Ex-Vivo Pulmonary Artery Angioscopy: A Novel Technique for Management of Donor Lung Pulmonary Embolism

Abstract

<h3>Purpose</h3> Although organ donors have high prevalence of pulmonary embolism (PE), the diagnosis of PE in donor lungs can be challenging and can have a detrimental effect on lung transplantion (LTx) outcomes. The aim of this study was to investigate the feasibility of a novel technique using ex-vivo pulmonary artery (EXPLORE) angioscopy for the diagnosis and treatment of PE in donor lungs post-procurement. <h3>Methods</h3> An adult fiber optic bronchoscope was utilized for the EXPLORE angioscopy technique (off-label use). EXPLORE angioscopy was first tested in donor lungs deemed non-suitable for LTx after ex-vivo lung perfusion (EVLP) (test group). It was then routinely utilized for screening of donor lungs with suspected PE before EVLP (application group). Criteria for PE suspicion included: consistently low P/F ratio during donor management, observed clots during retrograde flushing, and inadequate flushing of donor lungs presented as abnormal coloring of some lung areas. <h3>Results</h3> In the testing group, using EXPLORE angioscopy we were able to identify and remove pulmonary emboli from 4 lungs (<b>Figure 1</b>). In the application group, 16 lungs fulfilled the criteria for PE suspicion and were screened with EXPLORE angioscopy. In 5 cases, pulmonary emboli were identified and removed before EVLP, two of which were deemed suitable for LTx post-EVLP evaluation and were transplanted with good outcomes. Both recipients were extubated on post-transplant day 1 and primary graft dysfunction (PGD) grades at 72 hours post-transplant were 1. In the other 11 cases, PE screening was negative, 6 of which were transplanted. Four recipients had PGD 1 and two had PGD 0 at 72 hours. Median time to extubation was 2 days. <h3>Conclusion</h3> EXPLORE angioscopy can be a useful tool for PE screening in donor lungs post-procurement which can improve the outcomes of LTx. Additionally, it can be utilized for embolectomy prior to EVLP evaluation which can increase the number of initially declined donor lungs treated with EVLP and ultimately transplanted.