Lung Retrieval Research Articles

Extended Criteria Donor Use in Lung Transplants From Donation After Controlled Circulatory Death

BackgroundMost institutions apply the criteria for controlled donation after cardiac death (cDCD) lung retrieval identical to the criteria for donation after brain death (DBD). The availability of extended criteria donor (ECD) in lung transplants from cDCD remains unclear. MethodsThe United Network for Organ Sharing (UNOS) database was queried for adult lung transplants from cDCD, from May 03, 2005, to March 15, 2022. ECDs were defined by one or more items at variance from standard criteria: age 55 years or more, PaO2:FiO2 300 or less, smoking 20 pack-years or more, diabetes, or purulent secretions upon bronchoscopy. Recipients were divided into the standard criteria donor (SCD) group and the ECD group, and assessed for short- and long-term survival and postoperative events. ResultsAmong 827 records, the SCD and ECD group showed no differences in 5-year (P = .56) survival. No significant differences were found in 30-day, 90-day, 1-year mortality and postoperative outcomes before discharge, whether in length of hospital stay, rate of ventilator support for >48 hours or reintubation, incidence of grade 3 PGD 72 hours posttransplant, acute rejection, or dialysis. None of the 5 donor factors used as criteria for lung retrieval was independently associated with cDCD recipient survival. ConclusionsUsing donor lungs that extend the DBD criteria may be a safe strategy in cDCD lung transplantation. However, the current criteria may not be a perfect fit for cDCD lung retrieval. The specific DCD criteria for standard lung retrieval need to be determined.

Systemic Inflammation Differences in Brain-vs. Circulatory-Dead Donors: Impact on Lung Transplant Recipients.

Brain death triggers a systemic inflammatory response. Whether systemic inflammation is different in lung donors after brain- (DBD) or circulatory-death (DCD) is unknown, but this may potentially increase the incidence of primary graft dysfunction (PGD) after lung transplantation. We compared the plasma levels of interleukin (IL)-6, IL-8, IL-10 and TNF-α in BDB and DCD and their respective recipients, as well as their relationship with PGD and mortality after LT. A prospective, observational, multicenter, comparative, cohort-nested study that included 40 DBD and 40 DCD lung donors matched and their respective recipients. Relevant clinical information and blood samples were collected before/during lung retrieval in donors and before/during/after (24, 48 and 72h) LT in recipients. Incidence of PGD and short-term mortality after LT was recorded. Plasma levels of all determined cytokines were numerically higher in DBD than in DCD donors and reached statistical significance for IL-6, IL-10 and IL-8. In recipients with PGD the donor's plasma levels of TNF-α were higher. The post-operative mortality rate was very low and similar in both groups. DBD is associated with higher systemic inflammation than DCD donors, and higher TNF-α plasma levels in donors are associated with a higher incidence of PGD.

Improvement Gaps to Deal with the Shortage of Lungs for Transplant From a Middle Income Country's Perspective.

Our study aimed to identify the potential causes for the low lung procurement rate in Argentina and to develop strategies to the actual problems in donor management focused on lung retrieval. We performed a crosssectional study in which we analyzed data obtained from digital self-reported surveys conducted on professionals participating in the organ procurement process in Argentina. The surveys included questions on donor management, selection criteria, and resource availability involving increasing lung procurement. Among professionals surveyed, 23.7% did not use advanced hemodynamic monitoring in their donor maintenance and limited their use to central venous pressure. Only 35.8% of participants considered maintaining central venous pressure <10 mm Hg during donor maintenance. With regard to donors with severe deterioration of the ejection fraction, 47.4% of participants would not use restrictive fluid, and only 23.2% would use an advanced monitoring of the hemodynamic status to guide fluid management. Only 27.8% of participants routinely would use steroids to improve lung function in donors. With regard to mechanical ventilation, 80.4% of participants used protective ventilation, but only 4.10% used it adequately. Recruitment maneuvers were routinely used by only 3.1% of those surveyed. With regard to expanded selection criteria (age >55 years, smoking habit of >20 packs/year, positive upper airway cultures, unspecific infiltrates in radiography, and >72 hours of mechanical ventilation), 92.8% of surveyed participants would discount patients with some of these expanded selection criteria without considering offering the lungs for donation. Opportunities for improvement may involve training physicians involved in the donor maintenance process and reviewing the donor selection criteria used to increase adherence to expanded selection criteria.

