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Outcome of Lung Transplantation Using Grafts From Donors Over 65 Years of Age. Ann Thorac Surg 2021; 112:1142-1149. [DOI: 10.1016/j.athoracsur.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/02/2020] [Accepted: 10/07/2020] [Indexed: 12/20/2022]
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He J, Yang C, Suen HC, He J, Li S. A novel lung autotransplantation technique for treating central lung cancer: a case report. Transl Lung Cancer Res 2021; 10:2290-2297. [PMID: 34164276 PMCID: PMC8182719 DOI: 10.21037/tlcr-20-1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung autotransplantation is an alternative technique in treating central non-small cell lung cancer (NSCLC) for patients who are not suitable to undergo pneumonectomy. We hereby report a novel lung autotransplantation technique for treating central lung cancer. Two cases of central NSCLC involving right main bronchus underwent right basal segment and right lower lobe autotransplantation after resection. The inferior pulmonary vein of graft was anastomosed to superior pulmonary venous stump in both cases to reduce the bronchial and pulmonary arterial gap created after extensive resection. One case had anastomosis of basal segment artery to the right upper lobe anterior segment artery stump while the other case had pulmonary artery angioplasty only without segmental arterial resection. Both procedures were performed in situ without graft perfusion. The airway reconstructions were completed using parachute principle via end-to-side anastomosis of graft bronchus and lateral wall of trachea instead of end-to-end anastomosis with main bronchial stump. Both patients received ICU care postoperatively for 4 days. Chest tubes were successfully removed within 7 days. They were discharged within 11 days postoperatively. No major complication, such as severe infection, anastomotic dehiscence, anastomotic stenosis, atelectasis, or pulmonary embolism was observed. There was no evidence of recurrence at 9-month follow-up.
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Affiliation(s)
- Jiaxi He
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
| | - Chao Yang
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
| | - Hon Chi Suen
- Cardio-thoracic Surgery Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong, China
| | - Jianxing He
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
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Palleschi A, Rosso L, Musso V, Rimessi A, Bonitta G, Nosotti M. Lung transplantation from donation after controlled cardiocirculatory death. Systematic review and meta-analysis. Transplant Rev (Orlando) 2019; 34:100513. [PMID: 31718887 DOI: 10.1016/j.trre.2019.100513] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The interest in donation after cardiocirculatory death (DCD) donors for lung transplantation (LT) has been recently rekindled due to lung allograft shortage. Clinical outcomes following DCD have proved satisfactory. The aim of this systematic review is to provide a thorough analysis of published experience regarding outcomes of LT after controlled DCD compared with donation after brain death (DBD) donors. METHODS We performed a literature search in Cochrane Database of Systematic Reviews, PubMed and Web of Science using the items "lung transplantation" AND "donation after circulatory death" on November 1, 2018. The full text of relevant articles was evaluated by two authors independently. Quality assessment was performed using the NIH protocol for case-control and case series studies. A pooled Odds ratio (OR) and mean differences with inverse variance weighting using DerSimonian-Laird random effect models were computed to account for between-trial variance (τ2). RESULTS Of the 508 articles identified with our search, 9 regarding controlled donation after cardiac death (cDCD) were included in the systematic review, including 2973 patients (403 who received graft from DCD and 2570 who had DBD). Both 1-year survival and 2 and 3-grade primary graft dysfunction (PGD) were balanced between the two cohorts (OR = 1.00 and 1.03 respectively); OR for airway complications was 2.07 against cDCD. We also report an OR = 0.57 for chronic lung allograft dysfunction (CLAD) and an OR = 0.57 for 5-year survival against cDCD. CONCLUSIONS Our meta-analysis shows no significant difference between recipients after cDCD or DBD regarding 1-year survival, PGD and 1-year freedom from CLAD. Airway complications and long-term survival were both related with transplantation after cDCD, but these statistical associations need further research.
