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Utilization of Marginal Lung Donors With Low PaO 2 /FiO 2 Ratio and High Body Mass Index.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2020 Jun; Vol. 109 (6), pp. 1663-1669. Date of Electronic Publication: 2020 Feb 15. - Publication Year :
- 2020
-
Abstract
- Background: Lungs of donors with high body mass index (BMI) have more atelectasis and a lower PaO <subscript>2</subscript> /FiO <subscript>2</subscript> (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.<br />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/m <superscript>2</superscript> or greater. In the donor operating room, lung recruitment was performed by positive end-respiratory pressure of 25 to 30 cmH <subscript>2</subscript> O 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.<br />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.<br />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.<br /> (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 109
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32067990
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2019.12.072