Management of donor partial anomalous pulmonary veins during lung transplantation

Management of donor partial anomalous pulmonary veins during lung transplantation

The role of anesthesiologists in organ donation

With the continued deficit of available organs for transplantation, optimal care of the brain-dead and cardiac death donor is essential to optimize quality and quantity of precious organs. Anesthesiologists are a critical part of the perioperative surgical retrieval process, although individually, may rarely care for a donor. Prospective data to inform specific clinical practices is sparse although educational resources exist to guide anesthesiologists with ethical or clinical questions and protocols from intensive care units and organ procurement organizations serve as useful templates for maintenance of organ function. Pre-surgical resuscitation, optimization and homeostatic strategies should be continued into the operating room. Cautious titration of low dose anesthetic and analgesic agents may be required to blunt sympathetic and spinal reflexes but should not aggravate hypotension and muscle relaxation is recommended to facilitate surgical exposure. Anesthesiologists should be aware of procedural and pharmaceutical aspects of the donation process, including re-intubation of a deceased donor after death is confirmed when lung retrieval is planned.

Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience

Despite the benefits of abdominal normothermic regional perfusion (A-NRP) for abdominal grafts in controlled donation after circulatory death (cDCD), there is limited information on the effect of A-NRP on the quality of the cDCD lungs. We aimed to study the effect of A-NRP in lungs obtained from cDCD and its impact on recipients´ outcomes. This is a study comparing outcomes of lung transplants (LT) from cDCD donors (September 2014 to December 2021) obtained using A-NRP as the abdominal preservation method. As controls, all lung recipients transplanted from donors after brain death (DBD) were considered. The primary outcomes were lung recipient 3-month, 1-year, and 5-year survival. A total of 269 LT were performed (60 cDCD and 209 DBD). There was no difference in survival at 3months (98.3% cDCD vs. 93.7% DBD), 1year (90.9% vs. 87.2%), and 5years (68.7% vs. 69%). LT from the cDCD group had a higher rate of primary graft dysfunction grade 3 at 72h (10% vs. 3.4%; p<.001). This is the largest experience ever reported with the use of A-NRP combined with lung retrieval in cDCD donors. This combined method is safe for lung grafts presenting short-term survival outcomes equivalent to those transplanted through DBD.

Development of a cost-effective ex vivo lung perfusion system for lung transplantation in India.

Standard donor lung preservation with cold flush and storage allows up to six hours between retrieval of lungs from the donor and transplantation in the recipient. Ex vivo lung perfusion (EVLP) systems mimic physiological ventilation and perfusion in the donor lungs with potential for prolonged lung preservation and donor lung reconditioning. In this study, it was aimed to perform EVLP on discarded donor lungs using a locally developed EVLP system. Equipment that are routinely used for cardiac surgeries were collected and a functional EVLP system was assembled. This system was used on five pairs of lungs retrieved from brain-dead organ donors. The lungs were ventilated and pulmonary circulation was continuously perfused with a solution containing oxygen and nutrients for four hours. The system was tested without red blood cells (RBCs) added to the solution (acellular group; n=3; A1, A2 and A3) and also with RBCs added to the solution (cellular group; n=2; C1 and C2). The EVLP system was successfully used in four (A1, A2, A3 and C2) of the five lung pairs. Mechanical and gas exchange functions of the lungs were preserved in these lung pairs. One lung pair (C1) worsened and developed pulmonary oedema. Histopathological examination of all five lung pairs was satisfactory at the end of the procedure. Major challenges faced were leakage of solution from the system and obstruction to drainage of RBCs containing solution from the lungs. The results of the present study suggest that, it is possible to maintain the lungs retrieved for transplantation in a physiological condition using a locally prepared EVLP system and a solution without RBCs.

