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Bery A, Marklin G, Itoh A, Kreisel D, Takahashi T, Meyers BF, Nava R, Kozower BD, Shepherd H, Patterson GA, Puri V. Specialized Donor Care Facility Model and Advances in Management of Thoracic Organ Donors. Ann Thorac Surg 2022; 113:1778-1786. [PMID: 33421385 PMCID: PMC8257761 DOI: 10.1016/j.athoracsur.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Donor hearts and lungs are more susceptible to the inflammatory physiologic changes that occur after brain death. Prior investigations have shown that protocolized management of potential organ donors can rehabilitate donor organs that are initially deemed unacceptable. In this review we discuss advances in donor management models with particular attention to the specialized donor care facility model. In addition we review specific strategies to optimize donor thoracic organs and improve organ yield in thoracic transplantation. METHODS We performed a literature review by searching the PubMed database for medical subject heading terms associated with organ donor management models. We also communicated with our local organ procurement organization to gather published and unpublished information first-hand. RESULTS The specialized donor care facility model has been shown to improve the efficiency of organ donor management and procurement while reducing costs and minimizing travel and its associated risks. Lung protective ventilation, recruitment of atelectatic lung, and hormone therapy (eg, glucocorticoids and triiodothyronine/thyroxine) are associated with improved lung utilization rates. Stroke volume-based resuscitation is associated with improved heart utilization rates, whereas studies evaluating hormone therapy (eg, glucocorticoids and triiodothyronine/thyroxine) have shown variable results. CONCLUSIONS Lack of high-quality prospective evidence results in conflicting practices across organ procurement organizations, and best practices remain controversial. Future studies should focus on prospective, randomized investigations to evaluate donor management strategies. The specialized donor care facility model fosters a collaborative environment that encourages academic inquiry and is an ideal setting for these investigations.
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Affiliation(s)
- Amit Bery
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
| | | | - Akinobu Itoh
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Tsuyoshi Takahashi
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Ruben Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Hailey Shepherd
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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Murala JS, Hanif HM, Peltz M, Cheruku SR, Huffman LC, Hackmann AE, Jessen ME, Ring WS, Wait MA. Lung transplantation: how we do it. Indian J Thorac Cardiovasc Surg 2021; 37:454-475. [PMID: 34566281 PMCID: PMC8448665 DOI: 10.1007/s12055-021-01218-w] [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] [Received: 03/04/2021] [Revised: 05/17/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022] Open
Abstract
Lung transplantation is considered the gold standard for patients with chronic end-stage pulmonary disease. However, due to the complexity of management and relatively lower median survival as compared to other solid organs, many programs across the world have been slow to adopt the same. In our institution, we started lung transplantation in September 1990. And since then, we performed close to 900 lung transplantations. Here, we describe in detail the operative steps adopted in our institution for a successful lung transplantation. There have been very few variations over the years. We believe that having a standardized technique is one of the important features for success of a lung transplant program.
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Affiliation(s)
- John Santosh Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern (UTSW) Medical Center, 5959 Harry Hines Blvd., 10th Floor, Suite HP10.110, Dallas, TX 75390 USA
| | - Hashim Muhammad Hanif
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern (UTSW) Medical Center, 5959 Harry Hines Blvd., 10th Floor, Suite HP10.110, Dallas, TX 75390 USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern (UTSW) Medical Center, 5959 Harry Hines Blvd., 10th Floor, Suite HP10.110, Dallas, TX 75390 USA
| | - Sreekanth Reddy Cheruku
- Department of Anesthesiology and Pain Management, University of Texas Southwestern (UTSW) Medical Center, Dallas, TX USA
| | - Lynn Custer Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern (UTSW) Medical Center, 5959 Harry Hines Blvd., 10th Floor, Suite HP10.110, Dallas, TX 75390 USA
| | - Amy Elizabeth Hackmann
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern (UTSW) Medical Center, 5959 Harry Hines Blvd., 10th Floor, Suite HP10.110, Dallas, TX 75390 USA
| | - Michael Erik Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern (UTSW) Medical Center, 5959 Harry Hines Blvd., 10th Floor, Suite HP10.110, Dallas, TX 75390 USA
| | - William Steves Ring
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern (UTSW) Medical Center, 5959 Harry Hines Blvd., 10th Floor, Suite HP10.110, Dallas, TX 75390 USA
| | - Michael Alton Wait
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern (UTSW) Medical Center, 5959 Harry Hines Blvd., 10th Floor, Suite HP10.110, Dallas, TX 75390 USA
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Heid CA, Chandra R, Liu C, Pruszynski J, Khoury MK, Vela R, Zeng X, Maaraoui K, Kalsbeek A, Ring WS, Amin A, Murala J, Peltz M. Cardiac transplantation in adults with congenital heart disease: A single center case series. Clin Transplant 2021; 35:e14430. [PMID: 34288107 DOI: 10.1111/ctr.14430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adult congenital heart disease (CHD) transplant recipients historically experienced worse survival early after transplantation. We aim to review updated trends in adult CHD transplantation. METHODS We performed a single center case series of adult cardiac transplants from January 2013 through July 2020. Outcomes of patients with CHD were compared to non-CHD. The primary outcome was overall survival. Secondary outcomes included a variety of post-operative complications. RESULTS 18/262 (7%) transplants were CHD recipients. CHD patients were younger with median age 41 (32-47) versus 58 (48-65) (P < .001). Fontan circulation for single ventricle physiology was present in 4/18 (22%) of CHD recipients, while 16/18 (89%) had systemic right ventricles. CHD recipients had higher rates of previous cardiovascular operations (94% vs. 51%, P < .001). 9/18 (50%) of CHD patients required reconstructive procedures at the time of transplant. Operative and cardiopulmonary bypass times were longer for the CHD cohort (7.5 h [6.6-8.5] vs. 5.6 h [4.6-7] P < .001) and (197 min [158-240] vs. 130 [105-167] P < .001), respectively. There were no differences in operative complications or survival between CHD and non-CHD recipients. CONCLUSIONS These data highlight the added technical challenges of performing adult CHD transplants. However, similar outcomes can be achieved as for non-CHD recipients. SUMMARY Modern advances in palliation of congenital heart defects (CHD) has led to increased survival into adulthood. Many of these patients require heart transplantation as adults. There are limited data on adult CHD transplantation. Historically, these patients have had worse perioperative outcomes with improved long-term survival. We retrospectively analyzed 262 heart transplants at a single center, 18 of which were for adult CHD. Here, we report our series of 18 CHD recipients. We detail the palliative history of all CHD patients and highlight the added technical challenges for each of the 18 patients at transplant. In our analysis, CHD patients had more prior cardiovascular surgeries as well as longer transplant operative and bypass times. Despite this, there were no differences in perioperative and long-term outcomes. We have added patient and institution specific data for transplanting patients with adult CHD. We hope that our experience will add to the growing body of literature on adult CHD transplantation.
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Affiliation(s)
- Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Raghav Chandra
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Charles Liu
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Pruszynski
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan Vela
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xue Zeng
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kayla Maaraoui
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anya Kalsbeek
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - W Steves Ring
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alpesh Amin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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