High Donor Age, Low Donor Oxygenation, and High Recipient Inotrope Requirements Predict Early Graft Dysfunction in Lung Transplant Recipients

Pilcher, David; Snell, Gregory I; Scheinkestel, Carlos; Bailey, Michael; Williams, Trevor

doi:10.1016/j.healun.2005.04.003

Cited by 29 publications

(16 citation statements)

References 27 publications

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“…Also, it increased the number of retrieved organs by 71%. In addition, a study on lung transplantation stated that a low donor PaO 2 is correlated with a low recipient PaO 2 /FiO 2 ratio (P = 0.007), and this raises the incidence of prolonged postoperative mechanical ventilation, and predicts early graft dysfunction and hypoxia [11]. Although the organs donated in the present case were the kidneys, not the lungs, this fact points to the importance of active management of the brain dead patient, including maintenance of optimal oxygenation when an organ donation is scheduled.…”

Section: Discussionmentioning

confidence: 99%

Inhaled nitric oxide for the brain dead donor with neurogenic pulmonary edema during anesthesia for organ donation: a case report

Park

Son

Lee

et al. 2014

Korean J Anesthesiol

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Neurogenic pulmonary edema (NPE) in brain dead organ donors occurring after an acute central nervous system insult threatens organ preservation of potential organ donors and the outcome of organ donation. Hence the active and immediate management of NPE is critical. In this case, a 50-year-old male was admitted to the intensive care unit (ICU) for organ donation. He was hypoxic due to NPE induced by spontaneous intracerebral hemorrhage and intraventricular hemorrhage. Protective ventilatory management, intermittent recruitment maneuvers, and supportive treatment were maintained in the ICU and the operating room (OR). Despite this management, the hypoxemia worsened after the OR admission. So inhaled nitric oxide (NO) therapy was performed during the operation, and the hypoxic phenomena showed remarkable improvement. The organ retrieval was successfully completed. Therefore, NO inhalation can be helpful in the improvement of hypoxemia caused by NPE in brain dead organ donors during anesthesia for the organ donation.

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Section: Discussionmentioning

confidence: 99%

Inhaled nitric oxide for the brain dead donor with neurogenic pulmonary edema during anesthesia for organ donation: a case report

Park

Son

Lee

et al. 2014

Korean J Anesthesiol

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“…IL-6 has been implicated in the major complications of lung transplantation, including primary graft dysfunction [29–34], acute rejection [32,35–37], infection [37] and bronchiolitis obliterans syndrome [38–40]. Interestingly, cytomegalovirus seropositivity in community-dwelling elderly women has also been linked to frailty [41], and higher donor age in kidney, liver and lung transplantation has been linked to higher rates of early [42,43] and late [44–46] graft dysfunction.…”

Section: Current System Of Organ Allocation In the Usamentioning

confidence: 99%

Selecting lung transplant candidates: where do current guidelines fall short?

Hook

Lederer

2012

Expert Review of Respiratory Medicine

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In 2010, 1770 lung transplant procedures were performed in the USA, yet 2469 new candidates were added to the waiting list the same year. The shortage of suitable donor lungs requires that transplant professionals select patients for lung transplantation only if they are likely to sustain a survival benefit from the procedure. However, 20% of lung transplant recipients die within the first year of transplantation, suggesting that we are failing to identify those at high risk for severe early complications. In this perspective, we review the current guidelines for the selection of lung transplant candidates, which are based largely on expert opinion and small case series. We also propose the study of new extrapulmonary factors, such as frailty and sarcopenia, that might help improve the prediction of complications and early death after lung transplantation, leading to an improved candidate selection process.

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“…Older donor age has also been associated with poor gas exchange early after transplantation (13), higher rates of hospitalization for rejection (11), and higher rates of late bronchiolitis obliterans syndrome (9). In light of the organ donor shortage, we wondered if the risk associated with older donor age might be acceptable, particularly in the current era of assigning priority to waiting list candidates at a high risk of death without transplantation.…”

Section: Introductionmentioning

confidence: 99%

Donor Age and Early Graft Failure After Lung Transplantation: A Cohort Study

Baldwin

Peterson

Easthausen

et al. 2013

American Journal of Transplantation

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Lungs from older adult organ donors are often unused because of concerns for increased mortality. We examined associations between donor age and transplant outcomes among 8,860 adult lung transplant recipients using Organ Procurement and Transplantation Network and Lung Transplant Outcomes Group data. We used stratified Cox proportional hazard models and generalized linear mixed models to examine associations between donor age and both 1-year graft failure and primary graft dysfunction. The rate of 1-year graft failure was similar among recipients of lungs from donors age 18–64 years, but severely ill recipients (LAS > 47.7 or use of mechanical ventilation) of lungs from donors age 56–64 years had increased rates of 1-year graft failure (p-values for interaction = 0.04 and 0.02, respectively). Recipients of lungs from donors <18 and ≥65 years had increased rates of 1-year graft failure (adjusted hazard ratio 1.23, 95% CI 1.01–1.50 and adjusted hazard ratio 2.15, 95% CI 1.47–3.15, respectively). Donor age was not associated with the risk of primary graft dysfunction. In summary, the use of lungs from donors age 56–64 years may be safe for adult candidates without a high LAS, and the use of lungs from pediatric donors is associated with a small increase in early graft failure.

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High Donor Age, Low Donor Oxygenation, and High Recipient Inotrope Requirements Predict Early Graft Dysfunction in Lung Transplant Recipients

Cited by 29 publications

References 27 publications

Inhaled nitric oxide for the brain dead donor with neurogenic pulmonary edema during anesthesia for organ donation: a case report

Inhaled nitric oxide for the brain dead donor with neurogenic pulmonary edema during anesthesia for organ donation: a case report

Selecting lung transplant candidates: where do current guidelines fall short?

Donor Age and Early Graft Failure After Lung Transplantation: A Cohort Study

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