Prolonged EVLP to recondition an uncontrolled DCD lung

In a recent case in Milan, a uDCD lung was transplanted into a 32-year-old patient after 17 hours of EVLP.

Spain has long pioneered the utilization of organs derived from donors who died of uncontrolled circulatory /cardiac (uDCD) death outside the controlled environment of hospital care, partly due to assumed universal donation consent.

A couple of years ago XVIVO INSIGHTS(19) featured some of the largest series of uncontrolled DCD lung transplantations (including one series of 38 cases from Spain(20).) Uncontrolled DCD lungs are generally subjected to excessive warm ischemia and often have a higher airway complication rate. They can therefore be notoriously difficult to recondition and EVLP is now being increasingly utilized to restore acceptable functionality prior to transplantation.

Recently Italy has seen a remarkable uDCD case, which was published in Transplantation(21). In Milan, a uDCD lung was successfully reconditioned after an exceptionally prolonged session of warm EVLP totalling 17 hours! The 32-year-old patient was extubated after 36 hours and was discharged 21 days after the operation.

Lungs from uDCD donors may represent the extreme of marginality and EVLP in such cases is widely regarded as essential. This case report exemplifies the approach, as well as showing both that lengthy perfusions may be needed and that they work!

XVIVO Insights PB-2021-04-20


19. XVIVO INSIGHTS: More on Lungs Donated after Uncontrolled Circulatory Death (link to existing Insight)
20. Valdivia D, et al: Expanding the horizons: Uncontrolled donors after circulatory death for lung transplantation-First comparison with brain death donors. Clin Transplant. 2019; 33: e13561. (link to existing Abstract)
21. Palleschhi A,  L, G M, et al: Overcoming the Limits of Reconditioning: Seventeen Hours of Ex-Vivo Lung Perfusion (EVLP) with Successful Transplantation from Uncontrolled Circulatory Death Donor. Transplantation. 2021 Jan 25. doi: 10.1097/TP.0000000000003646 (link to Abstract)