A CLUE for better assessment of donor lungs: Novel technique in clinical ex vivo lung perfusion

Kamal S Ayyat; Toshihiro Okamoto; Hiromichi Niikawa; Ichiro Sakanoue; Siddharth Dugar; Samir Q Latifi; Daniel J Lebovitz; Ajit Moghekar; Kenneth R McCurry

doi:10.1016/j.healun.2020.07.013

A CLUE for better assessment of donor lungs: Novel technique in clinical ex vivo lung perfusion

J Heart Lung Transplant. 2020 Nov;39(11):1220-1227. doi: 10.1016/j.healun.2020.07.013. Epub 2020 Jul 24.

Authors

Kamal S Ayyat¹, Toshihiro Okamoto², Hiromichi Niikawa³, Ichiro Sakanoue³, Siddharth Dugar⁴, Samir Q Latifi⁵, Daniel J Lebovitz⁶, Ajit Moghekar⁴, Kenneth R McCurry⁷

Affiliations

¹ 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.
² Department of Inflammation and Immunology, Lerner Research Institute and; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Transplant Center.
³ Department of Inflammation and Immunology, Lerner Research Institute and; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
⁴ Respiratory Institute; and.
⁵ Department of Pediatric Critical Care, Cleveland Clinic, Cleveland, Ohio; Lifebanc, Cleveland, Ohio.
⁶ Lifebanc, Cleveland, Ohio; Department of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio.
⁷ Department of Inflammation and Immunology, Lerner Research Institute and; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Transplant Center. Electronic address: mccurrk@ccf.org.

PMID: 32773324
DOI: 10.1016/j.healun.2020.07.013

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.

Keywords: ex vivo lung perfusion; extravascular lung water; lung transplantation; lung ultrasound; marginal donor lungs; pulmonary edema.

MeSH terms

Adult
Extracorporeal Circulation / methods*
Female
Humans
Lung Transplantation*
Male
Middle Aged
Perfusion / methods*
Primary Graft Dysfunction / diagnosis
Primary Graft Dysfunction / prevention & control*
ROC Curve
Retrospective Studies
Tissue Donors*
Ultrasonography