title: First human transplantation of a nonacceptable donor lung after reconditioning ex vivo.
abstract: OBJECTIVE
  This article describes an ex vivo method to recondition and transplant rejected donor lungs.
  
  
  METHODS
  A 19-year-old man was brain dead after a traffic accident. A roentgenogram showed bilateral lung contusion. He had ongoing intratracheal bleeding. After optimizing ventilator treatment and suctioning the airways, PaO2 was 9 kPa (67.5 mm Hg) on FiO2 = 0.7. The lungs were rejected by all transplantation centers in the Nordic countries. We harvested the lungs for research. The right lung was severely injured. The left lung was edematous with bleeding spots in the lower lobe, and the mediobasal segment was atelectatic. The left lung was reconditioned ex vivo and kept in topical extracorporeal membrane oxygenation until it was transplanted into a 70-year-old man with chronic obstructive pulmonary disease 17 hours later.
  
  
  RESULTS
  The transplanted lung functioned very well, and the patient recovered uneventfully. At 3 months control, a computed tomographic thoracic scan and transbronchial biopsies showed a normal left lung, and the patient was in very good clinical condition, only to succumb to death from unrelated events 11 months after the transplantation.
  
  
  CONCLUSIONS
  Rejected donor lungs may be successfully transplanted after being reconditioned ex vivo.
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Division, Lund University Hospital, Lund, Sweden. stig.steen@med.lu.se
authors.forename: Stig
authors.initials: S
authors.lastname: Steen
authors.forename: Richard
authors.initials: R
authors.lastname: Ingemansson
authors.forename: Leif
authors.initials: L
authors.lastname: Eriksson
authors.forename: Leif
authors.initials: L
authors.lastname: Pierre
authors.forename: Lars
authors.initials: L
authors.lastname: Algotsson
authors.forename: Per
authors.initials: P
authors.lastname: Wierup
authors.forename: Qiuming
authors.initials: Q
authors.lastname: Liao
authors.forename: Atli
authors.initials: A
authors.lastname: Eyjolfsson
authors.forename: Ronny
authors.initials: R
authors.lastname: Gustafsson
authors.forename: Trygve
authors.initials: T
authors.lastname: Sjöberg
mesh_terms: D000328:Adult; D000368:Aged; D046148:Donor Selection / Q000592:standards*; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D008171:Lung Diseases / Q000628:therapy*; D055370:Lung Injury; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D009926:Organ Preservation / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D009927:Tissue and Organ Procurement