V-157 Successful lung transplantation from a donor on extracorporeal membrane oxygenation support.

Hintergrund

Under the aspect of organ shortage organ retrieval from donors under special conditions can be considered. We report the case of a lung transplantation from a donor who was on extracorporeal membrane oxygenation (ECMO) support.

Material und Methode

A 46-year-old male donor died of cerebral hypoxemia due to occlusion of the left anterior descending coronary artery (LAD). During cardiopulmonary resuscitation, ECMO was established for cardiac failure and continued for 4 days. There was no knowledge of any other risk factors. The donor lung showed a maximal arterial oxygen pressure (PaO2) of 378 mmHg and an arterial carbon dioxide pressure (PaCO2) of 41,9 mmHg at 100% O2 and a positive end-expiratory pressure (PEEP) of 9 cmH2O under ECMO support. Imaging was without pathological findings, there were no signs of pulmonary infection. On-site evaluation was revealed a regular lung. Bronchoscopy showed only mild inflammation and secretion. Since ECMO-support didn’t allow to evaluate the organ’s functionality properly, an intraoperatively blood gas analysis from the left upper pulmonary vein showed acceptable oxygenation of blood through the lung. The organ was accepted and successfully transplanted into a 52-year-old male patient with chronic obstructive pulmonary disease (COPD), listed with a lung allocation score (LAS) of 32,48. Surgery was done sequentially via bilateral anterolateral thoracotomy without ECMO or heart-lung-machine support.

Ergebnis

The patient was extubated on the first postoperative day. He left the intensive care unit (ICU) 3 days later. Recovery was uneventful besides the need of cardioversion due to atrial flatter. His relative one-second capacity increased from 18% pre-transplant to 112% at 6-months. The patient was released from the hospital 26 days after surgery and has been well since.

Schlussfolgerung

ECMO-support for cardiac failure may not limit the ability to transplant the lung successfully. Evaluation of the lungs ability to oxygenate blood may be performed by obtaining blood gasses from a pulmonary vein.

Publikationsverlauf

Artikel online veröffentlicht:
06. September 2021