Initial Experience With Lung Donation After Cardiocirculatory Death in Canada

Cypel, Marcelo; Sato, Masaaki; Yıldırım, Erkan; Karolak, Wojtek; Chen, Fengshi; Yeung, Jonathan C.; Boasquevisque, Carlos Henrique Ribeiro; Leist, V.; Singer, Lianne G.; Yasufuku, Kazuhiro; dePerrot, M.; Waddell, Thomas K.; Keshavjee, Shaf; Pierre, Andrew

doi:10.1016/j.healun.2009.05.009

Cited by 76 publications

(46 citation statements)

References 41 publications

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“…Although one of the largest single-center experiences to date, it includes only 55 DCDD LTxs and thus may be underpowered to draw conclusions on superiority or not of EVLP in the DCDD context. Another limitation resides in our center ''learning curve'' with the utilization of DCDDs, when we initially did not have EVLP available (44). Similarly, we also experienced an evolution in the indication for EVLP: in the beginning of our Human ex vivo Lung Perfusion Trial, EVLP was utilized for every DCDD case (16).…”

Section: Dcdd-no Evlp Vs Dcdd þ Evlpmentioning

confidence: 99%

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Machuca

Mercier

Collaud

et al. 2015

American Journal of Transplantation

130

116

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The growing demand for suitable lungs for transplantation drives the quest for alternative strategies to expand the donor pool. The aim of this study is to evaluate the outcomes of lung transplantation (LTx) with donation after circulatory determination of death (DCDD) and the impact of selective ex vivo lung perfusion (EVLP). From 2007 to 2013, 673 LTx were performed, with 62 (9.2%) of them using DCDDs (seven bridged cases). Cases bridged with mechanical ventilation/extracorporeal life support were excluded. From 55 DCDDs, 28 (51%) underwent EVLP. Outcomes for LTx using DCDDs and donation after neurological determination of death (DNDD) donors were similar, with 1 and 5-year survivals of 85% and 54% vs 86% and 62%, respectively (p ¼ 0.43). Although comparison of survival curves between DCDD þ EVLP vs DCDD-no EVLP showed no significant difference, DCDD þ EVLP cases presented shorter hospital stay (median 18 vs. 23 days, p ¼ 0.047) and a trend toward shorter length of mechanical ventilation (2 vs. 3 days, p ¼ 0.059). DCDDs represent a valuable source of lungs for transplantation, providing similar results to DNDDs. EVLP seems an important technique in the armamentarium to safely increase lung utilization from DCDDs; however, further studies are necessary to better define the role of EVLP in this context.

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Section: Dcdd-no Evlp Vs Dcdd þ Evlpmentioning

confidence: 99%

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Machuca

Mercier

Collaud

et al. 2015

American Journal of Transplantation

130

116

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“…They state that there is an ameliorative effect on the levels of inflammatory cytokines present in these lungs which off sets the perceived ischemic damage. (Cypel et al 2009) Donor age is another consideration that is factored in when considering possible transplantation. Not surprisingly, elevated donor age and increased ischemic times correlate with worse outcomes in transplant recipients.…”

Section: Other Donor Factorsmentioning

confidence: 99%

Lung Transplantation: Advances and Roadblocks in Treatment

Hardison¹,

Blalock²

2012

Lung Diseases - Selected State of the Art Reviews

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Section: Introductionmentioning

confidence: 99%

“…Graft dysfunction is considered the most common cause of early mortality, and its etiopathogenesis lies in ischemiareperfusion injury. (3,4) Donor lung preservation plays a key role in early graft function after transplantation.(5) The presence and severity of ischemia-reperfusion injury are influenced by factors pertaining to the donor and to the preservation techniques. (3) Ischemia-reperfusion injury is associated with cell death in various organ systems, and there is a correlation between the degree of apoptosis and ischemia-reperfusion injury.…”

