underwent EVLP (XVIVOTM) for 4 hours with Steen solutionTM. Post-EVLP spiral CT scans were obtained. Results: Over 6 months EMS identified 12 uDCDDs that met criteria: 4 NOK not found; 2 NOK refused assent; 3 had pulmonary disease (asthma, 40 pk-yr smoker, COPD). 3 uDCDDs had EVLP. Donor 1: cold agglutinin, pulmonary emboli with infarct, poor flush, pulmonary edema. CT = pulm infarct & edema. Donor 2: previous MVR & ascending aorta graft; A-fib, coumadin, left atrium full of clot. CT = minimal small ground glass opacities. Likely transplantable. Donor 3: mutiple tiny blebs, increasingly poor collapse, pulmonary edema. CT = emphysema & edema. See Table for data. Conclusion: Lungs from Category 1 uDCDDs can be evaluated with EVLP. Ex-vivo CT scan adds complementary information. Lungs from uDCDDs may be suitable for transplant. Logistical challenges to decrease warm ischemic times and identify NOK require address. uDCDDs could substantially increase donor lungs for transplant. Demographics/ Ischemic Time/EVLP Outcome Donor Age/Sex Death Ischemic Time (min) EVLP EVLP Cause non-vent O2-vent cold (hrs) pO2 1 60M PE 71 141 381 1 456 2 60M LA Clot 49 160 590 4 625 3 54M MI 27 141 578 2 380