Anterior Lung Evisceration Following an Assault with Knife: A Case Report.

IntroductionEvisceration of the lung is a rare consequence of open chest trauma that can be fatal. Evisceration of the lung refers to the protrusion of lung parenchyma through a defect of the thoracic wall, without parietal pleural or skin coverage.Case reportA 20-year-old man was brought to the emergency department (ED) with left lung evisceration from stab wounds. The eviscerated lung was left in place, and the patient was not intubated in the ED. He was immediately taken to the operating room (OR) for intubation and surgical repair. Other significant injuries were ruled out, the eviscerated lung was retrieved, the chest wall defect was closed, and the patient recovered well. He was discharged after seven days in good condition.ConclusionThe initial management of patients with lung evisceration is critical to prevent rapid decompensation and death. Appropriate ED airway management, lung retrieval in the OR, and thoracic wall repair is recommended for patients with lung evisceration.

PREDICTING TIME TO DEATH AFTER WITHDRAWAL IN CONTROLLED DONATION AFTER CIRCULATORY DEATH (DCD) DONORS: A COMPARISON OF 100 DCD LUNG TRANSPLANT (LTX) DONORS VERSUS 59 POTENTIAL DCD DONORS THAT DID NOT PROGRESS

Introduction: Since 2006, controlled DCD donors have been routinely utilized for LTx by our institution, now contributing an additional 25-30 % LTx annually. Donation of lungs from a potential DCD donor can only occur if the patient dies ≤90 minutes post withdrawal of cardio-respiratory support (WCRS). However, 20-25% of potential DCD donors still do not progress to asystole in 90 minutes, leading to disappointment for the patient’s grieving family as well as having major resourcing implications for the donation and transplant teams. Prediction of which patients will die within the 90 minutes limit remains problematic. Previous studies have evaluated ICU variables and clinical WCRS practices to try and predict time to death with limited success. In this study, we compared a cohort of LTx DCD donors with a cohort of potential DCD donors who did not progress, looking for factors that may better predict time to death. Methods: This retrospective study reviewed donor records of all potential DCD donors that were referred to our institution from our local state donor agency, between 2014 and 2018. We included data from all potential DCD donors that been formally accepted as suitable for LTx and where our LTx surgical retrieval team actually attended the donor hospital. Variables evaluated included donor demographics and medical history, hospital location, cause of injury leading to WCRS, ICU hemodynamic and ventilation data, Apache II Score, time, location and method of WCRS and time to death. Analysis of comparison between the 2 cohorts was done using Wilcoxon rank-sum tests and chi-square tests. Results: Between 2014-2018, there were 334 DCD donor referrals to our program, resulting in 159 (48%) potential DCD donors attended for potential LTx retrieval. 100/159 (63%) progressed to DCD LTx, but 59 donors (37%) did not progress in required 90 minutes. Potential DCD donors that did not progress were less likely to be on vasopressin compared to DCD LTx donors (p<0.02), they were more likely to be in CPAP ventilator mode (p<0.01) and in ICU and ventilated longer (P<0.001) before WCRS. There were no differences in donor demographics, P/F ratio, cause of injury leading to WCRS, hospital type/location, donor hemodynamics, abnormal CXR or smoking history (Table 1). Of the 59 who did not die within 90 minutes of WCRS, 26 patients (44%) died within the subsequent 6 hours (Figure 1).Conclusions: Progression to asystole within 90 minutes and subsequent lung donation for DCD LTx is more likely where the potential lung donor has a requirement for mandatory-mode mechanical ventilatory support and vasopressin, suggesting they have a significant brainstem neurological injury. Additionally, development of a protocol that allows potential retrieval of donor lungs in the subsequent 6hrs after WCRS would significantly increase the yield of lungs from this pool of otherwise acceptable donors.

Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal.

There is international variability in the determination of death. Death in donation after circulatory death (DCD) can be defined by the permanent cessation of brain circulation. Post‐mortem interventions that restore brain perfusion should be prohibited as they invalidate the diagnosis of death. Retrieval teams should develop protocols that ensure the continued absence of brain perfusion during DCD organ recovery. In situ normothermic regional perfusion (NRP) or restarting the heart in the donor's body may interrupt the permanent cessation of brain perfusion because, theoretically, collateral circulations may restore it. We propose refinements to current protocols to monitor and exclude brain reperfusion during in situ NRP. In abdominal NRP, complete occlusion of the descending aorta prevents brain perfusion in most cases. Inserting a cannula in the ascending aorta identifies inadequate occlusion of the descending aorta or any collateral flow and diverts flow away from the brain. In thoracoabdominal NRP opening the aortic arch vessels to atmosphere allows collateral flow to be diverted away from the brain, maintaining the permanence standard for death and respecting the dead donor rule. We propose that these hypotheses are correct when using techniques that simultaneously occlude the descending aorta and open the aortic arch vessels to atmosphere.

Prolonged Cold Ischemia Induces Necroptotic Cell Death in Ischemia-Reperfusion Injury and Contributes to Primary Graft Dysfunction after Lung Transplantation.

Primary graft dysfunction (PGD) is a major cause of morbidity and mortality after lung transplantation. Ischemia-reperfusion injury (IRI) is a key event that contributes to PGD, though complex interactions affect donor lungs status, such as preceding brain death (BD), hemorrhagic shock (HS), and pre-engraftment lung management, the latter recognized as important risk factors for PGD. We hypothesized that a multi-hit isogenic mouse model of lung transplantation is more closely linked to PGD than IRI alone. Left lung transplants were performed between inbred C57BL/6 mice. A one-hit model of IRI was established by inducing cold ischemia (CI) of the donor lungs at 0°C for 1, 72, or 96 hours before engraftment. Multi-hit models were established by inducing 24 hours of HS and/or 3 hours of BD before 24 hours of CI. The recipients were killed at 24 hours after transplant and lung graft samples were analyzed. In the one-hit model of IRI, up to 72-hour CI time resulted in minimal cellular infiltration near small arteries after 24-hour reperfusion. Extension of CI time to 96 hours led to increased cellular infiltration and necroptotic pathway activation, without evidence of apoptosis, after 24-hour reperfusion. In a multi-hit model of PGD, "HS + BD + IRI" demonstrated increased lung injury, cellular infiltration, and activation of necroptotic and apoptotic pathways compared with IRI alone. Treatment with an inhibitor of receptor-interacting protein kinase 1 kinase, necrostatin-1, resulted in a significant decrease of downstream necroptotic pathway activation in both single- and multi-hit models of IRI. Thus, activation of necroptosis is a central event in IRI after prolonged CI, though it may not be sufficient to cause PGD alone. Pathological evaluation of donor lungs after CI-induced IRI, in conjunction with pre-engraftment donor lung factors in our multi-hit model, demonstrated early evidence of lung injury consistent with PGD. Our findings support the premise that pre-existing donor lung status is more important than CI time alone for inflammatory pathway activation in PGD, which may have important clinical implications for donor lung retrieval.