mentioning

confidence: 99%

“…(3) Despite the evidence, controversy remains regarding the benefits of the LPD solution in terms of late graft performance and one-year mortality after transplantation. (20) More recently, the introduction of ex vivo lung reconditioning (21) and donation after cardiocirculatory death (4) have reignited the controversy and underscored the need to re-evaluate the preservation solutions that are currently used.…”

mentioning

confidence: 99%

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Modelo experimental de perfusão pulmonar ex vivo em ratos: avaliação histopatológica e de apoptose celular em pulmões preservados com solução de baixo potássio dextrana vs. solução histidina-triptofano-cetoglutarato

et al. 2012

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Objective: To compare histopathological findings and the degree of apoptosis among rat lungs preserved with low-potassium dextran (LPD) solution, histidine-tryptophan-ketoglutarate (HTK) solution, or normal saline (NS) at two ischemia periods (6 h and 12 h) using an experimental rat model of ex vivo lung perfusion. Methods: Sixty Wistar rats were anesthetized, randomized, and submitted to antegrade perfusion via pulmonary artery with one of the preservation solutions. Following en bloc extraction, the heart-lung blocks were preserved for 6 h or 12 h at 4°C and then reperfused with homologous blood for 60 min in an ex vivo lung perfusion system. At the end of the reperfusion, fragments of the middle lobe were extracted and processed for histopathological examination. The parameters evaluated were congestion, alveolar edema, alveolar hemorrhage, inflammatory infiltrate, and interstitial infiltrate. The degree of apoptosis was assessed using the TdT-mediated dUTP nick end labeling method. Results: The histopathological examination showed that all of the lungs preserved with NS presented alveolar edema after 12 h of ischemia. There were no statistically significant differences among the groups in terms of the degree of apoptosis. Conclusions: In this study, the histopathological and apoptosis findings were similar with the use of either LPD or HTK solutions, whereas the occurrence of edema was significantly more common with the use of NS. Keywords: Organ preservation; Organ preservation solutions; Lung transplantation; Reperfusion injury; Apoptosis. ResumoObjetivo: Comparar os achados histopatológicos e de apoptose em pulmões de ratos preservados em soluções low-potassium dextran (LPD, baixo potássio dextrana), histidine-tryptophan-ketoglutarate (HTK, histidina-triptofano-cetoglutarato) ou salina normal (SN) em 6 h e 12 h de isquemia pela utilização de um modelo experimental de perfusão pulmonar ex vivo. Métodos: Sessenta ratos Wistar foram anestesiados, randomizados e submetidos à perfusão anterógrada pela artéria pulmonar com uma das soluções preservadoras. Após a extração, os blocos cardiopulmonares foram preservados por 6 ou 12 h a 4°C, sendo então reperfundidos com sangue homólogo em um sistema de perfusão ex vivo durante 60 min. Ao final da reperfusão, fragmentos do lobo médio foram extraídos e processados para histopatologia, sendo avaliados os seguintes parâmetros: congestão, edema alveolar, hemorragia alveolar, hemorragia, infiltrado inflamatório e infiltrado intersticial. O grau de apoptose foi avaliado pelo método TdT-mediated dUTP nick end labeling. Resultados: A histopatologia demonstrou que todos os pulmões preservados com SN apresentaram edema alveolar após 12 h de isquemia. Não houve diferenças em relação ao grau de apoptose nos grupos estudados. Conclusões: No presente estudo, os achados histopatológicos e de apoptose foram semelhantes com o uso das soluções LPD e HTK, enquanto a presença de edema foi significativamente maior com o uso de SN. Descritores: Preservação de órgãos; Soluções para...

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Initial Experience With Lung Donation After Cardiocirculatory Death in Canada

Cited by 76 publications

References 41 publications

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Lung Transplantation With Donation After Circulatory Determination of Death Donors and the Impact of Ex Vivo Lung Perfusion

Lung Transplantation: Advances and Roadblocks in Treatment

Modelo experimental de perfusão pulmonar ex vivo em ratos: avaliação histopatológica e de apoptose celular em pulmões preservados com solução de baixo potássio dextrana vs. solução histidina-triptofano-cetoglutarato

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