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.

Ex-vivo lung perfusion to improve donor lung function and increase the number of organs available for transplantation / F. Valenza, L. Rosso, S. Coppola, S. Froio, A. Palleschi, D. Tosi, P. Mendogni, V. Salice, G.M. Ruggeri, J. Fumagalli, A. Villa, M. Nosotti, L. Santambrogio, L. Gattinoni. - In: TRANSPLANT INTERNATIONAL. - ISSN 0934-0874. - 27:6(2014), pp. 553-561. [10.1111/tri.12295]

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

F. Valenza
;
L. Rosso
Secondo
;
S. Coppola;S. Froio;A. Palleschi;P. Mendogni;V. Salice;G.M. Ruggeri;J. Fumagalli;A. Villa;M. Nosotti;L. Santambrogio
Penultimo
;
L. Gattinoni
Ultimo
2014

Abstract

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.
ex vivo lung perfusion organ regeneration; marginal donor criteria; lung transplantation; brain death; outcome
Settore MED/41 - Anestesiologia
Settore MED/21 - Chirurgia Toracica
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/233192
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