Aggressive management of lung donors classified as unacceptable: Excellent recipient survival one year after transplantation

Straznicka, Michaela; Follette, David M.; Eisner, Mark D.; Roberts, Peter; Menza, Rebecca; Babcock, Wayne D.

doi:10.1067/mtc.2002.123813

Cited by 124 publications

(65 citation statements)

References 14 publications

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“…Frequently, what seems to be a marginal donor can be made quite acceptable [21]. Although a significant smoking history (o30 pack-yrs) in the donor is concerning, it is not an absolute contraindication to the use of otherwise suitable donor lungs.…”

Section: Current Availability Of Donor Lungsmentioning

confidence: 99%

Current status of lung transplantation

Lau¹,

Patterson²

2003

Eur Respir J

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Two decades have passed since the first successful clinical lung transplant was performed in 1983, and, in the interim, lung transplantation has become the preferred treatment option for a variety of end-stage pulmonary diseases. Remarkable progress has been made in the field through refinement of technique and improved understanding of transplant immunology and microbiology.Unfortunately, donor shortages continue to limit the more widespread application of lung transplantation. In order to address this issue, marginal donors, living lobar and split lung donor techniques, and nonheartbeating donors have been used clinically to increase the number of donor lungs available.Chronic rejection of the lung allograft is currently the major hurdle limiting longterm survival. To date, prevention of known risk factors and treatment strategies have not lessened the devastating toll this process has on lung transplant survival. Better understanding of the cause of chronic rejection is needed in order to develop novel strategies for its treatment. Promotion of immune tolerance is a promising area that could potentially eliminate chronic rejection.The present article discusses recent advances in lung transplantation. It also details the major issues facing the field today. Only through continued clinical and experimental investigation will lung transplantation eventually reach its full potential. Eur Respir J 2003; 22: Suppl. 47, 57s-64s.

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Section: Current Availability Of Donor Lungsmentioning

confidence: 99%

Current status of lung transplantation

Lau¹,

Patterson²

2003

Eur Respir J

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“…Oxygenation has been one criterion with which clinicians have rarely compromised. However, STRAZNICKA et al [51] and GABBAY et al [44] have shown that donors with poor initial oxygenation can be improved with aggressive management, and eventually used for LTx without significant impact on the postoperative course and 1-yr survival. Hence, donors with poor oxygenation should not be deemed unsuitable for transplantation, since up to 35% of them can be improved to reach an arterial oxygen tension (Pa,O 2 )/FI,O 2 ratio of w39.9 kPa (300 mmHg) after aggressive resuscitation.…”

Section: Extension Of Lung Donor Selection Criteriamentioning

confidence: 99%

Strategies to increase limited donor resources

Perrot¹,

Weder²,

Patterson³

et al. 2004

Eur Respir J

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A number of strategies have been advocated to increase the number of lung donors including: 1) improvement in donor resuscitation; 2) better methods of lung preservation; 3) extension of the lung donor selection criteria; 4) development of a living-related lung donor programme; and 5) utilisation of nonheart beating donors.Other strategies such as the split-lung technique and techniques of lung reduction to accommodate large lungs into a small-size recipient have also been used successfully. In this article, each of these strategies have been reviewed and some recommendations are suggested based on the authors9 own experience and that of the literature.

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“…However, the lungs are susceptible to interstitial oedema particularly in the context of brainstem death and many feel these changes are reversible, making the underlying lung suitable for transplantation. Straznicka et al 56 described the management of 27 unacceptable donors with a mean PaO 2 :FiO 2 of 13.7 kPa at initial assessment. All were treated with invasive monitoring, methylprednisolone, fluid restriction, inotropic agents, bronchoscopy and diuresis.…”

Section: Aggressive Medical Management Of Donormentioning

confidence: 99%

Current status of lung transplantation

2012

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Lung transplantation is a well-established treatment option for selected patients with end-stage lung disease, leading to improved survival and improved quality of life. The last 20 years have seen a steady growth in number of lung transplantation procedures performed worldwide. The increase in clinical activity has been associated with tremendous progress in the understanding of cellular and molecular processes that limit both short-and long-term outcomes. This review gives a comprehensive overview of the current status of lung transplantation for the referring physician. It demonstrates that careful selection of potential recipients, optimisation of their condition prior to transplant, use of carefully assessed donor organs, excellent surgery and meticulous longterm follow-up are all essential ingredients in determining a successful outcome.

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Aggressive management of lung donors classified as unacceptable: Excellent recipient survival one year after transplantation

Abstract: Aggressive organ procurement organization management of donors initially considered unacceptable may increase the number of lungs available for transplantation.

Cited by 124 publications

References 14 publications

Current status of lung transplantation

Current status of lung transplantation

Strategies to increase limited donor resources

Current status of lung transplantation

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