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Ann Thorac Surg 2009;87:255-260. doi:10.1016/j.athoracsur.2008.09.049
© 2009 The Society of Thoracic Surgeons
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Richard Ingemansson
Atli Eyjolfsson
Leif Pierre
Ronny Gustafsson
Per Johnsson
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Right arrow Lung - transplantation

Original Articles: General Thoracic

Clinical Transplantation of Initially Rejected Donor Lungs After Reconditioning Ex Vivo

Richard Ingemansson, MD, PhD, Atli Eyjolfsson, MD, Lena Mared, MD, Leif Pierre, CCP, BSc, Lars Algotsson, MD, PhD, Björn Ekmehag, MD, PhD, Ronny Gustafsson, MD, PhD, Per Johnsson, MD, PhD, Bansi Koul, MD, PhD, Sandra Lindstedt, MD, PhD, Carsten Lührs, MD, Trygve Sjöberg, PhD, Stig Steen, MD, PhD*

Department of Cardiothoracic Surgery, Heart-Lung Division, Lund University Hospital, Lund, Sweden

Accepted for publication September 19, 2008.

* Address correspondence to Dr Steen, Department of Cardiothoracic Surgery, Heart Lung Division, Lund University Hospital, Lund, SE-221 87, Sweden (Email: stig.steen{at}med.lu.se).

Background: A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. A method to evaluate and recondition lungs ex vivo has been tested on donor lungs that have been rejected for transplantation.

Methods: The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation (ECMO) circuit with STEEN solution (Vitrolife AB, Kungsbacka, Sweden) mixed with erythrocytes. The hyperoncotic solution dehydrates edematous lung tissue. Functional evaluations were performed with deoxygenated perfusate by varying the inspired fraction of oxygen. After the reconditioning, the lungs were kept immersed at 8°C in extracorporeal membrane oxygenation until transplantation was performed.

Results: Six of nine initially rejected donor lungs were reconditioned to acceptable function, and in six recipients, double lung transplantation was performed. Three-month survival was 100%. One patient has since died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are alive and well without any sign of bronchiolitis obliterans syndrome 24 months after the transplantation.

Conclusions: The result from the present study is promising, and we continue to transplant reconditioned lungs.






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