In lung transplantation, are pulmonary grafts from donors deceased from hanging as suitable as grafts from donors deceased from other causes?

2019 ◽  
Vol 30 (1) ◽  
pp. 30-32
Author(s):  
João Santos Silva ◽  
Anne Olland ◽  
Gilbert Massard ◽  
Pierre-Emmanuel Falcoz
Keyword(s):  
Lung Transplantation ◽  
Observational Studies ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Graft Dysfunction ◽  
Post Transplantation ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Study Type

Abstract A best evidence topic was constructed according to a structured protocol. The question addressed was whether pulmonary grafts from donors deceased from hanging offer the same benefit as grafts from donors deceased from other causes in lung transplantation. Of the 17 papers found, 4 provided the best evidence to answer the question. The authors, date, journal, country of publication, study type, group studied, relevant outcomes and results of these papers are tabulated. One study reported a large cohort of donors and analysed the outcomes by cause of death, reporting no differences in survival. The remaining 3 papers analysed observational studies on the outcomes of lung transplantation using pulmonary grafts from donors deceased from hanging, compared with donors deceased from other causes. No differences in the rates of post-transplantation pulmonary graft dysfunction and long-term overall survival were reported. Although the cohort of donors deceased from hanging is small, we conclude that these donors are an important contribution to the donor pool. Ex vivo lung perfusion may have a role in assessing graft viability in this scenario.

Primary Graft Dysfunction

2021 ◽  
Vol 42 (03) ◽  
pp. 368-379
Author(s):  
Jake G. Natalini ◽  
Joshua M. Diamond
Keyword(s):  
Risk Factors ◽  
Lung Transplantation ◽  
Ex Vivo ◽  
Significant Risk ◽  
Subsequent Development ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Increased Risk

AbstractPrimary graft dysfunction (PGD) is a form of acute lung injury after transplantation characterized by hypoxemia and the development of alveolar infiltrates on chest radiograph that occurs within 72 hours of reperfusion. PGD is among the most common early complications following lung transplantation and significantly contributes to increased short-term morbidity and mortality. In addition, severe PGD has been associated with higher 90-day and 1-year mortality rates compared with absent or less severe PGD and is a significant risk factor for the subsequent development of chronic lung allograft dysfunction. The International Society for Heart and Lung Transplantation released updated consensus guidelines in 2017, defining grade 3 PGD, the most severe form, by the presence of alveolar infiltrates and a ratio of PaO2:FiO2 less than 200. Multiple donor-related, recipient-related, and perioperative risk factors for PGD have been identified, many of which are potentially modifiable. Consistently identified risk factors include donor tobacco and alcohol use; increased recipient body mass index; recipient history of pulmonary hypertension, sarcoidosis, or pulmonary fibrosis; single lung transplantation; and use of cardiopulmonary bypass, among others. Several cellular pathways have been implicated in the pathogenesis of PGD, thus presenting several possible therapeutic targets for preventing and treating PGD. Notably, use of ex vivo lung perfusion (EVLP) has become more widespread and offers a potential platform to safely investigate novel PGD treatments while expanding the lung donor pool. Even in the presence of significantly prolonged ischemic times, EVLP has not been associated with an increased risk for PGD.

scholarly journals Reduction of primary graft dysfunction using cytokine filtration following acute respiratory distress syndrome in lung transplantation

2021 ◽  
Author(s):  
Haider Ghaidan ◽  
Martin Stenlo ◽  
Nika Gvazava ◽  
Anna Niroomand ◽  
Dag Edstrom ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Lung Transplantation ◽  
Distress Syndrome ◽  
Ex Vivo ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Post Transplantation ◽  
Ex Vivo Lung Perfusion

Abstract Despite improvements, lung transplantation (LTx) remains hampered by both a scarcity of donor organs and by mortality following primary graft dysfunction (PGD). Since acute respiratory distress syndrome (ARDS) limits donor lungs utilization, we investigated cytokine filtration as a means of restoring ARDS donor lungs. We induced mild to moderate ARDS using lipopolysaccharide in 12 donor pigs. Lungs were then treated with or without cytokine filtration during ex vivo lung perfusion (EVLP) and post-transplantation using extracorporeal hemoperfusion. The treatment significantly decreased cytokine levels during EVLP and decreased levels of immune cells post-transplantation. Histology demonstrated fewer signs of lung injury across both treatment periods and the incidence of PGD was significantly reduced among treated animals. Overall, cytokine filtration was able to restore lung function and reduce PGD in lung transplantation. We suggest this treatment will increase the availability of donor lungs and increase the tolerability of donor lungs in the recipient.

