The First Experience of Ex-Vivo Lung Perfusion (EVLP) in Iran: An Effective Method to Increase Suitable Lung for Transplantation.

BACKGROUND: Although lung transplantation is a well-accepted treatment for end-stage lung diseases patients, only 15%-20% of the brain-dead donors' lungs are usable for transplantation. This results in high mortality of candidates on waiting lists. Ex-vivo lung perfusion (EVLP) is a novel method for better evaluation of a potential lung for transplantation. OBJECTIVE: To report the first experience of EVLP in Iran. METHODS: The study included a pig in Vienna Medical University, Vienna, Austria, and 4 humans in Masih Daneshvari Hospital, Tehran, Iran. All brain-dead donors from 2013 to 2015 in Tehran were evaluated for EVLP. Donors without signs of severe chest trauma or pneumonia, with poor oxygenation were included. RESULTS: An increasing trend in difference between the pulmonary arterial pO2 and left atrial pO2, an increasing pattern in dynamic lung compliance, and a decreasing trend in the pulmonary vascular resistance, were observed. CONCLUSION: The initial experience of EVLP in Iran was successful in terms of important/critical parameters. The results emphasize on some important considerations such as precisely following standard lung harvesting and monitoring temperature and pressure. EVLP technique may not be a cost-effective option for low-income countries at first glance. However, because this is the only therapeutic treatment for end-stage lung disease, it is advisable to continue working on this method to find alternatives with lesser costs.

Survival of Iranian patients on lung transplant waiting list: is there any difference?

OBJECTIVE: Lung transplantation is the last treatment option for end-stage pulmonary diseases. Reviewing the characteristics of patients on the lung transplant waiting list is a helpful way to evaluate and prioritize the patients in need of special care. Because we have no information about mortality on the lung transplantation waiting list in Iran, the aim of this study was to evaluate the characteristics and survival rates of these patients. METHODS: The file of lung transplant candidates listed between 2005 and 2010 were evaluated for patient demographic data, type of disorder, waiting list time, and outcomes of death, transplantation, or alive. RESULTS: The 131 patients on our list in this period revealed a mean age of 37±14 years with 86 (66%) males. The most common disorder among waiting list patients was pulmonary fibrosis (n=52; 40%). Among the 17 (13%) patients who were transplanted, most (35%) suffered from pulmonary fibrosis. The mean waiting time to transplantation was 17.2±11.8 months. Twenty-two patients (7%) died while on the waiting list. The mortality rate was unexpectedly highest among cystic fibrosis patients and then those with bronchiectasis. The mean survival time for all non-transplant patients based on the Kaplan-Meier method was 27.4 months and their 2-year survival rate was 74% based on life tables. CONCLUSION: Although pulmonary fibrosis patients show the poorest survival on lung transplant waiting lists, in other countries, patients with cystic fibrosis and bronchiectasis displayed the worst survival on the Iranian list probably due to their poor rehabilitation and sputum evacuation. We concluded that it is necessary for every center to evaluate the characteristics of its patient cohort to match the activity according to the needs.

Age and sex predict PaO2/FiO2 ratio in brain-dead donor lungs.

OBJECTIVES: To define the prevalence of various ranges of the ratio of partial arterial oxygen tension to fraction of inspired oxygen (Pao(2)/Fio(2)) and to determine correlative and predictive variables of donor lung Pao(2)/Fio(2). MATERIAL AND METHODS: From the brain death database of Masih Daneshvari Hospital Organ Procurement Center, we extracted demographic data, cause of injury, patient clinical condition, and laboratory findings as independent data. Donor lung suitability was determined with an oxygen challenge test, with results of 400 mm Hg considered ideal; 300 to 399 mm Hg, good; 200 to 299 mm Hg, borderline; and less than 200 mm Hg, not acceptable. RESULTS: Using the Pao(2)/Fio(2) cutoff points, 6.7% of donor lungs were considered ideal; 26.7%, good; 40%, borderline; and 26.7%, unacceptable. Mean (SD; range) Pao(2)/Fio(2) was 266.6 (85.6; 110-460). The Pao(2)/Fio(2) was significantly correlated with age (r = -0.35; P = .02). After entering the study variables into a linear regression model, age (-2.3; P = .008) and sex (51.5; P = .04) were significant predictors of donor lung suitability (R(2) = 0.95; P < .001). CONCLUSION: Results of oxygen challenge tests demonstrated better suitability of lungs from male and younger brain-dead donors. This finding is independent of other variables including cause of brain death and clinical and paraclinical data.