Splitting the Lungs in a Box for Single Lung Transplantation

Abstract

Introduction Donor after cardiac death (DCD) are avoided in general for lung transplantation (LTx). Ex-vivo lung perfusion (EVLP) utilizing a TransMedics support device minimizes ischemia-reperfusion injury and helps successful LTx in DCD. Bilateral LTx is usually performed using the support device. We present splitting the lungs in the support device utilizing single LTx in two DCD donors. Case Report Case#1: A 62y Male patient with 40 LAS and h/o IPF underwent single LTx. The donor lungs from a 48y Male with h/o intracranial hemorrhage were procured and placed in the support device. The lungs were transported by air in the device. At the recipient site, the lungs were assessed and split with a GIA stapler in the device. The patient received a single LTx with an anterio-axillary thoracotomy approach. Warm and cold ischemic time were 87 and 103 min. The patient was brought back to the CICU in stable condition and the donor lung functioning well. He spent 5 days in the CICU before being transferred to the floor. His hospital course was complicated post-operatively by primary graft dysfunction, donor derived MSSA, and atrial fibrillation that were managed medically. He was eventually discharged after a 15 day stay. Case#2: Another 72y Male patient with 86 LAS and h/o IPF and PHT underwent single LTx. The donor lungs from a 38y Male, with h/o asphyxiation were procured and placed in the support device for air travel. At the recipient site, the lungs were assessed and split with a GIA stapler in the support device. The recipient underwent cardiac arrest immediately after general anesthesia with epinephrine for PHT. He was intubated, and CPR was started with closed chest compression for 13 min and 4 doses of epi were given. VA ECMO was initiated, and CPR discontinued. A single LTx was completed with an anterio-axillary thoracotomy approach. The warm and cold ischemic times were 173 and 258 min. The patient was brought back to the CICU in stable condition with the decision to continue VA ECMO. Patient was de-cannulated the following day. His hospital course has been extremely complicated and is now on hospital day 34 and on the floor. Summary Our case report on two patients suggests growing acceptance of single LTx in selected patients using EVLP in DCD. This adds to the recent literature that suggests the utility of using EVLP for DCD making more lungs viable and a splitting technique of the lungs in a box may deem appropriate.