Purpose
To describe the first series of Ex Vivo evaluations of human lungs from Maastricht type I
non heart-
beating donors and clinical transplantations with these organs.
Methods and Materials
Eight potential male donors entered the non heart-beating protocol after sudden cardiac arrest in the street and unsuccessful resuscitation. Bipulmonary blocks were topically cooled and flushed with antegrade and retrograde cold Perfadex. A normothermic Ex Vivo evaluation was initiated, perfusing the lungs with a flow 40 % of the estimated cardiac output and protectively ventilating after reaching 32¡ãC. Oxygenation tests were performed hourly. Three criteria were to be met for acceptance: ¦¤pO2(difference between atrium and pulmonary artery pO2) over 400mmHg, stable or improving evaluation data and surgeon approval of lung appearance and procedure.
Results
Ex Vivo evaluation was correctly perfomed in all cases. Average perfusion time was 273min. Four blocks did not pass the evaluation because of low oxygenation and declining compliance. Bronchiolitis, diffuse emphysema and bone marrow emboli were found in the pre-Ex Vivo pathology analyses of rejected lungs. Four blocks passed the evaluation after an average time of perfusion of 270min. The mean ¦¤pO2 was 461mmHg and the mean compliance was 87.2mlL/cmH2O with a tendency to increase in each evaluation. Acceptable blocks were cold preserved until implantation. Four bilateral lung transplantations were performed (3 emphysema, 1 bronchiectasis) with a total ¡°out of the body?time of 15h19m and 17h35m for first and second lung. There were no cases of grade 3 PGD (31.6 % PGD=0; 10.5 % PGD=1) Two patients died of non-Ex Vivo related causes after 92 and 122 days. Two patients are alive and well after 204 and 333 days, with no signs of BOS.
Conclusions
Ex vivo evaluation of uncontrolled non-heart beating donor-lungs enables us to ensure an optimal function under physiological conditions before clinical implantation and promises a more widespread use of this kind of donors in the future.
