Ex Vivo Lung Perfusion of Rejected Human Donor Lungs; Are Donor Lungs with Prolonged Cold Ischemic Time Re-Conditioned by EVLP?

Abstract

Purpose Ex vivo lung perfusion (EVLP) has the potential to increase the number of donor lungs available for lung transplantation (LTx). While the current maximum cold ischemic time (CIT) for donor lungs in clinical LTx is around 8 hrs, there are no data regarding the potential use of rejected donor lungs with CIT longer than 8 hrs after EVLP. Methods and Materials Between 1/2012 to 11/2012, brain dead/DCD donor lungs (n=15) were obtained when they were rejected for clinical LTx. Procurement procedures were the same as for clinical LTx. Lungs with severe pulmonary infection, severe lung contusion, and severe bullous emphysema were excluded. CIT was defined as the time between cross clamping and the start of EVLP. Both the Toronto style system (acellular, 4 hr) and VivoLine® (cellular, 2 hr) were randomly used. Assessment for potential clinical use was established on ABG, fluid in airway, and airway/vascular parameters. A case of fluid in airway, PaO 2 /FiO 2 [sup]([/sup] P/F) ratio 20 was considered unsuitable for clinical use. Results Donor lungs (n=15) were rejected due to low P/F, abnormal CXR or other reason. Donor characteristics were: BD n=13, DCD n=2; Age, average 42, rang 18-66; P/F at donor hospital, 198.3, 66−336; CIT, 10.6 hrs, 3.5-19.5. EVLP was performed using Toronto system (n=11) and VivoLine (n=4). Seven lungs (46%) were assessed to be acceptable with 4 lungs (80%) in short CIT group ( 8 hrs, 15.0 hr, 9−19.5, n=10). There was a statistically significant difference in P/F (365.4 vs 270.9, p Conclusions These preliminary data suggest that a high percentage of rejected donor lungs with CIT of less than 8 hrs can be used for clinical LTx following EVLP. With CIT of more than 8 hrs, a smaller but still reasonable percentage of rejected donor lungs meet criteria for transplantation following EVLP.