Continued Successful Evolution of Extended Criteria Donor Lungs for Transplantation

Kotecha, Sakhee; Hobson, Jamie; Fuller, Jeremy; Paul, Eldho; Levvey, Bronwyn; Whitford, Helen; Paraskeva, Miranda; McGiffin, David C.; Snell, Gregory I; Westall, Glen P.

doi:10.1016/j.athoracsur.2017.05.042

Cited by 58 publications

(57 citation statements)

References 21 publications

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“…While the constituent studies of this meta-analysis applied varying EVLP protocols and methodologies, it is clear that EVLP provides the ability to expand the pool of available donor lungs by reconditioning and reassessing lungs not considered suitable under standard criteria lung transplant. Using marginal lungs under extended-criteria for standard protocol lung transplant has been reported as doubling utilization rates to around 30-40% (30,31). Using EVLP however, studies in the present analysis reported conversion rates from EVLP evaluated lungs to transplant ranging from 34% to 97% (8,20,21,23,24,26).…”

Section: Discussionmentioning

confidence: 50%

Ex-vivo lung perfusion versus standard protocol lung transplantation—mid-term survival and meta-analysis

Chakos

Ferret

Muston

et al. 2020

Ann Cardiothorac Surg

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Background: While extended criteria lung donation has helped expand the lung donor pool, utilization of lungs from donors of at least one other solid organ is still limited to around 15-30%. Ex-vivo lung perfusion (EVLP) offers the ability to expand the number of useable lung grafts through assessment and reconditioning of explanted lungs, particularly those not initially meeting criteria for transplantation. This meta-analysis aimed to examine the mid-to long-term survival and other short-term outcomes of patients transplanted with EVLP-treated lungs versus standard/cold-storage protocol lungs.Methods: Literature search of ten medical databases was conducted for original studies involving "ex-vivo lung perfusion" and "EVLP". Included articles were assessed by two independent researchers, survival data from Kaplan-Meier curves digitized, and individual patient data imputed to conduct aggregated survival analysis. Meta-analyses of suitably reported outcomes were conducted using a random-effects model. Results: Thirteen studies met inclusion criteria, with a total of 407 EVLP lung transplants and 1,765 as per standard/cold storage protocol. One study was a randomized controlled trial while the remainder were single-institution cohort series of varying design. The majority of donor lungs were from brain death donors, with EVLP lungs having significantly worse PaO 2 /FiO 2 ratio and significantly greater rate of abnormal chest X-ray. Aggregated survival analysis of all included studies revealed no significant survival difference for EVLP or standard protocol lungs (hazard ratio 1.00; 95% confidence interval: 0.79-1.27, P=0.981). Survival at 12, 24, and 36 months for the EVLP cohort was 84%, 79%, and 74%, respectively. Survival at 12, 24, and 36 months for the standard protocol cohort was 85%, 79%, and 73%, respectively. Meta-analysis did not find a significant difference in risk of 30-day mortality or primary graft dysfunction grade 3 at 72 hours between cohorts. Conclusions:There was no significant difference in mid-to long-term survival of EVLP lung transplant patients when compared to standard protocol donor lungs. The incidence of 30-day mortality and primary graft dysfunction grade 3 at 72 hours did not differ significantly between groups. EVLP offers the potential to increase lung donor utilization while providing similar short-term outcomes and mid-to long-term survival.

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Section: Discussionmentioning

confidence: 50%

Ex-vivo lung perfusion versus standard protocol lung transplantation—mid-term survival and meta-analysis

Chakos

Ferret

Muston

et al. 2020

Ann Cardiothorac Surg

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“…lung transplantation, uncontrolled donors after circulatory death marginal donors, 10 and donation after circulatory death (DCD). 11 In the last years, the usage of controlled DCD (cDCD) for lung transplantation has increased.…”

Section: Introductionmentioning

confidence: 99%

Expanding the horizons: Uncontrolled donors after circulatory death for lung transplantation—First comparison with brain death donors

Valdivia

Antonio

Hoyos

et al. 2019

Clinical Transplantation

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Uncontrolled donation after cardiac death is an appealing source of organs for lung transplantation. We compare early and long-term outcomes of lung transplantation with these donors with a cohort of transplants from brain death donors at our institution. Retrospective analysis of all lung transplantations was performed from 2002 to 2012. We collected variables regarding recipients, donors, recover and transplant procedures, early and late complications, and survival. We included 292 lung transplants from brain death donors and 38 from uncontrolled donors after cardiac death.Both groups were comparable except for sex mismatch (male recipient-female donor was more frequent in the brain death cohort, 17.8% vs 0%, P 0.002), total ischemic time (longer for donors after cardiac death, 657 minutes for the first lung and 822 minutes for the second vs 309 and 425 minutes, P < 0.001), and ex vivo evalua-

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“…Donor scarcity in western countries has been recognized in the past decades as a major burden in transplantation medicine, leading to a more extensive utilization of extended criteria donor organs. In lung transplantation, upon utilizing extended criteria lungs, careful donor and recipient selection has repeatedly shown to lead to similar outcomes as compared to utilizing standard donor lungs [3,7], lowering the threshold for routine use of nonideal donors. Structural defects such as fibrotic or bullous parenchymal changes in donor lungs remain unacceptable for lung donation.…”

Section: Discussionmentioning

confidence: 99%

“…Extended criteria donor organs have been successfully used for lung transplantation with similar short-and long-term outcome as compared to standard donor organs [3][4][5][6][7]. A majority of organs are classified as extended criteria donor lungs due to older age, impaired oxygenation, trauma, aspiration or drowning [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Transplantation of donor lungs with pulmonary embolism - a retrospective study

et al. 2019

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Summary Lung transplantation from donors with fulminant pulmonary arterial embolism as a cause of death remains controversial. An analysis was performed comparing preoperative characteristics and outcomes of 25 donors with a primary diagnosis of pulmonary arterial embolism to 1085 recipients of donor lungs without pulmonary arterial embolism. No early functional impairment of donor lungs with pulmonary embolism was detectable as depicted by the incidence of primary graft dysfunction immediately after surgery (P = 0.66), 24 (P = 0.79), 48 (P = 0.99) and 72 h (P = 0.99) after transplantation. Pulmonary function testing at 1 year (P = 0.003) and at last outpatient control (P < 0.05) showed superior results in the cohort receiving lungs from donors with pulmonary embolism. Incidence of chronic lung allograft dysfunction (CLAD) showed no difference within the first year after lung transplantation, however, 5 year‐CLAD free survival was superior in recipients (70.4% vs. 55.1%, P = 0.006) of donor lungs with pulmonary embolism. Overall survival was similar in both groups. Lungs from donors with fulminant pulmonary embolism prior to brain death can safely be used for lung transplantation without impairing postoperative outcomes. Lung function testing shows favorable midterm results in recipients of donor lungs with pulmonary embolism.

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Continued Successful Evolution of Extended Criteria Donor Lungs for Transplantation

Cited by 58 publications

References 21 publications

Ex-vivo lung perfusion versus standard protocol lung transplantation—mid-term survival and meta-analysis

Ex-vivo lung perfusion versus standard protocol lung transplantation—mid-term survival and meta-analysis

Expanding the horizons: Uncontrolled donors after circulatory death for lung transplantation—First comparison with brain death donors

Transplantation of donor lungs with pulmonary embolism - a retrospective study

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