Transplantation of Initially Rejected Donor Lungs after Ex-Vivo Lung Perfusion

Abstract

Purpose An increasing number of studies have shown that rejected donor lungs can be resuscitated during ex vivo lung perfusion (EVLP) and used for lung transplantation (LTx). Early clinical outcome in patients transplanted with reconditioned lungs at our centre were reviewed and compared to contemporary controls. Methods and Materials During 18 months starting January 2011, eleven pairs of donor lungs initially deemed unsuitable for transplantation underwent EVLP. Lungs witch improved to acceptable function were transplanted. Early clinical outcome was compared to 47 consecutive patients transplanted with lungs without prior EVLP during the same period. Results Donor lungs were initially rejected due to inferior PaO2/FiO2 ratio (n=9), bilateral infiltrate on chest x-ray (n=1) or on going ECMO (n=1). The donor lungs improved from a mean PaO2/FiO2 ratio of 27.9 kPa in the donor to a mean of 59.6 kPa during EVLP (median improvement 28.4 kPa, range 21.0 – 50.7 kPa). Hemodynamic (pulmonary vascular resistance and artery pressure) and respiratory (peak airway pressure, compliance) parameters were evaluated. Two single lungs were deemed unsuitable for LTx. Eleven recipients from the regular waiting list underwent single (n=3) or double (n=8) LTx with EVLP-treated lungs. There was no difference in occurrence of primary graft dysfunction at 72 hours between groups. Median time to extubation (12 (range, 3-912) vs 6 (range, 2-1296) hours) and median ICU stay (152 (range, 40-625) vs 48 (range, 22-1632) hours) were longer in the EVLP group (p=0.05 and p=0.01, respectively). There was no difference in length of hospital stay (p= 0.21). Three patients in the control group died before discharge. All recipients of EVLP lungs were discharged alive from hospital. Conclusions Lungs otherwise refused for LTx can be recovered and subsequently used for transplantation although time to extubation and ICU stay are longer for the EVLP group. Early results are not only acceptable but seem also in most aspects comparable to recipients of non-EVLP lungs.