title: Early results in transplantation of initially rejected donor lungs after ex vivo lung perfusion: a case-control study.
abstract: OBJECTIVE
  An increasing number of studies have shown that ex vivo lung perfusion (EVLP) is safe and that rejected donor lungs can be resuscitated and used for lung transplantation (LTx). Early clinical outcomes in patients transplanted with reconditioned lungs at our centre were reviewed and compared with those of contemporary non-EVLP controls.
  
  
  METHODS
  During 18 months starting January 2011, 11 pairs of donor lungs initially deemed unsuitable for transplantation underwent EVLP. Haemodynamic (pulmonary flow, vascular resistance and artery pressure) and respiratory (peak airway pressure and compliance) parameters were analysed during evaluation. Lungs that improved (n = 11) to meet International Society of Heart and Lung Transplantation criteria were transplanted and compared with patients transplanted with non-EVLP lungs (n = 47) during the same time period.
  
  
  RESULTS
  Donor lungs were initially rejected due to either inferior PaO2/FiO2 ratio (n = 9), bilateral infiltrate on chest X-ray (n = 1) or ongoing extra corporeal membrane oxygenation (n = 1). The donor lungs improved from a mean PaO2/FiO2 ratio of 27.9 kPa in the donor to a mean of 59.6 kPa at the end of the EVLP (median improvement 28.4 kPa, range 21.0-50.7 kPa). Two single lungs were deemed unsuitable and not used for LTx. Eleven recipients from the regular waiting list underwent either single (n = 3) LTx or double (n = 8) LTx with EVLP-treated lungs. The median time to extubation (12 (range, 3-912) vs 6 (range, 2-1296) h) and median intensive care unit (ICU) stay (152 (range, 40-625) vs 48 (range, 22-1632) h) were longer in the EVLP group (P = 0.05 and P = 0.01, respectively). There were no differences in length of hospital stay (median 28 (range 25-93) vs 28 (18-209), P = 0.21). Two patients in the EVLP group and 6 in the control group had primary graft dysfunction >Grade 1 at 72 h postoperatively. Three patients in the control group died before discharge. All recipients of EVLP lungs were discharged alive from hospital.
  
  
  CONCLUSIONS
  The use of EVLP seems safe and indicates that lungs otherwise refused for LTx can be recovered and subsequently used for transplantation, although time to extubation and ICU stay were longer for the EVLP group.
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wallinder
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Ricksten
authors.forename: Martin
authors.initials: M
authors.lastname: Silverborn
authors.forename: Christoffer
authors.initials: C
authors.lastname: Hansson
authors.forename: Gerdt C
authors.initials: GC
authors.lastname: Riise
authors.forename: Hans
authors.initials: H
authors.lastname: Liden
authors.forename: Anders
authors.initials: A
authors.lastname: Jeppsson
authors.forename: Göran
authors.initials: G
authors.lastname: Dellgren
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000502:physiology / Q000601:surgery; D016040:Lung Transplantation; D008875:Middle Aged; D015424:Reperfusion; D019737:Transplants / Q000098:blood supply / Q000502:physiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ex vivo lung perfusion; Lung reconditioning; Lung transplantation