The Value of Ex Situ CT Imaging of Donor Lungs Prior to Transplantation.

PURPOSE: Donor shortage remains a major obstacle associated with considerable mortality in patients waiting for lung transplantation (LTx). Objective donor lung assessment is crucial to obtain sufficient grafts of acceptable quality. We hypothesized that out of body chest CT may be an innovative way to assess grafts prior to LTx. Therefore, this study prospectively investigated the value of CT scan of donor lungs prior to LTx. METHODS: Between 12/2016 and 01/2018, all potential donor lungs were inspected in-situ, recovered and ex situ CT scanned during standard cold preservation. The transplant team and radiologist were blinded for the CT scan, which thus did not change the decision to transplant. CTs were scored for CT abnormalities and were compared between transplanted (Tx) and non-Tx grafts. In addition, CT of Tx grafts were compared between recipients developing PGD3 within 72 h ('PGD3') and recipients who did not ('No PGD3'). RESULTS: In total, 75 lungs were transplanted and 25 were not transplanted, of which 19 were declined for poor graft quality and 6 for extrapulmonary malignancies or logistics. CT abnormalities (CSL, GGO, EMPHY) differed between Tx and non-Tx grafts (Figure 1A). In lungs declined for poor graft quality (n=19), the reason for decline was confirmed in 13 lungs, however 4 lungs had only limited CT abnormalities present. In 2 out of 7 lungs declined at retrieval for clinical suspicion of emphysema, no emphysema was present on CT. In addition, CT abnormalities (CSL, RET/IST) of Tx grafts also significantly differed between recipients with PGD 3 and without PGD 3 (Fig 1B). CONCLUSION: Ex situ CT imaging of donor grafts during preservation is feasible and demonstrated significant differences between Tx and non-Tx grafts. Also grafts of patients with or without PGD3 differed in CT parameters. CT imaging could not confirm the reason for decline in 6 lungs, which might indicate an undisclosed graft potential and a role of CT imaging in donor assessment. The prognostic value of CT parameters on long-term outcomes remains elusive.

Jaar van publicatie:2020