Transplantation of Initially Rejected Donor Lungs after Ex-Vivo Lung Perfusion

Combined lung-liver transplantation is a logistically challenging procedure hampered by shortage of organ donors. We describe the case of a young patient with end-stage lung disease due to of cystic fibrosis and liver cirrhosis who needed combined lung-liver transplantation. The long waiting for this caused an interesting clinical dilemma. We decided to change our policy in this situation by listing him only for the lung transplantation and to apply for a high urgent liver transplantation if the liver failed after the lung transplantation. This strategy enabled us to use lungs treated with ex vivo lung perfusion (EVLP) from an unsuitable donor after circulatory death. After conditioning for 4 h via EVLP, the pO 2 was 59.7 kPa. The lungs were transplanted successfully. He developed an acute-onchronic liver failure for which he received a successful liver transplantation 19 days after the lung transplantation.

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“…Good results with the Steen protocol were reported by Wallinder et al . . Eleven pairs of rejected donor lungs were subjected to EVLP.…”

Section: Discussionmentioning

confidence: 99%

A staged approach for a lung-liver transplant patient usingex vivoreconditioned lungs first followed by an urgent liver transplantation

et al. 2014

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“…The group at the University of Goteborg reported in 2012 their experience with cellular EVLP of six pairs of initially rejected donor lungs because of low (mean 156 mmHg) PaO 2 /FiO 2 ( n = 5) or infiltrate on chest radiograph ( n = 1) . Oxygenation during EVLP improved in all cases (mean improvement 255 mmHg), and hemodynamic and respiratory parameters were stable.…”

Section: Clinical Experience With Evlpmentioning

confidence: 99%

Ex‐vivo lung perfusion

et al. 2014

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Summary This review outlines the new and promising technique of ex vivo lung perfusion and its clinical potential to increase the number of transplantable lungs and to improve the early and late outcome after transplantation. The rationale, the experimental background, the technique and protocols, and available devices for ex vivo lung perfusion are discussed. The current clinical experience worldwide and ongoing clinical trials are reviewed.

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“…146 Worldwide clinical experiences with EVLP are summarized in ►Table 7. 146,[149][150][151][152][153][154] Although most reports are small case series, the proportion of high-risk donor lungs transplanted after EVLP evaluation range between 46 and 87%, resulting in equivalent short-term outcomes as compared with standard criteria donors. It is remarkable that the incidence of severe PGD is generally lower in the EVLP group in comparison with the conventional group, with equivalent survival (96, 87 and 70% at 30 days, 1 year, and 3 years, respectively).…”

Section: Emerging Conceptsmentioning

confidence: 99%

Primary Graft Dysfunction

Suzuki

Cantu

Christie

2013

Semin Respir Crit Care Med

118

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Primary graft dysfunction (PGD) is a syndrome encompassing a spectrum of mild to severe lung injury that occurs within the first 72 hours after lung transplantation. PGD is characterized by pulmonary edema with diffuse alveolar damage that manifests clinically as progressive hypoxemia with radiographic pulmonary infiltrates. In recent years, new knowledge has been generated on risks and mechanisms of PGD. Following ischemia and reperfusion, inflammatory and immunological injury-repair responses appear to be key controlling mechanisms. In addition, PGD has significant impact on short- and long-term outcomes; therefore, the choice of donor organ is impacted by this potential adverse consequence. Improved methods of reducing PGD risk and efforts to safely expand the pool are being developed. Ex-vivo lung perfusion is a strategy which may improve risk assessment and become a promising platform to implement treatment interventions to prevent PGD. This review will detail recent updates in the epidemiology, pathophysiology, molecular and genetic biomarkers and state-of-the-art technical developments affecting PGD. (158 words)

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Transplantation of Initially Rejected Donor Lungs after Ex-Vivo Lung Perfusion

Cited by 18 publications

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A staged approach for a lung-liver transplant patient usingex vivoreconditioned lungs first followed by an urgent liver transplantation

A staged approach for a lung-liver transplant patient usingex vivoreconditioned lungs first followed by an urgent liver transplantation

Ex‐vivo lung perfusion

Primary Graft Dysfunction

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