Impact of normothermic ex vivo lung perfusion on early post-transplantation cytomegalovirus infection

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.

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Lung transplantation

10.1093/med/9780198702948.003.0011 ◽

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.

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Lung Transplantation from Donors after Circulatory Death Using PortableEx VivoLung Perfusion

Canadian Respiratory Journal ◽

10.1155/2015/357498 ◽

2015 ◽

Vol 22 (1) ◽

pp. 47-51 ◽

Cited By ~ 14

Author(s):

Sabin Bozso ◽

Vishnu Vasanthan ◽

Jessica GY Luc ◽

Katie Kinaschuk ◽

Darren Freed ◽

...

Keyword(s):

Ex Vivo ◽

Forced Expiratory Volume ◽

Lung Perfusion ◽

Post Transplantation ◽

Ex Vivo Lung Perfusion ◽

Oxygen Fraction ◽

Lung Transplants ◽

Fraction Of Inspired Oxygen ◽

Bilateral Lung ◽

Circulatory Death

BACKGROUND: Donation after circulatory death is a novel method of increasing the number of donor lungs available for transplantation. Using organs from donors after circulatory death has the potential to increase the number of transplants performed.METHODS: Three bilateral lung transplants from donors after circulatory death were performed over a six-month period. Following organ retrieval, all sets of lungs were placed on a portable ex vivo lung perfusion device for evaluation and preservation.RESULTS: Lung function remained stable during portable ex vivo perfusion, with improvement in partial pressure of oxygen/fraction of inspired oxygen ratios. Mechanical ventilation was discontinued within 48 h for each recipient and no patient stayed in the intensive care unit longer than eight days. There was no postgraft dysfunction at 72 h in two of the three recipients. Ninety-day mortality for all recipients was 0% and all maintain excellent forced expiratory volume in 1 s and forced vital capacity values post-transplantation.CONCLUSION: The authors report excellent results with their initial experience using donors after circulatory death after portable ex vivo lung perfusion. It is hoped this will allow for the most efficient use of available donor lungs, leading to more transplants and fewer deaths for potential recipients on wait lists.

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