Direct Lung Procurement with Ongoing Abdominal Normothermic Regional Perfusion

Abstract

<h3>Introduction</h3> Donation after circulatory death (DCD) has recently advanced with abdominal normothermic regional perfusion (A-NRP). The A-NRP technique has been implemented to minimize warm ischemic damage to the abdominal organs significantly improving recipient outcomes. There is now a necessity for a standardized and reproducible technique for direct procurement of cardiothoracic organs while A-NRP is ongoing. <h3>Case Report</h3> There were seven successful lung retrievals in the presence of A-NRP that we have performed and reporting. The mean age of the donors was 40 with 4 males. A-NRP was established either via femoral vessels or via the abdominal vessels after laparotomy while the chest was opened simultaneously. The cardiothoracic organs were isolated by application of vascular clamps to decending aorta, SVC caudal to azygos vein and the supradiaphragmatic IVC. Following antegrade pneumoplegia, cardiectomy was performed. After delivering retrograde pneumoplegia, lungs were carefully retrieved with meticulous hemostasis by using liga clips, stitches and diathermy allowing 2 hours of uninterrupted A-NRP in each of the seven successful lung procurements. In all the cases, there was a successful completion of A-NRP without blood loss in the chest. No thoracic cell salvage was required. All lungs once procured, were placed in cold saline, transported on ice to the implanting or research center. Two double and one single left lung (severe right-side consolidation) were successfully transplanted with good short-mid term outcome along with procurement and transplantation of abdominal organs. One pair of lungs was placed on EVLP but declined due to insufficient improvement. Three lungs were procured purely for research <h3>Summary</h3> Direct Lung procurement with A-NRP is a challenging retrieval technique requiring optimal coordination of the abdominal and thoracic retrieval teams. We have successfully performed seven retrievals with 100% successful completion of A-NRP consistently which is first in the world.