Donor Lung Referrals for Lung Transplantation: A ‘Behind The Scenes’ View

Australia's increasing organ donor rate has translated to increased lung donor referrals and subsequent lung transplantation (LTx). The LTx sector attempts to utilise as many organs as possible-but in reality, not all are used. This analysis aims to assess the utility and efficiency of donor lung referrals to the Alfred Hospital. All Donatelife Australia donor lung referrals for the year 2017 were analysed retrospectively. From a total of 440 lung referrals, 220 were local from the state of Victoria (population 6.4 million) and 220 from the Rest-of-Australia (ROA). Sixty-eight per cent (68%) of Victorian and 48% of the ROA were via the donation after circulatory death (DCD) pathway. One hundred and two (102) LTx were performed: 32 represent 21% of 149 Victorian and 8% of 106 ROA DCD donors, 70 represent 54% of the Victorian and 24% of the ROA donation after brain death (DBD) donors. Eighty per cent (80%) of all donors aged <35 and 30% >35 years were used or potentially useable. Thirteen per cent (13%) of DCD and 44% of DBD donors aged >65 years were used. Logistical and resource considerations, around the retrieval of older DCD lungs, are a significant issue. At 11.1 LTx per-million-population the Alfred has one of the highest lung donor conversion and LTx activity rates in the world. The Australian donor lung pool could still be further extended by focussing effort and logistics on optimising DBD referrals. Additional resources (staff and transport), tighter referral criteria, and the use of extended warm ischaemic time donors could increase particularly DCD recovery rates.

Restoring Blood Supply to the Heart While Replacing the Lungs

Restoring Blood Supply to the Heart While Replacing the Lungs

Analysis of different levels of positive end-expiratory pressure during lung retrieval for transplantation: an experimental study.

Atelectasis and inadequate oxygenation in lung donors is a common problem during the retrieval of these organs. Nevertheless, the use of high positive end-expiratory pressure (PEEP) is not habitual during procedures of lung retrieval. Twenty-one Sprague-Dawley male consanguineous rats were used in the study. The animals were divided into 3 groups according to the level of PEEP used: low (2 cmH2O), moderate (5 cmH2O), and high (10 cmH2O). Animals were ventilated with a tidal volume of 6 mL/kg. Before lung removal, the lungs were inspected for the presence of atelectasis. When atelectasis was detected, alveolar recruitment maneuvers were performed. Blood gasometric analysis was performed immediately. Finally, the lungs were retrieved, weighed, and submitted to histological analysis. The animals submitted to higher PEEP showed higher levels of oxygenation with the same tidal volumes PO2=262.14 (PEEP 2), 382.4 (PEEP 5), and 477.0 (PEEP 10). The occurrence of atelectasis was rare in animals with a PEEP of 10 cmH2O, which therefore required less frequent recruitment maneuvers (need for recruitment: PEEP 2=100%, PEEP 5 =100%, and PEEP 10=14.3%). There was no change in hemodynamic stability, occurrence of pulmonary edema, or other histological injuries with the use of high PEEP. The use of high PEEP (10 cmH2O) was feasible and probably a beneficial strategy for the prevention of atelectasis and the optimization of oxygenation during lung retrieval. Clinical studies should be performed to confirm this hypothesis.

Modified Surgical Technique of Normothermic Ex-Vivo Perfusion Reduces Cold Ischemic Time in Lung Transplantation During the EXPAND Trial

Normothermic ex-vivo perfusion with the Organ Care System (OCS) during the INSPIRE Trial demonstrated reduced primary graft dysfunction (PGD) when compared to cold storage. However en-bloc lung retrieval after OCS perfusion was the standard of care. The cold ischemic time for the second lung was increased waiting for first lung implantation and second lung pneumonectomy. Accordingly, we modified the surgical technique performing a sequential retrieval from the OCS device in an attempt to reduce PGD rates.

Beware Cold Agglutinins in Organ Donors! Ex Vivo Lung Perfusion From an Uncontrolled Donation After Circulatory-Determination-of-Death Donor With a Cold Agglutinin: A Case Report

BackgroundWe began to recover lungs from uncontrolled donation after circulatory determination of death to assess for transplant suitability by means of ex vivo lung perfusion (EVLP) and computerized tomographic (CT) scan. Our first case had a cold agglutinin with an interesting outcome. Case reportA 60-year-old man collapsed at home and was pronounced dead by Emergency Medical Services personnel. Next-of-kin consented to lung retrieval, and the decedent was ventilated and transported. Lungs were flushed with cold Perfadex, removed, and stored cold. The lungs did not flush well. Medical history revealed a recent hemolytic anemia and a known cold agglutinin. Warm nonventilated ischemia time was 51 minutes. O2-ventilated ischemia time was 141 minutes. Total cold ischemia time was 6.5 hours. At cannulation for EVLP, established clots were retrieved from both pulmonary arteries. At initiation of EVLP with Steen solution, tiny red aggregates were observed initially. With warming, the aggregates disappeared and the perfusate became red. After 1 hour, EVLP was stopped because of florid pulmonary edema. The lungs were cooled to 20°C; tiny red aggregates formed again in the perfusate. Ex vivo CT scan showed areas of pulmonary edema and a pyramidal right middle lobe opacity. Dissection showed multiple pulmonary emboli—the likely cause of death. However, histology showed agglutinated red blood cells in the microvasculature in pre- and post-EVLP biopsies, which may have contributed to inadequate parenchymal preservation. ConclusionsOrgan donors with cold agglutinins may not be suitable owing to the impact of hypothermic preservation.

Donors after cardiocirculatory death and lung transplantation.

The number of patients actively awaiting lung transplantation (LTx) is more than the number of suitable donor lungs. The percentage of lung retrieval rate is lower when compared to other solid organs. The use of lungs from donation after cardiocirculatory death (DCD) donors is one of the options to avoid organ shortage in LTx. After extensive experimental research, clinical application of DCD donation is becoming wider. The results from most of the centers show at least equal survival rate compared to donors from brain death. This review paper will summarize experimental background and clinical experience from DCD donors.

Abstract 3222: Disulfiram equivalent to doxorubicin in reducing quantitative osteosarcoma metastatic tumor burden in a validated orthotopic mouse model

Abstract Introduction: The five-year survival of patients with osteosarcoma (OS) with lung metastases is as low as 15%. Our group has shown that disulfiram, a FDA-approved aldehyde dehydrogenase inhibitor, inhibit osteosarcoma proliferation and metastasis in vitro. Here we compare the quantitative effects of disulfiram and doxorubicin on metastatic OS burden in a orthotopic mouse model using near-infrared indocyanine green (ICG) angiography. Methodology: In an IACUC-approved protocol, 60 immunocompetent balb/c mice were given tibial trans-physeal injections of 500K K7M2 mouse OS cells into their left hindlimbs. Legs were amputated 4 weeks after OS injection, and mice were euthanized with ex vivo lung retrieval 10 weeks after OS injection. Animals in the doxorubicin group (n=20) were administered 2 mg/kg retro-orbitally each week, starting 2 weeks after OS injection to simulate the start of therapy only after a clinical tumor was palpable. Disulfiram (n=20) 50 mg/kg was administered retro-orbitally daily, also starting 2 weeks after OS injection. Controls (n=20) received no therapy. Quantitative near-infrared imaging of the hindlimb and lungs was performed by injecting 20 uL of 25 mg/cc ICG retro-orbitally 24 hours prior to amputation and lung salvage, respectively. ICG reliably extravasates specifically into tumor mass when injected 24 hours prior to fluorescence measurements. Fluorescence analysis was performed using Novadaq SPY (Novadaq, Bonita Springs, FL) and NIH ImageJ (Bethesda, MD). Statistical analysis was performed using Prism 6.0 (GraphPad, LaJolla CA) using Fisher's Exact Test and a one-way analysis of variance with Tukey's post-test as indicated. Significance was defined as p &amp;lt; .05. All numbers are represented as mean ± standard deviation, and are described in arbitrary perfusion units (APU). Results: Both disulfiram (2.4 ± 1.7 APU) and doxorubicin (0.8 ± 1.7 APU)-treated animals demonstrated a significantly decreased metastatic tumor burden compared to untreated controls (6.4 ± 3.4 APU, p &amp;lt; .01). This finding was independent of hindlimb fluorescence (p &amp;gt; .05). No significant differences were noted between the doxorubicin and disulfiram groups using Tukey's post-test (p = .76). Nineteen of 20 control animals developed metastatic disease, compared to nine of 19 surviving disulfiram-treated and two of 12 surviving doxorubicin-treated (both p &amp;lt; .01) animals. No animals died prematurely in the control group, while one animal died in the disulfiram group (5% mortality) and eight animals died in the doxorubicin group (40% mortality, p &amp;lt; .05 compared to controls). Conclusion: In our model of metastatic OS, disulfiram appears to have potent anti-metastatic properties. It may also be better tolerated by hosts. Molecular analysis of disulfiram and doxorubicin-treated primary and metastatic tumors is ongoing, which can help us understand the mechanism behind disulfiram's anti-tumor effect. Citation Format: Mitchell S. Fourman, Adel Mahjoub, Jared A. Crasto, Jonathan Mandell, David C. Hirsch, Jessica Tebbets, Rebbeca Watters, Kurt R. Weiss. Disulfiram equivalent to doxorubicin in reducing quantitative osteosarcoma metastatic tumor burden in a validated orthotopic mouse model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3222. doi:10.1158/1538-7445.AM2017-3222

