Donor lung assessment using selective pulmonary vein gases

Area of Science:

• Cardiology
• Pulmonology
• Transplant Surgery

Background:

• Standard donor lung assessment relies on subjective methods like imaging, challenge gases, and visual interpretation.
• Central gases may not accurately reflect the true quality and function of donor lungs.
• There is a need for more objective measures to enhance donor lung evaluation.

Purpose of the Study:

• To evaluate the utility of selective pulmonary vein gases in corroborating subjective assessments of donor lungs.
• To compare the effectiveness of pulmonary vein gases versus central gases in predicting lung quality.

Main Methods:

• Donor lungs were assessed using intraoperative bronchoscopy, palpation, visual judgment, central aortic gases, and selective pulmonary vein gases.
• Partial pressure of oxygen (pO2) <300 mmHg on FiO2 of 1.0 was considered low.
• Post-transplant outcomes, including primary graft dysfunction and survival rates, were monitored.

Main Results:

• Selective pulmonary vein pO2 showed significant associations with bronchoscopic findings, palpation, and lung collapse assessments (P < 0.001).
• Intraoperative central pO2 poorly correlated with last intensive care unit pO2 (rs = 0.29).
• Low rates of primary graft dysfunction (13% and 11% for grades 2 and 3) and 90-day/1-year mortality (4% and 8%) were observed.

Conclusions:

• Selective pulmonary vein gases provide objective support for subjective donor lung assessments.
• Central gases may not accurately reflect individual lower lobe gas exchange, leading to false positives.
• Objective measures like pulmonary vein gases can optimize donor lung assessment, potentially lowering graft dysfunction and mortality.