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Affiliation(s)
- Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy; Dipartimento di Scienze della Salute, Università degli studi di Milano, Milan, Italy
| | | | | | - Gianluca Bonitta
- Dipartimento di Fisiopatologia medico-chirurgica e dei Trapianti, Università degli studi di Milano, Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy; Dipartimento di Fisiopatologia medico-chirurgica e dei Trapianti, Università degli studi di Milano, Milan, Italy
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Meng C, Cui X, Qi S, Zhang J, Kang J, Zhou H. Lung inflation with hydrogen sulfide during the warm ischemia phase ameliorates injury in rat donor lungs via metabolic inhibition after cardiac death. Surgery 2016; 161:1287-1298. [PMID: 27989602 DOI: 10.1016/j.surg.2016.10.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/22/2016] [Accepted: 10/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hydrogen sulfide attenuates lung ischemia-reperfusion injury when inhaled or administered intraperitoneally. This study investigated the effects of lung inflation with H2S during the warm ischemia phase on lung grafts from rat donors after cardiac death. METHODS One hour after cardiac death, donor lungs were inflated in situ for 2 h with either O2 or H2S (O2 or H2S group) during the warm ischemia phase or were deflated as a control procedure (n = 8). After 3 h of cold preservation, lung transplantation was performed. During the warm ischemia phase, the metabolism and mitochondrial structures of donor lungs were analyzed. Arterial blood gas analysis was performed on the recipients. Protein expression in the graft of nuclear factor E2-related factor (Nrf)2 and nuclear factor kappa B (NF-κB) was analyzed by Western blotting, and static compliance, inflammation, oxidative stress, and cell apoptosis were assessed after 3 h of reperfusion. RESULTS When the O2 and H2S groups were compared with the control group, the mitochondrial structures were improved, and lactic acid levels, inflammation, oxidative stress, and cell apoptosis were significantly decreased; and glucose levels, as well as graft oxygenation and static compliance were increased. Simultaneously, the above indices showed further improvements, and the Nrf2 protein expression was significantly greater, and NF-κB protein expression was less in the H2S group than the O2 group. CONCLUSION Lung inflation with H2S during the warm ischemia phase inhibited metabolism in donor lungs via mitochondrial protection, attenuated graft ischemic-reperfusion injury, and improved graft function through NF-κB-dependent anti-inflammatory and Nrf2-dependent antioxidative and antiapoptotic effects.
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Affiliation(s)
- Chao Meng
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, and the Hei Longjiang Province Key Lab of Research on Anesthesiology and Critical Care Medicine, Harbin, China
| | - Xiaoguang Cui
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, and the Hei Longjiang Province Key Lab of Research on Anesthesiology and Critical Care Medicine, Harbin, China
| | - Sihua Qi
- Department of Anesthesiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiahang Zhang
- Department of Anesthesiology, the Second Affiliated Hospital of Harbin Medical University, and the Hei Longjiang Province Key Lab of Research on Anesthesiology and Critical Care Medicine, Harbin, China
| | - Jiyu Kang
- Department of Anesthesiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huacheng Zhou
- Department of Anesthesiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
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van Loo ES, Krikke C, Hofker HS, Berger SP, Leuvenink HGD, Pol RA. Outcome of pancreas transplantation from donation after circulatory death compared to donation after brain death. Pancreatology 2016; 17:13-18. [PMID: 27838258 DOI: 10.1016/j.pan.2016.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To overcome the gap of organ shortage grafts from donation after circulatory death (DCD) can be used. This review evaluates the outcomes after DCD pancreas donation compared to donation after brain death (DBD). MATERIALS AND METHODS A literature search was performed using Medline, Embase, and PubMed databases. All comparative cohort studies reporting the outcome after DCD and DBD pancreas transplantation were included. All data were assessed according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. To evaluate the event rates, pooled odds ratios (ORs) as well as the 95% confidence intervals (CI) were calculated. Since the number of studies is small we used the random-effects model only to overcome heterogeneity. RESULTS There is no difference in 1-year pancreas graft survival (OR 1.092, CI 95% 0.649-1.837, P = 0.741) or patient survival (OR 0.699, CI 95% 0.246-1.985, P = 0.502). Simultaneous pancreas-kidney (SPK) transplantation showed significantly higher graft survival rates compared to pancreas transplantation alone (87.2% vs. 76.6%, P < 0.001 in DBD and 86.5% vs. 74.9%, P < 0.001 in DCD). DCD SPK grafts show a higher delayed kidney graft function rate compared to DBD SPK-grafts (OR 0.209, CI 95% 0.104-0.421, P < 0.001). There is significantly less pancreas graft thrombosis after DBD-donation (OR 0.567, CI 95% 0.340-0.946, P = 0.030). We found no difference in the HbA1c level at 1-year follow-up with a median of 5.4% in both groups and a mean of 5.63% (DCD) vs 5.43% (DBD). DISCUSSION DCD pancreas transplantation has comparable patient and 1-year graft survival rates and should be considered a safe alternative for DBD pancreas transplantation.
