title: Early outcomes of bilateral sequential single lung transplantation after ex-vivo lung evaluation and reconditioning.
abstract: BACKGROUND
  Ex vivo lung perfusion (EVLP) is a novel approach for extended evaluation and/or reconditioning of donor lungs not meeting standard International Society for Heart and Lung Transplantation criteria for transplantation.
  
  
  METHODS
  We retrospectively evaluated 13 consecutive EVLP runs between January 2009 and December 2010. Lungs rejected for routine transplantation were implanted to the EVLP circuit and reperfused using acellular supplemented Steen Solution (Vitrolife, Göteborg, Sweden) up to a target flow rate of 40% of the donor's calculated flow at a cardiac index of 3.0 liters/min/m(2); target left atrial pressure < 5 mm Hg; and pulmonary artery pressure < 15 mm Hg. Mechanical ventilation was introduced after rewarming to 32°C: tidal volume, 6 to 8 ml/kg; respiratory rate, 7 to 8 breaths/min; duration of inspiration/expiration (I/E) ratio, 1:2; and positive end-expiratory pressure, 5 to 10 cm H(2)O. Hemodynamic and respiratory data monitoring with hourly clinical assessment were performed. Donor data, conversion rate to transplantation, and recipient outcome were analyzed.
  
  
  RESULTS
  Donor data (n = 13) were: age, 44.23 ± 8.33 years; female/male, 8:5; cause of death: intracranial hemorrhage, 11 (85%), stroke, 1 (7.5%), hypoxic brain injury, 1 (7.5%); smoking history, 9 (69%), 17.44 ± 8.92 pack-years; mechanical ventilation, 102.6 ± 91.92 hours; chest x-ray imaging: abnormal, 12 (92.5%); normal, 1 (7.5%). EVLP: mean 141 ± 28.83 minutes. Arterial partial pressure of oxygen/fraction of inspired oxygen 100% before termination of the circuit vs pre-retrieval value: 57.32 ± 9.1 vs 42.36 ± 14.13 kPa (p < 0.05). Six (46%) pairs of donor lungs were transplanted. Median follow-up was 297.5 days (range, 100-390 days), with 100% survival at 3 months.
  
  
  CONCLUSIONS
  EVLP may facilitate assessment and/or reconditioning of borderline lungs, with a conversion rate of 46 % and good short-term survival.
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, UK. B.Zych@rbht.nhs.uk
authors.forename: Bartlomiej
authors.initials: B
authors.lastname: Zych
authors.forename: Aron F
authors.initials: AF
authors.lastname: Popov
authors.forename: George
authors.initials: G
authors.lastname: Stavri
authors.forename: Alison
authors.initials: A
authors.lastname: Bashford
authors.forename: Toufan
authors.initials: T
authors.lastname: Bahrami
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.forename: Fabio
authors.initials: F
authors.lastname: De Robertis
authors.forename: Martin
authors.initials: M
authors.lastname: Carby
authors.forename: Nandor
authors.initials: N
authors.lastname: Marczin
authors.forename: Andre R
authors.initials: AR
authors.lastname: Simon
authors.forename: Karen C
authors.initials: KC
authors.lastname: Redmond
mesh_terms: D000328:Adult; D003550:Cystic Fibrosis / Q000601:surgery; D004646:Emphysema / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality* / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*