Abstract
Purpose Anatomical regions of marginal donor lungs display significant heterogeneity in function raising the possibility that good functioning regions might be suitable for transplantation. The aim of this study was to compare gas exchange of upper lobes, which are possibly less susceptible to injury, with whole lungs using ex vivo lung perfusion (EVLP). Methods Nine rejected donor lungs were perfused for 2 hours of cellular EVLP utilizing the Swedish protocol. Transplant suitability was evaluated based on blood gas analysis, hemodynamics, ventilator parameters, palpation, visual findings, and lung weight. In order to assess upper lobe gas exchange, blood samples from upper lobe pulmonary vein (ULPV) were taken selectively at 2 hours of EVLP. PaO2/FiO2 (P/F) ratio, shunt fraction (SF), and A-a gradient in ULPV samples were compared with those of left atrium (LA). Results Upper lobes demonstrated a significantly higher P/F ratio [median (minimum - maximum)] [396 (315-583) vs. 284 (104-415), mmHg, p = 0.02, Figure A] and lower SF [21.8 (7.3-34.6) vs. 29.1 (22.7-73.9), %, p = 0.04] than whole lungs. Based on evaluation at 2 hours of EVLP, 6 of 9 lungs were deemed to be non-suitable for transplantation. In non-suitable group, P/F ratio in ULPV was significantly higher than that in LA [439 (315-583) vs. 245 (104-415) mmHg, p = 0.02, Figure B], whereas SF and A-a gradient of ULPV were significantly lower than those of LA [SF, 18.5 (7.3-34.6) vs. 34.8 (22.7-73.9) %, p = 0.04; A-a gradient, 224.9 (83.5-347.9) vs. 418.4 (246.2-569.6) mmHg, p = 0.02]. In contrast, no difference was found between the ULPV and LA parameters in lungs deemed suitable for transplant. Conclusion These results demonstrate that in marginal donor lungs judged to be non-suitable for transplant at 2 hours of EVLP, the majority of lungs have well-functioning upper lobes. These findings suggest that, in this setting, upper lobes may be suitable for lobar transplantation which could help reduce wait-list mortality.
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