O-097lung transplantation of initially rejected donors after ex-vivo lung reconditioning: the french experience

Only 15% of the brain death donor lungs are considered suitable for lung transplantation (LT). The normothermic ex-vivo lung perfusion (EVLP) technique is used to potentially increase the availability of high-risk donor lungs. We report our clinical experience of LT with initially rejected donors after ex-vivo lung reconditioning (EVLR). From April 2011 to July 2012, we performed EVLR in 21 pairs of lungs deemed unsuitable for transplantation and rejected by the 11 French lung transplant teams. After EVLR, lungs with acceptable function were transplanted. During the same period, 48 double lung transplantations (DLT) without EVLR were used as controls. Among 21 donor lungs, 20 recovered physiological function during EVLR with a median PO2/FIO2 ratio increasing from 256 mmHg to 485 mmHg at the end of EVLR (P < 0.0001) and 20 DLT were performed. The incidence of primary graft dysfunction 72 hours after LT was 10% in the EVLR group and 8% in the control group (P = 1). The median times of extubation, intensive care unit stay, and hospital discharge were 2, 10, and 37 days, respectively, in the EVLR group and they were 1, 5, and 28 days, respectively, in the control group (P = 0.055). Thirty-day mortality was 5% in the EVLR group and 4.2% in the control group (P = 1). One-year survival rates are 95 % in the EVLR group and 90% in the control group. EVLR is a reliable and repeatable technique that offers a significant increase of available donors. The results of LT with EVLR lungs are similar to those obtained with conventional donors. All authors have declared no conflicts of interest.