Department of Thoracic and Cardiovascular Surgery; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, Ohio; Transplant Center, Cleveland, Ohio.
Department of Thoracic and Cardiovascular Surgery; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland, Ohio.
J Heart Lung Transplant. 2022 Jun;41(6):818-828. doi: 10.1016/j.healun.2022.02.011. Epub 2022 Feb 19.
Elevated donor lung weight may adversely affect donor lung transplant suitability and post-transplant outcomes. The objective of this study is to investigate the impact of lung weight after procurement and ex vivo lung perfusion (EVLP) on transplant suitability, post-transplant graft dysfunction, and clinical outcomes and define the donor lung weight range most relevant to clinical outcomes.
From February 2016 to August 2020, 365 human lung donors to a single transplant center were retrospectively reviewed. 239 were transplanted without EVLP, 74 treated with EVLP (50 went on to transplant), and 52 declined for transplant without EVLP consideration. Donor lung weights were measured immediately after procurement and, when performed, after EVLP. Lung weights were adjusted by donor height and divided into 4 quartiles.
Donor lungs in the highest weight quartile at donor hospital had a significantly lower transplant suitability rate after EVLP, higher rates of primary graft dysfunction grade 3 at 72 hours, and longer intensive care unit/hospital stay. For lungs treated with lung perfusion, the highest lung weight quartile at the end of lung perfusion was associated with a significantly lower transplant suitability rate, higher incidence of primary graft dysfunction grade 3 at 72 hours, and longer intensive care unit/hospital stay, compared to the other categories.
Donor lung weight stratified by quartile categories can assist decision-making regarding need for EVLP at the donor hospital as well as during EVLP evaluation. Caution should be used when considering donor lungs in the highest weight quartile for transplantation.
供体肺重量升高可能对供体肺移植的适宜性和移植后的结果产生不利影响。本研究的目的是探讨获取后和体外肺灌注（EVLP）后的肺重量对移植适宜性、移植后移植物功能障碍和临床结果的影响，并确定与临床结果最相关的供体肺重量范围。
从 2016 年 2 月至 2020 年 8 月，回顾性分析了一家移植中心的 365 例人肺供体。239 例未行 EVLP 移植，74 例接受 EVLP 治疗（50 例继续移植），52 例因未考虑 EVLP 而拒绝移植。供体肺在获取后立即测量重量，并在进行 EVLP 时测量。供体肺重量按供体身高进行调整，并分为 4 个四分位区间。
供体医院供体肺重量最高四分位区间的 EVLP 后移植适宜性率显著降低，72 小时原发性移植物功能障碍 3 级发生率更高，重症监护病房/住院时间更长。对于接受肺灌注治疗的肺，肺灌注结束时肺重量最高四分位区间的移植适宜性率显著降低，72 小时原发性移植物功能障碍 3 级发生率更高，重症监护病房/住院时间更长。
按四分位区间分层的供体肺重量可协助决策是否在供体医院和 EVLP 评估期间需要 EVLP。在考虑移植最高四分位区间的供体肺时应谨慎。
