Evaluation of uncontrolled donation after circulatory death lungs by conventional in-situ effluent gas analysis and ex vivo lung perfusion

2021 ◽  
Author(s):  
Shin Tanaka ◽  
Lucas Hoyos Mejía ◽  
Alejandra Romero Román ◽  
Jose Luis Campo-Cañaveral de la Cruz ◽  
Silvana Crowley Carrasco ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Lung Perfusion ◽  
Gas Analysis ◽  
Donation After Circulatory Death ◽  
Ex Vivo Lung Perfusion ◽  
Circulatory Death

scholarly journals Donation After Circulatory Death Lungs Transplantable Up to Six Hours After Ex Vivo Lung Perfusion

2016 ◽  
Vol 102 (6) ◽  
pp. 1845-1853 ◽  
Author(s):  
Eric J. Charles ◽  
Mary E. Huerter ◽  
Cynthia E. Wagner ◽  
Ashish K. Sharma ◽  
Yunge Zhao ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Lung Perfusion ◽  
Donation After Circulatory Death ◽  
Ex Vivo Lung Perfusion ◽  
Circulatory Death

scholarly journals Subnormothermic ex vivo lung perfusion attenuates ischemia reperfusion injury from donation after circulatory death donors

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255155
Author(s):  
Stephan Arni ◽  
Tatsuo Maeyashiki ◽  
Isabelle Opitz ◽  
Ilhan Inci
Keyword(s):  
Lung Tissue ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Atp Content ◽  
Donation After Circulatory Death ◽  
Immunological Parameters ◽  
Ex Vivo Lung Perfusion ◽  
Ischemic Time ◽  
Physiological Variables ◽  
Circulatory Death

Use of normothermic ex vivo lung perfusion (EVLP) was adopted in clinical practice to assess the quality of marginal donor lungs. Subnormothermic perfusion temperatures are in use among other solid organs to improve biochemical, clinical and immunological parameters. In a rat EVLP model of donation after circulatory death (DCD) lung donors, we tested the effect of four subnormothermic EVLP temperatures that could further improve organ preservation. Warm ischemic time was of 2 hours. EVLP time was of 4 hours. Lung physiological data were recorded and metabolic parameters were assessed. Lung oxygenation at 21°C and 24°C were significantly improved whereas pulmonary vascular resistance and edema formation at 21°C EVLP were significantly worsened when compared to 37°C EVLP. The perfusate concentrations of potassium ions and lactate exiting the lungs with 28°C EVLP were significantly lower whereas sodium and chlorine ions with 32°C EVLP were significantly higher when compared to 37°C EVLP. Also compared to 37°C EVLP, the pro-inflammatory chemokines MIP2, MIP-1α, GRO-α, the cytokine IL-6 were significantly lower with 21°C, 24°C and 28°C EVLP, the IL-18 was significantly lower but only with 21°C EVLP and IL-1β was significantly lower at 21°C and 24°C EVLP. Compared to the 37°C EVLP, the lung tissue ATP content after 21°C, 24°C and 28°C EVLP were significantly higher, the carbonylated protein content after 28°C EVLP was significantly lower and we measured significantly higher myeloperoxidase activities in lung tissues with 21°C, 24°C and 32°C. The 28°C EVLP demonstrated acceptable physiological variables, significantly higher lung tissue ATP content and decreased tissue carbonylated proteins with reduced release of pro-inflammatory cytokines. In conclusion, the 28°C EVLP is a non inferior setting in comparison to the clinically approved 37°C EVLP and significantly improve biochemical, clinical and immunological parameters and may reduce I/R injuries of DCD lung donors.

Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues

2018 ◽  
Vol 39 (02) ◽  
pp. 138-147 ◽  
Author(s):  
Bronwyn Levvey ◽  
Kovi Levin ◽  
Miranda Paraskeva ◽  
Glen Westall ◽  
Gregory Snell
Keyword(s):  
Brain Death ◽  
Ex Vivo ◽  
Scoring Systems ◽  
Donation After Circulatory Death ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Conversion Rates ◽  
Donor Lung ◽  
Donation After Brain Death ◽  
Circulatory Death

AbstractLung transplantation (LTx) has traditionally been limited by a lack of suitable donor lungs. With the recognition that lungs are more robust than initially thought, the size of the donor pool of available lungs has increased dramatically in the past decade. Donation after brain death (DBD) and donation after circulatory death (DCD) lungs, both ideal and extended are now routinely utilized. DBD lungs can be damaged. There are important differences in the public's understanding, legal and consent processes, intensive care unit strategies, lung pathophysiology, logistics, and potential-to-actual donor conversion rates between DBD and DCD. Notwithstanding, the short- and long-term outcomes of LTx from any of these DBD versus DCD donor scenarios are now similar, robust, and continue to improve. Large audits suggest there remains a large untapped pool of DCD (but not DBD) lungs that may yet further dramatically increase lung transplant numbers. Donor scoring systems that might predict the donor conversion rates and lung quality, the role of ex vivo lung perfusion as an assessment and lung resuscitation tool, as well as the potential of donor lung quality biomarkers all have immense promise for the clinical field.

scholarly journals Reduced-flow ex vivo lung perfusion to rehabilitate lungs donated after circulatory death

2020 ◽  
Vol 39 (1) ◽  
pp. 74-82
Author(s):  
Jared P. Beller ◽  
Matthew R. Byler ◽  
Dustin T. Money ◽  
William Z. Chancellor ◽  
Aimee Zhang ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Lung Perfusion ◽  
Ex Vivo Lung Perfusion ◽  
Circulatory Death ◽  
Reduced Flow

scholarly journals Successful preservation and transplant of warm ischaemic lungs from controlled donors after circulatory death by prolonged in situ ventilation during normothermic regional perfusion of abdominal organs

2019 ◽  
Vol 29 (5) ◽  
pp. 699-705 ◽  
Author(s):  
Alessandro Palleschi ◽  
Davide Tosi ◽  
Lorenzo Rosso ◽  
Alberto Zanella ◽  
Riccardo De Carlis ◽  
...  
Keyword(s):  
Ex Vivo ◽  
Organ Procurement ◽  
Regional Perfusion ◽  
Low Flow ◽  
Ex Vivo Lung Perfusion ◽  
Abdominal Organs ◽  
Using Data ◽  
Normothermic Regional Perfusion ◽  
Circulatory Death

Abstract OBJECTIVES Donation after circulatory death (DCD) potentially provides transplantable lungs suitable for a transplant, but in Italy, the need for 20 min of a no-touch period after cardiac arrest for legal declaration of death poses real challenges to organ preservation. METHODS This is a single-institution, retrospective study using data collected prospectively between October and December 2017. After the approval of the multidisciplinary DCD study group of Regione Lombardia, Maastricht category III DCD donors became eligible for combined procurement of lungs and abdominal organs. Our group subsequently established a dedicated technical protocol. Our protocol consists of a non-rapid normothermic open-lung procurement process that takes place during abdominal normothermic regional perfusion, namely without pleural topical cooling before the start of pneumoplegia. After the lung is procured according to the technique described in the article, lung function is evaluated by ex vivo lung perfusion, which is run with the low-flow, open atrium, low haematocrit technique. RESULTS During the study, we managed 5 controlled DCDs. In 3 cases, the lungs were successfully transplanted. All 3 patients are alive after 1 year, with good respiratory function. CONCLUSIONS Our approach resulted in adequate lung preservation and successful transplants without detrimental effects on abdominal organ procurement, confirming the possibility of overcoming the obstacle of a long no-touch period in a DCD setting.

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