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Ex Vivo Lung Perfusion (EVLP) Clemens Aigner , MD Vienna Lung Transplant Program

Ex Vivo Lung Perfusion (EVLP) Clemens Aigner , MD Vienna Lung Transplant Program Head: Walter Klepetko , MD. Background Logistics III. Technique IV. Results. Ex-vivo evaluation of donor lungs. Ex-vivo evaluation of donor lungs. I. Background II . Logistics III. Technique

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Ex Vivo Lung Perfusion (EVLP) Clemens Aigner , MD Vienna Lung Transplant Program

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  1. Ex Vivo Lung Perfusion (EVLP) Clemens Aigner, MD Vienna Lung Transplant Program Head: Walter Klepetko, MD

  2. Background Logistics III. Technique IV. Results

  3. Ex-vivo evaluation of donor lungs

  4. Ex-vivo evaluation of donor lungs

  5. I. Background II. Logistics III. Technique IV. Results

  6. EVLP Design • We examine donor lungs that do not meet • the standard clinical criteria for donor lung utilization. • In order to more accurately predict donor lung function • and therefore, the safety of the transplant, • The lungs are functionally evaluated ex vivo.

  7. Inclusioncriteriafor EVLP assessment

  8. Exclusioncriteriafor EVLP assessment

  9. Inclusioncriteriafor transplant suitability

  10. Exclusioncriteriafor transplant suitability

  11. EVLP Flow Chart Donor lungs do not meet standard donor criteria for transplantation Donor lungs meet study inclusion criteria Lung harvest and transfer to Vienna. Potential recipient is called in. EVLP for 2h

  12. EVLP Flow Chart 2 ΔPaO2 > 350mmHg, Lung function maintained (PVR, compliance, PawP) Surgeon clinically satisfied with lungs Δ PaO2 < 350 mmHg, Lung function maintained (PVR, compliance, PawP) Additional up to 2hours on EVLP and hourly re-evaluation (up to 4h in total) Δ PaO2 > 350 mmHg Surgeon clinically satisfied with lungs Δ PaO2 < 350mmHg or Lung function deterioration(PVR, compliance, PawP) Transplantation Notransplantation. Lungssenttopathology.

  13. I. Background II. Logistics III. Technique IV. Results

  14. Organ harvesting • Long commonpulmonaryarterycuff!!! (ifshortharvestpieceofdonoraorta) • Sufficientatrialcuff • Staple trachea just underthelarynx

  15. Organ harvesting • Do NOT separate thelungs

  16. EVLP Circuit

  17. EVLP Circuit

  18. EVLP Circuit

  19. EVLP Circuit

  20. EVLP Circuit

  21. EVLP Circuit Perfusion evaluation (hourly, always performed 10min after recruitment) The following functional parameters should be measured and recorded hourly : • pulmonary artery flow (PAF): L/min • (mean) pulmonary artery pressure (PAP): mm Hg • left atrial pressure (LAP): mm Hg • pulmonary vascular resistance (PVR= [PAP-LAP] x 80 / PAF): dynes x sec x cm-5 • mean, peak and plateau airway pressure (mAwP, peak AwP, platAwP): cm H2O • dynamic compliance (mL/cm H2O) • perfusate gas analysis- inflow (PA) and outflow (PV) PO2, PCO2 and pH.

  22. I. Background II. Logistics III. Technique IV. Results

  23. Vienna Experience since 3/2010 10 EVLP runs 6 transplants after EVLP 30 daymortality 0%

  24. Donorcharacteristics

  25. Recipientcharacteristics

  26. Conclusion EVLP is a valuableandsafetooltoevaluatedonorlungswho do not meetstandardcriteria. Therebythedonorpoolcanbepotentiallyexpanded.

  27. Thankyoufor yourattention

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