X-Ray Analysis of Donor Lungs within an Ex Vivo Lung Perfusion System (EVLP): A Pilot Study for the Assessment of the Brixia Score to Predict Transplantability

Background: Ex vivo lung perfusion (EVLP) is a safe and effective technique for lung evaluation and reconditioning of marginal donor lungs (DLs). The assessment of the DLs during EVLP is crucial for the transplantability decision making. There are a limited number of studies regarding the radiographic analysis of EVLP lungs. Furthermore, there are only few X-ray grading scores available. The Brixia score is a proven radiological score for the severity grading of lung abnormalities with confirmed predictive power of the clinical outcome that was successfully used in pneumonia patients during the COVID-19 pandemic. It was the aim of our study to evaluate the X-ray findings of DLs within EVLP and investigate the prognostic potential of this score regarding transplantability and clinical outcome.

Method: This is a retrospective observational pilot study. Between 2016 and 2022, a total of 277 double-lung transplantations (DLTx) were performed in our department. X-Rays of the last ten consecutive EVLP-DLs were blindly evaluated regarding the severity of interstitial and alveolar infiltrates and the Brixia score was calculated. Furthermore, the results (transplantability, severe primary graft dysfunction PGD, survival, hospital stay) and EVLP parameters (delta pO₂) of these EVLP-DLs cases were analyzed and compared with the Brixia score for each case.

Results: A range of Brixia score values from min 4 to max 18 was determined. Seven DLs were transplanted (mean delta pO₂ 391 mm Hg, mean Brixia score 6.7) while three were rejected (mean delta pO₂ 211 mm Hg, mean Brixia score 6). The two EVLP–DLs cases with the higher Brixia score (mean 15) were transplanted after EVLP. Postoperative PGD Grade 3 at 48 hours was recorded in one case without correlation to the Brixia score (Brixia score 4). All patients survived hospital discharge with a mean ICU and hospital stay of 9 and 30 days, respectively.

Conclusion: In our pilot study, the Brixia score did not predict transplantability or postoperative function during EVLP. Additional studies are needed to further evaluate the use and clinical prognostic power of radiologic assessment with this or other scores in the EVLP lung assessment.

Publication History

Article published online:
28 January 2023