title: Extracorporeal lung perfusion and ventilation to improve donor lung function and increase the number of organs available for transplantation.
abstract: BACKGROUND
  Ex vivo lung perfusion (EVLP) has been validated as a valuable technique to increase the pool of organs available for lung transplantation.
  
  
  METHODS
  After a preclinical experience, we obtained permission from the Ethics Committee of our institution to transplant lungs after EVLP reconditioning. ABO compatibility, size match, and donor arterial oxygen pressure (PaO(2))/fraction of inspired oxygen (FiO(2)) ≤ 300 mm Hg were considered to be inclusion criteria, whereas the presence of chest trauma and lung contusion, evidence of gastric content aspiration, pneumonia, sepsis, or systemic disease were exclusion criteria. We only considered subjects on an extra corporeal membrane oxygenation (ECMO) bridge to transplantation with rapid functional deterioration. Using Steen solution with packed red blood cells oxygenated with 21% O(2), 5% to 7% CO(2) was delivered, targeted with a blood flow of approximately 40% predicted cardiac output. Once normothermic, the lungs were ventilated with a tidal volume of 7 mL/kg a PEEP of 5 cmH(2)O and a respiratory rate of 7 bpm. Lungs were considered to be suitable for transplantation if well oxygenated [P(v-a) O(2) > 350 mm Hg on FiO(2) 100%], in the absence of deterioration of pulmonary vascular resistance and lung mechanics over the perfusion time.
  
  
  RESULTS
  From March to September 2011, six lung transplantations were performed, including two with EVLP. The functional outcomes were similar between groups: at T72 posttransplantation, the median PaO(2)/FiO(2) were 306 mm Hg (range, 282 to 331 mm Hg) and 323 mm Hg (range, 270 to 396 mm Hg) (P = 1, EVLP versus conventional). Intensive care unit ICU and hospital length of stay were similar (P = .533 and P = .663, respectively) with no mortality at 60 days in both groups. EVLP donors were older (49 ± 6 y versus 21 ± 7 y, P < .05), less well oxygenated (184 ± 6 mm Hg versus 570 ± 30, P < .05), displaying higher Oto scores (9.5 ± 0.7 versus 1.7 ± 1.5, P < .05).
  
  
  CONCLUSIONS
  The first 6 months of the EVLP program allowed us to increase the number of organs available for transplantation with short-term outcomes comparable to conventional transplantations.
authors.affiliation: Dipartimento di Anestesia, Terapia Intensiva e Subintensiva e Terapia del Dolore, Università degli Studi di Milano, Milano, Italy. franco.valenza@unimi.it
authors.forename: F
authors.initials: F
authors.lastname: Valenza
authors.forename: L
authors.initials: L
authors.lastname: Rosso
authors.forename: S
authors.initials: S
authors.lastname: Gatti
authors.forename: S
authors.initials: S
authors.lastname: Coppola
authors.forename: S
authors.initials: S
authors.lastname: Froio
authors.forename: J
authors.initials: J
authors.lastname: Colombo
authors.forename: R
authors.initials: R
authors.lastname: Dossi
authors.forename: M
authors.initials: M
authors.lastname: Pizzocri
authors.forename: V
authors.initials: V
authors.lastname: Salice
authors.forename: M
authors.initials: M
authors.lastname: Nosotti
authors.forename: P
authors.initials: P
authors.lastname: Reggiani
authors.forename: D
authors.initials: D
authors.lastname: Tosi
authors.forename: A
authors.initials: A
authors.lastname: Palleschi
authors.forename: M
authors.initials: M
authors.lastname: Pappalettera
authors.forename: S
authors.initials: S
authors.lastname: Ferrero
authors.forename: A
authors.initials: A
authors.lastname: Perazzoli
authors.forename: D
authors.initials: D
authors.lastname: Costantini
authors.forename: M
authors.initials: M
authors.lastname: Scalamogna
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: C
authors.initials: C
authors.lastname: Colombo
authors.forename: L
authors.initials: L
authors.lastname: Santambrogio
authors.forename: L
authors.initials: L
authors.lastname: Gattinoni
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008168:Lung / Q000502:physiology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D014019:Tissue Donors