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Tommasino N, Koolhaas A, Mizraji R, Zamit O, Lacuesta G. Ultrasound Scanning in Lung Procurement. Protocol for Decision-Making With the Purpose of Increasing Transplant Eligible Lungs. Transplant Proc 2023; 55:1463-1465. [PMID: 36973147 DOI: 10.1016/j.transproceed.2023.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/08/2023] [Accepted: 02/20/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The main obstacle to obtaining lungs for transplantation is the shortage of donors. Once potential donors have been offered to transplant programs, the acceptance rate is highly variable, ranging from 5% to 20%. Minimizing donor leakage by converting potential lung donors into real donors is one of the key elements to improve results, and it is essential to have tools that facilitate decision-making in this scenario. The selection and rejection of transplantation-eligible lungs are usually made with chest x-rays; however, lung ultrasound scanning has shown better sensitivity and specificity for diagnosing pulmonary pathologies. Lung ultrasound scanning allows us to identify the reversible causes of low PaO2/fraction of inspired oxygen (FIO2) ratio, thus enabling the establishment of specific interventions, which, if proved successful, could turn lungs into transplant-eligible lungs. The available literature on its use in managing brain death donors and lung procurement is extremely scarce. METHODS A simple protocol aimed at identifying and treating the main reversible causes of low PaO2/FIO2 ratio to aid in decision-making is presented in this paper. CONCLUSION Lung ultrasound is a powerful, useful, and cheap technique available at the donor's bedside. It is conspicuously underused, despite being potentially helpful in decision-making by minimizing the discarding of donors, thus probably increasing the number of lungs sui for transplantation.
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Affiliation(s)
- Nicolas Tommasino
- National Lung Transplant Program, National Resources Fund, Montevideo, Uruguay; Procurement Department, National Institute for Donation and Transplantation, Montevideo, Uruguay.
| | - Andrea Koolhaas
- Critical Care Department, Evangelic Hospital, Montevideo, Uruguay
| | - Raul Mizraji
- Procurement Department, National Institute for Donation and Transplantation, Montevideo, Uruguay
| | - Olga Zamit
- Procurement Department, National Institute for Donation and Transplantation, Montevideo, Uruguay
| | - Gonzalo Lacuesta
- Procurement Department, National Institute for Donation and Transplantation, Montevideo, Uruguay
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Rodrigues-Filho EM, Franke CA, Junges JR. Lung transplantation and organ allocation in Brazil: necessity or utility. Rev Saude Publica 2019; 53:23. [PMID: 30810660 PMCID: PMC6390640 DOI: 10.11606/s1518-8787.2019053000445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
The philosophy of organ allocation is the result of two seemingly irreconcilable principles: utilitarianism and distributive justice. The process of organ donation and transplantation in Brazil reveals large inequalities between regions and units of the Federation, from the harvesting of organs to their implantation. In this context, lung transplantation is performed in only a few centers in the country and is still a treatment with limited long-term results. The allocation of the few organs harvested for the few procedures performed is defined mainly by chronology, a criterion that is not linked to necessity, which is a criterion of distributive justice, and neither to utility, a criterion of utilitarianism. This article reviews the organ allocation philosophy focusing on the case of lung transplantations in Brazil.
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Affiliation(s)
| | | | - José Roque Junges
- Universidade do Vale do Rio do Sinos. Programa de Pós-Graduação em Saúde Coletiva. São Leopoldo, RS, Brasil
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de Souza Carraro D, Carraro RM, Campos SV, Iuamoto LR, de Oliveira Braga KA, de Oliveira LC, Sabino EC, Rossi F, Pêgo-Fernandes PM. Burkholderia cepacia, cystic fibrosis and outcomes following lung transplantation: experiences from a single center in Brazil. Clinics (Sao Paulo) 2018; 73:e166. [PMID: 29538493 PMCID: PMC5840825 DOI: 10.6061/clinics/2018/e166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation. METHODS We prospectively analyzed clinical data and respiratory tract samples (sputum and bronchoalveolar lavage) collected from suppurative lung disease patients between January 2008 and November 2013. We also subtyped different Burkholderia cepacia complex genotypes via DNA sequencing using primers against the recA gene in samples collected between January 2012 and November 2013. RESULTS From 2008 to 2013, 34 lung transplants were performed on cystic fibrosis patients at our center. Burkholderia cepacia complex was detected in 13 of the 34 (38.2%) patients. Seven of the 13 (53%) strains were subjected to genotype analysis, from which three strains of B. metallica and four strains of B. cenocepacia were identified. The mortality rate was 1/13 (7.6%), and this death was not related to B. cepacia infection. CONCLUSION The results of our study suggest that colonization by B. cepacia complex and even B. cenocepacia in patients with cystic fibrosis should not be considered an absolute contraindication to lung transplantation in Brazilian centers.