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Affiliation(s)
- Ellen S van Loo
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Christina Krikke
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Hendrik S Hofker
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Stefan P Berger
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Henri G D Leuvenink
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Robert A Pol
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Karube Y, Chida M, Nishihira M, Inoue T, Araki O, Kobayashi S, Sado T. Back-table procedure and auto-lung transplantation for locally advanced lung cancer: a case report. J Cardiothorac Surg 2016; 11:3. [PMID: 26772735 PMCID: PMC4715357 DOI: 10.1186/s13019-016-0399-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/10/2016] [Indexed: 12/05/2022] Open
Abstract
Background To avoid a pneumonectomy and preserve the lung parenchyma, a bronchovascular double-sleeve plasty including an extended sleeve lobectomy is a good choice for locally advanced lung cancer. Case presentation We describe a case with lung adenocarcinoma enrolled in our new protocol for ex situ auto-lung transplantation following an en bloc pneumonectomy and back table procedure for central lung cancer. Following completion of the pneumonectomy, the excised lung was irrigated with a cold extracellular phosphate-buffered solution to protect the lung graft from ischemia-reperfusion injury during preparation of the graft of a right basal segment as a back-table procedure. Conclusion Although auto-lung transplantation is a complicated procedure, an en bloc pneumonectomy following a back table procedure makes preparation of the graft easy, while simultaneous mediastinal lymph node dissection by another surgeon shortens operation time.
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Affiliation(s)
- Yoko Karube
- Department of General Thoracic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Masayuki Chida
- Department of General Thoracic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Morimichi Nishihira
- Department of General Thoracic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Takashi Inoue
- Department of General Thoracic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Osamu Araki
- Department of General Thoracic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Satoru Kobayashi
- Department of General Thoracic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Tetsu Sado
- Department of General Thoracic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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Tryfon S, Zarogoulidis P, Tsavlis D, Tsirgogianni K, Zissimopoulos A, Kioumis I, Emmanouilides C, Baka S, Titopoulos H, Dager A, Filippou D. Ex situ reimplantation technique, in central lung tumors. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:178. [PMID: 26366395 DOI: 10.3978/j.issn.2305-5839.2015.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/04/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The parenchyma-sparing resection is most often performed in patients with impaired preoperative lung or cardiovascular function who would not be able to tolerate a pneumonectomy. METHODS Our experience on the ex situ reimplantation procedure and the outcome of patients with lung malignancies, who underwent upper or upper-middle lobectomy, with reimplantation of the lower lobe was reported. RESULTS We present 9 patients mean age 62.6+16.2 years (7 males/2 females) underwent ex situ reimplantation due to extensive lung tumor of upper lobes. The surgical technique precludes IV heparinization and then radical pneumonectomy. The entire lung was immersed in Ringer's solution (temperature 4 degrees centigrade) and bench surgery was performed. The involved upper (or upper-middle) lobes with involved lymph nodes were resected, thus leaving the healthy lower lobe of the lung. Pneumoplegia solution, named "Papworth pneumoplegia", was administered (1,473 mL) through catheterization of the pulmonary artery and vein stumps (ante grade and retrograde) along with 250 mL of prostaglandin E1. Re-implantation of the lower lobe was performed (I) on the right side, implantation involved the anastomosis of lower pulmonary vein in the site of the cuff of left atrium, followed by suturing the stump of the intermedius pulmonary artery to the right main pulmonary artery and finally the bronchial stumps-intermedius bronchus to the right main bronchus; (II) on the left side the pulmonary vein was anastomosed first, followed by the bronchial stumps and finally by the pulmonary artery. The graft ischemia time was 70.2+8.4 minutes ranged between 55 and 80 minutes. CONCLUSIONS Re-implantation or auto-transplantation should be considered as a safe option for the appropriate patient with lung cancer. The ex situ separation of the cancerous lobes is technically feasible and allows extensive pulmonary resection while minimizing the loss of pulmonary reserve. Based on our work, the major factors that play a role for the survival of initially resected and then re-implanted lung graft, are: (I) the ischemia time of the re-implanted lobe; (II) the proper use of pneumoplegia solutions, along with prostaglandin E1 and heparin; (III) the occurrence of pulmonary vein thrombosis; and (IV) the bronchial anastomosis.
