Ex-vivo recruitment and x-ray assessment of donor lungs in a challenging retrieval from a donor supported by lvad using the portable normothermic perfusion system: a case report

Abstract

BackgroundLung transplantation (LTx) is limited by the shortage of suitable donors. To overcome this problem, many programs have begun to use donors with extended criteria (marginal donors). However, brain-dead patients with implanted mechanical circulatory support system have rarely been considered as potential lung donors. This case demonstrates the feasibility of lung transplantations from organ donors supported by a mechanical circulatory support system despite the possible difficulties of lung retrieval.Case presentationOur case presents a successful procurement and bilateral lung transplantation from a donor supported by a left ventricular assist device (LVAD) who experienced an intraoperatively haemodynamic complication. The use of portable normothermic perfusion device let us to reduce ischemic injury and assess these marginal donor lungs helping us to determine the clinical suitability for transplantation. Given our extensive experience with the device instrumentation and management, the EVLP process was uneventful with excellent post-transplant course.ConclusionsThis case report demonstrates the feasibility of lung transplantations from organ donors supported by a mechanical circulatory support system using the portable normothermic perfusion platform to assess and preserve these donor lungs.

Multiple organ retrieval in a brain dead left ventricular assist device donor

“…The number of reports describing organ retrieval from donors with LVADs is still small [1][2][3][4][5].…”

“…The suitability of patients with LVADs for organ donation has not been addressed in terms of guidelines [1,4]. Considering prior cardiac failure and cardiac surgery, it is a relative contraindication [1][2][3][4][5]. However, after LVAD implantation, all systemic organs could be kept stable.…”

“…Left ventricular assist device (LVAD) support in donors may contribute in preserving proper haemodynamics and systemic perfusion during organ retrieval thus decreasing the risk of multiple organ injury. This is an option to expand the current organ supply [1][2][3][4][5].…”

Evaluation of the efficacy of a novel perfusion solution for normothermic ex vivo lung perfusion compared with Steen solution™ (animal experimental study)

“…Steen Solution -это раствор, содержащий декстран и альбумин, имитирующий концентрации внеклеточных электролитов [8,14,15]. OCS Lung Solution -это аналогичный буферный раствор, содержащий декстран вместо альбумина [5,8,20,21].…”

Evolving Trend of EVLP: Advancements and Emerging Pathways

“…Some more complicated cases, such as donors as brain-dead patients implanted with mechanical circulatory support system or bilateral lungs procured and transplanted after using of portable normothermic perfusion device, reaching the aim of reducing ischemic injury while assessing the marginal donor lungs for suitability [28]. A large and non-randomized trial DEVELOP-UK, showed that 34% untransplantable lung could be put into procedure after EVLP.…”