Influence of Donor Characteristics on Outcome After Lung Transplantation: A Multicenter Study

Thabut, Gabriel; Mal, Hervé; Cerrina, Jacques; Dartevelle, Philippe; Dromer, C.; Velly, Jean-François; Stern, M.; Loirat, Philippe; Bertocchi, M.; Mornex, Jean‐François; Haloun, A.; Despins, Philippe; Pison, Christophe; Blin, D.; Simonneau, Gérald; Reynaud‐Gaubert, Martine

doi:10.1016/j.healun.2004.10.016

Cited by 82 publications

(38 citation statements)

References 23 publications

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“…A previous study found that many lungs rejected for transplantation based on conventional clinical criteria were without significant histological or functional abnormalities (39). Those data, along with patient outcome data from recipients of lungs not meeting all of the usual pretransplant clinical criteria (4,9,18,31,32), call into question the validity of certain clinical criteria used for screening donor organs. To investigate whether air space or circulating levels of biological markers of alveolar epithelial cell injury were associated with measures of epithelial barrier function, we also measured levels of RAGE in the perfusate and air spaces in these donor lungs.…”

Section: Discussionmentioning

confidence: 99%

Physiological and biochemical markers of alveolar epithelial barrier dysfunction in perfused human lungs

Frank¹,

Briot²,

Lee³

et al. 2007

American Journal of Physiology-Lung Cellular and Molecular Phys

107

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Frank JA, Briot R, Lee JW, Ishizaka A, Uchida T, Matthay MA. Physiological and biochemical markers of alveolar epithelial barrier dysfunction in perfused human lungs. Am J Physiol Lung Cell Mol Physiol 293: L52-L59, 2007. First published March 9, 2007; doi:10.1152/ajplung.00256.2006.-To study air space fluid clearance (AFC) under conditions that resemble the clinical setting of pulmonary edema in patients, we developed a new perfused human lung preparation. We measured AFC in 20 human lungs rejected for transplantation and determined the contribution of AFC to lung fluid balance. AFC was then compared with air space and perfusate levels of a biological marker of epithelial injury. The majority of human lungs rejected for transplant had intact basal (75%) and ␤2-adrenergic agonist-stimulated (70%) AFC. For lungs with both basal and stimulated AFC, the basal AFC rate was 19 Ϯ 10%/h, and the ␤2-adrenergic-stimulated AFC rate was 43 Ϯ 13%/h. Higher rates of AFC were associated with less lung weight gain (Pearson coefficient Ϫ0.90, P Ͻ 0.0001). Air space and perfusate levels of the type I pneumocyte marker receptor for advanced glycation end products (RAGE) were threefold and sixfold higher, respectively, in lungs without basal AFC compared with lungs with AFC (P Ͻ 0.05). These data show that preserved AFC is a critical determinant of favorable lung fluid balance in the perfused human lung, raising the possibility that ␤2-agonist therapy to increase edema fluid clearance may be of value for patients with acute lung injury and pulmonary edema. Also, although additional studies are needed, a biological marker of alveolar epithelial injury may be useful clinically in predicting preserved AFC. alveolar epithelial fluid transport; acute lung injury; acute respiratory distress syndrome; lung transplantation; biological markers; pulmonary edema; primary graft failure; air space fluid clearance POSTLUNG TRANSPLANT REPERFUSION PULMONARY EDEMA is a form of acute lung injury that contributes to early mortality in lung transplant patients (6 -8, 37). Acute lung injury is characterized by the loss of alveolar epithelial barrier function, including increased permeability to protein and decreased fluid transport from the air spaces, resulting in pulmonary edema (6 -8, 37). Removal of edema fluid from the air spaces, or distal air space fluid clearance (AFC), is dependent on a transepithelial sodium concentration gradient established by basolateral sodium-potassium ATPase (19,20). The basal rate of alveolar epithelial ion and fluid transport can be increased by ␤ 2 -adrenergic agonists (15,17,20,22). Edema fluid cleared from the distal air spaces into the interstitial space is transported from the lungs primarily by direct absorption into the pulmonary venous circulation, but also by pulmonary lymphatic drainage and clearance into the pleural space (20,30). Lung fluid balance is the sum of edema formation and lung fluid clearance.Data from nonperfused human lungs obtained from donated organs rejected for transplant (39) and from p...