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Affiliation(s)
- Danila de Souza Carraro
- Divisao de Cirurgia Toracica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Rafael Medeiros Carraro
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Silvia Vidal Campos
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Leandro Ryuchi Iuamoto
- Divisao de Cirurgia Toracica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Lea Campos de Oliveira
- Laboratorio de Investigacao Medica (LIM3), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ester Cerdeira Sabino
- Departamento de Biologia Molecular Divisao de Sorologia, Fundacao Pro Sangue Hemocentro de Sao Paulo, Secretaria de Saude do Estado de São Paulo, São Paulo, SP, BR
| | - Flavia Rossi
- Microbiologia, Divisao de Laboratorio Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Affiliation(s)
- Marcos Naoyuki Samano
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração (INCOR), Divisão de Cirurgia Torácica, São Paulo/SP, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração (INCOR), Divisão de Cirurgia Torácica, São Paulo/SP, Brazil
- Corresponding author: E-mail:
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Araujo LFL, Holand ARR, Paludo ADO, Silva ÉF, Forgiarini LA, Forgiarini LF, Barbachan E Silva M, Andrade CF. Effect of the systemic administration of methylprednisolone on the lungs of brain-dead donor rats undergoing pulmonary transplantation. Clinics (Sao Paulo) 2014; 69:128-33. [PMID: 24519204 PMCID: PMC3912341 DOI: 10.6061/clinics/2014(02)09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/14/2013] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Most lung transplants are obtained from brain-dead donors. The physiopathology of brain death involves hemodynamics, the sympathetic nervous system, and inflammatory mechanisms. Administering methylprednisolone 60 min after inducing brain death in rats has been shown to modulate pulmonary inflammatory activity. Our objective was to evaluate the effects of methylprednisolone on transplanted rat lungs from donors treated 60 min after brain death. METHODS Twelve Wistar rats were anesthetized, and brain death was induced. They were randomly divided into two groups (n=6), namely a control group, which was administered saline solution, and a methylprednisolone group, which received the drug 60 min after the induction of brain death. All of the animals were observed and ventilated for 2 h prior to being submitted to lung transplantation. We evaluated the hemodynamic and blood gas parameters, histological score, lung tissue levels of thiobarbituric acid-reactive substances, level of superoxide dismutase, level of tumor necrosis factor-alpha, and level of interleukin-1 beta. RESULTS After transplantation, a significant reduction in the levels of tumor necrosis factor-alpha and IL-1β was observed in the group that received methylprednisolone (p=0.0084 and p=0.0155, respectively). There were no significant differences in tumor necrosis factor-alpha and superoxide dismutase levels between the control and methylprednisolone groups (p=0.2644 and p=0.7461, respectively). There were no significant differences in the blood gas parameters, hemodynamics, and histological alterations between the groups. CONCLUSION The administration of methylprednisolone after brain death in donor rats reduces inflammatory activity in transplanted lungs but has no influence on parameters related to oxidative stress.
