The Importance of Repeated Measurements To Assess Transplant Suitability in Clinical Ex Vivo Lung Perfusion (EVLP)

Abstract

Purpose Normothermic acellular EVLP is a safe and feasible option to evaluate and recondition marginal donor lungs. A ΔPo2 of 350 mmHg between venous and arterial solution is used as a cutoff value for acceptance. The validity of oxygenation values obtained in an acellular perfusion solution remain however unclear. Methods and Materials An analysis of our prospective clinical EVLP database since 3/2010 was performed to compare oxygenation values during clinical EVLP to values obtained in the brain dead donor as well as differences in functional parameters between accepted and rejected lungs assessed during EVLP. Results From 3/2010-10/2012 20 EVLPs were performed (15 lungs transplanted, 5 rejected). The first pvO2 (FiO2=1.0) in the venous solution was significantly higher in both, accepted lungs (median: 429 mmHg, range 258-523) and rejected lungs (median: 417mmHg, range 304–474) compared to the respective last donor blood gases (median accepted 215 mmHg, range 133–330, p Conclusions Oxygenation values obtained during EVLP are not directly comparable to donor values. pvO2, ΔPo2, compliance as well as AWP showed a significantly different development in accepted lungs compared to rejected lungs. These findings underline that the decision for transplant suitability during EVLP should not be based on a single assessment but the trend in all functional parameter should be taken into account.