Assessment of lung edema during ex-vivo lung perfusion by single transpulmonary thermodilution: A preliminary study in humans

Trebbia G1, Sage E2, Le Guen M3, Roux A4, Soummer A5, Puyo P2, Parquin F2, Stern M4, Pham T6, Sakka SG7, Cerf C8; Foch Lung Transplant Group. ( Foch Hospital, Suresnes, FR + Toronto + Cologne.

J Heart Lung Transplant. 2019 Jan;38(1):83-91. doi: 10.1016/j.healun.2018.09.019. Epub 2018 Oct 1.

Single transpulmonary thermodilution (SD) with extravascular lung water index (EVLWI) could become a new tool to better assess lung graft edema during ex-vivo lung perfusion (EVLP). In this study we compare EVLWI with conventional methods to better select lungs during EVLP and to predict post-transplant primary graft dysfunction (PGD).

We measured EVLWI, arterial oxygen/fraction of inspired oxygen (P/F) ratio, and static lung compliance (SLC) during EVLP in an observational study. At the end of EVLP, grafts were accepted or rejected according to a standardized protocol blinded to EVLWI results. We compared the respective ability of EVLWI, P/F, and SLC to predict PGD. Mann-Whitney U-test, Fisher’s exact test, and receiver-operating characteristic (ROC) curve data were used for analysis. p < 0.05 was considered statistically significant.

Thirty-five lungs were evaluated by SD during EVLP. Three lungs were rejected for pulmonary edema. Thirty-two patients were transplanted, 8 patients developed Grade 2 or 3 PGD, and 24 patients developed Grade 0 or 1 PGD. In contrast to P/F ratio, SLC, and pulmonary artery pressure, EVLWI differed between these 2 populations (p < 0.001). The area under the ROC for EVLWI assessing Grade 2 or 3 PGD at the end of EVLP was 0.93. Donor lungs with EVLWI >7.5 ml/kg were more likely associated with a higher incidence of Grade 2 or 3 PGD at Day 3.

Increased EVLWI during EVLP was associated with PGD in recipients.

Copyright © 2018 Elsevier Ltd. All rights reserved. KEYWORDS: ex-vivo lung perfusion; extravascular lung water index; lung edema; primary graft dysfunction; single transpulmonary thermodilution PMID: 30391201 DOI: 10.1016/j.healun.2018.09.019