title: Successful Transplantation of Lungs From an Uncontrolled Donor After Circulatory Death Preserved In Situ by Alveolar Recruitment Maneuvers and Assessed by Ex Vivo Lung Perfusion.
abstract: We developed a protocol to procure lungs from uncontrolled donors after circulatory determination of death (NCT02061462). Subjects with cardiovascular collapse, treated on scene by a resuscitation team and transferred to the emergency room, are considered potential donors once declared dead. Exclusion criteria include unwitnessed collapse, no-flow period of >15 min and low flow >60 min. After death, lung preservation with recruitment maneuvers, continuous positive airway pressure, and protective mechanical ventilation is applied to the donor. After procurement, ex vivo lung perfusion (EVLP) is performed. From November 2014, 10 subjects were considered potential donors; one of these underwent the full process of procurement, EVLP, and transplantation. The donor was a 46-year-old male who died because of thoracic aortic dissection. Lungs were procured 4 h and 48 min after death, and deemed suitable for transplantation after EVLP. Lungs were then offered to a rapidly deteriorating recipient with cystic fibrosis (lung allocation score [LAS] 46) who consented to the transplant in this experimental setting. Six months after transplantation, the recipient is in good condition (forced expiratory volume in 1 s 85%) with no signs of rejection. This protocol allowed procurement of lungs from an uncontrolled donor after circulatory determination of death following an extended period of warm ischemia.
authors.affiliation: Dipartimento di Anestesia Rianimazione (Intensiva e Sub intensiva) e Terapia del dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.|Dipartimento di Fisiopatologica Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Valenza
authors.affiliation: Scuola di Medicina e Chirurgia, Università di Milano-Bicocca, Milan, Italy.|Dipartimento Anestesia e Rianimazione, Azienda Ospedaliera San Gerardo, Monza, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Citerio
authors.affiliation: Unità Operativa di Chirurgia Toracica, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Palleschi
authors.affiliation: Dipartimento Anestesia e Rianimazione, Azienda Ospedaliera San Gerardo, Monza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Vargiolu
authors.affiliation: Dipartimento di Anestesia Rianimazione (Intensiva e Sub intensiva) e Terapia del dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: B Safaee
authors.initials: BS
authors.lastname: Fakhr
authors.affiliation: Dipartimento Anestesia e Rianimazione, Azienda Ospedaliera San Gerardo, Monza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Confalonieri
authors.affiliation: Dipartimento di Fisiopatologica Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.|Unità Operativa di Chirurgia Toracica, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Nosotti
authors.affiliation: Centro di Ricerche Chirurgiche Precliniche, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gatti
authors.affiliation: Dipartimento Emergenza Urgenza-EAS, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ravasi
authors.affiliation: Direzione Generale Salute Lombardia, Regione Lombardia, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Vesconi
authors.affiliation: Scuola di Medicina e Chirurgia, Università di Milano-Bicocca, Milan, Italy.|Dipartimento Anestesia e Rianimazione, Azienda Ospedaliera San Gerardo, Monza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pesenti
authors.affiliation: Dipartimento di Fisiopatologica Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.|Unità Operativa Complessa Broncopneumologia, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Blasi
authors.affiliation: Dipartimento di Fisiopatologica Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.|Unità Operativa di Chirurgia Toracica, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Santambrogio
authors.affiliation: Dipartimento di Anestesia Rianimazione (Intensiva e Sub intensiva) e Terapia del dolore, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.|Dipartimento di Fisiopatologica Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Gattinoni
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D003550:Cystic Fibrosis / Q000601:surgery*; D005112:Extracorporeal Circulation; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D011379:Prognosis; D011650:Pulmonary Alveoli; D012121:Respiration, Artificial; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*