Ex Vivo Lung Perfusion: Early Report of Brazilian Experience

• Published in: Transplantation proceedings Vol. 42; no. 2; pp. 440 - 443
• Main Authors: Pêgo-Fernandes, P.M, de Medeiros, I.L, Mariani, A.W, Fernandes, F.G, Unterpertinger, F.d.V, Samano, M.N, Werebe, E.d.C, Canzian, M, Jatene, F.B
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.03.2010; Elsevier
• Subjects: Aged; Biological and medical sciences; Blood Gas Analysis; Cadaver; Cause of Death; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Lung - blood supply; Lung - pathology; Lung - physiopathology; Lung Compliance; Lung Transplantation - physiology; Lung Transplantation - statistics & numerical data; Male; Medical sciences; Middle Aged; Organ Preservation - methods; Patient Selection; Perfusion - methods; Positive-Pressure Respiration; Refusal to Treat - statistics & numerical data; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Donors; Tissue, organ and graft immunology; Vascular Resistance; South America; Brazil; America; Medicine; Experience; Treatment; Ex vivo; Perfusion; Surgery; Lung; Graft; Early; Transplantation; Review; Respiratory system
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.01.015

Abstract Introduction Only about 15% of the potential candidates for lung donation are considered suitable for transplantation. A new method for ex vivo lung perfusion (EVLP) can be used to evaluate and recondition “marginal,” nonacceptable lungs. We have herein described an initial experience with ex vivo perfusion of 8 donor lungs deemed nonacceptable. Materials and Methods After harvesting, the lungs were perfused ex vivo with Steen Solution, an extracellular matrix with high colloid osmotic pressure. A membrane oxygenator connected to the circuit received gas from a mixture of nitrogen and carbon dioxide, maintaining a normal mixed venous blood gas level in the perfusate. The lungs were gradually rewarmed, reperfused, and ventilated for evaluation through analyses of oxygenation capacity, pulmonary vascular resistance (PVR), lung compliance (LC), and biopsy. Results The arterial oxygen pressure (with inspired oxygen fraction of 100%) increased from a mean of 206 mm Hg in the organ donor at the referring hospital to a mean of 498 mm Hg during the ex vivo evaluation. After 1 hour of EVLP, PVR varied from 440–1454 dynes/sec/cm5 ; LC was in the range of 26–90 mL/cmH2 O. There was no histological deterioration after 10 hours of cold ischemia and 1 hour of EVLP. Conclusions The ex vivo evaluation model can improve oxygenation capacity of “marginal” lungs rejected for transplantation. It has great potential to increase lung donor availability and, possibly, reduce time on the waiting list.