Julien de Wolf, Philippe Puyo, Pierre Bonnette, Matthieu Glorion, Nicolas Salley, Antoine Roux, Ngai Liu, Alain Chapelier, Édouard Sage et le groupe de transplantation pulmonaire de Foch
Institution : Service de chirurgie thoracique et transplantation pulmonaire, hôpital Foch, Paris
Objectives : Ex vivo lung perfusion (EVLP) has been developed as a method to reassess and recondition marginal lungs. However, evaluation of the lung during procedure is limited to a combination of physiological variables. We aim to evaluate the feasibility and utility of a scan via the O-Arm® (Medtronic Inc., Minneapolis, MN, USA) imaging to help the evaluation of the lung during ex vivo lung reconditioning (EVLR) procedure in Operating Room.
Methods : We used the Toronto protocol for the EVLP. For assessing the lung graft we used; a clinical and functionnal assessment associated with a parenchyma evaluation, using the O-Arm®. The decision to transplant was taken based on a recovered physiological function with P/F ratio more than 400 mmHg, as well as the associated improvement or stability of the other functional parameters.
Results : We evaluated three consecutive extended-criteria brain-death donor lungs in July and August 2013. Two donors died after a stroke. In those two cases, CT scan showed a right lower lobe opacification and was associated with purulent secretion in the right lower lobe evidenced in the bronchoscopy. The other donor died after a high kinetic trauma with head and chest lesions. The CT scan showed left lung contusion. The O-Arm® evaluation highlight on 2 grafts an attenuation of ground-glass opacification and better lung inflation. Because they were associated with recovered physiological functions, the two grafts were transplanted.
On the other hand, O-Arm® scan showed an increase in the parenchyma opacification for the other graft (died after a stroke). This evaluation was associated with deterioration of the clinical and functionnal assessment. The lungs were not transplanted.
Conclusion : The use of a high-performance real-time imaging system, such as O-Arm®, to evaluate lung grafts from extended-criteria donors during EVLR show an additional argues to select and increase the lung transplants pool.