“Hybrid Lung Transplantation” Combining Living Donor and Cadaveric Lung Transplants: Report of 2 Cases

Abstract Background Primary graft dysfunction (PGD) remains a major obstacle after lung transplantation. We developed a novel approach to selectively assess reperfusion injury in transplanted lung and investigated the impact of pulmonary flow.Materials Twelve porcine left lung transplants were divided in two groups (n = 6, in low (LF) and high flow (HF) group). Donor lungs were stored for 24 hours on ice, followed by left lung transplantation. Recipient animals were observed for 6h after reperfusion with partially clamping of right PA in HF group. Results Survival at 6 hours was 100% in both groups. PaO2/FiO2 (P/F) ratio of the transplanted lung was lower (229.1 mmHg vs 308.9 mmHg, p=0.01), mPAP was higher (34.62 mmHg vs 29.88 p=0.01) in HF versus LF group. Wet-to-dry (W/D) ratios of right native and left transplanted lung were not different after 6 h of reperfusion. Conclusions Lung transplantation in large animal settings is feasible. P/F ratio in allograft is dependent on PA flow. Our innovative approach to control blood flow to transplanted lung demonstrates that higher flows induce more PGD and allows to further study development and treatment of PGD. Our findings might have an important impact on sequential intra-operative approach during lung transplantation.

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Outcomes of various transplant procedures (single, sparing, inverted) in living-donor lobar lung transplantation

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2016.10.017 ◽

2017 ◽

Vol 153 (2) ◽

pp. 479-486 ◽

Cited By ~ 20

Author(s):

Hiroshi Date ◽

Akihiro Aoyama ◽

Kyoko Hijiya ◽

Hideki Motoyama ◽

Tomohiro Handa ◽

...

Keyword(s):

Lung Transplantation ◽

Living Donor

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Anesthesia for Lung Transplantation

Cardiac Anesthesia: A Problem-Based Learning Approach ◽

10.1093/med/9780190884512.003.0032 ◽

2019 ◽

pp. 322-329

Author(s):

J. Devin Roberts

Keyword(s):

Lung Transplantation ◽

Transesophageal Echocardiography ◽

Gold Standard ◽

Anesthetic Management ◽

Survival Rates ◽

Anesthesia Care ◽

Lung Isolation ◽

The Past ◽

Lung Transplants ◽

End Stage

Since the first human procedure in 1963, lung transplantation has become the gold standard treatment of a variety of end-stage lung diseases. With over 4000 lung transplants performed in 2015 and steadily improving survival rates over the past three decades, anesthetic management of patients undergoing lung transplant can significantly contribute to patient outcomes. Anesthesia care for lung transplantation can be both complex and clinically challenging. Anesthesiologists taking part in these procedures need to have specific skills regarding thoracic and cardiac anesthesia. There are both technical and physiological challenges, such as achieving adequate lung isolation and oxygenation, interpretation and use of transesophageal echocardiography, and the management of respiratory and myocardial impairments. This chapter provides an overview of these perioperative anesthetic management considerations utilizing a problem-based format.

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Necrotizing Choroiditis-Retinitis as Presenting Symptom of Disseminated Aspergillosis after Lung Transplantation

European Journal of Ophthalmology ◽

10.1177/112067219700700316 ◽

1997 ◽

Vol 7 (3) ◽

pp. 294-296 ◽

Cited By ~ 12

Author(s):

I. Anteby ◽

M. Kramer ◽

G. Rahav ◽

D. Benezra

Keyword(s):

Lung Transplantation ◽

Fungal Infection ◽

Aspergillus Fumigatus ◽

Endogenous Endophthalmitis ◽

Ocular Involvement ◽

Blurred Vision ◽

Systemic Manifestations ◽

Lung Transplants ◽

Disseminated Aspergillosis ◽

Aspergillus Endophthalmitis

Background. Endogenous endophthalmitis due to Aspergillus is rare affecting the severely immunosuppressed population, in particular recipients of heart and lung transplants. Ocular involvement of aspergillosis has always been observed late in the course of the disease. Subject. A young woman noted blurred vision in one eye three weeks after lung transplantation. At this stage, no systemic manifestations of fungal infection were detected and the ocular findings were attributed to viral infection. Results. Twenty-four hours after the original ocular complaint, an aggressive endophthalmitis developed in the left eye. The possibility of fungal endophthalmitis was raised. Within 48 hours of her first ocular complaint the patient died. Cultures from a vitreous tap and from autopsy ocular specimens were positive for Aspergillus fumigatus. Conclusions. Aspergillus endophthalmitis may occur in patients undergoing lung transplantation despite antifungal therapy. Increased awareness of this unusual entity may be life and vision saving in these patients.

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