Lung transplantation

2015 ◽  
Author(s):  
John Blaikley ◽  
Andrew J Fisher
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Early Phase ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Donor Organ ◽  
Specific Group ◽  
Post Transplantation ◽  
Ex Vivo Lung Perfusion

This chapter describes common issues along the transplantation journey from assessment to common conditions that are diagnosed post transplantation. Assessment for transplant suitability against several objective criteria is covered as well as the importance of optimizing techniques prior to this. Recent advances mean that some patients can now be bridged to transplant using extracorporeal membrane oxygenation (ECMO) when previously they would have been removed from the transplant list. Drawbacks to ECMO are discussed. Ex-vivo lung perfusion (EVLP) of a donor organ is covered. Follow-up is considered, especially in the early phase whilst being stabilized on their new medications as well as monitoring for the development of lung rejection (acute and chronic). These conditions often present when patients are being seen away from the transplant centre. CF patients have the best outcomes of the groups after lung transplantation, emphasising that lung transplantation should be considered in this specific group of patients.

scholarly journals Developments in lung transplantation over the past decade

2020 ◽  
Vol 29 (157) ◽  
pp. 190132 ◽  
Author(s):  
Sophie C. van der Mark ◽  
Rogier A.S. Hoek ◽  
Merel E. Hellemons
Keyword(s):  
Lung Transplantation ◽  
Ex Vivo ◽  
Smoking Status ◽  
Lung Perfusion ◽  
Long Term Outcomes ◽  
Donor Pool ◽  
The Past ◽  
End Stage

With an improved median survival of 6.2 years, lung transplantation has become an increasingly acceptable treatment option for end-stage lung disease. Besides survival benefit, improvement of quality of life is achieved in the vast majority of patients. Many developments have taken place in the field of lung transplantation over the past decade. Broadened indication criteria and bridging techniques for patients awaiting lung transplantation have led to increased waiting lists and changes in allocation schemes worldwide. Moreover, the use of previously unacceptable donor lungs for lung transplantation has increased, with donations from donors after cardiac death, donors with increasing age and donors with positive smoking status extending the donor pool substantially. Use of ex vivo lung perfusion further increased the number of lungs suitable for lung transplantation. Nonetheless, the use of these previously unacceptable lungs did not have detrimental effects on survival and long-term graft outcomes, and has decreased waiting list mortality. To further improve long-term outcomes, strategies have been proposed to modify chronic lung allograft dysfunction progression and minimise toxic immunosuppressive effects. This review summarises the developments in clinical lung transplantation over the past decade.

Differential Outcomes for Long Term ex vivo Lung Perfusion in a Porcine Model - With or without Red Cells?

2015 ◽  
Vol 63 (S 01) ◽  
Author(s):  
W. Sommer ◽  
M. Avsar ◽  
J. Salman ◽  
C. Kühn ◽  
I. Tudorache ◽  
...  
Keyword(s):  
Porcine Model ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Red Cells ◽  
Ex Vivo Lung Perfusion ◽  
Differential Outcomes

scholarly journals Lung transplantation after ex vivo lung perfusion in two Scandinavian centres

2018 ◽  
Vol 55 (4) ◽  
pp. 766-772 ◽  
Author(s):  
Tobias Nilsson ◽  
Andreas Wallinder ◽  
Ian Henriksen ◽  
Jens Christian Nilsson ◽  
Sven-Erik Ricksten ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Ex Vivo ◽  
Lung Perfusion ◽  
Ex Vivo Lung Perfusion
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