Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Ex vivo lung perfusion in Brazil

A experiência brasileira na perfusão pulmonar ex vivo

Luis Gustavo Abdalla1, Karina Andrighetti de Oliveira Braga1, Natalia Aparecida Nepomuceno1, Lucas Matos Fernandes1, Marcos Naoyuki Samano1, Paulo Manuel Pêgo-Fernandes1

J Bras Pneumol.2016;42(2):95-99

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the use of ex vivo lung perfusion (EVLP) clinically to prepare donor lungs for transplantation. Methods: A prospective study involving EVLP for the reconditioning of extended-criteria donor lungs, the criteria for which include aspects such as a PaO2/FiO2 ratio < 300 mmHg. Between February of 2013 and February of 2014, the lungs of five donors were submitted to EVLP for up to 4 h each. During EVLP, respiratory mechanics were continuously evaluated. Once every hour during the procedure, samples of the perfusate were collected and the function of the lungs was evaluated. Results: The mean PaO2 of the recovered lungs was 262.9 ± 119.7 mmHg at baseline, compared with 357.0 ± 108.5 mmHg after 3 h of EVLP. The mean oxygenation capacity of the lungs improved slightly over the first 3 h of EVLP-246.1 ± 35.1, 257.9 ± 48.9, and 288.8 ± 120.5 mmHg after 1, 2, and 3 h, respectively-without significant differences among the time points (p = 0.508). The mean static compliance was 63.0 ± 18.7 mmHg, 75.6 ± 25.4 mmHg, and 70.4 ± 28.0 mmHg after 1, 2, and 3 h, respectively, with a significant improvement from hour 1 to hour 2 (p = 0.029) but not from hour 2 to hour 3 (p = 0.059). Pulmonary vascular resistance remained stable during EVLP, with no differences among time points (p = 0.284). Conclusions: Although the lungs evaluated remained under physiological conditions, the EVLP protocol did not effectively improve lung function, thus precluding transplantation.

 


Keywords: Lung transplantation; Organ preservation; Brain death; Donor selection.

 


Ex vivo lung reconditioning: a new era for lung transplantation

Recondicionamento pulmonar ex vivo: uma nova era para o transplante pulmonar

Alessandro Wasum Mariani, Paulo Manuel Pêgo-Fernandes, Luis Gustavo Abdalla, Fabio Biscegli Jatene

J Bras Pneumol.2012;38(6):776-785

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Lung transplantation has come to be viewed as the best treatment option for various end-stage lung diseases. The low number of viable donors continues to be a major obstacle to increasing the number of lung transplants, resulting in high mortality among patients on the waiting list. Unlike transplantation of other solid organs, lung transplantation is primarily limited not by the absolute number of donors but by the viability of the donor lungs, which can be damaged by brain death and by treatments given in the ICU. There are various proposals of ways to increase the number of lung donors: intensification of donation campaigns, use of non-heart-beating donors, living lobar lung transplantation, and adoption of more flexible criteria for donors. However, the proposal that has attracted the most attention from lung transplant groups is ex vivo lung perfusion, especially due to the prospect of reconditioning previously discarded lungs. This system consists of perfusion and ventilation of the isolated heart-lung block using a modified cardiopulmonary bypass circuit. Various authors have been studying this technique due to the satisfactory results obtained and the prospect of an increase in the number of organs suitable for transplantation. Researchers in Sweden, Canada, Austria, England, Spain, and Brazil have extensive experience with the method and have introduced modifications to it. The objective of this article was to review the development of, state of the art in, and future prospects for the ex vivo model of lung perfusion and reconditioning.

 


Keywords: Lung transplantation; Transplantation conditioning; Perfusion; Organ preservation.

 


Lung transplantation: overall approach regarding its major aspects.

Transplante pulmonar: abordagem geral sobre seus principais aspectos.

Priscila Cilene León Bueno de Camargo1, Ricardo Henrique de Oliveira Braga Teixeira1, Rafael Medeiros Carraro1, Silvia Vidal Campos1, José Eduardo Afonso Junior1, André Nathan Costa1, Lucas Matos Fernandes1, Luis Gustavo Abdalla1, Marcos Naoyuki Samano1, Paulo Manuel Pêgo-Fernandes1,2

J Bras Pneumol.2015;41(6):547-553

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CNPq, Capes, Ministério da Educação, Ministério da Ciência e Tecnologia, Governo Federal, Brasil, País Rico é País sem Pobreza
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