Pushing the limits of reconditioning: extended normothermic lung perfusion in an extended criteria donor

Abstract

ratio was 450 mmHg, leading to an Oto score of 5 (5) and a UMN-DLQI score of 40 (6). Among the clinical information collected at time of donation, the most relevant was the

Overcoming the Limits of Reconditioning: Seventeen Hours of EVLP With Successful Transplantation From Uncontrolled Circulatory Death Donor

“…To the best of the authors’ knowledge, human EVLP of similar duration has been reported only by the Padua group. 21 It is worth mentioning how both protocols, the Padua Organ Care System and our Milan EVLP technique, used perfusate enriched with erythrocytes. Few preclinical studies on prolonged EVLP are available, and those reporting extended EVLP time beyond 12 h are even fewer.…”

“…The present report is meaningful: without the opportunity to extend the lungs preservation through normothermic perfusion, the graft would have been discarded due to high oncological risk. To the best of the authors' knowledge, human EVLP of similar duration has been reported only by the Padua group 21 . It is worth mentioning how both protocols, the Padua Organ Care System and our Milan EVLP technique, employed perfusate…”

Lung preservation: from perfusion to temperature

“…The EXPAND trial demonstrated the feasibility of utilizing the OCS device in extended-criteria donors (including DCD donors and anticipated ischemic time greater than 6 h) with utilization of 87% of potential donor lungs and 30-day and 1-year survival over 90%, despite 44% of patients experiencing PGD 3 within the initial 72 h posttransplant, the majority of whom were from DCD donors [48]. The limits of ischemic time utilizing OCS EVLP are unknown, though case reports of successful transplantation with ischemic times greater than 12 h exist [49].…”

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

“…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 …”

“…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]). [19][20][21][22] While the most commonly considered measurement of allograft function when considering lung donors and during EVLP is the PaO 2 :FiO 2 (P:F) ratio, we have demonstrated the value of other measurements when evaluating the function of allografts from beating-heart and DCD donors during prolonged preservation, including pulmonary vascular resistance (PVR) and allograft edema formation.…”