Ex Vivo Lung Perfusion Allows Successful Transplantation of Donor Lungs From Hanging Victims

Bennett, Daine T.; Reece, T. Brett; Smith, Phillip D.; Grandhi, Miral S.; Rove, Jessica A. Yu; Justison, George A.; Mitchell, John D.; Fullerton, David A.; Zamora, Martin R.; Weyant, Michael J.

doi:10.1016/j.athoracsur.2014.04.102

Cited by 14 publications

(12 citation statements)

References 23 publications

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“…In addition to increased venous return, decreased left ventricular compliance and increased after load, because of the decrease in negative pressure, increase overall pulmonary blood volume and rise the pulmonary capillary hydrostatic pressure, further exacerbating the pulmonary edema. [23] The acceptable results of MAT in patients who had hypoxic brain injury due to hanging were due to the preservation of PEEP. This PEEP could help to sustain end-expiratory lung volume by opening airways, recruiting alveoli and, possibly, preventing the redistribution of fluid to the lung interstitium.…”

Section: Discussionmentioning

confidence: 99%

Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis

Park¹,

Lee²,

Hong

2019

Medicine

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The apnea test is an essential examination for the determination of brain death; however, hypotension, hypoxemia, and other complications during the apnea test can affect the stability of brain-dead patients, as well as organ function for recipients. Therefore, it is necessary to establish standard guidelines for apnea testing. The modified apnea test (MAT) comprises delivery of 100% oxygen through the endotracheal tube connected to manual resuscitator (Ambu bag) with the positive end-expiratory pressure (PEEP) valve after disconnection of the mechanical ventilator for maintenance of PEEP. Forty-nine instances of the conventional apnea test (CAT) were performed in 25 brain-dead patients; 77 instances of the MAT were performed in 39 brain-dead patients. The mean duration of the apnea test was 3.5 ± 1.4 minutes in the CAT group and 3.0 ± 1.2 minutes in the MAT group. There were no significant changes in PaCO 2 , PaO 2 , or pH between the CAT and MAT groups ( P = .341, .593, and .503, respectively). In overweight patients (body mass index ≥ 23 kg/m 2 ), MAT prevented dramatic reductions in PaO 2 and SaO 2 ( P < .05 for both). In the patients who had hypoxic brain injury due to hanging, differences in PaO 2 and SaO 2 in the MAT group were significantly smaller than in the CAT group ( P < .05). Although MAT, which was invented to maintain PEEP, was not efficient for all brain-dead patients, it could be helpful in selected patient groups, such as overweight patients or those who had hypoxic injury due to hanging. And clinicians should consider short-term apnea test to avoid unnecessarily prolonged hypoxemia.

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Section: Discussionmentioning

confidence: 99%

Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis

Park¹,

Lee²,

Hong

2019

Medicine

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“…The reputation of hanging grafts for being marginal was highlighted by the study of Bennett et al in 2014 using EVLP systematically in these types of donor organs . In five successive lung grafts, they used EVLP on hanging donors.…”

Section: Discussionmentioning

confidence: 99%

“…Lung grafts from hanging donors are historically considered as unsuitable for lung transplantation because of possible irreversible postobstructive barotrauma injuries . Indeed, this obstruction leads to alveolar‐capillary barrier injury and an increase in capillary permeability .…”

Section: Introductionmentioning

confidence: 99%

Hanging donor lungs give good short‐, mid‐ and long‐term results in lung transplantation

Wolf

Renard

Lehouerou

et al. 2019

Clinical Transplantation

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Background:Hanging donors are considered as marginal donors and frequently unsuitable for lung transplantation. However, there is no evidence of higher lung transplantation (LTx) morbidity-mortality with lungs providing by hanging donor. Methods:Between January 2010 and July 2015, we performed a retrospective study at Foch hospital. We aimed to assess whether hanging donor grafts are suitable for lung transplantation. Results: A total of 299 LTx were performed. Subjects were allocated to a hanging group (HG) (n = 20) and a control group (CG) (n = 279). Donor and recipient characteristics did not differ. Primary graft dysfunction (PGD) at 72 hours was comparable in both groups (P = .75). The median duration of postoperative mechanical ventilation (1 [range, 0-84] vs 1 [range, 0-410] day, P = .35), the hospital length of stay (31 days [20-84] vs 32 days [12-435], P = .36) did not differ between the two groups. No statistically significant difference was found in 1-year and 5-year survival between the HG (83% and 78%) and the CG (86% and 75%), P = .85. Conclusion: We believe that hanging donors should be considered as conventional donors with particular caution in the final evaluation of the graft and in perioperative management. K E Y W O R D S extended donors, hanging donors, lung transplantation, marginal donors, primary graft dysfunction R E FE R E N C E S

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“…Moreover, when the compression is suddenly removed, a prompt variation in venous return and intrathoracic pressure leads to reperfusion pulmonary edema with hyperemia [ 23 , 24 ]. Bennett et al suggested that hanging donors may have higher pulmonary vascular resistance and higher peak airway pressure (PAP) [ 25 ]. Most centers are very conservative when selecting these types of donors [ 24 , 25 ].…”

Section: Donor Quality Assessmentmentioning

confidence: 99%

Donor quality assessment and size match in lung transplantation

Mangukia

Shigemura

Brann

et al. 2021

Indian J Thorac Cardiovasc Surg

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Ex Vivo Lung Perfusion Allows Successful Transplantation of Donor Lungs From Hanging Victims

Cited by 14 publications

References 23 publications

Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis

Proposed safe apnea test using positive end-expiratory pressure valve and short-term blood gas analysis

Hanging donor lungs give good short‐, mid‐ and long‐term results in lung transplantation

Donor quality assessment and size match in lung transplantation

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