Successful clinical experience with extended normothermic ex-vivo lung perfusion (> 8 hours)

L. Ceulemans, A. Neyrinck, R. Vos, A. Stanzi, M. Boada, A. Martens, S. Ordies, K. Degezelle, G. Verleden, D. van Raemdonck

Thursday 15 march 2018

12:30 - 12:40h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 5: Clinical

Aim

Ex-vivo lung perfusion (EVLP) has become a clinical reality with most reported cases for short-term (<4h) assessment of questionable lungs. To fully explore the EVLP potential, this time window should be safely extended. However, the graft function during longer EVLP largely remains unknown. We studied EVLP graft parameters and recipient outcome in clinical lung transplantation (LuTx) with EVLP time >8h.

Methods

Retrospective study (2013-2017) of 4 cases with normothermic portable EVLP (OCS™Lung) >8h. All patients underwent combined liver-LuTx with the liver first (cold storage) while the lungs were preserved on EVLP. Median age 43y (17-63); M/F ratio 1/3; indications: cystic fibrosis with cirrhosis (2); acute liver failure with COPD (1); hepatic epithelioid hemangio-endothelioma with lung metastases (1). EVLP time, cold/warm ischemic time (CIT/WIT), cross clamp time, Pulmonary Vascular Resistance (PVR), Peak Airway Pressure (PawP) and final oxygenation (PO2/FiO2) during EVLP, primary graft dysfunction at 72h (PGD72), ventilation days, rejection and patient/graft survival were analyzed. Results are presented as median (range).

Results

EVLP time was 625min (492-675), CIT 276min (80-497), WIT 66min(57-99), cross clamp time 923min (712-1232). PVR and PawP evolution remained stable (Image) and final PO2/FiO2 ratio was >300 for all cases (Image). No lungs were declined after EVLP. PGD72 grade was 2, 1, 0, 0 for each case respectively. Ventilation period was 6d (3-8). No rejections occurred. Actuarial patient/graft survival is 100% with a follow-up of 3y (2mo-4.2y).

Conclusions

In this unique series, pulmonary graft function remained stable during extended normothermic EVLP >8h, resulting in an excellent final EVLP oxygenation capacity with PO2/FiO2 >300 and excellent post-transplant outcome. Longer preservation periods may offer opportunities for long-distance travel, organ repair and immunomodulation prior to LuTx.