89 Early Outcomes of Bilateral Sequential Single Lung Transplantation after Ex-Vivo Lung Evaluation and Reconditioning

Abstract

Purpose Ex-vivo lung perfusion (EVLP) is a novel approach for extended evaluation and/or reconditioning of donor lungs not meeting standard ISHLT criteria for transplantation (tx). This is a prospective evaluation of 11 consecutive EVLP runs performed between January 2009 and September 2010 at a single institution. Methods and Materials Lungs offered and rejected for routine tx were evaluated and procured normally if they met the inclusion criteria for EVLP. Thus obtained grafts were implanted in the EVLP circuit and reperfused according to the institutional protocol using acellular supplemented STEEN Solution™ up to a target flow rate of 40% of the donor's calculated flow at a cardiac index of 3.0 l/min/m2 with a LA pressure <5mmHg and PA pressure <15mmHg. After re-warming to 37°C, grafts were ventilated with a 6-8ml/kg(donor weight) tidal volume with a respiratory rate of 7-8/minute, an IE ratio of 1:2 and PEEP of 5-10cmH20. Hemodynamic and respiratory data was monitored continuously and the graft was underwent hourly clinical assessments. Results Donor data: n=11, age 44.81±8.82 years, cause of death: intracranial hemorrhage - 10(91%), stroke - 1(9%), history of smoking 7(64%), average pack year 19.57±8.59 years, mechanical ventilation time 98.36±91.60 hours, CXR: abnormal - 10(91%), normal - 1(9%). EVLP: Mean duration 146.04±31.06 minutes. Arterial PaO2 before termination of the circuit improved significantly compared to the last pre-retrieval value: 55.95±9.46 vs 40.4±14.92 kPa (p<0.05). After ex-vivo evaluation and reconditioning, 5 (45%) pairs of lungs were successfully transplanted. Recipient data: Age 41.8±15.69 years, underlying disease: cystic fibrosis - 2(40%), emphysema - 3(60%). Median ITU stay was 7 (range 3–72) days, median follow-up 91 (range 67–269) days, with a 30 day survival rate of 100%. There was one late death (day 203) due to pneumonia. Conclusions EVLP facilitates assessment and reconditioning of borderline lungs with a conversion rate to tx of 45% and excellent short-term survival. Ex-vivo lung perfusion (EVLP) is a novel approach for extended evaluation and/or reconditioning of donor lungs not meeting standard ISHLT criteria for transplantation (tx). This is a prospective evaluation of 11 consecutive EVLP runs performed between January 2009 and September 2010 at a single institution. Lungs offered and rejected for routine tx were evaluated and procured normally if they met the inclusion criteria for EVLP. Thus obtained grafts were implanted in the EVLP circuit and reperfused according to the institutional protocol using acellular supplemented STEEN Solution™ up to a target flow rate of 40% of the donor's calculated flow at a cardiac index of 3.0 l/min/m2 with a LA pressure <5mmHg and PA pressure <15mmHg. After re-warming to 37°C, grafts were ventilated with a 6-8ml/kg(donor weight) tidal volume with a respiratory rate of 7-8/minute, an IE ratio of 1:2 and PEEP of 5-10cmH20. Hemodynamic and respiratory data was monitored continuously and the graft was underwent hourly clinical assessments. Donor data: n=11, age 44.81±8.82 years, cause of death: intracranial hemorrhage - 10(91%), stroke - 1(9%), history of smoking 7(64%), average pack year 19.57±8.59 years, mechanical ventilation time 98.36±91.60 hours, CXR: abnormal - 10(91%), normal - 1(9%). EVLP: Mean duration 146.04±31.06 minutes. Arterial PaO2 before termination of the circuit improved significantly compared to the last pre-retrieval value: 55.95±9.46 vs 40.4±14.92 kPa (p<0.05). After ex-vivo evaluation and reconditioning, 5 (45%) pairs of lungs were successfully transplanted. Recipient data: Age 41.8±15.69 years, underlying disease: cystic fibrosis - 2(40%), emphysema - 3(60%). Median ITU stay was 7 (range 3–72) days, median follow-up 91 (range 67–269) days, with a 30 day survival rate of 100%. There was one late death (day 203) due to pneumonia. EVLP facilitates assessment and reconditioning of borderline lungs with a conversion rate to tx of 45% and excellent short-term survival.