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Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie

24.-26.10.2013, Basel, Schweiz

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The Importance of Repeated Measurements to Assess Transplant Suitability in Clinical Ex-Vivo Lung Perfusion (EVLP)

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  • A. Slama - Dept. of Thoracic Surgery, Medical University of Vienna, Vienna
  • A. Scheed - Dept. of Thoracic Surgery, Medical University of Vienna, Vienna
  • K. Hötzenecker - Dept. of Thoracic Surgery, Medical University of Vienna, Vienna
  • G. Lang - Dept. of Thoracic Surgery, Medical University of Vienna, Vienna
  • B. Urbanek - Dept. of Anaesthesiology, Medical University of Vienna, Vienna
  • W. Schmidt - Dept. of Anaesthesiology, Medical University of Vienna, Vienna
  • F. J. Nierscher - Dept. of Anaesthesiology, Medical University of Vienna, Vienna
  • W. Klepetko - Dept. of Thoracic Surgery, Medical University of Vienna, Vienna
  • C. Aigner - Dept. of Thoracic Surgery, Medical University of Vienna, Vienna

Deutsche Gesellschaft für Thoraxchirurgie. Österreichische Gesellschaft für Thoraxchirurgie. Schweizerische Gesellschaft für Thoraxchirurgie. Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie. Basel, Schweiz, 24.-26.10.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocS5.2

doi: 10.3205/13dgt042, urn:nbn:de:0183-13dgt0424

Published: October 14, 2013

© 2013 Slama et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Normothermic acellular EVLP is a safe and feasible option to evaluate and recondition marginal donor lungs. A deltaPo2 of 350 mmHg between venous and arterial solution is used as a cutoff value for acceptance. The validity of oxygenation values obtained in an acellular perfusion solution remain however unclear.

Methods: An analysis of our prospective clinical EVLP database since 3/2010 was performed to compare oxygenation values during clinical EVLP to values obtained in the brain dead donor as well as differences in functional parameters between accepted (group 1) and rejected (group 2) lungs assessed during EVLP.

Results: From 3/2010-11/2012 22 EVLPs were performed (16 lungs transplanted, 6 rejected). The first pvO2 (FiO2=1.0) in the venous solution was significantly higher in both, accepted lungs (mean: 415 ± 18 mmHg,) and rejected lungs (median: 406 ± 30 mmHg) compared to the respective last donor blood gases (mean accepted 214 ± 13.3 mmHg, p<0.001; mean rejected 246 ± 7.8 mmHg; p=0.001). Donor gasses showed no significant difference between the two groups (p=0.173)

During EVLP, pvO2 as well as its deviation from the first recorded value were significantly higher in accepted lung compared to rejected lungs (mean 430.6 mmHg ± 6.2 vs. 368 mmHg ± 12.34, p=0.004; +27.3 vs. –33.5 p=0.042). This was also observed for deltaPo2 (334.2 mmHg ± 15.1 vs. 287.4 mmHg ± 13.6; p=0,061; +89.1 ± 21.0 vs. –50.0 ± 22.5 p= 0.011).

Additionally peak AWP during EVLP were significantly higher in rejected lungs (mean: 12.0 vs. 14.3 cm H2O; p<0.001; –1.38 vs. –0.41 cm H2O p=0.25). Lung compliance was significantly better and increased significantly in accepted lungs (mean: 82.8 vs. 73.8; p=0.026; +13.2 vs. +1.8; p=0.032).

Conclusion: Oxygenation values obtained during EVLP are not directly comparable to donor values as the pvO2 in acellular perfusate will be significantly higher. pvO2, deltaPo2, compliance as well as AWP showed a significantly different development during EVLP in accepted lungs compared to rejected lungs. These findings underline that the decision for transplant suitability during EVLP should not be based on a single assessment but rather by taking into account the trends of all functional parameters.