Extended donor criteria for lung transplantation—a clinical reality

Aigner, Clemens; Winkler, G.; Jaksch, Péter; Seebacher, Gernot; Láng, György; Taghavi, S.; Wisser, Wilfried; Klepetko, Walter

doi:10.1016/j.ejcts.2005.01.024

Cited by 118 publications

(71 citation statements)

References 11 publications

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“…Likewise, donation criteria have also expanded. Patients as well as organs transplanted are generally in worse condition now than several years ago and LTx recipients are therefore at increased risk of complications after LTx, among which CKD (37). If the association of former smoking and CKD after LTx is confirmed in other studies, it would be relevant to gain further insight in the biology of this association.…”

Section: Discussionmentioning

confidence: 99%

Former Smoking Is a Risk Factor for Chronic Kidney Disease After Lung Transplantation

Hellemons¹,

Agarwal²,

Bij³

et al. 2011

American Journal of Transplantation

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Chronic kidney disease (CKD) is a common complication after lung transplantation (LTx).Smoking is a risk factor for many diseases, including CKD. Smoking cessation for >6 months is required for LTx enlistment. However, the impact of smoking history on CKD development after LTx remains unclear. We investigated the effect of former smoking on CKD and mortality after LTx. CKD was based on glomerular filtration rate (GFR) ( 125 I-iothalamate measurements). GFR was measured before and repeatedly after LTx. One hundred thirty-four patients never smoked and 192 patients previously smoked for a median of 17.5 pack years. At 5 years after LTx, overall cumulative incidences of CKD-III, CKD-IV and death were 68.5%, 16.3% and 34.6%, respectively. Compared to never smokers, former smokers had a higher risk for CKD-III (hazard ratio [

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Section: Discussionmentioning

confidence: 99%

Former Smoking Is a Risk Factor for Chronic Kidney Disease After Lung Transplantation

Hellemons¹,

Agarwal²,

Bij³

et al. 2011

American Journal of Transplantation

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“…As a consequence of that, lungs are currently used in only 15% of all reported donors (3,4). One approach to overcome the scarcity of donor organs is the use of marginal donor lungs (5). However, there is evidence suggesting an increased incidence of primary graft dysfunction (PGD) in recipients of such marginal organs (6).…”

Section: Introductionmentioning

confidence: 99%

Clinical Ex Vivo Lung Perfusion—Pushing the Limits

Aigner

Slama

Hötzenecker

et al. 2012

American Journal of Transplantation

162

104

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Ex vivo lung perfusion (EVLP) provides the ability to evaluate donor lungs before transplantation. Yet, limited prospective clinical data exist with regard to its potential to recondition unacceptable donor lungs. This paper summarizes the results of a prospective study of lung transplantation using only initially unacceptable donor lungs, which were improved by EVLP for 2-4 h. From March 2010-June 2011, 13 lungs were evaluated ex vivo. Median donor PaO 2 at FiO 2 1.0/PEEP5 was 216 mmHg (range 133-271). Four lungs, all with trauma history, showed no improvement and were discarded. Nine lungs improved to a ΔPO 2 higher than 350 mmHg. Median PvO 2 at final assessment in these lungs was 466 mmHg (range 434-525). These lungs were transplanted with a median total ischemic time of 577 min (range 486-678). None of the patients developed primary graft dysfunction grades 2 or 3 within 72 h after transplantation. One patient with secondary pulmonary hypertension was left on a planned prolonged extracorporeal membrane oxygenation postoperatively. Median intubation time was 2 days. Thirtyday mortality was 0%. During the observation period, 119 patients received standard lung transplantation with comparable perioperative outcome. EVLP has a significant potential to improve the quality of otherwise unacceptable donor lungs.

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“…146 Many studies reported approximately 50 to 100 recipients of extended criteria lungs compared to approximately equal or larger numbers of recipients of standard lungs and found no significant differences in lung function, or short-or long-term survival up to 1 year following transplantation. [147][148][149][150][151][152] However, a number of similarly sized studies suggested caution in proceeding with transplantation using extended criteria donor lungs based on increased rates of early or late mortality, 153,154 increased primary graft dysfunction either in the postoperative period or after 1 or more years after transplant, 153,155 longer ICU courses, or prolonged hospital stays. 155 Interpretation of these studies is generally difficult because of the moderately small numbers of patients with widely varying characteristics and multiple paths to qualification as an extended criteria donor.…”

Section: Extended Criteria Donationmentioning

confidence: 99%

Lung transplantation for chronic obstructive pulmonary disease

Liou¹,

Raman²,

Cahill³

2013

TRRM

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Abstract:Patients with end-stage chronic obstructive pulmonary disease (COPD) comprise the largest single lung disease group undergoing transplantation. Selection of appropriate candidates requires consideration of specific clinical characteristics, prognosis in the absence of transplantation, and likely outcome of transplantation. Increased availability of alternatives to transplantation for end-stage patients and the many efforts to increase the supply of donor organs have complicated decision making for selecting transplant candidates. Many years of technical and clinical refinements in lung transplantation methods have improved survival and quality of life outcomes. Further advances will probably come from improved selection methods for the procedure. Because no prospective trial has been performed, and because of confounding and informative censoring bias inherent in the transplant selection process in studies of the existing experience, the survival effect of lung transplant in COPD patients remains undefined. There is a lack of conclusive data on the impact of lung transplantation on quality of life. For some patients with end-stage COPD, lung transplantation remains the only option for further treatment with a hope of improved survival and quality of life. A prospective trial of lung transplantation is needed to provide better guidance concerning survival benefit, resource utilization, and quality of life effects for patients with COPD.

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Extended donor criteria for lung transplantation—a clinical reality

Cited by 118 publications

References 11 publications

Former Smoking Is a Risk Factor for Chronic Kidney Disease After Lung Transplantation

Former Smoking Is a Risk Factor for Chronic Kidney Disease After Lung Transplantation

Clinical Ex Vivo Lung Perfusion—Pushing the Limits

Lung transplantation for chronic obstructive pulmonary disease

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