88 Clinical Ex Vivo Lung Perfusion – Pushing the Limits

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<h3>Purpose</h3> Ex vivo lung perfusion (EVLP) has been proven to provide the opportunity to evaluate and optimise unacceptable donor lungs prior to transplantation. We report on the initial clinical results of a prospective study of lung transplantation after ex vivo perfusion. <h3>Methods and Materials</h3> All donors lungs who are deemed unacceptable by our standard criteria and meet the inclusion criteria of our prospective non-randomized clinical study are evaluated with ex vivo lung perfusion using acellular Steen Solution for two to four hours. Lungs showing a ΔPO₂ of at least 350 mmHg between arterial and venous solution with stable or improving functional parameters are accepted for transplantation. <h3>Results</h3> From 3/2010 – 10/2010 10 lungs were evaluated ex vivo. Mean donor age was 45 years (range 16-58). Mean donor PaO₂ at FiO₂ 1,0/PEEP 5 was 206±50 mmHg. 4 lungs, all with trauma history did not improve and were not used. 6 lungs improved to a ΔPO₂ of more than 350 mmHg. Mean PaO₂ in those lungs was 468±34 mmHg after EVLP. These lungs were transplanted with a mean total ischemic time of 570 minutes. Mean recipient age was 42 years (range 18-66) Diagnoses were fibrosis (n=2), COPD (n=2), CF (n=1), SPH (n=1). 5 recipients had a PGD score 0 at 24 hours posttransplant. The patient with secondary pulmonary hypertension was left on a planned prolonged ECMO postoperatively for hemodynamic reasons showing good lung function. Median intubation time was 2 days. 30 day mortality was 0%. <h3>Conclusions</h3> Ex lung perfusion is a safe and effective method to evaluate and optimise nonacceptable donor lungs. In the setting of an already very liberal use of marginal donor organs we were able to transplant 6 additional lungs which would not have been used otherwise with excellent short term results.