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Section: Discussionmentioning

confidence: 99%

Physiological and biochemical markers of alveolar epithelial barrier dysfunction in perfused human lungs

Frank¹,

Briot²,

Lee³

et al. 2007

American Journal of Physiology-Lung Cellular and Molecular Phys

107

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“…However, it should be noted that the classification of these tests as normal or not depends on highly subjective criteria. (25) Another study (26) demonstrated that, although 39 (60.9%) of the 64 marginal donors analyzed presented chest X-ray abnormalities, there was no impact on the survival rate of the recipients. Another group of authors, (27) in a retrospective study, did not observe any difference between donors with chest X-ray abnormalities and those without in terms of the recipient survival rate.…”

Section: Discussionmentioning

confidence: 99%

Perfil do doador de pulmão disponibilizado no estado de São Paulo, Brasil, em 2006

et al. 2008

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Objective: To analyze the rate at which lungs available for transplantation in the state of São Paulo in 2006 were utilized and to determine the lung donor profile in the same period. Methods: A retrospective study of 497 clinical charts of lung tissue donors from January to December of 2006. Results: According to the clinical charts, lungs were not offered for transplant in 149 cases (30%), which were therefore excluded from the study. Among the 348 lung donors eligible for inclusion in the study, the mean age was 37.4 ± 16.1 years, and 56.9% were males. The main causes of brain death among the donors were stroke (in 40.5%), skull-brain trauma (in 34.2%) and subarachnoid hemorrhage (in 10.9%). The great majority of these lung donors (90.5%) received vasoactive agents, and 13.5% presented cardiopulmonary arrest. The mean donor leukocyte count was 15,008 ± 6,467 cells/mm 3 , 67.8% of the donors received anti-bacterial agents, and 26.1% presented lung infection. Nearly 40% of the lung donors presented chest X-ray abnormalities. Only 4.9% of the lung donors were accepted, representing 28 lungs (allograft utilization rate of 4%). The causes for donor exclusion were gas exchange alterations (in 30.1%), infection (in 23.7%) and distance (in 10.9%). Conclusions: The lung utilization rate in the state of São Paulo is low when compared to mean rates worldwide. In addition, more than half of the donor pool was excluded due to altered gas exchange or pulmonary infection. The combination of better care of the potential donor and more flexible selection criteria could increase allograft utilization. Keywords: Lung transplantation; Donor selection; Tissue donors. ResumoObjetivo: Analisar a taxa de aproveitamento de pulmões disponibilizados em São Paulo no ano de 2006, bem como caracterizar o perfil dos doadores de pulmão deste período. Métodos: Estudo retrospectivo de 497 prontuários de doadores de pulmão, no período de janeiro a dezembro de 2006. Resultados: Não houve oferta de doação de pulmões para transplante em 149 (30%) dos prontuários analisados, sendo excluídos do estudo. A idade média dos 348 doadores eleitos para o estudo foi de 37,4 ± 16,1 anos, e 56,9% deles eram do sexo masculino. As principais causas da morte cerebral dos doadores foram: acidente vascular cerebral (40,5%); trauma cranioencefálico (34,2%); e hemorragia subaracnóidea (10,9%). A grande maioria dos doadores recebia drogas vasoativas (90,5%), sendo que 13,5% haviam apresentado parada cárdio-respiratória. Do ponto de vista infeccioso, o leucograma médio foi de 15.008 ± 6.467 células/mm 3 , 67,8% recebiam antibioticoterapia e 26,1% apresentavam infecção pulmonar. Quase 40% dos doadores apresentavam alterações radiográficas. Apenas 4,9% dos doadores foram aceitos, representando 28 pulmões (taxa de aproveitamento de órgãos de 4%). Os motivos de recusa foram: alteração gasométrica (30,1%); infecção (23,7%); e distância (10,9%). Conclusões: A taxa de aproveitamento de pulmões em nosso meio é baixa quando comparada às taxas médias de aproveitamento ...

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“…161 Using multiple linear regression, Thabut et al found no effect of 10 year intervals of donor age on postoperative oxygenation, or long-term survival. 162 A study of the effects of smoking donor lungs found prolonged ICU length of stay and decreased 90-day survival in 454 patients, including 50 with COPD. 163 A larger analysis of 1295 lung transplantations in the UK found that 510 involved organs from donors with positive smoking histories.…”

Section: Extended Criteria Donationmentioning

confidence: 99%

“…This study included 250 COPD patients but found that recipient diagnosis had no effect on posttransplant outcomes. 162 No blanket statement of the advisability of using all the different extended criteria for lung donation can be made; however, specific criteria can be considered. Lungs from older and smoking donors are associated with poorer posttransplant outcomes; however, waiting for a more ideal organ is associated with poorer outcomes than the decision to undergo transplantation.…”

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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Influence of Donor Characteristics on Outcome After Lung Transplantation: A Multicenter Study

Cited by 82 publications

References 23 publications

Physiological and biochemical markers of alveolar epithelial barrier dysfunction in perfused human lungs

Physiological and biochemical markers of alveolar epithelial barrier dysfunction in perfused human lungs

Perfil do doador de pulmão disponibilizado no estado de São Paulo, Brasil, em 2006

Lung transplantation for chronic obstructive pulmonary disease

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