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Okamoto T, Niikawa H, Wheeler D, Soliman B, Ayyat KS, Itoda Y, Farver CF, McCurry KR. Significance of Lung Weight in Cellular Ex Vivo Lung Perfusion. J Surg Res 2020; 260:190-199. [PMID: 33348170 DOI: 10.1016/j.jss.2020.11.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/27/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Currently, pulmonary edema is evaluated via surgical inspection and palpation in donor lungs, and there is no quantitative standard diagnostic tool for evaluating pulmonary edema in donor procurement and ex vivo lung perfusion (EVLP). The purpose of this study was to investigate the significance of lung weight at the donor hospital and lung weight during EVLP as a complementary parameter of transplant suitability in EVLP. MATERIALS AND METHODS Twenty-one of rejected human lungs were perfused in cellular EVLP. Transplant suitability was evaluated at 2 h as per standard criteria of Lund-protocol EVLP. RESULTS Lung weight at donor hospital was significantly correlated with PaO2/FiO2 (P/F) ratio in EVLP (r = -0.44). There was a significant difference in lung weight at donor hospital between suitable cases (n = 13) and nonsuitable cases (n = 8). Light lung group (lung weight at donor hospital < 1280 g; n = 17) was suitable for transplant in 76%, whereas none of heavy lung group (lung weight at donor hospital ≥ 1280 g; n = 4) was suitable (P < 0.05). Lung weight at 2 h and lung weight change during EVLP were significantly associated with P/F ratio at 2 h and transplant suitability (P < 0.05, each). CONCLUSIONS Our findings demonstrate that lung weight at donor hospital, lung weight change, and lung weight at 2 h of EVLP might be a predictor of P/F ratio and transplant suitability in cellular EVLP.
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Affiliation(s)
- Toshihiro Okamoto
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Transplant Center, Cleveland Clinic, Cleveland, Ohio
| | - Hiromichi Niikawa
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David Wheeler
- Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, Ohio
| | - Basem Soliman
- Transplant Center, Cleveland Clinic, Cleveland, Ohio
| | - Kamal S Ayyat
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Yoshifumi Itoda
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Kenneth R McCurry
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
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Ayyat KS, Okamoto T, Niikawa H, Itoda Y, Dugar S, Latifi SQ, Lebovitz DJ, Moghekar A, McCurry KR. DireCt Lung Ultrasound Evaluation (CLUE): A novel technique for monitoring extravascular lung water in donor lungs. J Heart Lung Transplant 2019; 38:757-766. [DOI: 10.1016/j.healun.2019.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/24/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022] Open
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Schraufnagel DP, Steffen RJ, Vargo PR, Attia T, Elgharably H, Hasan SM, Bribriesco A, Wierup P. Devices for ex vivo heart and lung perfusion. Expert Rev Med Devices 2018; 15:183-191. [PMID: 29376452 DOI: 10.1080/17434440.2018.1430568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The number of organs available for heart and lung transplantation is far short of the number that is needed to meet demand. Perfusion and ventilation of donor organs after procurement has led to exciting advances in the field of cardiothoracic transplantation. The clinical implications of this technology allows for techniques to evaluate the quality of an organ, active rehabilitation of organs after procurement and prior to implantation, and increased time between organ procurement and implantation. This ex-vivo perfusion technique has also been referred to in the lay press as the 'heart in a box' or 'lung in a box.' AREAS COVERED This review includes information from case reports, case series, and clinical trials on ex vivo heart and lung perfusion. The focus is on the devices, ventilation and perfusion techniques, outcomes, and application of the technology. EXPERT COMMENTARY Ex vivo perfusion of donor hearts and lungs prior to transplantation has proven to be a viable alternative to standard cold-preservation strategies. Its use has allowed for ongoing expansion of the donor pool. The biggest barriers to expansion of this technology are access, cost, and lack of evidence which clearly supports superior outcomes.
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Affiliation(s)
- Dean P Schraufnagel
- a Department of Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Robert J Steffen
- a Department of Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Patrick R Vargo
- a Department of Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Tamer Attia
- a Department of Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Haytham Elgharably
- a Department of Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Saad M Hasan
- a Department of Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Alejandro Bribriesco
- a Department of Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Per Wierup
- a Department of Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
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Ex vivo lung graft perfusion. Anaesth Crit Care Pain Med 2016; 35:123-31. [DOI: 10.1016/j.accpm.2015.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/25/2015] [Indexed: 01/08/2023]
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Raemdonck D, Neyrinck A, Cypel M, Keshavjee S. Ex‐vivo lung perfusion. Transpl Int 2014; 28:643-56. [DOI: 10.1111/tri.12317] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/11/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Dirk Raemdonck
- Department of Thoracic Surgery University Hospitals Leuven Leuven Belgium
- Laboratory for Experimental Thoracic Surgery KU Leuven University Leuven Belgium
| | - Arne Neyrinck
- Laboratory for Experimental Thoracic Surgery KU Leuven University Leuven Belgium
- Department of Anaesthesiology University Hospitals Leuven Leuven Belgium
| | - Marcelo Cypel
- Division of Thoracic Surgery Toronto General Hospital Toronto ON Canada
- The Latner Thoracic Surgery Laboratories Toronto General Research Institute Toronto ON Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery Toronto General Hospital Toronto ON Canada
- The Latner Thoracic Surgery Laboratories Toronto General Research Institute Toronto ON Canada
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Corrigendum. Transpl Int 2013. [DOI: 10.1111/tri.12153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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