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Affiliation(s)
- Luiz Felipe Lopes Araujo
- Federal University of Rio Grande do Sul, Postgraduate Program in Pulmonary Sciences, Porto AlegreRS, Brazil, Federal University of Rio Grande do Sul (UFRGS), Postgraduate Program in Pulmonary Sciences, Porto Alegre/RS, Brazil
| | - Arthur Rodrigo Ronconi Holand
- Hospital de Clínicas de Porto Alegre, Lung and Airway Laboratory, Porto AlegreRS, Brazil, Hospital de Clínicas de Porto Alegre (HCPA), Lung and Airway Laboratory, Porto Alegre/RS, Brazil
| | - Artur de Oliveira Paludo
- Hospital de Clínicas de Porto Alegre, Lung and Airway Laboratory, Porto AlegreRS, Brazil, Hospital de Clínicas de Porto Alegre (HCPA), Lung and Airway Laboratory, Porto Alegre/RS, Brazil
| | - Éverton Franco Silva
- Hospital de Clínicas de Porto Alegre, Lung and Airway Laboratory, Porto AlegreRS, Brazil, Hospital de Clínicas de Porto Alegre (HCPA), Lung and Airway Laboratory, Porto Alegre/RS, Brazil
| | - Luiz Alberto Forgiarini
- Hospital de Clínicas de Porto Alegre, Lung and Airway Laboratory, Porto AlegreRS, Brazil, Hospital de Clínicas de Porto Alegre (HCPA), Lung and Airway Laboratory, Porto Alegre/RS, Brazil
| | - Luiz Felipe Forgiarini
- Hospital de Clínicas de Porto Alegre, Lung and Airway Laboratory, Porto AlegreRS, Brazil, Hospital de Clínicas de Porto Alegre (HCPA), Lung and Airway Laboratory, Porto Alegre/RS, Brazil
| | - Mariel Barbachan E Silva
- Hospital de Clínicas de Porto Alegre, Lung and Airway Laboratory, Porto AlegreRS, Brazil, Hospital de Clínicas de Porto Alegre (HCPA), Lung and Airway Laboratory, Porto Alegre/RS, Brazil
| | - Cristiano Feijó Andrade
- Federal University of Rio Grande do Sul, Postgraduate Program in Pulmonary Sciences, Porto AlegreRS, Brazil, Federal University of Rio Grande do Sul (UFRGS), Postgraduate Program in Pulmonary Sciences, Porto Alegre/RS, Brazil
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Pilla ES, Pereira RB, Forgiarini Junior LA, Forgiarini LF, Paludo ADO, Kulczynski JMU, Cardoso PFG, Andrade CF. Effects of methylprednisolone on inflammatory activity and oxidative stress in the lungs of brain-dead rats. J Bras Pneumol 2013; 39:173-80. [PMID: 23670502 PMCID: PMC4075818 DOI: 10.1590/s1806-37132013000200008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/22/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE: To evaluate the effects that early and late systemic administration of methylprednisolone have on lungs in a rat model of brain death. METHODS: Twenty-four male Wistar rats were anesthetized and randomly divided into four groups (n = 6 per group): sham-operated (sham); brain death only (BD); brain death plus methylprednisolone (30 mg/kg i.v.) after 5 min (MP5); and brain death plus methylprednisolone (30 mg/kg i.v.) after 60 min (MP60). In the BD, MP5, and MP60 group rats, we induced brain death by inflating a balloon catheter in the extradural space. All of the animals were observed and ventilated for 120 min. We determined hemodynamic and arterial blood gas variables; wet/dry weight ratio; histological score; levels of thiobarbituric acid reactive substances (TBARS); superoxide dismutase (SOD) activity; and catalase activity. In BAL fluid, we determined differential white cell counts, total protein, and lactate dehydrogenase levels. Myeloperoxidase activity, lipid peroxidation, and TNF-α levels were assessed in lung tissue. RESULTS: No significant differences were found among the groups in terms of hemodynamics, arterial blood gases, wet/dry weight ratio, BAL fluid analysis, or histological score-nor in terms of SOD, myeloperoxidase, and catalase activity. The levels of TBARS were significantly higher in the MP5 and MP60 groups than in the sham and BD groups (p < 0.001). The levels of TNF-α were significantly lower in the MP5 and MP60 groups than in the BD group (p < 0.001). CONCLUSIONS: In this model of brain death, the early and late administration of methylprednisolone had similar effects on inflammatory activity and lipid peroxidation in lung tissue.
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Risk Factors and Survival Impact of Primary Graft Dysfunction After Lung Transplantation in a Single Institution. Transplant Proc 2012; 44:2462-8. [DOI: 10.1016/j.transproceed.2012.07.134] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Medeiros IL, Pêgo-Fernandes PM, Mariani AW, Fernandes FG, do Vale Unterpertinger F, Canzian M, Jatene FB. Histologic and functional evaluation of lungs reconditioned by ex vivo lung perfusion. J Heart Lung Transplant 2011; 31:305-9. [PMID: 22133788 DOI: 10.1016/j.healun.2011.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/02/2011] [Accepted: 10/04/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Only about 15% of donor lungs are considered suitable for transplantation (LTx). Ex vivo lung perfusion (EVLP) has been developed as a method to reassess and repair damaged lungs. We report our experience with EVLP in non-acceptable donor lungs and evaluate its ability to recondition these lungs. METHODS We studied lungs from 16 brain-dead donors rejected for LTx. After harvesting, the lungs were stored at 4°C for 10 hours and subjected to normothermic EVLP with Steen Solution (Vitrolife, Göteborg, Sweden) for 60 minutes. For functional evaluation, the following variables were assessed: partial pressure of arterial oxygen (Pao(2)), pulmonary vascular resistance (PVR), and lung compliance (LC). For histologic assessment, lung biopsy was done before harvest and after EVLP. Tissue samples were examined under light microscopy. To detect and quantify apoptosis, terminal deoxynucleotide transferase-mediated deoxy uridine triphosphate nick-end labeling assay was used. RESULTS Thirteen lung donors were refused for having impaired lung function. The mean Pao(2) obtained in the organ donor at the referring hospital was 193.7 mm Hg and rose to 489 mm Hg after EVLP. During EVLP, the mean PVR was 652.5 dynes/sec/cm(5) and the mean LC was 48 ml/cm H(2)O. There was no significant difference between the mean Lung Injury Score before harvest and after EVLP. There was a trend toward a reduction in the median number of apoptotic cells after EVLP. CONCLUSIONS EVLP improved lung function (oxygenation capacity) of organs considered unsuitable for transplantation. Lung tissue structure did not deteriorate even after 1 hour of normothermic perfusion.
