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Transplantation |

Evaluation of Human Lungs From Category 1 Non-Heart-Beating Donors (NHBDs) With Ex-Vivo Lung Perfusion (EVLP) in the U.S.

Thomas Egan, MD; John Blackwell, BS; Lolita Forrest, PhD; William Simmons, MS; Katherine Birchard, MD; William Funkhouser, MD; Boming Dong, MD; Staci Beamer, MD; Sheakar Reddy, MB; J Brent Meyers, MD; Michael Bachman, MHS; Nissa Casey, BA; Ginger Delario, PhD; Danielle Niedfeldt, JD
Author and Funding Information

Dept. of Surgery, School of Medicine, UNC Chapel Hill, Chapel Hill, NC


Chest. 2014;145(3_MeetingAbstracts):635A. doi:10.1378/chest.1779672
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Abstract

SESSION TITLE: Transplantation Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: We developed a protocol to procure human lungs from victims of cardiac arrest in an urban county in North Carolina by co-operation with Emergency Medical Services (EMS), our organ procurement organization (OPO), and our hospital, and evaluate them for transplant suitability with EVLP (XVIVO™).

METHODS: Over 2 months, EMS identified 4 potential NHBDs for lung retrieval. After failed resuscitation at home, EMS facilitated contact between next-of-kin and our OPO. After assent was obtained, two deceased donors were ventilated with O2 and transported for lung recovery in an operating room. A detailed medical/social donor history was obtained by our OPO. Lungs were flushed antegrade with cold Perfadex™ (containing Alprostadil and heparin) and retrograde. EVLP was performed as described at Chest 2011 for 4 hours with Steen solution™. Post-EVLP spiral CT scans were obtained.

RESULTS: Two identified potential donors were not evaluated: one failed consent; one with currently treated asthma. Lungs were obtained from 2 males, age 60. Warm ischemic time was 71 and 49 minutes (non-ventilated); and 141 and 135 minutes (O2-ventilated). Donor one was being investigated for a recently discovered cold agglutinin. These lungs did not flush well and looked pink after flush with cold Perfadex™. Large pulmonary emboli were removed from both pulmonary arteries and an obvious pulmonary infarct was seen. These lungs developed pulmonary edema with EVLP, stopped after 1 hour. The second donor had a prior sternotomy for ascending aorta and mitral valve replacement, making dissection difficult and long. However, function during EVLP was excellent. Post-EVLP CT scan showed minimal patchy ground glass opacities. These lungs were judged transplantable but no suitable size- and blood-type-appropriate consented recipient was available.

CONCLUSIONS: Lungs from Category 1 NHBDs may be suitable for transplant. Logistical challenges to decrease warm ischemic times require address. Therapies to NHBD lungs via the airway or during EVLP could be evaluated.

CLINICAL IMPLICATIONS: Victims of cardiac arrest - Category 1 NHBDs - may provide a large number of lungs that are suitable for transplant.

DISCLOSURE: Thomas Egan: Other: Received donations-in-kind (equipment and supplies) from XVIVO for this research, Shareholder: and Founder, X-In8 Biologicals Corporation, deveoping products to reduce ischemia-reperfusion injury for transplant. My spouse is paid hourly for bookkeeping of NIH-funded grants., Fiduciary position (of any organization, association, society, etc, other than ACCP: President and founder of Lung Banks of America, a 501(c)3 Corporation whose mission is to promote lung retrieval from non-heart-beating donors. I am not paid. My spouse will be paid to administer a subcontract on a NIH-funded subcontract as Sect-Treasurer., Grant monies (from sources other than industry): This work was supported by NIH grant 1RC2HL101641-01, which paid part of my salary John Blackwell: Other: My PI and my Department received donations-in-kind (equipment and supplies) from XVIVO for this project, Grant monies (from sources other than industry): This work was supported by NIH grant 1RC2HL101641-01, which paid part of my salary Lolita Forrest: Other: My PI and my Department received donations-in-kind (equipment and supplies) from XVIVO for this project, Grant monies (from sources other than industry): This work was supported by NIH grant 1RC2HL101641-01, which paid part of my salary William Simmons: Other: My PI and my Department received donations-in-kind (equipment and supplies) from XVIVO for this project, Grant monies (from sources other than industry): This work was supported by NIH grant 1RC2HL101641-01, which paid part of my salary Katherine Birchard: Grant monies (from sources other than industry): This work was supported by NIH grant 1RC2HL101641-01, which paid part of my salary William Funkhouser: Grant monies (from sources other than industry): This work was supported by NIH grant 1RC2HL101641-01, which paid part of my salary Boming Dong: Other: My PI and my Department received donations-in-kind (equipment and supplies) from XVIVO for this project, Grant monies (from sources other than industry): This work was supported by NIH grant 1RC2HL101641-01, which paid part of my salary Staci Beamer: Other: My PI and my Department received donations-in-kind (equipment and supplies) from XVIVO for this project Sheakar Reddy: Grant monies (from sources other than industry): This work was supported by NIH grant 1RC2HL101641-01, which paid part of my salary Nissa Casey: Grant monies (from sources other than industry): This work was supported by NIH grant 1RC2HL101641-01, which paid part of my salary The following authors have nothing to disclose: J Brent Meyers, Michael Bachman, Ginger Delario, Danielle Niedfeldt

Ex-vivo lung perfusion (EVLP) is not approved by the FDA in humans for transplant. EVLP of lungs retrieved after death is also not approved for use in humans. The presenter has an IDE from the FDA and UNC IRB approval to offer suitable lungs retrieved after death assessed by EVLP for transplant to consented patients.


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