Ex Vivo Lung Perfusion: Establishment and Operationalization in Iran.

Although the number of lung transplants is limited because of general shortage of organ donors, ex vivo lung perfusion is a novel method with 2 main benefits, including better evaluation of lung potential and recovery of injured lungs. The main aim of this study was to establish and operationalize ex vivo lung perfusion as the first experience in Iran. This was a prospective operational research study on 5 cases, including 1 pig from Vienna Medical University and 4 patients from Masih Daneshvari Hospital. All organ donations from brain dead donors were evaluated according to lung transplant or ex vivo lung perfusion criteria from May 2013 to July 2015 in Tehran, Iran. If a donor did not have any sign of severe chest trauma or pneumonia but had poor oxygenation due to possible atelectasis or neurogenic pulmonary edema, their lungs were included for ex vivo lung perfusion. A successful trend in the difference between the pulmonary arterial Po2 and the left atrial Po2 was observed, as well as an increasing pattern in other functional parameters, including dynamic lung compliance and a decreasing trend in pulmonary vascular resistance. These initial trials indicate that ex vivo lung perfusion can lead to remarkable progress in lung transplant in Iran. They also provide several important pieces of guidance for successful ex vivo lung perfusion, including the necessity of following standard lung retrieval procedures and monitoring temperature and pressure precisely. The development of novel methods can provide opportunities for further research studies on lungs of deceased donors and lead to undiscovered findings. By keeping this science up to date in Iran and developing such new and creative methods, we can reveal effective strategies to promote the quality of donor lungs to support patients on transplant wait lists.

(26) - The EXPAND Lung International Trial to Evaluate the Safety and Effectiveness of the Portable Organ Care System (OCS™) Lung for Recruiting, Preserving and Assessing Expanded Criteria Donor Lungs for Transplantation

s S17 O2 and transported to an operating room. A detailed medical/social donor history was obtained by our OPO. Lungs were flushed antegrade with cold PerfadexTM (containing Alprostadil and heparin) and retrograde. Lungs were evaluated for transplant suitability with EVLP (XVIVOTM) for 4 hours. PostEVLP spiral CT scans were obtained. Consented recipients receive whichever lung becomes available first based on blood type, LAS, and size. Lung availability is a random event. Primary outcome measures are 72 hour PGD score and survival at 30 days & 1 year. Results: EMS identified __ potential NHBDs for lung retrieval. ___ donor lungs were evaluated by EVLP. As of March 10, 2014 ___ have been transplanted with conv donors, and ___ with uDCDDs. Data and outcomes will be updated March 10, 2014. Conclusion: LTX from Cat 1 & 2 uDCDDs may provide large numbers of lungs for transplant.