Assessing lung edema to predict risk of primary graft dysfunction (PGD)

A couple of novel, non-invasive direct techniques (ultrasound and thermodilution) for assessing extravascular lung water (EVLW)/edema before or during EVLP have recently been evaluated.

The Cleveland group (1) studied the feasibility and accuracy of a direCt Lung Ultrasound Evaluation (CLUE) technique to assess total lung and regional lobe lung water (edema) in both rejected human and porcine lungs. The CLUE point score was found to correlate locally with wet/dry ratio in human and porcine models and total score with total lung weight. The lobe score correlated negatively with partial pressure of oxygen/fraction of inspired oxygen ratio in the human model. CLUE scores were found to be significantly correlated with lung weight, wet/dry, and PaO2/FIO2 ratio.

Earlier this year, another rapid non-invasive, bedside technique – single transpulmonary thermodilution – was evaluated by authors from Paris, Cologne and Toronto(2) as a new tool to better assess lung graft edema and the related risk of Primary Graft Dysfunction (PGD) during ex-vivo lung perfusion (EVLP).

Here again, donor lungs measuring >7.5 ml/kg on the extravascular lung water index (EVLWI) were more likely to be associated with a higher incidence of Grade 2 or 3 Primary Graft Dysfunction (PGD) at Day 3. Increased EVLWI during EVLP was associated with PGD in recipients.

References:

  1. Ayyat KS et al, DireCt Lung Ultrasound Evaluation (CLUE): A novel technique for monitoring extravascular lung water in donor lungs. J Heart Lung Transplant. 2019 Jul;38(7):757-766 (link to abstract)
  2. Trebbia G et al, Assessment of lung edema during ex-vivo lung perfusion by single transpulmonary thermodilution: A preliminary study in humans. J Heart Lung Transplant. 2019 Jan;38(1):83-91 (link to abstract)

Xvivo Insights PB-2019-10-13