Clinical Ex Vivo Lung Perfusion - Pushing the Limits

Ex vivo lung perfusion (EVLP) provides the ability to evaluate donor lungs before transplantation. Yet, limited prospective clinical data exist with regard to its potential to recondition unacceptable donor lungs. This paper summarizes the results of a prospective study of lung transplantation using only initially unacceptable donor lungs, which were improved by EVLP for 24 h. From March 2010June 2011, 13 lungs were evaluated ex vivo. Median donor PaO2 at FiO21.0/PEEP5 was 216 mmHg (range 133271). Four lungs, all with trauma history, showed no improvement and were discarded. Nine lungs improved to a ?PO2 higher than 350 mmHg. Median PvO2 at final assessment in these lungs was 466 mmHg (range 434525). These lungs were transplanted with a median total ischemic time of 577 min (range 486678). None of the patients developed primary graft dysfunction grades 2 or 3 within 72 h after transplantation. One patient with secondary pulmonary hypertension was left on a planned prolonged extracorporeal membrane oxygenation postoperatively. Median intubation time was 2 days. Thirty-day mortality was 0%. During the observation period, 119 patients received standard lung transplantation with comparable perioperative outcome. EVLP has a significant potential to improve the quality of otherwise unacceptable donor lungs.