One-Year Outcome after Lung Transplantation from Controllo DCD with Long WIT. Initial Experience

Abstract

Purpose Although the lung tolerance to prolonged ischemia is theoretically widely accepted in donation after cardiac death (DCD) setting, most of the centres have strict criteria for warm ischemia time (WIT). We present the 1-year follow up of first 3 lung transplants (LuTx) from controlled DCD donors after extended WIT. Methods We established a dedicated technical protocol, consisting of a non-rapid normothermic open-lung procurement during abdominal normothermic regional perfusion (NRP) without pleural cooling before the pneumoplegia. After treatments withdrawal, asystole onset, death is declared (20-min of flat ECG). NRP is established percutaneously with the aortic balloon, respiratory setting provided cycles of recruitment manoeuvres and protective ventilation. During the lung procurement, we performed two NRP tests in order to decide the definitive retrieval. After lung block stored on ice, chest haemostasis ensured. NRP is continued until necessary for abdominal organs. The lungs are evaluated by ex vivo lung perfusion (EVLP). Results Table 1 shows recipients characteristics, details of procurement, EVLP run, transplantation and clinical outcome. Notably, in Case 1, treatments withdrawal did not include extubation. Due to detection of thrombi during retrograde perfusion, urokinase was added to the solution in Case 1 and we proceeded to atypical resection of parenchymal infarction of right lower lobe. For sizing mismatch, right upper lobectomy was carried out in Case 2. The recipients were females, median age 42 years; 2 patients had cystic fibrosis, 1 usual interstitial pneumonia. In all cases, we performed a bilateral transplantation. All 3 patients are alive, with good respiratory function. Patient 1 experienced an episode of acute rejection 6 weeks after transplantation. Conclusion Our initial experience resulted in successful LuTx without detrimental effects on abdominal organs procurement. Promising results confirm the possibility of overcoming the obstacle of a long WIT.