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Assessment of lung edema during ex-vivo lung perfusion by single transpulmonary thermodilution: A preliminary study in humans.
- Source :
-
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2019 Jan; Vol. 38 (1), pp. 83-91. Date of Electronic Publication: 2018 Oct 01. - Publication Year :
- 2019
-
Abstract
- Background: 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).<br />Methods: 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.<br />Results: 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.<br />Conclusions: Increased EVLWI during EVLP was associated with PGD in recipients.<br /> (Copyright © 2018 Elsevier Ltd. All rights reserved.)
- Subjects :
- Adult
Extravascular Lung Water
Female
Follow-Up Studies
Humans
Male
Middle Aged
Pulmonary Edema etiology
Pulmonary Edema physiopathology
Pulmonary Wedge Pressure
ROC Curve
Retrospective Studies
Perfusion adverse effects
Primary Graft Dysfunction prevention & control
Pulmonary Edema diagnosis
Thermodilution methods
Tissue Donors
Subjects
Details
- Language :
- English
- ISSN :
- 1557-3117
- Volume :
- 38
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 30391201
- Full Text :
- https://doi.org/10.1016/j.healun.2018.09.019