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Affiliation(s)
- Stavros Tryfon
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Drosos Tsavlis
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Katerina Tsirgogianni
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Athanasios Zissimopoulos
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Christos Emmanouilides
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Sofia Baka
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Hercules Titopoulos
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Albert Dager
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
| | - Dimitrios Filippou
- 1 Pulmonary Clinic, General Hospital "G. Papanikolaou", Thessaloniki, Greece ; 2 Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece ; 3 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece ; 4 Interbalkan European Medical Center Oncology Department, Thessaloniki, Greece ; 5 Interbalkan European Medical Center Pulmonary Department, Thessaloniki, Greece ; 6 Interbalkan European Medical Center Cardiothoracic Department, Thessaloniki, Greece
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Bennett SC, Beal EW, Dumond CA, Preston T, Ralston J, Pope-Harman A, Black S, Hayes Jr D, Whitson BA. Mechanical circulatory support in lung transplantation: Cardiopulmonary bypass, extracorporeal life support, and ex-vivo lung perfusion. World J Respirol 2015; 5:78-92. [DOI: 10.5320/wjr.v5.i2.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/15/2015] [Accepted: 04/20/2015] [Indexed: 02/06/2023] Open
Abstract
Lung transplant is the standard of care for patients with end-stage lung disease refractory to medical management. There is currently a critical organ shortage for lung transplantation with only 17% of offered organs being transplanted. Of those patients receiving a lung transplant, up to 25% will develop primary graft dysfunction, which is associated with an 8-fold increase in 30-d mortality. There are numerous mechanical lung assistance modalities that may be employed to help combat these challenges. We will discuss the use of mechanical lung assistance during lung transplantation, as a bridge to transplant, as a treatment for primary graft dysfunction, and finally as a means to remodel and evaluate organs deemed unsuitable for transplant, thus increasing the donor pool, improving survival to transplant, and improving overall patient survival.
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Abstract
Lung transplantation (LTx) is the definitive treatment of patients with end-stage lung disease. Availability of donor lungs remains the primary limitation and leads to substantial wait-list mortality. Efforts to expand the donor pool have included a resurgence of interest in the use of donation after cardiac death (DCD) lungs. Unique in its physiology, lung viability seems more tolerant to the variable durations of ischemia that occur in DCD donors. Initial experience with DCD LTx is promising and, in combination with ex vivo lung perfusion systems, seems a valuable opportunity to expand the lung donor pool.
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Krutsinger D, Reed RM, Blevins A, Puri V, De Oliveira NC, Zych B, Bolukbas S, Van Raemdonck D, Snell GI, Eberlein M. Lung transplantation from donation after cardiocirculatory death: a systematic review and meta-analysis. J Heart Lung Transplant 2014; 34:675-84. [PMID: 25638297 DOI: 10.1016/j.healun.2014.11.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/14/2014] [Accepted: 11/04/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung transplantation (LTx) can extend life expectancy and enhance the quality of life for select patients with end-stage lung disease. In the setting of donor lung shortage and waiting list mortality, the interest in donation after cardiocirculatory death (DCD) is increasing. We performed a systematic review and meta-analysis to compare outcomes between DCD and conventional donation after brain death (DBD). METHODS PubMed, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and ClinicalTrials.gov were searched. We identified original research studies with 1-year post-transplant survival data involving >5 DCD transplants. We performed meta-analyses examining 1-year survival, primary graft dysfunction, and acute rejection after LTx. RESULTS We identified 519 citations; 11 observational cohort studies met our inclusion criteria for systematic review, and 6 met our inclusion criteria for meta-analysis. There were no differences found in 1-year mortality after LTx between DCD and DBD cohorts in individual studies or in the meta-analysis (DCD [n = 271] vs DBD [n = 2,369], relative risk [RR] 0.88, 95% confidence interval [CI] 0.59-1.31, p = 0.52, I(2) = 0%). There was also no difference between DCD and DBD in a pooled analysis of 5 studies reporting on primary graft dysfunction (RR 1.09, 95% CI 0.68-1.73, p = 0.7, I(2) = 0%) and 4 studies reporting on acute rejection (RR 0.72, 95% CI 0.49-1.05, p = 0.09, I(2) = 0%). CONCLUSIONS Survival after LTx from DCD is comparable to survival after LTx from DBD in observational cohort studies. DCD appears to be a safe and effective method to expand the donor pool.
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Affiliation(s)
| | - Robert M Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, Maryland
| | - Amy Blevins
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, Iowa
| | - Varun Puri
- Department of Surgery, Washington University, St. Louis, Missouri
| | - Nilto C De Oliveira
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bartlomiej Zych
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom
| | - Servet Bolukbas
- Department of Thoracic Surgery, Dr. Korst Schmidt Klinik, Wiesbaden, Germany
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery and Lung Transplant Unit, University Hospitals Leuven, Leuven, Belgium
| | - Gregory I Snell
- Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Michael Eberlein
- Department of Medicine, University of Iowa, Iowa City, Iowa; Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa.
