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Right arrow Lung - transplantation

Ann Thorac Surg 2006;81:1205-1213
© 2006 The Society of Thoracic Surgeons

Original article: General thoracic

Ex Vivo Evaluation of Human Lungs for Transplant Suitability

Thomas M. Egan, MD, MS a , * , John A. Haithcock, RRT b , William A. Nicotra, BS b , Giovanna Koukoulis, MD a , Hidetoshi Inokawa, MD, PhD a , Mayura Sevala, PhD a , Paul L. Molina, MD a , William K. Funkhouser, MD, PhD a , Burton J. Mattice, MBA c

a School of Medicine, University of North Carolina, Chapel Hill
b UNC Hospitals, University of North Carolina, Chapel Hill
c Carolina Donor Services, Durham, North Carolina

Accepted for publication September 15, 2005.

* Address correspondence to Dr Egan, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, CB 7065, 3040 Burnett Womack Building, Chapel Hill, NC 27599-7065 (Email: ltxtme{at}med.unc.edu).

Presented at the Basic Science Forum of the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

BACKGROUND: If lungs could be retrieved from non-heart-beating donors, the critical shortage of lungs for transplant could be alleviated. An obstacle to this approach is the inability to predict these lungs' suitability for transplant. We used human lungs deemed unsuitable for transplant to develop a method to perfuse and ventilate human lungs ex vivo to assess gas exchange and vascular resistance, and to perform bronchoscopic inspection and radiographic evaluation.

METHODS: Lungs were retrieved from six brain-dead organ donors after cold Perfadex (Vitrolife, Kungsbacka, Sweden) flush, stored cold for 6 to 13 hours (mean, 8.7 hours) then perfused and rewarmed in a modified cardiopulmonary bypass circuit. Circuit perfusate was buffered colloid-crystalloid containing type-specific leukocyte-filtered blood (hematocrit of 10%–12%), circulated through a membrane oxygenator ventilated with CO2 and nitrogen to deoxygenate it. Lungs were ventilated with fraction of inspired oxygen (FIO 2) 0.5 when 32°C was reached. Gas exchange and vascular resistance was assessed at 5 L/minute flow at 37°C, FIO 2 0.5 and 1.0. Bronchoscopy, plain radiographs, and spiral computed tomographic (CT) scans were performed. Lung biopsies were obtained pre- and post-reperfusion.

RESULTS: Ex vivo perfusion did not cause increased wet to dry ratio, or major abnormalities by microscopy but was associated with elevated tissue levels of conjugated dienes. The alveolar-arterial difference in partial pressure of oxygen (PaO 2)/FIO 2 ratio in the ex vivo circuit was generally higher than in the six donors. Ex vivo radiographs and CT scans were abnormal in all lungs, confirming unsuitability of these lungs for transplant.

CONCLUSIONS: Ex vivo evaluation of human lungs is feasible and may be useful to evaluate transplant suitability of lungs retrieved after circulatory arrest from non-heart-beating donors.




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