Study group and donor characteristics
Sixteen consecutive clinical EVLP assessments of lungs deemed unacceptable for standard transplant were included in the study (Table 1). Seven (44%) were accepted for transplant after EVLP assessment and were implanted as four bilateral and three single-lung procedures. Nine (56%) failed to achieve transplant criteria and were excluded. The characteristics of the donor groups of transplanted and non-transplanted lungs were not significantly different and are shown in Tables 1 and 2.
Table 1: Donor characteristics
Donor no. Age/ gender Smoker Donor cause of death Donor type TLC (L) Micro on offer Radiographic infiltrates Secretions EVLP indication
EVLP 01 18 m No Diabetic coma DL DBD 7.30 Nil Bilateral Nil PaO2 <300 mmHg
EVLP 02 51 f Yes ICH DL DBD 4.31 Nil Clear Nil PaO2 <300 mmHg
EVLP 03 33 m Yes ICH DL DBD 7.14 Nil Left diffuse Purulent PaO2 <300 mmHg
EVLP 04 15 f No Hanging DL DCD 5.10 Nil Bilateral Nil PaO2 <300 mmHg
EVLP 05 52 m No ICH DL DBD 5.78 Nil Clear Mucopurulent PaO2 <300 mmHg
EVLP 06 57 m Yes ICH DL DBD 7.54 Nil Right basal Mucopurulent oedema
EVLP 07 52 f Yes ICH SL DBD 2.70 Nil Bibasal Purulent PaO2 <300 mmHg
EVLP 08 20 m Yes Hanging SL DBD 3.18 Nil Right basal Nil PV PaO2 <225 mmHg + oedema
EVLP 09 36 m No Brain tumour SL DBD 3.11 Yesa Left diffuse Nil PaO2 <300 mmHg
EVLP 10 47 m No HBI DL DBD 6.74 Nil Clear Nil PaO2 <300 mmHg
EVLP 11 45 f No TBI DL DBD 6.18 Nil Clear Nil PV PaO2 <225 mmHg + mild contusion RLL
EVLP 12 56 m No ICH DL DBD 6.50 Nil Clear Purulent PaO2 <300 mmHg
EVLP 13 18 f Yes ICH DL DCD 5.03 Nil Bilateral Mucopurulent oedema
EVLP 14 53 m Yes ICH DL DBD 7.06 Nil Clear Purulent PaO2 <300 mmHg
EVLP 15 48 f No ICH DL DBD 4.57 Nil Bibasal Purulent PaO2 <300 mmHg
EVLP 16 38 m Yes Hanging DL DCD 6.98 Nil Left basal Nil oedema
Shaded donor lungs were not transplanted after EVLP .
BALF: bronchoalveolar lavage fluid; EVLP : ex vivo lung perfusion; ICH: intracranial haemorrhage; HBI: hypoxic brain injury secondary to variceal bleed; TBI: traumatic brain injury following a road traffic accident; DL: double lung perfusion; SL: single lung perfusion; DBD: organ donation after brain death; DCD: organ donation after circulatory death; TLC: predicted total lung capacity of perfused lung; PaO2: partial pressure of arterial oxygen; PV: selective pulmonary vein blood gas analyses; RLL: right lower lobe.
a Sputum culture with moderate growth of Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae.
Table 2: EVLP and transplant outcomes
Donor no. Optimized donor PaO2:FiO2 (mmHg) PaO2:FiO2 after EVLP (mmHg) Ischaemic time (min)a EVLP time (min)b Total time ex vivo (min)c Transplant PGD 3 at 72 h 90-day survival
EVLP 01 149 521 345 290 1020 Yes–BL Yes Yes
EVLP 02 248 342 360 360 N/A No–emphysema
EVLP 03 209 167 330 270 N/A No–gross oedema
EVLP 04 222 426 450 360 870 Yes–SL No Yes
EVLP 05 167 440 320 330 N/A No–heavy gram-stain in BALF
EVLP 06 357 525 395 240 582 Yes–SL No Yes
EVLP 07 178 557 315 255 1048 Yes–SL Yes Yes
EVLP 08 372 392 340 240 N/A No–emphysema
EVLP 09 293 330 430 300 N/A No–gross oedema
EVLP 10 171 291 305 300 N/A No–gross oedema
EVLP 11 526 452 340 330 N/A No–gross oedema
EVLP 12 191 512 395 220 785 Yes–BL No Yesd
EVLP 13 360 352 345 180 N/A No–gross oedema
EVLP 14 165 516 270 190 496 Yes–BL No Yes
EVLP 15 293 443 360 165 713 Yes–BL No Yes
EVLP 16 527 322 335 180 N/A No–gross oedema
Shaded donor lungs were not transplanted after EVLP.
PaO2:FiO2: the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen; EVLP: ex vivo lung perfusion; PGD: primary graft dysfunction at 72 h; SL: single lung transplant; BL: bilateral lung transplant; N/A: not applicable; BALF: bronchoalveolar lavage fluid.
a Start of donor lung flush at procurement to start of pulmonary artery (PA) perfusion on EVLP circuit.
b Start of PA perfusion to disconnection from EVLP circuit.
c Start of donor lung flush at procurement to reperfusion in recipient.
d Death due to H1N1 infection 11 months post-transplant.