T-05 – Real-time imaging with the O-Arm® of lung parenchyma during ex vivo lung reconditioning

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.