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Mrazkova H, Lischke R, Hodyc D, Herget J. The protective effect of hypercapnia on ischemia-reperfusion injury in lungs. Respir Physiol Neurobiol 2014; 205:42-6. [PMID: 25450116 DOI: 10.1016/j.resp.2014.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/16/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
Lifesaving therapy for patients with end-stage lung disease is lung transplantation. However, there are not enough available donors. A relatively new method of transplantation from non-heart-beating donors (NHBDs) allows the treatment of the lung outside the body and could increase the number of suitable lungs. We have focused on hypercapnic ventilation, which has the possibility of reducing reactive oxygen species damage. We used four experimental and two control groups of adult rats. Each experimental group underwent the protocol of NHBD lung harvesting. The lungs were than perfused in an ex vivo model and we measured weight gain, arterial-venous difference in partial pressure of oxygen and perfusion pressure. We observed that hypercapnic ventilation during reperfusion reduces the development of pulmonary oedema and has a protective effect on the oxygen transport ability of the lungs after warm ischemia. The effect of CO2 on pulmonary oedema and on oxygen transport ability after warm ischemia could be of clinical importance for NHBD transplantation.
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Affiliation(s)
- Hana Mrazkova
- 3rd Department of Surgery, University Hospital Motol and 1st Medical School, Charles University in Prague, Prague, Czech Republic.
| | - Robert Lischke
- 3rd Department of Surgery, University Hospital Motol and 1st Medical School, Charles University in Prague, Prague, Czech Republic
| | - Daniel Hodyc
- Department of Physiology, 2nd Medical School, Charles University in Prague, Prague, Czech Republic
| | - Jan Herget
- Department of Physiology, 2nd Medical School, Charles University in Prague, Prague, Czech Republic
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Pottecher J, Santelmo N, Noll E, Charles AL, Benahmed M, Canuet M, Frossard N, Namer IJ, Geny B, Massard G, Diemunsch P. Cold ischemia with selective anterogradein situpulmonary perfusion preserves gas exchange and mitochondrial homeostasis and curbs inflammation in an experimental model of donation after cardiac death. Transpl Int 2013; 26:1027-37. [DOI: 10.1111/tri.12157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 01/07/2013] [Accepted: 06/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Julien Pottecher
- Department of Anaesthesiology and Critical Care; Hautepierre Hospital; Strasbourg University Hospital; Strasbourg Cedex France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS); Faculty of Medicine; Physiology Institute; EA 3072; Strasbourg University; Strasbourg France
| | - Nicola Santelmo
- Department of Thoracic Surgery; Nouvel Hôpital Civil; Strasbourg University Hospital; Strasbourg France
| | - Eric Noll
- Department of Anaesthesiology and Critical Care; Hautepierre Hospital; Strasbourg University Hospital; Strasbourg Cedex France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS); Faculty of Medicine; Physiology Institute; EA 3072; Strasbourg University; Strasbourg France
| | - Anne-Laure Charles
- Fédération de Médecine Translationnelle de Strasbourg (FMTS); Faculty of Medicine; Physiology Institute; EA 3072; Strasbourg University; Strasbourg France
- Department of Physiology; Nouvel Hôpital Civil; Strasbourg University Hospital; Strasbourg France
| | - Malika Benahmed
- ICube; UMR 7357 University of Strasbourg/CNRS; Strasbourg Cedex France
| | - Matthieu Canuet
- Department of Pneumology; Nouvel Hôpital Civil; Strasbourg University Hospital; FMTS, Faculty of Medicine, Strasbourg France
| | - Nelly Frossard
- Faculty of Pharmacy; Strasbourg University/CNRS UMR 7200; Illkirch France
| | - Izzie J. Namer
- ICube; UMR 7357 University of Strasbourg/CNRS; Strasbourg Cedex France
- Department of Biophysics and Nuclear Medicine; Hautepierre Hospital; Strasbourg University Hospital; Strasbourg Cedex France
| | - Bernard Geny
- Fédération de Médecine Translationnelle de Strasbourg (FMTS); Faculty of Medicine; Physiology Institute; EA 3072; Strasbourg University; Strasbourg France
- Department of Physiology; Nouvel Hôpital Civil; Strasbourg University Hospital; Strasbourg France
| | - Gilbert Massard
- Department of Thoracic Surgery; Nouvel Hôpital Civil; Strasbourg University Hospital; Strasbourg France
| | - Pierre Diemunsch
- Department of Anaesthesiology and Critical Care; Hautepierre Hospital; Strasbourg University Hospital; Strasbourg Cedex France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS); Faculty of Medicine; Physiology Institute; EA 3072; Strasbourg University; Strasbourg France
