title: Ex vivo lung evaluation and reconditioning.
abstract: OBJECTIVE
  Only about 15% of the potential candidates for lung donation are considered suitable for transplantation. A new method for ex vivo lung perfusion (EVLP) has been developed and can be used for evaluation and reconditioning of "marginal" and unacceptable lungs. This is a report of functional evaluation experience with ex vivo perfusion of twelve donor lungs deemed unacceptable in São Paulo, Brazil.
  
  
  METHODS
  After harvesting, the lungs are perfused ex vivo with Steen Solution, an extra-cellular solution with high colloid osmotic pressure. A membrane oxygenator connected to the circuit receives gas from a mixture of nitrogen and carbon dioxide and maintains a normal mixed venous blood gas level in the perfusate. The lungs are gradually rewarmed, reperfused and ventilated. They are evaluated through analyses of oxygenation capacity, pulmonary vascular resistance (PVR), lung compliance (LC).
  
  
  RESULTS
  The arterial oxygen pressure (with inspired oxygen fractions of 100%) increased from a mean of 193.3 mmHg in the organ donor at the referring hospital to a mean of 495.3 mmHg during the ex vivo evaluation. After 1 hour of EVLP, mean PVR was 737.3 dynes/sec/cm5, and mean LC was 42.2 ml/cmH2O.
  
  
  CONCLUSIONS
  The ex vivo evaluation model can improve oxygenation capacity of "marginal" lungs rejected for transplantation. It has a great potential to increase lung donor availability and, possibly, to reduce the waiting time on the list.
authors.affiliation: Department of Thoracic Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. paulopego@incor.usp.br
authors.forename: Paulo Manuel
authors.initials: PM
authors.lastname: Pêgo-Fernandes
authors.forename: Alessandro Wasum
authors.initials: AW
authors.lastname: Mariani
authors.forename: Israel Lopes de
authors.initials: IL
authors.lastname: Medeiros
authors.forename: Artur Eugenio de Azevedo
authors.initials: AE
authors.lastname: Pereira
authors.forename: Flávio Guimarães
authors.initials: FG
authors.lastname: Fernandes
authors.forename: Fernando do
authors.initials: Fd
authors.lastname: Valle Unterpertinger
authors.forename: Mauro
authors.initials: M
authors.lastname: Canzian
authors.forename: Fabio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D000328:Adult; D000368:Aged; D046148:Donor Selection / Q000592:standards*; D005260:Female; D006801:Humans; D008168:Lung; D008170:Lung Compliance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods* / Q000592:standards; D020858:Tissue and Organ Harvesting / Q000379:methods; D014655:Vascular Resistance / Q000502:physiology*; D055815:Young Adult