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Ex vivo evaluation of nonacceptable donor lungs

Wierup, P ; Haraldsson, A ; Nilsson, F ; Pierre, L ; Schersten, H ; Silverborn, M ; Sjöberg, Trygve LU ; Westfeldt, U and Steen, Stig LU (2006) In Annals of Thoracic Surgery 81(2). p.460-466
Abstract
Background. Only a minority of the potential candidates for lung donation are considered suitable, using current evaluation methods. A new method for ex vivo evaluation, with the potential for reconditioning of marginal and nonacceptable lungs, has been developed. This is a report of the ex vivo evaluation of six donor lungs deemed nonacceptable (arterial oxygen pressure less than 40 kPa) by the Scandiatransplant, Eurotransplant, and UK transplant organizations. Methods. The lungs are perfused ex vivo with Steen solution, a lung evaluation-preservation solution, mixed with red blood cells to a hematocrit of 15%. This extracellular solution is designed to have an optimal colloid osmotic pressure so that physiologic pressure and flow can be... (More)
Background. Only a minority of the potential candidates for lung donation are considered suitable, using current evaluation methods. A new method for ex vivo evaluation, with the potential for reconditioning of marginal and nonacceptable lungs, has been developed. This is a report of the ex vivo evaluation of six donor lungs deemed nonacceptable (arterial oxygen pressure less than 40 kPa) by the Scandiatransplant, Eurotransplant, and UK transplant organizations. Methods. The lungs are perfused ex vivo with Steen solution, a lung evaluation-preservation solution, mixed with red blood cells to a hematocrit of 15%. This extracellular solution is designed to have an optimal colloid osmotic pressure so that physiologic pressure and flow can be maintained without development of pulmonary edema. An oxygenator connected to the extracorporeal circuit maintains a normal mixed venous blood gas level in the perfusate. The lungs are ventilated and evaluated through analyses of pulmonary vascular resistance, oxygenation capacity, and arterial carbon dioxide pressure minus end-tidal carbon dioxide difference. Results. The arterial oxygen pressure (inspired oxygen fraction, 1.0) increased from 27 kPa (range, 17 to 34 kPa) in situ in the organ donor at the referring hospital to 57 kPa (range, 39 to 66 kPa) during the ex vivo evaluation. The pulmonary vascular resistance varied from 3.2 to 5.7 Wood units, and the arterial carbon dioxide pressure minus end-tidal carbon dioxide difference was in the range of 1 to 2.5 kPa. Conclusions. The arterial oxygen pressure improves significantly in this model. This ex vivo evaluation model is a valuable addition to the armamentarium in finding acceptable lungs in a donor population with inferior arterial oxygen pressure values. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Thoracic Surgery
volume
81
issue
2
pages
460 - 466
publisher
Elsevier
external identifiers
  • wos:000235142400009
  • pmid:16427831
  • scopus:31044434788
ISSN
1552-6259
DOI
10.1016/j.athoracsur.2005.08.015
language
English
LU publication?
yes
id
8422016f-69ed-4bbb-9361-afdf1a8844d9 (old id 417974)
alternative location
http://ats.ctsnetjournals.org/cgi/content/abstract/81/2/460
date added to LUP
2016-04-01 12:34:21
date last changed
2020-12-29 01:44:10
@article{8422016f-69ed-4bbb-9361-afdf1a8844d9,
  abstract     = {Background. Only a minority of the potential candidates for lung donation are considered suitable, using current evaluation methods. A new method for ex vivo evaluation, with the potential for reconditioning of marginal and nonacceptable lungs, has been developed. This is a report of the ex vivo evaluation of six donor lungs deemed nonacceptable (arterial oxygen pressure less than 40 kPa) by the Scandiatransplant, Eurotransplant, and UK transplant organizations. Methods. The lungs are perfused ex vivo with Steen solution, a lung evaluation-preservation solution, mixed with red blood cells to a hematocrit of 15%. This extracellular solution is designed to have an optimal colloid osmotic pressure so that physiologic pressure and flow can be maintained without development of pulmonary edema. An oxygenator connected to the extracorporeal circuit maintains a normal mixed venous blood gas level in the perfusate. The lungs are ventilated and evaluated through analyses of pulmonary vascular resistance, oxygenation capacity, and arterial carbon dioxide pressure minus end-tidal carbon dioxide difference. Results. The arterial oxygen pressure (inspired oxygen fraction, 1.0) increased from 27 kPa (range, 17 to 34 kPa) in situ in the organ donor at the referring hospital to 57 kPa (range, 39 to 66 kPa) during the ex vivo evaluation. The pulmonary vascular resistance varied from 3.2 to 5.7 Wood units, and the arterial carbon dioxide pressure minus end-tidal carbon dioxide difference was in the range of 1 to 2.5 kPa. Conclusions. The arterial oxygen pressure improves significantly in this model. This ex vivo evaluation model is a valuable addition to the armamentarium in finding acceptable lungs in a donor population with inferior arterial oxygen pressure values.},
  author       = {Wierup, P and Haraldsson, A and Nilsson, F and Pierre, L and Schersten, H and Silverborn, M and Sjöberg, Trygve and Westfeldt, U and Steen, Stig},
  issn         = {1552-6259},
  language     = {eng},
  number       = {2},
  pages        = {460--466},
  publisher    = {Elsevier},
  series       = {Annals of Thoracic Surgery},
  title        = {Ex vivo evaluation of nonacceptable donor lungs},
  url          = {http://dx.doi.org/10.1016/j.athoracsur.2005.08.015},
  doi          = {10.1016/j.athoracsur.2005.08.015},
  volume       = {81},
  year         = {2006},
}