title: Lung transplantation from initially rejected donors after ex vivo lung reconditioning: the French experience.
abstract: OBJECTIVE
  Only 15% of brain death donors are considered suitable for lung transplantation (LTx). The normothermic ex vivo lung perfusion technique is used to potentially increase the availability of high-risk lung donors. We report our experience of LTx with initially rejected donors after ex vivo lung reconditioning (EVLR).
  
  
  METHODS
  From April 2011 to May 2013, we performed EVLR for 32 pairs of donor lungs deemed unsuitable for transplantation and rejected by the 11 French lung transplant teams. After EVLR, lungs with acceptable function were transplanted. During the same period, 81 double-lung transplantations (DLTx) were used as controls.
  
  
  RESULTS
  During EVLR, 31 of 32 donor lungs recovered physiological function with a median PO2/FiO2 ratio increasing from 274 (range 162-404) mmHg to 511 (378-668) mmHg at the end of EVLR (P < 0.0001). Thirty-one DLTx were performed. The incidence of primary graft dysfunction 72 h after LTx was 9.5% in the EVLR group and 8.5% in the control group (P = 1). The median time of extubation, intensive care unit and hospital lengths of stay were 1, 9 and 37 days in the EVLR group and 1 (P = 0.17), 6 (P = 0.06) and 28 days (P = 0.09) in the control group, respectively. Thirty-day mortality rates were 3.3% (n = 1) in the EVLR group and 3.7% (n = 3) in the control group (P = 0.69). One-year survival rates were 93% in the EVLR group and 91% in the control group.
  
  
  CONCLUSIONS
  EVLR is a reliable and repeatable technique that offers a significant increase of available donors. The results of LTx with EVLR lungs are similar to those obtained with conventional donors.
authors: Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France e.sage@hopital-foch.org.
authors: Edouard
authors: E
authors: Sage
authors: Department of Thoracic Surgery and Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
authors: Sacha
authors: S
authors: Mussot
authors: Department of Intensive Care, Hôpital Foch, Suresnes, France.
authors: Grégoire
authors: G
authors: Trebbia
authors: Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France.
authors: Philippe
authors: P
authors: Puyo
authors: Department of Pneumology, Hôpital Foch, Suresnes, France.
authors: Marc
authors: M
authors: Stern
authors: Department of Thoracic Surgery and Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
authors: Philippe
authors: P
authors: Dartevelle
authors: Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France.
authors: Alain
authors: A
authors: Chapelier
authors: Department of Anaesthesia, Hôpital Foch, Suresnes, France.
authors: Marc
authors: M
authors: Fischler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008168:Lung / Q000502:physiology / Q000601:surgery; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011446:Prospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: EVLP; Ex vivo lung reconditioning; Lung transplantation