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The incidence of potential missed organ donors in intensive care units and emergency rooms: a retrospective cohort. Intensive Care Med 2013; 39:1452-9. [PMID: 23702637 DOI: 10.1007/s00134-013-2952-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/03/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE There is a shortage of organ donors in Canada. The number of potential organ donors that are not referred to organ procurement organizations in Canada is unknown. METHODS We conducted a retrospective cohort study of all deaths in ICUs and emergency rooms not referred to the Human Organ Procurement and Exchange Program in four hospitals between 1 January 2008 and 31 December 2010. The primary outcome was the number of normal and expanded criteria heart-beating donors and circulatory death (DCD) donors. RESULTS Of 2,931 deaths, 64 patients were identified as having a high probability for progression to heart-beating donation (Glasgow Coma Score of 3 and three or more absent brainstem reflexes) and 130 patients were assessed for possible DCD donation. The number of potential abdominal and lung heart-beating donors ranged from 3.2 to 7.5 and 0.5 to 2.7 per million population. The number of potential DCD abdominal and lung donors ranged from 3.9 to 6.5 and 2.7 to 4.3 per million population. Potential heart-beating abdominal (p = 0.04) and lung (p = 0.06) donors increased after legislation mandating donation discussion. Non-pupillary brainstem reflexes were documented in fewer than 60 % of records. Life-sustaining treatment was withdrawn in 19 of 46 (41.3 %) cardiac arrest patients not requiring high doses of vasoactive drugs within 24 h. CONCLUSION The number of heart-beating or DCD organ donors represented by missed referrals may represent up to 7.5 donors per million population. Improved documentation of brainstem reflexes and encouraging referral of patients suffering cardiac arrest to ICU specialists may improve donor numbers.
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Detry O, Le Dinh H, Noterdaeme T, De Roover A, Honoré P, Squifflet JP, Meurisse M. Categories of donation after cardiocirculatory death. Transplant Proc 2012; 44:1189-95. [PMID: 22663982 DOI: 10.1016/j.transproceed.2012.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The interest in donation after cardiocirculatory death (DCD) was renewed in the early 1990s, as a means to partially overcome the shortage of donations after brain death. In some European countries and in the United States, DCD has become an increasingly frequent procedure over the last decade. To improve the results of DCD transplantation, it is important to compare practices, experiences, and results of various teams involved in this field. It is therefore crucial to accurately define the different types of DCD. However, in the literature, various DCD terminologies and classifications have been used, rendering it difficult to compare reported experiences. The authors have presented herein an overview of the various DCD descriptions in the literature, and have proposed an adapted DCD classification to better define the DCD processes, seeking to provide a better tool to compare the results of published reports and to improve current practices. This modified classification may be modified in the future according to ongoing experiences in this field.
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Affiliation(s)
- O Detry
- Department of Abdominal Surgery and Transplantation, CHU Liège, University of Liège, Liège, Belgium.
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15
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Abstract
Lung transplantation for end-stage lung disease results in prolonged survival and improved pulmonary function. However, the shortage of donor lungs has been a major limiting factor in Korea. We sought to investigate the number and utilization of donor lungs by the five institutions performing LTx in Korea, retrospectively reviewing outcomes of organs registered in the Korean Network for Organ Sharing from January to December, 2010. Lungs were offered from 270 brain-dead patients (189 males and 81 females) of mean age of 45.2 ± 14.2 years (range, 12 to 77 years). The most common cause of brain death was hemorrhage (n = 219, 81%). Only 18 (6.7%) donor lungs were used, which was low compared with kidney (93.3%), liver (86.3%), heart (26.7%), and pancreas (11.1%) use. The mean age of donors of transplanted lungs was 35.7 years (range, 14 to 51 years) compared with 45.9 years for other organs (P = .003). The characteristics of utilized donor lungs were: mean partial pressure of oxygen (PaO(2)), 300.9 mm Hg; mean smoking history, as 2.7 pack-years; and mean body mass index, 21.2 kg/m(2). The causes of refusal were medical ineligibility (n = 129) including poor PaO(2), abnormal chest x-ray, long smoking history, older age (n = 46), no properly matched recipient (n = 46), unknown (n = 17), and family withdrawal (n = 14). Only 8 (33.3%) were transplanted from standard criteria and 10 from the lungs that did not satisfy these criteria. An efficient utilization system is needed to improve lung transplantations.
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Gámez P, Díaz-Hellín V, Marrón C, Meneses JC, de Pablo A, Martín de Nicolás JL. Desarrollo de un programa de donación pulmonar en asistolia con «preservación en bitermia» y resultados tras un año de experiencia clínica. Arch Bronconeumol 2012; 48:338-41. [DOI: 10.1016/j.arbres.2011.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 11/07/2011] [Accepted: 11/15/2011] [Indexed: 11/16/2022]
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17
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Gámez P, Díaz-Hellín V, Marrón C, Meneses JC, de Pablo A, Martín de Nicolás JL. Development of a Non-Heart-Beating Lung Donor Program With «Bithermia Preservation», and Results After One Year of Clinical Experience. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.arbr.2012.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Paik H, Haam S, Lee D, Yi G, Song S, Kim Y, Kang C, Kim K, Park S, Jheon S. The Fate of Patients on the Waiting List for Lung Transplantation in Korea. Transplant Proc 2012; 44:865-9. [DOI: 10.1016/j.transproceed.2011.12.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oto T, Kiura K, Toyooka S, Miyoshi S. Basal segmental auto-transplantation after pneumonectomy for advanced central lung cancer. Eur J Cardiothorac Surg 2012; 42:579-81. [PMID: 22544868 DOI: 10.1093/ejcts/ezs224] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In patients with central lung cancer that extensively involves the bronchus/pulmonary artery, a double-sleeve lobectomy is often difficult to perform. We describe a case of post-pneumonectomy basal segmental auto-transplantation using a lung preservation technique that uses cold low-potassium dextran glucose solution to protect the lung graft from ischaemia-reperfusion injury during the ex situ division of the segmental graft and the pathological investigations for the clearance of the surgical margins. A right basal segmental auto-transplantation procedure was performed in a patient with stage-IIIA squamous cell lung cancer. This technique could allow extensive pulmonary resection while minimizing the loss of pulmonary reserve.
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Affiliation(s)
- Takahiro Oto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
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20
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Prediction of time of death after withdrawal of life-sustaining treatment in potential donors after cardiac death*. Crit Care Med 2012; 40:766-9. [DOI: 10.1097/ccm.0b013e318232e2e7] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Donation after Cardiac Death for Lung Transplant: A Case Study. Prog Transplant 2011; 21:156-60. [DOI: 10.1177/152692481102100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In late 2009, Gift of Life Michigan facilitated a donation after cardiac death lung recovery resulting in the first set of donation after cardiac death lungs to be utilized by a Michigan transplant center. Although placing lungs obtained via donation after cardiac death is more difficult because of a multitude of factors, the transplant coordinators, in conjunction with the transplant center, overcame several obstacles in order to transplant the lungs with good outcomes so far. Lung donation after cardiac death is becoming a more acceptable method of decreasing the length of the transplant waiting list as more data are becoming available.
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23
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Early effects of the ex vivo evaluation system on graft function after swine lung transplantation. Eur J Cardiothorac Surg 2011; 40:956-61. [PMID: 21354808 DOI: 10.1016/j.ejcts.2010.12.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 12/07/2010] [Accepted: 12/24/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Ex vivo lung evaluation (ex vivo) has been developed as a useful method by which to assess lungs from donation-after-cardiac death (DCD) donors prior to transplant. However, the safety of the ex vivo circulation itself with respect to grafts has not been fully investigated. The aim of this study is to evaluate the effects of the ex vivo circuit using a swine lung transplant model. METHODS Lungs with or without 2-h warm ischemia were used. To assess post-transplant graft function, the left lung was transplanted after 2-h ex vivo or cold preservation; blood gas analysis of the left pulmonary vein (partial pressure of oxygen, PO(2)) was performed during the 6-h post-transplant follow-up period. Data were compared between the ex vivo (+) and ex vivo (-) groups. RESULTS Partial pressure of oxygen/ inspired oxygen fraction (PO(2)/FiO(2)) in the ex vivo (-) group was significantly greater than that in the ex vivo (+) group until 3h after transplant. The PO(2)/FiO(2) levels in both groups then increased and became similar at 6 h after transplant, regardless of whether ischemic or non-ischemic lungs (p<0.001 and p=0.004, respectively) were used. CONCLUSIONS Negative effects of the ex vivo system were limited and seen only in the immediate post-transplant period. Therefore, in DCD swine lung transplantation, the ex vivo system appears to be safe.
