title: Donor lung assessment using selective pulmonary vein gases.
abstract: OBJECTIVE
  Standard donor lung assessment relies on imaging, challenge gases and subjective interpretation of bronchoscopic findings, palpation and visual assessment. Central gases may not accurately represent true quality of the lungs. We report our experience using selective pulmonary vein gases to corroborate the subjective judgement.
  
  
  METHODS
  Starting, January 2012, donor lungs have been assessed by intraoperative bronchoscopy, palpation and visual judgement of lung collapse upon temporary disconnection from ventilator, central gases from the aorta and selective pulmonary vein gases. Partial pressure of oxygen (pO2) <300 mmHg on FiO2of 1.0 was considered low. The results of the chest X-ray and last pO2in the intensive care unit were also collected. Post-transplant primary graft dysfunction and survival were monitored.
  
  
  RESULTS
  To date, 259 consecutive brain-dead donors have been assessed and 157 transplants performed. Last pO2in the intensive care unit was poorly correlated with intraoperative central pO2(Spearman's rank correlation rs= 0.29). Right inferior pulmonary vein pO2was associated (Mann-Whitney, P < 0.001) with findings at bronchoscopy [clean: median pO2443 mmHg (25th-75th percentile range 349-512) and purulent: 264 mmHg (178-408)]; palpation [good: 463 mmHg (401-517) and poor: 264 mmHg (158-434)] and visual assessment of lung collapse [good lung collapse: 429 mmHg (320-501) and poor lung collapse: 205 mmHg (118-348)]. Left inferior pulmonary pO2was associated (P < 0.001) with findings at bronchoscopy [clean: 419 mmHg (371-504) and purulent: 254 mmHg (206-367)]; palpation [good: 444 mmHg (400-517) and poor 282 mmHg (211-419)] and visual assessment of lung collapse [good: 420 mmHg (349-496) and poor: 246 mmHg (129-330)]. At 72 h, pulmonary graft dysfunction 2 was in 21/157 (13%) and pulmonary graft dysfunction 3 in 17/157 (11%). Ninety-day and 1-year mortalities were 6/157 (4%) and 13/157 (8%), respectively.
  
  
  CONCLUSIONS
  Selective pulmonary vein gases provide corroborative objective support to the findings at bronchoscopy, palpation and visual assessment. Central gases do not always reflect true function of the lungs, having high false-positive rate towards the individual lower lobe gas exchange. Objective measures of donor lung function may optimize donor surgeon assessment, allowing for low pulmonary graft dysfunction rates and low 90-day and 1-year mortality.
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Costa
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Sowmyashree
authors.initials: S
authors.lastname: Sreekanth
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Kossar
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Kashif
authors.initials: K
authors.lastname: Raza
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lederer
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Robbins
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Shah
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA.
authors.forename: Selim
authors.initials: S
authors.lastname: Arcasoy
authors.affiliation: Department of Surgery, Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA fd2133@cumc.columbia.edu.
authors.forename: Frank
authors.initials: F
authors.lastname: D'Ovidio
mesh_terms: D000328:Adult; D001999:Bronchoscopy; D051799:Delayed Graft Function / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010173:Palpation; D010313:Partial Pressure; D011667:Pulmonary Veins / Q000378:metabolism; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: Central gases; Donor Lung Assessment; Pulmonary graft dysfunction; Recruitment gases; Selective pulmonary vein gases