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Ayyat KS, Okamoto T, Niikawa H, Sakanoue I, Dugar S, Latifi SQ, Lebovitz DJ, Moghekar A, McCurry KR. A CLUE for better assessment of donor lungs: Novel technique in clinical ex vivo lung perfusion. J Heart Lung Transplant 2020; 39:1220-1227. [PMID: 32773324 DOI: 10.1016/j.healun.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The direCt Lung Ultrasound Evaluation (CLUE) technique was proven to be an accurate method for monitoring extravascular lung water in donor lungs during ex vivo lung perfusion (EVLP) in an experimental model. The aim of this study was to examine the application of CLUE in the clinical setting. METHODS Lungs were evaluated using acellular EVLP protocol. Ultrasound images were obtained directly from the lung surface. Images were graded according to the percentage of B-lines seen on ultrasound. CLUE scores were calculated at the beginning and end of EVLP for the whole lung, each side, and lobe based on the number (No.) of images in each grade and the total No. of images taken and evaluated retrospectively. RESULTS A total of 23 EVLP cases were performed resulting in 13 lung transplants (LTxs) with no hospital mortality. Primary graft dysfunction (PGD) occurred in only 1 recipient (PGD3, no PGD2). Significant differences were found between suitable and non-suitable lungs in CLUE scores (1.03 vs 1.85, p < 0.001), unlike the partial pressure of oxygen/fraction of inspired oxygen ratio. CLUE had the highest area under the receiver operating characteristic curve (0.98) compared with other evaluation parameters. The initial CLUE score of standard donor lungs was significantly better than marginal lungs. The final CLUE score in proned lungs showed improvement when compared with initial CLUE score, especially in the upper lobes. CONCLUSIONS The CLUE technique shows the highest accuracy in evaluating donor lungs for LTx suitability compared with other parameters used in EVLP. CLUE can optimize the outcomes of LTx by guiding the decision making through the whole process of clinical EVLP.
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Affiliation(s)
- Kamal S Ayyat
- Department of Inflammation and Immunology, Lerner Research Institute and; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Toshihiro Okamoto
- Department of Inflammation and Immunology, Lerner Research Institute and; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Transplant Center
| | - Hiromichi Niikawa
- Department of Inflammation and Immunology, Lerner Research Institute and; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ichiro Sakanoue
- Department of Inflammation and Immunology, Lerner Research Institute and; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Samir Q Latifi
- Department of Pediatric Critical Care, Cleveland Clinic, Cleveland, Ohio; Lifebanc, Cleveland, Ohio
| | - Daniel J Lebovitz
- Lifebanc, Cleveland, Ohio; Department of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio
| | | | - Kenneth R McCurry
- Department of Inflammation and Immunology, Lerner Research Institute and; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Transplant Center.
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Ayyat KS, Okamoto T, Niikawa H, Itoda Y, Dugar S, Latifi SQ, Lebovitz DJ, Moghekar A, McCurry KR. DireCt Lung Ultrasound Evaluation (CLUE): A novel technique for monitoring extravascular lung water in donor lungs. J Heart Lung Transplant 2019; 38:757-766. [DOI: 10.1016/j.healun.2019.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/24/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022] Open
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Niikawa H, Okamoto T, Ayyat KS, Itoda Y, Farver CF, Hata JS, McCurry KR. A novel concept for evaluation of pulmonary function utilizing PaO2/FiO2 difference at the distinctive FiO2 in cellular ex vivo lung perfusion-an experimental study. Transpl Int 2019; 32:797-807. [PMID: 30891833 DOI: 10.1111/tri.13426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/30/2018] [Accepted: 03/14/2019] [Indexed: 11/28/2022]
Abstract
For more accurate lung evaluation in ex vivo lung perfusion (EVLP), we have devised a new parameter, PaO2 /FiO2 ratio difference (PFD); PFD1-0.4 = P/F ratio at FiO2 1.0 - P/F ratio at FiO2 0.4. The aim of this study is to compare PFD and transplant suitability, and physiological parameters utilized in cellular EVLP. Thirty-nine human donor lungs were perfused. At 2 h of EVLP, PFD1-0.4 was compared with transplant suitability and physiological parameters. In a second study, 10 pig lungs were perfused in same fashion. PFD1-0.4 was calculated by blood from upper and lower lobe pulmonary veins and compared with lobe wet/dry ratio and pathological findings. In human model, receiver operating characteristic curve analysis showed PFD1-0.4 had the highest area under curve, 0.90, sensitivity, 0.96, to detect nonsuitable lungs, and significant negative correlation with lung weight ratio (R2 = 0.26, P < 0.001). In pig model, PFD1-0.4 on lower and upper lobe pulmonary veins were significantly associated with corresponding lobe wet/dry ratios (R2 = 0.51, P = 0.019; R2 = 0.37, P = 0.060), respectively. PFD1-0.4 in EVLP demonstrated a significant correlation with lung weight ratio and allowed more precise assessment of individual lobes in detecting lung edema. Moreover, it might support decision-making in evaluation with current EVLP criteria.
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Affiliation(s)
- Hiromichi Niikawa
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Toshihiro Okamoto
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Kamal S Ayyat
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.,Department of Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt
| | - Yoshifumi Itoda
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Carol F Farver
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - J Steven Hata
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | - Kenneth R McCurry
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA.,Department of Transplant Center, Cleveland Clinic, Cleveland, OH, USA
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