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Affiliation(s)
- Israel Lopes Medeiros
- Thoracic Surgery Department, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Prognostic factors in lung transplantation: the Santa Casa de Porto Alegre experience. Transplantation 2011; 91:1297-303. [PMID: 21572382 DOI: 10.1097/tp.0b013e31821ab8e5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lung transplantation (LT) has been established as a current therapy for selected patients with end-stage lung disease. Different prognostic factors have been reported by transplant centers. The objective of this study is to report our recent results with LT and to search for prognostic factors. METHODS We performed a retrospective analysis of 130 patients who underwent LT at our institution from January 2004 to July 2009. Donor, recipient, intraoperative, and postoperative variables were collected. RESULTS The mean age was 53.14 years (ranging from 8 to 72 years) and 80 (61.5%) were male. The main causes of end-stage respiratory disease were pulmonary fibrosis 53 (40.7%) and chronic obstructive pulmonary disease 52 (40%). The actuarial 1-year survival was 67.7%. Variables correlated with survival were age (P=0.004), distance in the 6-min walk test (P=0.007), coronary heart disease (P=0.001), cardiopulmonary bypass (P=0.02), intraoperative transfusion of red blood cells (P=0.016), increasing central venous pressure at 24th postoperative hour (P=0.001), increasing pulmonary capillary wedge pressure at 24th postoperative hour (P=0.01); length of intubation (P<0.01), reintubation (P=0.001), length of intensive care unit stay (P<0.001), abdominal complication (P=0.003), acute renal failure requiring dialysis (P<0.001), native lung hyperinflation (P=0.02), and acute rejection in the first month (P=0.03). In multivariate analysis, only dialysis (P=0.004, hazards ratio [HR] 2.68), length of intubation (P=0.004, HR 1.002 for each hour), and reintubation (P=0.003, HR 2.88) proved to be independent predictors. CONCLUSION Analysis of variables in our cohort highlighted dialysis, longer mechanical ventilation requirement, and reintubation as independent prognostic factors in LT.
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Pêgo-Fernandes PM, Samano MN, Fiorelli AI, Fernandes LM, Camargo SM, Xavier AM, Sarmento PA, Bernardo WM, de Castro MCR, Jatene FB. Recommendations for the use of extended criteria donors in lung transplantation. Transplant Proc 2011; 43:216-9. [PMID: 21335191 DOI: 10.1016/j.transproceed.2010.12.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Selection criteria for lung donation were based on initial experiences with lung transplantation without further studies to improve them, thereby guaranteeing the best use of donated organs. A definition of an extended criteria donor is therefore required to obtain more lungs to meet the demands of patients awaiting transplantation. Studies have been reviewed for the impact on survival and morbidity of age ranges, oxygen fraction, cause of death, smoking habits, x-ray findings, infection, hepatitis serology and non-heart-beating status, seeking to support physicians to make decisions regarding the use of marginal organs.
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Affiliation(s)
- P M Pêgo-Fernandes
- Department of Cardiopneumonology, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil.
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Pêgo-Fernandes PM, Garcia VD. Current status of transplantation in Brazil. SAO PAULO MED J 2010; 128:3-4. [PMID: 20512272 PMCID: PMC10936129 DOI: 10.1590/s1516-31802010000100001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 11/18/2009] [Accepted: 12/18/2009] [Indexed: 11/21/2022] Open
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Costa da Silva F, Afonso J, Pêgo-Fernandes P, Caramori M, Jatene F. São Paulo Lung Transplantation Waiting List: Patient Characteristics and Predictors of Death. Transplant Proc 2009; 41:927-31. [DOI: 10.1016/j.transproceed.2009.01.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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