title: Incidence and severity of primary graft dysfunction after lung transplantation using rejected grafts reconditioned with ex vivo lung perfusion.
abstract: OBJECTIVE
  Ex vivo lung perfusion (EVLP) is a novel technique used to evaluate and recondition marginal or rejected grafts. Primary graft dysfunction (PGD) is a major early complication after lung transplantation (LTx). The use of marginal or initially rejected grafts may increase its incidence and severity. The aim of this study is to evaluate the incidence of PGD after LTx using rejected grafts reconditioned with EVLP.
  
  
  METHODS
  PGD has been evaluated immediately after LTx (t0) and after 72 h (t72) in patients receiving standard (Group A) or reconditioned (Group B) grafts. EVLP was performed using a controlled acellular perfusion according to the Toronto technique.
  
  
  RESULTS
  From July 2011 to February 2013, 36 LTxs have been performed: 28 patients (21 M/7 F, mean age 51.7 ± 14.7 years) in Group A and 8 (6 M/2 F, mean age 46.6 ± 9.8 years) in Group B (successful recondition rate of 73%, 8 of 11 cases). Incidence rate of PGD 3 at t0 and at t72 (Group A versus Group B) was 50 vs 37% (P = NS) and 25 vs 0% (P = NS), respectively. Post-transplant extracorporeal membrane oxygenation was required in 5 and 2 patients in Groups A and B, respectively (P = NS).
  
  
  CONCLUSIONS
  The use of initially rejected grafts treated with EVLP does not increase the incidence and severity of PGD after LTx. Although comparison of PGD 3 incidence in the two groups did not reach a statistical difference, all EVLP patients suffering from severe PGD early after transplant recovered normal lung function at 72 h, suggesting a protective role of EVLP against PGD occurrence and severity.
authors: Department of Cardiac Surgery, University of Turin, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy massimo.boffini@unito.it.
authors: Massimo
authors: M
authors: Boffini
authors: Department of Cardiac Surgery, University of Turin, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy.
authors: Davide
authors: D
authors: Ricci
authors: Department of Cardiac Surgery, University of Turin, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy.
authors: Riccardo
authors: R
authors: Bonato
authors: Intensive Care Medicine, University of Turin, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy.
authors: Vito
authors: V
authors: Fanelli
authors: Department of Cardiac Surgery, University of Turin, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy.
authors: Matteo
authors: M
authors: Attisani
authors: Department of Cardiac Surgery, University of Turin, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy.
authors: Marco
authors: M
authors: Ribezzo
authors: Cardiothoracic and Vascular Department, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy.
authors: Paolo
authors: P
authors: Solidoro
authors: Intensive Care Medicine, University of Turin, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy.
authors: Lorenzo
authors: L
authors: Del Sorbo
authors: Intensive Care Medicine, University of Turin, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy.
authors: Vito Marco
authors: VM
authors: Ranieri
authors: Department of Cardiac Surgery, University of Turin, Città Della Salute e Della Scienza, San Giovanni Battista Hospital, Turin, Italy.
authors: Mauro
authors: M
authors: Rinaldi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008168:Lung / Q000098:blood supply* / Q000502:physiology / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data
keywords: Ex vivo lung perfusion; Lung transplantation; Primary graft dysfunction