Sue A. Braithwaite ^1* Jitte Jennekens ¹ Elize M. Berg ¹ Linda De Heer ¹ Faiz Ramjankhan ¹ Michel De Jong ¹ Jean Luc Luc Charlier ¹ Thomas C. Dessing ¹ Marcel Veltkamp ² Amy Scheren Msc ¹ Dieuwertje Ruigrok ¹ Rob H. Schönwetter ² Wolfgang F. Buhre ¹ Niels Van Der Kaaij ¹

• ¹ University Medical Center Utrecht, Utrecht, Netherlands
• ² St. Antonius Hospital, Nieuwegein, Netherlands

Reducing the risk of high-grade primary graft dysfunction (PGD) is vital in order to achieve acceptable short-and long-term outcome for recipients following lung transplantation. The utilization of injured lung allografts, which may confer a higher risk of PGD, must be considered however, due to the disparity between the increasing numbers of patients requiring lung transplantation and the limited donor pool.We describe a case in which highly marginal lung allografts were utilized with good posttransplant outcome. Donor-recipient PGD risk compatibility was taken into consideration.Normothermic ex vivo lung perfusion (EVLP) was utilized to functionally interrogate the allografts. A second cold ischemia time following EVLP was avoided by converting the EVLP mode to a hypothermic oxygenated perfusion set-up from which the lungs were transplanted directly. We attempted to mitigate for lung ischemia-reperfusion injury in the recipient by employing cytokine adsorption both during the EVLP and intraoperatively during the implant procedure.In this case report we describe our hypothermic oxygenated perfusion set-up on EVLP for the first time. Furthermore we describe the utilization of cytokine adsorption in two phases of the same transplant process.