Clinical transplantation of initially rejected donor lungs after reconditioning ex vivo.
BACKGROUND
A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. A method to evaluate and recondition lungs ex vivo has been tested on donor lungs that have been rejected for transplantation.


METHODS
The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation (ECMO) circuit with STEEN solution (Vitrolife AB, Kungsbacka, Sweden) mixed with erythrocytes. The hyperoncotic solution dehydrates edematous lung tissue. Functional evaluations were performed with deoxygenated perfusate by varying the inspired fraction of oxygen. After the reconditioning, the lungs were kept immersed at 8 degrees C in extracorporeal membrane oxygenation until transplantation was performed.


RESULTS
Six of nine initially rejected donor lungs were reconditioned to acceptable function, and in six recipients, double lung transplantation was performed. Three-month survival was 100%. One patient has since died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are alive and well without any sign of bronchiolitis obliterans syndrome 24 months after the transplantation.


CONCLUSIONS
The result from the present study is promising, and we continue to transplant reconditioned lungs.
Ingemansson
Richard
R
Department of Cardiothoracic Surgery, Heart-Lung Division, Lund University Hospital, Lund, Sweden.
Eyjolfsson
Atli
A
Mared
Lena
L
Pierre
Leif
L
Algotsson
Lars
L
Ekmehag
Björn
B
Gustafsson
Ronny
R
Johnsson
Per
P
Koul
Bansi
B
Lindstedt
Sandra
S
Lührs
Carsten
C
Sjöberg
Trygve
T
Steen
Stig
S
D000328:Adult; D015331:Cohort Studies; D046148:Donor Selection; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D015424:Reperfusion / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D009927:Tissue and Organ Procurement