TY - JOUR
T1 - Utilization of Marginal Lung Donors With Low PaO2/FiO2 Ratio and High Body Mass Index
AU - Okamoto, Toshihiro
AU - Omara, Mohamed
AU - Ahmad, Usman
AU - Yun, James
AU - Bribriesco, Alejandro
AU - Unai, Shinya
AU - Zeeshan, Ahmad
AU - Johnston, Douglas
AU - Niikawa, Hiromichi
AU - Blackstone, Eugene H.
AU - Budev, Marie
AU - McCurry, Kenneth R.
N1 - Publisher Copyright:
© 2020 The Society of Thoracic Surgeons
PY - 2020/6
Y1 - 2020/6
N2 - Background: Lungs of donors with high body mass index (BMI) have more atelectasis and a lower PaO2/FiO2 (P/F) ratio than those with normal BMI. This study prospectively evaluated outcomes of a new approach for these lungs in our lung transplant program. Methods: From February 2016 to December 2018, 336 lung transplants were performed at Cleveland Clinic. Of these, 58 met criteria for our aggressive approach to donors with a P/F ratio of less than 300 mm Hg at offer and BMI of 25 kg/m2 or greater. In the donor operating room, lung recruitment was performed by positive end-respiratory pressure of 25 to 30 cmH2O for 30 seconds and lungs were converted to either straight transplantation or ex vivo lung perfusion (EVLP). Postoperative outcomes of the low P/F–high BMI group were compared with those of recipients receiving lungs meeting standard criteria. Results: Of the 58 donors, 33 were converted to straight lung transplantation because they demonstrated significant improvement in the P/F ratio after lung recruitment compared with the P/F ratio at lung offer (median, 278 versus 420 mm Hg; P < .01). Seventeen lungs with a persistently low P/F ratio underwent EVLP, 8 of which were transplanted. There was no significant difference in primary graft dysfunction grade 3 at 72 hours (n = 3 of 41 [7.5%] versus 31 of 247 [13%]; P = .79) or in 30-day survival (100% versus 97%; P = .60) between low P/F–high BMI and standard groups. Conclusions: These data suggest that atelectasis in high-BMI donors contributes to P/F ratios less than 300 mm Hg and that intraoperative lung recruitment or EVLP can allow the use of lungs from these donors with good outcomes.
AB - Background: Lungs of donors with high body mass index (BMI) have more atelectasis and a lower PaO2/FiO2 (P/F) ratio than those with normal BMI. This study prospectively evaluated outcomes of a new approach for these lungs in our lung transplant program. Methods: From February 2016 to December 2018, 336 lung transplants were performed at Cleveland Clinic. Of these, 58 met criteria for our aggressive approach to donors with a P/F ratio of less than 300 mm Hg at offer and BMI of 25 kg/m2 or greater. In the donor operating room, lung recruitment was performed by positive end-respiratory pressure of 25 to 30 cmH2O for 30 seconds and lungs were converted to either straight transplantation or ex vivo lung perfusion (EVLP). Postoperative outcomes of the low P/F–high BMI group were compared with those of recipients receiving lungs meeting standard criteria. Results: Of the 58 donors, 33 were converted to straight lung transplantation because they demonstrated significant improvement in the P/F ratio after lung recruitment compared with the P/F ratio at lung offer (median, 278 versus 420 mm Hg; P < .01). Seventeen lungs with a persistently low P/F ratio underwent EVLP, 8 of which were transplanted. There was no significant difference in primary graft dysfunction grade 3 at 72 hours (n = 3 of 41 [7.5%] versus 31 of 247 [13%]; P = .79) or in 30-day survival (100% versus 97%; P = .60) between low P/F–high BMI and standard groups. Conclusions: These data suggest that atelectasis in high-BMI donors contributes to P/F ratios less than 300 mm Hg and that intraoperative lung recruitment or EVLP can allow the use of lungs from these donors with good outcomes.
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U2 - 10.1016/j.athoracsur.2019.12.072
DO - 10.1016/j.athoracsur.2019.12.072
M3 - Article
C2 - 32067990
AN - SCOPUS:85082806186
SN - 0003-4975
VL - 109
SP - 1663
EP - 1669
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -