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Schiavon M, Zampieri D, Marulli G, Verderi E, Rebusso A, Comacchio GM, Nicotra S, Loy M, Lunardi F, Feltracco P, Calabrese F, Cozzi E, Rea F. Pushing the limits of reconditioning: extended normothermic lung perfusion in an extended criteria donor. J Thorac Dis 2018; 10:E796-E801. [PMID: 30746256 DOI: 10.21037/jtd.2018.10.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Schiavon
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Davide Zampieri
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Enrico Verderi
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Alessandro Rebusso
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Giovanni Maria Comacchio
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Samuele Nicotra
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Monica Loy
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Francesca Lunardi
- Pathology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Paolo Feltracco
- Institute of Anesthesiology and Intensive Care, Department of Medicine, Padova University Hospital, Padova, Italy
| | - Fiorella Calabrese
- Pathology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Emanuele Cozzi
- Transplant Immunology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova University Hospital, Padova, Italy
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Schiavon M, Faggi G, Rebusso A, Lunardi F, Comacchio G, Di Gregorio G, Feltracco P, Gregori D, Calabrese F, Marulli G, Cozzi E, Federico R. Extended criteria donor lung reconditioning with the organ care system lung: a single institution experience. Transpl Int 2018; 32:131-140. [PMID: 30350894 DOI: 10.1111/tri.13365] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/21/2018] [Accepted: 10/15/2018] [Indexed: 01/28/2023]
Abstract
Lung transplantation is a life-saving procedure limited by donor's availability. Lung reconditioning by ex vivo lung perfusion represents a tool to expand the donor pool. In this study, we describe our experience with the OCS™ Lung to assess and recondition extended criteria lungs. From January 2014 to October 2016, of 86 on-site donors evaluated, eight lungs have been identified as potentially treatable with OCS™ Lung. We analyzed data from these donors and the recipient outcomes after transplantation. All donor lungs improved during OCS perfusion in particular regarding the PaO2 /FiO2 ratio (from 340 mmHg in donor to 537 mmHg in OCS) leading to lung transplantation in all cases. Concerning postoperative results, primary graft dysfunction score 3 at 72 h was observed in one patient, while median mechanical ventilation time, ICU, and hospital stay were 60 h, 14 and 36 days respectively. One in-hospital death was recorded (12.5%), while other two patients died during follow-up leading to 1-year survival of 62.5%. The remaining five patients are alive and in good conditions. This case series demonstrates the feasibility and value of lung reconditioning with the OCS™ Lung; a prospective trial is underway to validate its role to safely increase the number of donor lungs.
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Affiliation(s)
- Marco Schiavon
- Thoracic Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Giulio Faggi
- Anestesiology Division, Azienda Ospedaliera di Padova, Padova, Italy
| | - Alessandro Rebusso
- Thoracic Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Francesca Lunardi
- Pathology Division, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Giovanni Comacchio
- Thoracic Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Guido Di Gregorio
- Istituto di Anestesia e Rianimazione, Padova University Hospital, Padova, Italy
| | - Paolo Feltracco
- Istituto di Anestesia e Rianimazione, Padova University Hospital, Padova, Italy
| | - Dario Gregori
- Department of Statistics, University of Padova, Padova, Italy
| | - Fiorella Calabrese
- Pathology Division, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Emanuele Cozzi
- Transplant Immunology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Rea Federico
- Thoracic Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
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Schiavon M, Calabrese F, Di Gregorio G, Loy M, Marulli G, Rebusso A, Calabrese F, Rea F. Ex-vivo recruitment and x-ray assessment of donor lungs in a challenging retrieval from a donor supported by lvad using the portable normothermic perfusion system: a case report. J Cardiothorac Surg 2017; 12:30. [PMID: 28521795 PMCID: PMC5437590 DOI: 10.1186/s13019-017-0597-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/10/2017] [Indexed: 01/25/2023] Open
Abstract
Background Lung transplantation (LTx) is limited by the shortage of suitable donors. To overcome this problem, many programs have begun to use donors with extended criteria (marginal donors). However, brain-dead patients with implanted mechanical circulatory support system have rarely been considered as potential lung donors. This case demonstrates the feasibility of lung transplantations from organ donors supported by a mechanical circulatory support system despite the possible difficulties of lung retrieval. Case presentation Our case presents a successful procurement and bilateral lung transplantation from a donor supported by a left ventricular assist device (LVAD) who experienced an intraoperatively haemodynamic complication. The use of portable normothermic perfusion device let us to reduce ischemic injury and assess these marginal donor lungs helping us to determine the clinical suitability for transplantation. Given our extensive experience with the device instrumentation and management, the EVLP process was uneventful with excellent post-transplant course. Conclusions This case report demonstrates the feasibility of lung transplantations from organ donors supported by a mechanical circulatory support system using the portable normothermic perfusion platform to assess and preserve these donor lungs.
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Affiliation(s)
- Marco Schiavon
- Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Via Giustiniani 2, 35100, Padova, Italy.
| | - Francesca Calabrese
- Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Via Giustiniani 2, 35100, Padova, Italy
| | - Guido Di Gregorio
- Department of Anaesthesiology and Intensive Care, University-Hospital of Padova, via Giustiniani 2, 35100, Padova, Italy
| | - Monica Loy
- Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Via Giustiniani 2, 35100, Padova, Italy
| | - Giuseppe Marulli
- Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Via Giustiniani 2, 35100, Padova, Italy
| | - Alessandro Rebusso
- Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Via Giustiniani 2, 35100, Padova, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic and Vascular Sciences, Pathologic Division, University of Padova, via Giustiniani 2, 35100, Padova, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic and Vascular Sciences, Thoracic Surgery Division, University of Padova, Via Giustiniani 2, 35100, Padova, Italy
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