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Suppression of Inflammatory Cytokines During Ex Vivo Lung Perfusion With an Adsorbent Membrane. Ann Thorac Surg 2010; 89:1773-9. [DOI: 10.1016/j.athoracsur.2010.02.077] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 02/25/2010] [Accepted: 02/26/2010] [Indexed: 11/18/2022]
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Innovative surgical techniques address the organ donation crisis, ... don't they? Curr Opin Organ Transplant 2010; 14:507-14. [PMID: 19623071 DOI: 10.1097/mot.0b013e32833067f3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Retrospectively analysing the role that innovative technique and strategies have played to face organ shortage during the last decades, and elaborating rationally about their potential contribution to expand organ availability in the coming future. RECENT FINDINGS Current organ donation crisis proceeds from both decreasing offers, qualitatively and quantitatively, and steadily increasing demand. Innovative surgical techniques using the existing donor pool have been extensively used for paediatric transplantation, but these techniques both have been insufficiently implemented in overall transplant activity to meet the demand, and are less usable on the emerging potential pool of donors ('extended-criteria' and nonheart-beating donors), as combining both approaches could carry a higher risk of complications. SUMMARY The future is emerging through complementary approaches and strategies in which innovative techniques have a role to play to match the existing pool with the paediatric demand, with an increasing attention to donor management and organ care and with development of preprocurement and postprocurement new therapies.
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Noiseux N, Nguyen BK, Marsolais P, Dupont J, Simard L, Houde I, Lallier M, Langevin S, Cantin B, Ferraro P. Pulmonary recruitment protocol for organ donors: a new strategy to improve the rate of lung utilization. Transplant Proc 2010; 41:3284-9. [PMID: 19857731 DOI: 10.1016/j.transproceed.2009.08.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Because lung transplantation is the only effective therapy for terminal respiratory failure, the demand for donor lungs has increased steadily. However, the number of donors has remained fairly constant over the years, which results in an increasing duration of waiting for lung transplantation. To overcome the lack of organs, various strategies have been developed by transplant centers including use of marginal donors. To increase the lung utilization rate in multiorgan donors, we implemented a simple lung recruitment protocol involving a brief period of controlled sustained inflation. In 2005, the lung utilization rate in the transplant program at our institution was only 20% in multiorgan donors. With the lung recruitment protocol, the rate of lung utilization for transplantation increased to 33%, in 2006, 24% in 2007, and 24% in 2008. Following the lung recruitment protocol, the arterial oxygen tension/fraction of inspired oxygen ratio increased to greater than 15% in more than 40% of donors. We were able to improve gas exchange sufficiently that as many as two-thirds of the lungs were suitable for transplantation. During the protocol, no complications were reported, and no patient became hemodynamically unstable, precluding organ procurement. We believe that optimization of multiorgan donor management with simple interventions may improve oxygenation, reducing the number of inadequate donor lungs and increasing the overall donor pool and organ availability.
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Affiliation(s)
- N Noiseux
- Division of Cardiac and Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal; Centre de Recherche CHUM, Montréal, Québec, Canada.
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Detection of bronchial function of NHBD lung following one-h warm ischemia by organ bath model. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2009; 29:340-3. [PMID: 19513618 DOI: 10.1007/s11596-009-0315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Indexed: 10/19/2022]
Abstract
This study investigated the feasibility and effects of organ bath to be used for detection of bronchial function of non-heart-beating donor (NHBD) lung after 1-h warm ischemia. Sixteen Swedish pigs were divided into two groups randomly: heart-beating donor (HBD) group and NHBD with 1-h warm ischemia (NHBD-1 h) group. The bronchial rings whose lengths and inner diameters were both 1.5 mm were obtained from isolated left lungs of all the pigs. Acetylcholine, arachidonic acid natrium and papaverine were used to test and compare the contractile and relaxant function of bronchial smooth muscles and epithelium-dependent relaxation (EpiDR) response between HBD and NHBD-1 h groups. The results showed that there was no significant difference in the values of bronchial precontraction between HBD and NHBD-1 h groups (5.18+/-0.07 vs 5.10+/-0.11 mN, P>0.05). No significant difference in the values of EpiDR responses between HBD and NHBD-1 h groups (1.26+/-0.05 vs 1.23+/-0.07 mN, P>0.05) was observed either. During the process of EpiDR induction, the rings had no spontaneous relaxation in two groups. In addition, papaverine solution completely relaxed the bronchial smooth muscles of all bronchial rings. It was concluded that after warm ischemia for 1 h, the contractile and relaxant abilities of bronchial smooth muscles, and the epithelium-dependent adjustment both kept intact. Organ bath model could be a liable and scientific way to evaluate the bronchial function of NHBD lung.
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