Impact of donor lung quality on post‐transplant recipient outcome in the Lung Allocation Score era in Eurotransplant – a historical prospective study

Smits, Jacqueline M.; Gottlieb, Jens; Verschuuren, Erik; Evrard, Patrick; Hoek, Rogier A.S.; Knoop, Christiane; Lang, G. A.; Erp, Johanna M. Kwakkel-van; Vos, Robin; Verleden, Geert M.; Rondelet, Benoît; Hoefer, Daniel; Langer, Frank; Schramm, René; Höetzenecker, Konrad; Kessel, Diana van; Luijk, Bart; Seghers, Leonard; Deuse, T.; Buhl, Roland; Witt, Christian; Strēlniece, Agita; Green, Dave; Vries, Erwin de; Laufer, G; Raemdonck, Dirk Van

doi:10.1111/tri.13582

Cited by 13 publications

(5 citation statements)

References 25 publications

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“…Although the absolute numbers of death on the waitlist increased, so did the total amount of transplants. The increase in the number of transplantations may be attributed to more frequent acceptation of donor lungs with extended criteria within the Eurotransplant region as shown by Smits et al (25). As a result of more transplantations the percentage waitlist mortality did not change.…”

Section: Discussionmentioning

confidence: 92%

Long-term outcome and bridging success of patients evaluated and bridged to lung transplantation on the ICU

Gan¹,

Hoek²,

Bij³

et al. 2022

The Journal of Heart and Lung Transplantation

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 92%

Long-term outcome and bridging success of patients evaluated and bridged to lung transplantation on the ICU

Gan¹,

Hoek²,

Bij³

et al. 2022

The Journal of Heart and Lung Transplantation

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“…In addition, a recent study showed that the use of extended criteria organ donors has increased in the Eurotransplant region over the years and that this was associated with shorter survival after transplantation. 17 Given these findings, the absence of a decrease in overall posttransplantation survival could actually represent a beneficial effect of the introduction of the LAS. It is important to note that an improved overall survival was never the goal of the LAS.…”

Section: Discussionmentioning

confidence: 99%

Waiting List Dynamics and Lung Transplantation Outcomes After Introduction of the Lung Allocation Score in The Netherlands

Hoffman

Hemke²,

Zanen

et al. 2021

Transplantation Direct

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Background. The Netherlands was the third country to adopt the lung allocation score (LAS) for national allocation of donor lungs in April 2014. Evaluations of the introduction of the LAS in the United States and Germany showed mainly beneficial effects, including increased survival after transplantation. Methods. Data for transplant candidates from 2010 to 2019 were retrieved from the Dutch Transplant Foundation database. Diagnosis categories and outcomes were compared between the periods before and after the introduction of the LAS. Time-dependent Cox regression and Fine-Gray analyses were performed to compare the chance for transplantation before and after introduction of the LAS. Results. The cohort comprised 1276 patients. After introduction of the LAS, the annual number of transplantations and waiting list mortality did not change. The proportion of patients on the waiting list and transplanted patients with pulmonary fibrosis increased (25%–37%, P < 0.001; 22%–39%, P < 0.001). The chance of transplantation increased significantly for patients with pulmonary fibrosis after introduction of the LAS (hazard ratio 1.9 [95% confidence interval 1.4-2.9]). Patients who died on the waiting list had an increased LAS compared to the time of placement on the waiting list, reflecting clinical deterioration. This was not the case in patients with chronic obstructive pulmonary disease (P < 0.001). Overall survival was similar after introduction of the LAS (5-y survival 68%, compared to 74% [P = 0.171]). Conclusions. After the introduction of the LAS in The Netherlands, an increased proportion of transplantations was performed for patients with pulmonary fibrosis. Overall survival after transplantation did not change.

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“…In Europe, the 2018 figures of lung donor utilisation rate were significantly higher in Austria and Belgium (9.8 and 10.8 ppm) where they have opt-out systems for organ donation, compared to Germany and the Netherlands (3.8 and 4.7 ppm) where an opt-in system remains [36]. The waiting list mortality rates in countries with high donation rates are lower compared to those in countries with low donation rates (7% vs. 12% at 1 year), with higher quality donor lungs more often used in these countries with high donation rates, thus offering a chance of better outcomes in recipients [37].…”

Section: Donorsmentioning

confidence: 99%

Lung Transplantation in Patients with Cystic Fibrosis

Mohite¹,

Dave²,

Reed³

et al. 2021

Cystic Fibrosis - Facts, Management and Advances

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Cystic fibrosis (CF) is one of the most common indications for lung transplant (LTx) and nearly one-third of the LTx worldwide are performed in people with CF (PwCF). Due to vast developments in diagnostic modalities, antibiotic therapies, and management of associated comorbidities in dedicated and experienced centres, over the past few decades, more PwCF are reaching adulthood than ever before. This has increased the burden on transplant programs particularly in a universal donor shortage scenario. To improve the donor pool a diligent and proactive donor care management, acceptance of marginal organs and utilisation of ex-vivo lung perfusion systems for organ preservation, assessment, and improvement is being advocated widely. LTx is not a readily available therapy and the average waiting time is 18 months in the UK. Therefore, it is essential that PwCF are referred for LTx assessment when their disease is stable, before respiratory deterioration leads to overall deconditioning of the patients. Once listed for LTx, it is crucial to control waiting list mortality by prioritising rapidly deteriorating patients through schemes like the lung allocation score, national urgent and super-urgent waiting lists, and institutional highlighting of deteriorating patients that do not meet other urgent criteria. LTx in PwCF is challenging due to colonisation of the respiratory tract with multi-drug resistant organisms, associated comorbidities such as diabetes, liver disease, gastro-oesophageal reflux, and distal intestinal obstruction syndrome (DIOS) and CF-specific technical difficulties (adhesions due to prior pneumothoraces or pleurodesis, or bronchial collaterals that increase surgical time). Hilar lymphadenopathy and bronchial collaterals may increase surgical time, organ ischemia time, intra and post-operative bleeding, and blood transfusions. Advances in immunosuppression, prophylactic anti-viral and anti-fungal therapies, early ambulation and rigorous physiotherapy, and meticulous postoperative follow up with spirometry, x-rays, and bronchoscopies to detect rejection at the early stage followed by its efficient treatment have helped to improve post-LTx survival in the CF patients. Constant development in the surgical field with adoption of off-pump transplantation, sternal sparing bilateral thoracotomy approach, and utilisation of mechanical circulatory assist as a bridge to transplant and as a support for primary graft failure strives for better outcomes. However, chronic lung allograft dysfunction, chronic refractory infections, malignancies, and CF associated comorbidities remain major determinants of post-LTx long term survival. Despite this, CF patients are often good candidates for re-do LTx with improving survival outcomes. In this chapter, we are compiling the different aspects of LTx in PwCF emphasising the advances in bridge to transplantation, the surgical approach, management of primary graft failure, and immunosuppression as well as complications post-transplant.

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Impact of donor lung quality on post‐transplant recipient outcome in the Lung Allocation Score era in Eurotransplant – a historical prospective study

Cited by 13 publications

References 25 publications

Long-term outcome and bridging success of patients evaluated and bridged to lung transplantation on the ICU

Long-term outcome and bridging success of patients evaluated and bridged to lung transplantation on the ICU

Waiting List Dynamics and Lung Transplantation Outcomes After Introduction of the Lung Allocation Score in The Netherlands

Lung Transplantation in Patients with Cystic Fibrosis

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