Many lung donor offers are refused despite increasing demand. Portable normothermic ex vivo lung perfusion (EVLP) could increase donor yield by monitoring and reconditioning extended criteria donor (ECD) lungs. We report its use in human lungs declined for clinical transplantation. Ten sets of such lungs were procured from brain-dead donors and underwent 24 hours of normothermic EVLP using a perfusate based on donor whole blood. Hemodynamic and ventilatory data and P:F ratios were measured. Advanced donor age and borderline oxygenation (donor mean P:F 228 ± 73) were the most commonly cited reasons for refusal for transplantation. There was no significant worsening of pulmonary hemodynamics or compliance or significant P:F decline during preservation in the overall cohort. Mean P:F ratio in the overall cohort was 315 ± 88 mm Hg after 24 hours EVLP. At EVLP termination 5/10 lung blocks met standard EVLP thresholds for acceptability for transplant. Eventual EVLP performance was poorly predicted by donor P:F ratio but well predicted by data gathered early in EVLP. Portable normothermic EVLP is useful for transportation, monitoring, and reconditioning of ECD lungs. Early EVLP measurements are more effective than preprocurement donor P:F in predicting eventual allograft performance. We advocate an aggressive strategy of evaluation of ECD lungs using blood-based EVLP.
Bibliographical noteFunding Information:
This study was funded by grants from United Therapeutics Corporation (Silver Spring, MD, USA); the University of Minnesota's Lillehei Heart Institute, Department of Surgery, and Institute for Engineering in Medicine. These funding organizations did not have any role in collecting, analyzing, or interpreting data or the decision to publish the manuscript. Nonclinical grade disposable perfusion equipment was provided courtesy of TransMedics (Andover, MA, USA). This included the blood collection chambers, disposable EVLP modules, and OCS Lung solution. Dr Loor's institutions (University of Minnesota and Baylor College of Medicine) received grant support for EVLP clinical trials from TransMedics. Dr Loor also received travel support from TransMedics for investigators meetings and presentations related to EVLP clinical trials. Dr Loor's institution (Baylor College of Medicine) also received grant support from Maquet. Dr Loor's institution (University of Minnesota) received grant support from United Therapeutics and nonfinancial product support from TransMedics for preclinical translational animal studies (nonclinical grade disposable perfusion equipment).
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Copyright 2020 Elsevier B.V., All rights reserved.
- donation after circulatory death
- ex vivo lung perfusion
- extended criteria donor
- lung donation
- lung transplantation
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't