Ex Vivo Evaluation of Human Lungs for Transplant Suitability

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Ex Vivo Evaluation of Human Lungs for Transplant Suitability Thomas M. Egan, MD, MS, John A. Haithcock, RRT, William A. Nicotra, BS, Giovanna Koukoulis, MD, Hidetoshi Inokawa, MD, PhD, Mayura Sevala, PhD, Paul L. Molina, MD, William K. Funkhouser, MD, PhD, Burton J. Mattice, MBA The Annals of Thoracic Surgery Volume 81, Issue 4, Pages 1205-1213 (April 2006) DOI: 10.1016/j.athoracsur.2005.09.034 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Photograph of ventilation-perfusion circuit with human lungs (LU) suspended into opened Medtronic cell saver bag. (B = Medtronic Biomedicus pump; M = Medtronic Affinity oxygenator; T = Terumo CDI-500 display; V = Siemens C900 ventilator.) (B) Schematic of ex vivo ventilation-perfusion circuit. The Annals of Thoracic Surgery 2006 81, 1205-1213DOI: (10.1016/j.athoracsur.2005.09.034) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Pao2/Fio2 in the circuit with Fio2 1.0 compared with Pao2/Fio2 in the donor. (B) Pao2/Fio2 in the circuit with Fio2 0.5 compared with Pao2/Fio2 in the donor. The Pao2/Fio2 ratio in the donor was determined only on Fio2 1.0, and when more than one Pao2 was available on Fio2 1.0, the average was used, as reported in Table 3. There was a better correlation between Pao2/Fio2 assessed in the circuit with Pao2/ Fio2 in the donor when lungs were ventilated ex vivo with Fio2 0.5. The reason for this is unclear. (Fio2 = fraction of inspired oxygen; Pao2 = partial pressure of oxygen.) The Annals of Thoracic Surgery 2006 81, 1205-1213DOI: (10.1016/j.athoracsur.2005.09.034) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Ex vivo plain radiograph and computed tomographic scan images of donor lung No. 1 showing bilateral lower lobe consolidation consistent with bilateral lower lobe pneumonia. This donor had good arterial blood gases but bilateral purulent bronchoscopy resulted in a determination that the lungs were not suitable for transplant. The Annals of Thoracic Surgery 2006 81, 1205-1213DOI: (10.1016/j.athoracsur.2005.09.034) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions