Portable normothermic ex-vivo lung perfusion, ventilation, and functional assessment with the Organ Care System on donor lung use for transplantation from extended-criteria donors (EXPAND): a single-arm, pivotal trial

Loor, Gabriel; Warnecke, G.; Villavicencio, Mauricio A.; Smith, Michael A.; Kukreja, Jasleen; Ardehali, A.; Hartwig, Matthew G.; Daneshmand, Mani A.; Hertz, Marshall I.; Huddleston, Stephen J.; Haverich, Axel; Madsen, Joren C.; Raemdonck, Dirk Van

doi:10.1016/s2213-2600(19)30200-0

Cited by 105 publications

(95 citation statements)

References 29 publications

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“…All organs had unacceptable in situ functional status and/or high‐risk donor features, which necessarily created a pool of ECD lungs for study. Despite initially unfavorable clinical features, 50% of lungs studied met standard EVLP criteria for transplant following 24 hours of normothermic EVLP, suggesting that EVLP should be used more liberally prior to declining marginal organs based on quality …”

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

“…Multiple investigators have reported evaluation and reconditioning of DCD and ECD lungs in the clinical setting using EVLP prior to transplant, with recipient survival similar to that of recipients of standard donor lungs . While the use of EVLP with these donors provides organs to patients who may not otherwise receive them, relatively high rates of primary graft dysfunction (PGD) can be seen, which can prolong hospitalization and increase morbidity after lung transplant . Although normothermic preservation up for up to 18 hours prior to transplant has been reported, most of these studies also make use of static EVLP equipment with preservation intervals limited to 12 hours or less, creating logistical limitations …”

Section: Introductionmentioning

confidence: 99%

“…relatively high rates of primary graft dysfunction (PGD) can be seen, which can prolong hospitalization and increase morbidity after lung transplant. 13,17 Although normothermic preservation up for up to 18 hours prior to transplant has been reported, most of these studies also make use of static EVLP equipment with preservation intervals limited to 12 hours or less, creating logistical limitations. [14][15][16][17][18] Our group has reported experience with prolonged (~24 hours) preservation of porcine donor lungs from beating-heart and DCD donors in an acceptable functional state with the use of a portable normothermic EVLP system (Organ Care System [OCS] Lung [TransMedics]), combined with a perfusate based on autologous donor whole blood (ADWB) and a low-potassium dextran crystalloid solution (OCS Lung solution [TransMedics]).…”

mentioning

confidence: 99%

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Prolonged extracorporeal preservation and evaluation of human lungs with portable normothermic ex vivo perfusion

Spratt

Mattison

Kerns

et al. 2020

Clinical Transplantation

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Many lung donor offers are refused despite increasing demand. Portable normothermic ex vivo lung perfusion (EVLP) could increase donor yield by monitoring and reconditioning extended criteria donor (ECD) lungs. We report its use in human lungs declined for clinical transplantation. Ten sets of such lungs were procured from brain‐dead donors and underwent 24 hours of normothermic EVLP using a perfusate based on donor whole blood. Hemodynamic and ventilatory data and P:F ratios were measured. Advanced donor age and borderline oxygenation (donor mean P:F 228 ± 73) were the most commonly cited reasons for refusal for transplantation. There was no significant worsening of pulmonary hemodynamics or compliance or significant P:F decline during preservation in the overall cohort. Mean P:F ratio in the overall cohort was 315 ± 88 mm Hg after 24 hours EVLP. At EVLP termination 5/10 lung blocks met standard EVLP thresholds for acceptability for transplant. Eventual EVLP performance was poorly predicted by donor P:F ratio but well predicted by data gathered early in EVLP. Portable normothermic EVLP is useful for transportation, monitoring, and reconditioning of ECD lungs. Early EVLP measurements are more effective than preprocurement donor P:F in predicting eventual allograft performance. We advocate an aggressive strategy of evaluation of ECD lungs using blood‐based EVLP.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Prolonged extracorporeal preservation and evaluation of human lungs with portable normothermic ex vivo perfusion

Spratt

Mattison

Kerns

et al. 2020

Clinical Transplantation

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“…A number of studies have addressed the use of extended donor criteria to enlarge the donor organ pool, or resuscitation of initially declined lungs using ex vivo lung perfusion (EVLP) . In a retrospective study, our group previously identified that 20% of declined lungs could potentially be transplantable after EVLP; and the EXPAND trial recently reported excellent clinical outcomes after EVLP of initially questionable lungs . However, only few studies have systematically assessed the actual abnormalities in lungs that were considered to be of insufficient quality for transplantation .…”

Section: Introductionmentioning

confidence: 99%

Histopathologic and radiologic assessment of nontransplanted donor lungs

Vanstapel

Dubbeldam

Weynand

et al. 2020

American Journal of Transplantation

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Donor organ shortage results in significant waiting list mortality. Donor lung assessment is currently based on donors’ history, gas exchange, chest X‐ray, bronchoscopy findings, and ultimately in situ inspection but remains subjective. We correlated histopathology and radiology in nontransplanted donor lungs with the clinical indications to decline the offered organ. Sixty‐two donor lungs, not used for transplantation (2010‐2019), were procured, air‐inflated, frozen, scanned with computed tomography, systematically sampled, and histologically and radiologically assessed. Thirty‐nine (63%) lungs were declined for allograft‐related reasons. In 13/39 (33%) lungs, histology could not confirm the reason for decline, in an additional 8/39 (21%) lungs, histologic abnormalities were only considered mild. In 16/39 (41%) lungs, radiology could not confirm the reason for decline. Twenty‐three (37%) donor lungs were not transplanted due to extrapulmonary causes, of which three (13%) lungs displayed severe histologic abnormalities (pneumonia, n = 2; emphysema, n = 1), in addition to mild emphysema in 9 (39%) lungs and minor bronchopneumonia in 1 (4%). Radiology revealed ground‐glass opacities in 8/23 (35%) and emphysema in 4/23 (17%) lungs. Histopathologic and radiologic assessment of nontransplanted donor lungs revealed substantial discrepancy with the clinical reason for decline. Optimization of donor lung assessment is necessary to improve current organ acceptance rates.

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