P-187SUCCESSFUL PERIOPERATIVE MANAGEMENT OF DONOR-ACQUIRED FAT EMBOLISM AFTER DOUBLE LUNG TRANSPLANTATION

Abstract

Objectives: Donor-acquired fat embolism(DAFE) is a rare but severe complication occurring after transplantation of lungs from donors with trauma history. Herein we describe the perioperative course and management of a recipient with DAFE. Case description: Donor lungs from a 21-year-old male donor 2 days after polytrauma were allocated to a 21-year-old recipient with cystic fibrosis. A contrast-enhanced CT scan at admission revealed severe parenchymal brain injury and a fracture of the scapula. The blood gases during organ procurement were 555mmHg pO2 and 43 mmHg pCO2 at 100% FiO2. The procurement was uneventful. However, during retrograde flushing massive fat embolism became evident at the back-table. The lungs were flushed extensively, which resulted in good retrograde backflow. There was no significant oedema. Considering the excellent blood gases, a good organ quality and a good backflow during the retrograde flushing, the lungs were accepted for lung transplantation. Sequential double lung transplantation was performed with central veno-arterial ECMO support. At the end of the procedure, the lungs became increasingly oedematous with rising respiratory effort. Therefore an inguinal VA-ECMO was implanted. After transfer to the ICU, the patient was put in prone-position, received -additionally to the standard medication - levosimendan, nitrogen inhalation and 500 mg prednisolone for 3 days. The first X-ray showed bilateral, patchy infiltrates, which gradually resolved during the early postoperative course. The VA-ECMO could be removed on the 3rd postoperative day (POD). The patient was extubated at the 6th POD. Conclusions: Donor lungs with evidence for fat embolism may harbor excessive tissue injury, despite excellent functional parameters during organ procurement. Acceptance for transplantation should be carefully re-considered if fat-embolism becomes evident during retrograde flushing. Aggressive therapeutic management with levosimendan, nitrogen inhalation, cortisone, ECMO-support and pronepositioning led to rapid restoration of organ function in our case.