Ex vivo lung perfusion: Instrument for optimized utilization of donor organs

被引：0
作者：
Koch A. [1 ]
Pizanis N. [1 ]
Olbertz C. [1 ]
Abou-Issa O. [1 ]
Slama A. [1 ]
Taube C. [1 ]
Aigner C. [1 ]
Jakob H. [1 ]
Kamler M. [1 ]
机构：
[1] Westdeutsches Lungentransplantationszentrum, Universitätsklinikum Essen, Hufelandstr. 55, Essen
来源：
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie | 2018年 / 32卷 / 4期
关键词：
Donor selection; Extracorporeal circulation; Lung transplantation; Organ preservation; Ventilation;
D O I：
10.1007/s00398-017-0175-9
中图分类号：
学科分类号：
摘要：
Backround: In Germany only 40–50% of lungs from multiorgan donors are transplanted. Thus, it is of utmost importance to use every potential transplantable organ. Normothermic ex vivo lung perfusion (EVLP) offers the possibility to reevaluate donor lungs that were previously deemed unsuitable for transplantation. Material and methods: The technique of normothermic acellular EVLP is described in detail. Especially practical aspects of the handling are addressed. Since January 2016 we have performed 56 lung transplantations. In this period 11 lungs which initially did not conform to the standard criteria were reevaluated by the use of EVLP and of these 9 were transplanted. According to the Toronto protocol the lungs were reconditioned for 4 h. Before lung transplantation (LuTx) the ∆ pO2/FIO2 ratio between arterial and venous perfusion should be >350 mmHg. In a retrospective analysis, we examined donor and recipient data, organ perfusion data and postoperative course. Results: The mean age of donors with LuTx was 54 ± 14 years and for non-transplanted donors (non-LuTx) 51 ± 8 years (not significant n. s.). Before explantation the partial oxygen pressure (pO2) with an inspiratory oxygen fraction (FIO2) of 1.0 was: LuTx 324 ± 72 mmHg vs. non-LuTx 382 ± 88 mmHg (n. s.). Donor ventilation time was: LuTx: 104 ± 44 h and non-LuTx 245 ± 180h (n. s.) The ∆ pO2/FIO2 for LuTx after 4 h was 389 ± 49 mmHg and 254 ± 0 mmHg for non-Tx (n. s.). Lungs were transplanted with a mean out of body time after implantation of the second lung of 724 ± 133 min. Postoperative ventilation time was 232 ± 305 h and the length of intensive care stay was 274 ± 293 h. The 30-day mortality was 9% for EVLP recipients. Conclusion: Normothermic EVLP procedures can safely be used in the evaluation of lungs initially considered unacceptable for transplantation. This experience from a single center shows that transplantation of 81% of donor lungs initially classified as unsuitable for transplantation is possible. The perioperative results are comparable to standard lung transplantation. © 2017, Springer Medizin Verlag GmbH.
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页码：325 / 330
页数：5
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