title: Ex vivo lung perfusion to improve donor lung function and increase the number of organs available for transplantation.
abstract: This paper describes the initial clinical experience of ex vivo lung perfusion (EVLP) at the Fondazione Ca' Granda in Milan between January 2011 and May 2013. EVLP was considered if donor PaO2 /FiO2 was below 300 mmHg or if lung function was doubtful. Donors with massive lung contusion, aspiration, purulent secretions, pneumonia, or sepsis were excluded. EVLP was run with a low-flow, open atrium and low hematocrit technique. Thirty-five lung transplants from brain death donors were performed, seven of which after EVLP. EVLP donors were older (54 ± 9 years vs. 40 ± 15 years, EVLP versus Standard, P < 0.05), had lower PaO2 /FiO2 (264 ± 78 mmHg vs. 453 ± 119 mmHg, P < 0.05), and more chest X-ray abnormalities (P < 0.05). EVLP recipients were more often admitted to intensive care unit as urgent cases (57% vs. 18%, P = 0.05); lung allocation score at transplantation was higher (79 [40-84] vs. 39 [36-46], P < 0.05). After transplantation, primary graft dysfunction (PGD72 grade 3, 32% vs. 28%, EVLP versus Standard, P = 1), mortality at 30 days (0% vs. 0%, P = 1), and overall survival (71% vs. 86%, EVLP versus Standard P = 0.27) were not different between groups. EVLP enabled a 20% increase in available donor organs and resulted in successful transplants with lungs that would have otherwise been rejected (ClinicalTrials.gov number: NCT01967953).
authors.affiliation: Dipartimento di Anestesia Rianimazione (Intensiva e Subintensiva) e Terapia del dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy; Dipartimento di Fisiopatologica Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Valenza
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rosso
authors.forename: Silvia
authors.initials: S
authors.lastname: Coppola
authors.forename: Sara
authors.initials: S
authors.lastname: Froio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Palleschi
authors.forename: Davide
authors.initials: D
authors.lastname: Tosi
authors.forename: Paolo
authors.initials: P
authors.lastname: Mendogni
authors.forename: Valentina
authors.initials: V
authors.lastname: Salice
authors.forename: Giulia M
authors.initials: GM
authors.lastname: Ruggeri
authors.forename: Jacopo
authors.initials: J
authors.lastname: Fumagalli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Villa
authors.forename: Mario
authors.initials: M
authors.lastname: Nosotti
authors.forename: Luigi
authors.initials: L
authors.lastname: Santambrogio
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012129:Respiratory Function Tests; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: brain death; ex vivo lung perfusion organ regeneration; lung transplantation; marginal donor criteria; outcome