Clinical Transplantation of Initially Rejected Donor Lungs After Reconditioning Ex Vivo

Ingemansson, Richard; Eyjolfsson, Atli; Mared, L.; Pierre, Leif; Algotsson, Lars; Ekmehag, Björn; Gustafsson, Ronny; Johnsson, Per; Koul, Bansi; Lindstedt, Sandra; Lührs, Carsten; Sjöberg, Trygve; Steen, Stig

doi:10.1016/j.athoracsur.2008.09.049

Cited by 232 publications

(169 citation statements)

References 11 publications

Supporting

Mentioning

160

Contrasting

Unclassified

Order By: Relevance

“…Ingemansson et al [5], in 2009, reported six cases of lung transplantation, whose organs were initially rejected and reconditioned through EVLP. Survival at 90 days was 100%.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Avaliação e recondicionamento pulmonar ex vivo

Pêgo-Fernandes

Mariani

Medeiros

et al. 2010

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

Objective: Only about 15% of the potential candidates for lung donation are considered suitable for transplantation. A new method for ex vivo lung perfusion (EVLP) has been developed and can be used for evaluation and reconditioning of "marginal" and unacceptable lungs. This is a report of functional evaluation experience with ex vivo perfusion of twelve donor lungs deemed unacceptable in São Paulo, Brazil.Methods: After harvesting, the lungs are perfused ex vivo with Steen Solution, an extra-cellular solution with high colloid osmotic pressure. A membrane oxygenator connected to the circuit receives gas from a mixture of nitrogen and carbon dioxide and maintains a normal mixed venous blood gas level in the perfusate. The lungs are gradually rewarmed, reperfused and ventilated. They are evaluated through analyses of oxygenation capacity, pulmonary vascular resistance (PVR), lung compliance (LC).Results: The arterial oxygen pressure (with inspired oxygen fractions of 100%) increased from a mean of 193.3 mmHg in the organ donor at the referring hospital to a mean of 495.3 mmHg during the ex vivo evaluation. After 1 hour of EVLP, mean PVR was 737.3 dynes/sec/cm 5 , and mean LC was 42.2 ml/cmH 2 O. Conclusions:The ex vivo evaluation model can improve oxygenation capacity of "marginal" lungs rejected for transplantation. It has a great potential to increase lung donor availability and, possibly, to reduce the waiting time on the list. Descriptors: Lung transplantation. Organ preservation. Lung injury.Resumo Objetivo: Apenas 15% dos pulmões doados são aproveitados para transplante. Um novo método de Perfusão Pulmonar Ex Vivo (PPEV) foi desenvolvido e pode ser usado para avaliação e recondicionamento de pulmões "marginais" e rejeitados para o transplante. Esse trabalho relata nossa experiência com a avaliação funcional da PPEV.Métodos: Foram estudados pulmões de 12 doadores considerados inapropriados para transplante pulmonar. Após a captação, os pulmões são perfundidos ex vivo com Steen Solution, uma solução de composição eletrolítica extracelular com alta pressão coloidosmótica. Um oxigenador de membrana ligado ao circuito recebe uma mistura gasosa (nitrogênio e dióxido de carbono) e Bras Cir Cardiovasc 2010; 25(4): 441-446 "desoxigena" o perfusato, mantendo uma concentração de gases semelhante a do sangue venoso. Os pulmões são gradualmente aquecidos, perfundidos e ventilados. A avaliação dos órgãos é feita por gasometrias e medidas como a resistência vascular pulmonar (RVP) e complacência pulmonar (CP). 442 PÊGO-FERNANDES, PM ET AL -Ex vivo lung evaluation and reconditioning RevResultados: A PaO 2 (FiO 2 100%) passou de um valor médio de 193,3 mmHg no doador para 495,3 mmHg durante a PPEV. Após uma hora de PPEV, a RVP média era de 737,3 dinas/seg/ cm 5 e a CP era de 42,2 ml/cmH 2 O.Conclusões: O modelo de avaliação pulmonar ex vivo pode melhorar a capacidade de oxigenação de pulmões "marginais" inicialmente rejeitados para transplante. Isso denota um grande potencial do método para aumentar a disponibili...

show abstract

“…Ingemansson et al [5], in 2009, reported six cases of lung transplantation, whose organs were initially rejected and reconditioned through EVLP. Survival at 90 days was 100%.…”

Section: Discussionmentioning

confidence: 99%

“…The EVLP then began to be used for reconditioning of lungs rejected for transplantation. These researchers published in the early 2009s [5] a study regarding the first six lung transplants initially rejected (the mean PaO2 mmHg donors = 158.25) and reconditioned through EVLP (mean PaO2 after EVLP = 515.25 mmHg).…”

Section: Introductionmentioning

confidence: 99%

Avaliação e recondicionamento pulmonar ex vivo

Pêgo-Fernandes

Mariani

Medeiros

et al. 2010

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

show abstract

“…published a report on six patients who received initially rejected lungs after they were reconditioned through AVLP. (9) Most of the lungs that are not used for transplantation are rejected due to poor blood gas analysis results, that is, PaO 2 < 300 mmHg, with FiO 2 of 100% and positive end-expiratory pressure (PEEP) of 5 cmH 2 O. The solution used in EVLP, marketed under the name Steen Solution ® (Vitrolife, Göteborg, Sweden), is a solution of extracellular electrolyte composition that contains albumin and dextran and therefore has high oncotic pressure.…”

Section: Descritoresmentioning

confidence: 99%

“…When the perfusion flow reaches the maximum calculated value, perfusate samples as well as to the expansion of prior areas of atelectasis. (8,9) Our research protocol began in January of 2009 If the lungs are rejected for transplantation (usually due to poor blood gas analysis results), the research consent form is presented to the family members. If authorized, we collect the lungs in the usual manner, together with the other teams.…”

Section: Descritoresmentioning

confidence: 99%

Perfusão pulmonar ex vivo: experiência nacional inicial

et al. 2009

View full text Add to dashboard Cite

In the last 20 years, lung transplantation has become the standard treatment for patients with end-stage lung disease. However, less than 20% of the donor lungs available for transplant are actually usable. This disparity between the growing number of recipients and the small number of donors has resulted in increased mortality among lung transplant candidates on waiting lists. Strategies such as the utilization of organs from marginal donors have proven ineffective in increasing the number of transplants. In 2000, a new method for reconditioning human lungs that had been previously rejected for transplantation was developed in Sweden. We describe our initial experience with ex vivo lung perfusion.

show abstract

“…Studies have examined blood-based perfusates and acellular perfusates, with the acellular Steen's Solution emerging as the current standard [56]. Clinical trials are currently underway in the United States and market approval is ending Steen's Solution is a hy okalemic, hyperoncotic, high-dextran containing perfusate [57]. The extracellular electrolyte composition contains a low concentration of potassium to minimize the formation of free radicals and to avoid vascular spasm [58].…”

Section: Perfusate Composition In Evlpmentioning

confidence: 99%

Pulsatile flow does not improve efficacy in ex vivo lung perfusion.

Zoeller¹

View full text Add to dashboard Cite

Clinical Transplantation of Initially Rejected Donor Lungs After Reconditioning Ex Vivo

Cited by 232 publications

References 11 publications

Avaliação e recondicionamento pulmonar ex vivo

Avaliação e recondicionamento pulmonar ex vivo

Perfusão pulmonar ex vivo: experiência nacional inicial

Pulsatile flow does not improve efficacy in ex vivo lung perfusion.

Contact Info

Product

Resources

About