Extracorporeal life support after heart or lung transplantation

Whyte, Richard I.; Deeb, G. Michael; McCurry, Kenneth R.; Anderson, Harry L.; Boiling, Steven F.; Bartlett, Robert H.

doi:10.1016/0003-4975(94)90741-2

Cited by 27 publications

(8 citation statements)

References 8 publications

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“…1,2,25 Because as an organ, the lung is one of the most richly vascularized, with nearly 40% of its parenchymal cellular mass composed of endothelial cells, 26 it is not surprising that endothelial activation during the preservation or early transplantation period may represent a significant cause of primary lung graft failure. Because the lungs are detached from their native blood supply during the mechanical lung harvest procedure, we hypothesized that this would present an opportune time to deliver a therapeutic agent directly to endothelial cells to prevent their activation during or shortly after preservation.…”

Section: Discussionmentioning

confidence: 99%

Antisense Intercellular Adhesion Molecule-1 (ICAM-1) Oligodeoxyribonucleotide Delivered During Organ Preservation Inhibits Posttransplant ICAM-1 Expression and Reduces Primary Lung Isograft Failure

Toda

Kayano

Karimova

et al. 2000

Circulation Research

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Abstract-Transiently increased expression of leukocyte adhesion receptors after lung preservation contributes to early graft demise by recruiting leukocytes, activating complement, and causing microcirculatory stasis. We hypothesized that inhibiting intercellular adhesion molecule-1 (ICAM-1) expression even briefly may significantly improve lung graft function and that the preservation period might provide a unique window to deliver a therapeutic pulse of antisense oligonucleotide ICAM-1 to inhibit ICAM-1 expression after transplantation. Interleukin-1␤-treated rat pulmonary endothelial cells given a 20-mer phosphorothioate oligonucleotide comprising an antisense span targeted to the 3Ј-untranslated region of rat ICAM-1 demonstrated an oligonucleotide dose-dependent reduction in ICAM-1 expression. Using a cationic liposomal carrier, this same antisense oligonucleotide (but not the sense control) instilled into the pulmonary vasculature at the time of preservation reduced subsequent graft ICAM-1 expression and graft leukostasis and markedly improved oxygenation, pulmonary blood flow, and graft survival. These experiments demonstrate that the preservation period presents a window during which to target an anti-ICAM-1 expression strategy to inhibit early adhesion receptor expression and improve functional outcome after lung transplantation. (Circ Res. 2000;86:166-174.)Key Words: intercellular adhesion molecule-1 Ⅲ lung transplantation Ⅲ isograft Ⅲ leukocyte adhesion receptor C linical lung transplantation at its best is a harrowing experience, because lung grafts can fail catastrophically shortly after reperfusion for reasons that are often not understood. 1,2 Clinical lung preservation strategies are directed toward maintaining proper electrolyte and osmotic homeostasis, but surprisingly little is done to protect the vast pulmonary vascular network on which the lung depends for both integrity and function. Because the early expression of the leukocyte adhesion receptor P-selectin can result in rapid sequestration of neutrophils (polymorphonuclear leukocytes [PMNs]) after lung transplantation, 3 promoting microcirculatory stasis and local tissue destruction, we hypothesized that a strategy that protects the lungs from early leukocyte recruitment could confer clinical benefit. Because P-selectin places neutrophils into a favorable steric relationship for intercellular adhesion molecule-1 (ICAM-1) binding to ␤ 2 -integrins, we hypothesized that early inhibition of inducible ICAM-1 expression might serve as a useful target for therapeutic intervention in lung transplantation to prevent acute graft injury. Toward this end, we have focused on the unique opportunity provided by the lung harvest procedure, during which it is possible to deliver agents (such as antisense oligodeoxynucleotides) ex vivo directly into the vasculature, which can block adhesion receptor expression during the first few critical hours after reperfusion. The current studies were designed to (1) elucidate the nature and functional relevance of endo...

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Section: Discussionmentioning

confidence: 99%

Antisense Intercellular Adhesion Molecule-1 (ICAM-1) Oligodeoxyribonucleotide Delivered During Organ Preservation Inhibits Posttransplant ICAM-1 Expression and Reduces Primary Lung Isograft Failure

Toda

Kayano

Karimova

et al. 2000

Circulation Research

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“…Bleeding accompanying systemic heparinization remains the most common problem in PCPS or extracorporeal membrane oxygenation (ECMO) ( 11, 12). Clot formation inside the device and the consequent necessitated systemic heparinization have been the major barriers to the prolonged use of an artificial lung, rendering the risk of bleeding and thromboembolism.…”

Section: Discussionmentioning

confidence: 99%

Development of an Ultracompact Integrated Heart‐Lung Assist Device

et al. 1999

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A novel integrated heart-lung assist device has been developed as a simple to use portable cardiopulmonary support system. The device comprises a centrifugal pump and an artificial lung, which is located around the pump, in an all in one system. The special membrane employed precludes plasma breakthrough in protracted use and enables preprimed setup. Test lungs consisting of the same membrane preserved gas exchange function well after 3 months of preprimed storage. The entire blood contacting surface is treated with covalent heparin bonding to impart good antithrombogenicity. Heparin bonded test lungs could be continuously perfused without systemic anticoagulation as long as 36 days in a venoarterial bypass chronic animal study using goats. The prototype device (diameter, 126 mm; height, 59 mm; membrane area, 0.85 m2; priming volume, 180 ml) demonstrated 9 L/min pump output at a 400 mm Hg pressure head and 180 ml/min oxygen and 110 ml/min carbon dioxide transfer rates at 5 L/min blood flow. We conclude that this device has potential to be the next generation cardiopulmonary support system.

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“…Occasionally, the recipient's pulmonary vascular resistance is elevated, leading to right-sided failure of the donor heart. This immediate complication has been controlled with inhaled nitric oxide (35,36), ventricular assist devices (37,38), and, in extreme cases, extracorporeal membrane oxygenation (39,40).…”

Section: Postoperative Carementioning

confidence: 99%

Heart Transplantation: A Thirty-Year Perspective

Miniati

Robbins

2002

Annu. Rev. Med.

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Heart transplantation has evolved over the past 30 years into a mainstay of therapy for heart failure patients. As the surgical technique and basic immunology were defined, heart transplantation became a real therapeutic option. Over the next few decades, thoracic transplant teams at Stanford University and other institutions refined this mode of therapy. This review addresses the history, current surgical technique, recipient and donor selection, postoperative care, immunosuppression, short- and long-term complications, and clinical outcomes associated with this procedure.

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Extracorporeal life support after heart or lung transplantation

Cited by 27 publications

References 8 publications

Antisense Intercellular Adhesion Molecule-1 (ICAM-1) Oligodeoxyribonucleotide Delivered During Organ Preservation Inhibits Posttransplant ICAM-1 Expression and Reduces Primary Lung Isograft Failure

Antisense Intercellular Adhesion Molecule-1 (ICAM-1) Oligodeoxyribonucleotide Delivered During Organ Preservation Inhibits Posttransplant ICAM-1 Expression and Reduces Primary Lung Isograft Failure

Development of an Ultracompact Integrated Heart‐Lung Assist Device

Heart Transplantation: A Thirty-Year Perspective

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