Ex-vivo lung perfusion to improve donor lung function and increase the number of organs available for transplantation

This paper describes the initial clinical experience of ex-vivo lung perfusion (EVLP) at the Fondazione Ca' Granda in Milan between January 2011 and May 2013. EVLP was considered if donor PaO2 /FiO2 was below 300 mmHg, or if lung function was doubtful. Donors with massive lung contusion, aspiration, purulent secretions, pneumonia or sepsis were excluded. EVLP was run with a low flow, open atrium and low hematocrit technique. 35 lung transplants from brain death donors were performed, 7 of which after EVLP. EVLP donors were older (54±9 years vs. 40±15, EVLP vs. Standard, P<0.05), had lower PaO2 /FiO2 (264±78 mmHg vs. 453±119, P<0.05), and more chest X-ray abnormalities (P<0.05). EVLP recipients were more often admitted to Intensive Care Unit as urgent cases (57% vs. 18, P=0.05), Lung Allocation Score at transplantation was higher (79 [40-84] vs. 39 [36-46], P<0.05). After transplantation, primary graft dysfunction (PGD72 grade 3, 32% vs. 28, EVLP vs. Standard, P=1), mortality at 30 days (0% vs. 0%, P=1), and overall survival (71% vs. 86, EVLP vs. Standard, P=0.27) were not different between groups. EVLP enabled a 20% increase in available donor organs and resulted in successful transplants with lungs that would have otherwise been rejected.