Impact of anastomosis time during lung transplantation on primary graft dysfunction

Vandervelde, C.; Vos, Robin; Vanluyten, Cedric; Fieuws, Steffen; Verleden, Stijn E.; Slambrouck, Jan Van; Leyn, Paul De; Coosemans, Willy; Nafteux, Philippe; Decaluwé, Herbert; Veer, Hans Van; Depypere, Lieven; Dauwe, Dieter; Troy, Erwin De; Ingels, Catherine; Neyrinck, Arne; Jochmans, Ina; Vanaudenaerde, Bart M.; Godinas, Laurent; Verleden, Geert M.; Raemdonck, Dirk Van; Ceulemans, Laurens J.

doi:10.1111/ajt.16957

Cited by 13 publications

(10 citation statements)

References 43 publications

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“…Donor and recipient demographics as well as surgical and postoperative characteristics were selected based on potential correlations in prior studies. 7,8 Donors are directly offered to our center through our local donor network or by Eurotransplant and screened for medico-legal objections, family protests, or other contraindications. Donor characteristics included: age, sex, body mass index (BMI), cytomegalovirus (CMV) immunoglobulin-G status, smoking history, PaO 2 /FiO 2 ratio, ventilation time, ex vivo lung perfusion (EVLP), and donor type (donation after brain death or DCD-III).…”

Section: Study Populationmentioning

confidence: 99%

Lung Transplant Outcome From Selected Older Donors (≥70 Years) Equals Younger Donors (<70 Years)

et al. 2023

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Objective: To describe our experience with lung transplantation (LTx) from donors ≥70 years and compare short and long-term outcomes to a propensity-matched cohort of donors <70 years. Background: Although extended-criteria donors have been widely used to enlarge the donor pool, the experience with LTx from older donors (≥70 years) remains limited. Methods: All single-center bilateral LTx between 2010 and 2020 were retrospectively analyzed. Matching (1:1) was performed for the donor (type, sex, smoking history, x-ray abnormalities, partial pressure of oxygen/fraction of inspired oxygen ratio, and time on ventilator) and recipient characteristics (age, sex, LTx indication, perioperative extracorporeal life support, and cytomegalovirus mismatch). Primary graft dysfunction grade-3, 5-year patient, and chronic lung allograft dysfunction-free survival were analyzed. Results: Out of 647 bilateral LTx, 69 were performed from donors ≥70 years. The mean age in the older donor cohort was 74 years (range: 70–84 years) versus 49 years (range: 12–69 years) in the matched younger group. No significant differences were observed in the length of ventilatory support, intensive care unit, or hospital stay. Primary graft dysfunction-3 was 26% in the older group versus 29% in younger donor recipients (P = 0.85). Reintervention rate was comparable (29% vs 16%; P = 0.10). Follow-up bronchoscopy revealed no difference in bronchial anastomotic complications (P = 1.00). Five-year patient and chronic lung allograft dysfunction-free survivals were 73.6% versus 73.1% (P = 0.72) and 51.5% versus 59.2% (P = 0.41), respectively. Conclusions: LTx from selected donors ≥70 years is feasible and safe, yielding comparable short and long-term outcomes in a propensity-matched analysis with younger donors (<70 years).

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Section: Study Populationmentioning

confidence: 99%

Lung Transplant Outcome From Selected Older Donors (≥70 Years) Equals Younger Donors (<70 Years)

et al. 2023

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“…19 Additionally, DCD was shown not to be a risk factor for PGD grade 3. 20 This tolerance to warm ischemic injury makes the lung a privileged organ in the setting of DCD. For these reasons, although performing a simultaneous procurement of both lungs and liver may potentially prolong dPT, a limited impact on outcome after LuT may be expected.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Lung-abdominal Organ Procurement From Donation After Circulatory Death Donors Reduces Donor Hepatectomy Time

