Early pulmonary function and mid‐term outcome in lung transplantation after<i>ex‐vivo</i>lung perfusion – a single‐center, retrospective, observational, cohort study

Fumagalli, Jacopo; Rosso, Lorenzo; Gori, F.; Morlacchi, Letizia Corinna; Rossetti, V.; Tarsia, Paolo; Blasi, Francesco; Righi, I.; Mendogni, Paolo; Palleschi, Alessandro; Tosi, Davide; Bonitta, Gianluca; Nosotti, Mario; Benazzi, E.; Scaravilli, Vittorio; Valenza, Franco; Grasselli, Giacomo; Zanella, Alberto

doi:10.1111/tri.13606

Cited by 16 publications

(23 citation statements)

References 50 publications

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“…In our centre in Milan, we perform a 4-hour-long normothermic EVLP with an open atrium technique, using a perfusion solution made of both Steen solution and red blood cells (reaching a 5-10% haematocrit) and maintaining the target flow at 40% of the estimated donor's cardiac output, as previously described (Figure 4) (10). Our clinical experience with machine perfusion began in 2011, when our team performed the first lung transplantation after EVLP in Italy, and we have been using it ever since, with good results (11). In 2016, we started using portable organ care system (OCS) for selected cases as well.…”

Section: Ex-vivo Lung Perfusion (Evlp)mentioning

confidence: 87%

Donation after circulatory death program in Italy

Palleschi¹,

Musso²,

Mendogni³

et al. 2022

Curr Chall Thorac Surg

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Donation after cardiac death (DCD) donors may help increase the donor pool for lung transplantation. Here, we briefly describe the Italian organ transplantation system and present the Italian DCD program. Our country adopts a mixed "opting-in" and "opting-out" system. Death declaration is confirmed by neurological or cardiocirculatory criteria; in case of cardiac death, the Italian law requires 20 minutes of documented asystole. Organs are primarily allocated to urgent patients, otherwise they are offered to a centre within the region. Lung transplantation centres in Lombardy, instead, use Lung Allocation Score (LAS). In Italy organ donation activity and transplantation has been growing, but the gap remains between patients on the waiting list and the number of transplantations. DCDs may alleviate donor shortage, but the path towards a DCD Italian program was complicated, and physicians had to face the challenge of organ preservation with a prolonged no-touch period. The first DCD program (Alba protocol) started in 2007 and proved DCD after unexpected cardiac arrest [uncontrolled DCD (uDCD)] possible for kidney transplantation, using post-mortem normothermic regional perfusion (NRP) before recovery. In 2015 the first DCD liver transplantation in Italy was performed at Niguarda Hospital in Milan using innovative strategies based on NRP and ex-situ organ perfusion. The Careggi Teaching Hospital in Florence started a DCD protocol for kidney and liver transplantation. The first lung transplantation from an uDCD donor in Italy was performed at the Policlinico transplant centre in Milan in 2014: our protocol consists of a normothermic open-lung preservation, namely without chest drainages for topical cooling, avoiding lung hypoxia through recruitment manoeuvres, continuous positive airway pressure (CPAP), and protective ventilation. Lungs are assessed using ex-vivo lung perfusion (EVLP). Eventually, we also began including controlled DCDs (cDCDs). A dedicated protocol for thoracic and abdominal organs retrieval was established in 2017, combining NRP with our open lung approach, with good results. Over the last 5 years, transplantation with grafts from DCDs has been increasing: in 2019, they represented 4.5% of such procedures and 8.5% of lung transplantations. Our results showed the feasibility of combined procurement in different settings with no detrimental effects on abdominal organs despite extended ischemia times.

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Section: Ex-vivo Lung Perfusion (Evlp)mentioning

confidence: 87%

Donation after circulatory death program in Italy

Palleschi¹,

Musso²,

Mendogni³

et al. 2022

Curr Chall Thorac Surg

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“…Grafts were transported to our center for the usual evaluation. 6 , 7 In short, our EVLP system consists of a custom-made circuit. The lungs are accommodated in a dedicated organ chamber from which the perfusate is drained by gravity in a venous reservoir and then drawn by a centrifugal pump and pushed into a deoxygenator connected to a heat exchanger.…”

Section: Methodsmentioning

confidence: 99%

“…LGL), the retrieval team obtained lymphnode, spleen, hepatic and renal biopsies. Grafts were transported to our centre for the usual evaluation 6,7 . In short, our EVLP system consists of a custom-made circuit.…”

Section: A C C E P T E Dmentioning

confidence: 99%

Overcoming the Limits of Reconditioning: Seventeen Hours of EVLP With Successful Transplantation From Uncontrolled Circulatory Death Donor

et al. 2021

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“…Most centres routinely use EVLP to assess the functionality of grafts procured in the uncontrolled setting (31,36). In this particular clinical scenario, machine perfusion is also a valuable tool to expand the times and to preserve the organs while dealing with the logistical issues.…”

Section: Machine Perfusion Technique In Dcdmentioning

confidence: 99%

Lung donation after circulatory death

Musso¹,

Righi²,

Damarco³

et al. 2023

Curr Chall Thorac Surg

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Donation after circulatory death (DCD) defines organs procurement after death determined using circulatory criteria, as opposed to a declaration based on neurological criteria. Nowadays, DCD donors represent a valuable resource to contrast lung donor shortage and waiting list mortality, while also avoiding the potential lung damages generated by brain death. On the other hand, lungs from DCD donors are exposed to a variable warm ischemia time and related potential detrimental effects. The extensive experimental investigation proved the feasibility of this practice, and the subsequent clinical experiences around the world showed good outcomes. In this paper, we review the pre-clinical and clinical experiences in the DCD field, focusing on ischemia time and the biological peculiarities of the lung tissue in animal models.We illustrate the clinical paths of the DCD donor categories as described in the Maastricht classification, and the different preservation techniques and procurement protocols, with particular regard to the ethical and legal differences around the world. We analyse the characteristics of both the controlled and uncontrolled setting, highlighting the advantages and disadvantages of each donation setting. We then proceed to review the clinical outcomes as well as the complications after lung transplantation from DCD donors as reported in literature. Lastly, we outline the role of machine perfusion for the function assessment and reconditioning of grafts procured in this scenario.

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Early pulmonary function and mid‐term outcome in lung transplantation afterex‐vivolung perfusion – a single‐center, retrospective, observational, cohort study

Abstract: Preliminary results of the present study have been presented as brief oral presentation at the 2019 Meeting of the European Society of Organ Transplantation in Copenhagen.

Cited by 16 publications

References 50 publications

Donation after circulatory death program in Italy

Donation after circulatory death program in Italy

Overcoming the Limits of Reconditioning: Seventeen Hours of EVLP With Successful Transplantation From Uncontrolled Circulatory Death Donor

Lung donation after circulatory death

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