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Objectives Bronchial anastomotic complications remain a major concern in lung transplantation. We aim to compare two different techniques, continuous versus interrupted suture by analyzing airway complications requiring intervention. Methods Lung transplantations between January-2015 and December-2020 were included. Airway complications requiring intervention were classified following the 2018 ISHLT consensus and analyzed comparing three groups of patients according to surgical technique: Group A, both anastomosis performed with continuous suture; Group B, both with interrupted; and Group C, interrupted suture for one side and continuous suture for the contralateral side. Results A total of 461 anastomoses were performed in 245 patients. The incidence of airway complications requiring intervention was 5.7% (95%CI 2.8; 8.6) per patient (14/245) and 3.7% (95%CI 2.0; 5.4) per anastomosis (17/461). Complications that required intervention were present in 5 out of 164 (3.1%) anastomosis with interrupted technique, and in 12/240 (5%) with continuous suture. No significant differences were found between techniques (p = 0.184). No statistical differences were found among Group A, B or C in terms of incidence of anastomotic complications, demographics, transplant outcomes or overall survival (log-rank p = 0.513). In a multivariable analysis, right laterality was significantly associated to complications requiring intervention (OR 3.7[CI 95%:1.1-12.3], p = 0.030). Endoscopic treatment was successful in 12 patients (85.7%). Retransplantation was necessary in two patients. Conclusion In summary, although it seems that anastomotic complications requiring intervention occur more frequently with continuous suture, there are no statistical differences compared to interrupted suture. Endoscopic treatment offers good outcomes in most of the airway complications after lung transplantation.

ObjectiveDue to the decrease in brain death donors (BDD), donation after controlled cardiac death (Maastricht III type patients, DCD-III) has aroused as another strategy of donation. The objective of this research is to study the general characteristics and the impact on donation rates of a DCD-III protocol (Figure 1), after its implementation (January 2012), in a tertiary hospital. MethodsRetrospective, descriptive and observational study (January 2012-February 2015. The DCD-III protocol enclosed limitation of life sustaining therapies (LLST) in both the intensive care unit (UCI) and the operating room (OR), and included two strategies (Strategy A: rapid surgery and Strategy B: cannulation, Figure 2). Type and number of organs obtained, and their impact on donation rates were analyzed. ResultsDuring the study period there were 73 potential donors that turned out in 52 real donors. BDD accounted for 27 donations and DCD-III for 25 (48% increase in donations after the introduction of DCD-III). In the DCD-III group, LLST was done in all patients but one in the OR. Eighteen patients underwent rapid surgery. Characteristics of donation and differences in organ retrieval are shown in Figure 3. In the 2010-2012 period, monthly organ donation rate was 0,45, and it tripled to 1,4 donors/month after the establishment of the DCD-III protocol. Mean organ rate recovered by donor was 2,96 for BDD and 2,24 for DCD-III. DCD-III donors were responsible for a 48,8%, 29,6% and 44,4% of the kidney, liver and lung transplants in the study period. ConclusionsDCD-III is a valid method for increasing organ donation rates. DCD-III programs should form part of organ donation strategies.

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