Noninflammatory Causes of Pulmonary Edema During Ex Vivo Lung Perfusion

Ex vivo lung perfusion (EVLP) is used to evaluate donor lungs prior to lung transplantation. Development of pulmonary edema during EVLP is generally thought to represent inflammatory breakdown of the air-fluid barrier and these lungs are declined for transplant. We present the case of a donor lung that underwent stapled wedge resection during cold storage for air leak and the subsequent development of profound (∼650 mL) pulmonary edema around the staple line during EVLP. Nevertheless, the edema cleared shortly after implantation. This report illustrates the potential for significant alveolar fluid clearance and sealing of vascular injury after implantation when edema is not caused by inflammatory injury.