Blondeel

Gilbo

et al. 2023

Transplantation

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Introduction. Prolonged organ procurement time impairs the outcome of donation after circulatory death (DCD) and liver transplantation (LiT). Our transplant team developed a simultaneous, rather than sequential, lung-abdominal organ explantation strategy for DCD donation to prioritize liver procurement. We evaluated whether this change in strategy effectively reduced donor hepatectomy time (dHT), without affecting donor pneumonectomy time (dPT), and influenced LiT and lung transplantation outcome. Methods. All lung-abdominal and abdominal-only transplant procedures between 2010 and 2020 were analyzed in this retrospective cohort study. Relationships were assessed between the year of transplant and dHT and dPT (univariate linear regression), 1-y patient and graft survival, primary graft dysfunction, and nonanastomotic biliary strictures (univariate logistic regression). Results. Fifty-two lung-abdominal and 110 abdominal-only DCD procedures were analyzed. A significant decrease in dHT was noted in lung-abdominal (slope −1.14 [−2.14; −0.15], P = 0.026) but not in abdominal-only procedures; dPT did not increase. There were no significant associations between the year of transplant and nonanastomotic biliary strictures frequency, primary graft dysfunction incidence, 1-y patient, and graft survival. Conclusions. Simultaneous organ procurement in multiorgan lung-abdominal DCD procedures is feasible, and effectively shortened dHT without affecting lung transplantation outcome. No impact on LiT outcome was observed; however, larger multicenter studies are needed.

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“…Significant interest in the immunologic signature of PGD has resulted in a body of evidence that proinflammatory factors, including free radicals, ROS, cytokines and neutrophilic inflammation are critical to the development of PGD [1,2,13 ▪ ,14 ▪▪ ,15 ▪ ,16,17]. The recipient inflammatory environment plays a crucial role in the development of PGD posttransplant.…”

Section: Pathogenesismentioning

confidence: 99%

“…Previous work has established that PGD occurs in two phases: an early phase modulated by donor lung macrophages and lymphocytes, and a later phase regulated by recipient neutrophils and lymphocytes [2]. In response to acute inflammation, reactive oxygen species (ROS) are generated and accelerate the pace of injury by disturbing cellular function, activating proteolytic enzymes and increasing autophagy [12 ▪ ,13 ▪ ,14 ▪▪ ]. The transcriptional signature of this process of ischemia-reperfusion injury is the upregulation of genes involved in cell survival, cell surface signalling and oxidative stress response [4 ▪ ].…”

Section: Pathogenesismentioning

confidence: 99%

“…Following procurement, conduct of the implant operation is also a significant contributor to PGD risk, with the major contributing variables, including use of mechanical circulatory support, ischemic time and type of transplant (single vs. bilateral) [13 ▪ ]. Cardiopulmonary bypass (CPB) has consistently been shown to increase PGD risk: in a recent multicentre analysis of 852 patients, patients undergoing lung transplant with CPB were found to have the highest risk of PGD compared with transplants performed without CPB (OR 4.24) or with VA ECMO (OR 1.89) [50 ▪ ].…”

Section: Risk Factorsmentioning

confidence: 99%

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Primary graft dysfunction after lung transplantation

Hunt

Cantu

2023

Current Opinion in Organ Transplantation

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Purpose of reviewPrimary graft dysfunction (PGD) is a clinical syndrome occurring within the first 72 h after lung transplantation and is characterized clinically by progressive hypoxemia and radiographically by patchy alveolar infiltrates. Resulting from ischemia-reperfusion injury, PGD represents a complex interplay between donor and recipient immunologic factors, as well as acute inflammation leading to alveolar cell damage. In the long term, chronic inflammation invoked by PGD can contribute to the development of chronic lung allograft dysfunction, an important cause of late mortality after lung transplant. Recent findingsRecent work has aimed to identify risk factors for PGD, focusing on donor, recipient and technical factors both inherent and potentially modifiable. Although no PGD-specific therapy currently exists, supportive care remains paramount and early initiation of ECMO can improve outcomes in select patients. Initial success with ex-vivo lung perfusion platforms has been observed with respect to decreasing PGD risk and increasing lung transplant volume; however, the impact on survival is not well delineated.

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Impact of anastomosis time during lung transplantation on primary graft dysfunction

Cited by 13 publications

References 43 publications

Lung Transplant Outcome From Selected Older Donors (≥70 Years) Equals Younger Donors (<70 Years)

Lung Transplant Outcome From Selected Older Donors (≥70 Years) Equals Younger Donors (<70 Years)

Simultaneous Lung-abdominal Organ Procurement From Donation After Circulatory Death Donors Reduces Donor Hepatectomy Time

Primary graft dysfunction after lung transplantation

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