OPTN/SRTR 2017 Annual Data Report: Lung

Valapour, Maryam; Lehr, Carli J.; Skeans, M. A.; Smith, Jodi M.; Uccellini, K.; Lehman, Rebecca R.; Robinson, A. M.; Israni, Ajay K.; Snyder, Jon J.; Kasiske, B. L.

doi:10.1111/ajt.15279

Cited by 119 publications

(79 citation statements)

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“…This figure is similar to that seen in the United Kingdom [26,27], but it is vastly different from recent US data. The latest report of the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients demonstrates that the rate of used lung donors with significant smoking history (20 pack-years or more) has decreased from more than 20% in 2004 to 8% in 2014 [28]. In our study, 22% of our used donors had a significant smoking history.…”

Section: Commentsupporting

confidence: 42%

Continued Successful Evolution of Extended Criteria Donor Lungs for Transplantation

Kotecha

Hobson

Fuller

et al. 2017

The Annals of Thoracic Surgery

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Section: Commentsupporting

confidence: 42%

Continued Successful Evolution of Extended Criteria Donor Lungs for Transplantation

Kotecha

Hobson

Fuller

et al. 2017

The Annals of Thoracic Surgery

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“…Given that access to transplant is limited by the supply of donor lungs, donor lungs are distributed according to national organ allocation policies. 1 In 2000, the United States Department of Health and Human Services (DHHS) mandated that cadaveric organ allocation within the U.S. occur by medical urgency while minimizing the effect of geography. 2 The Lung Allocation Score (LAS) was subsequently introduced in May 2005, which changed candidate prioritization for donor lungs from accumulated waitlist time to a numerical score based on the candidate's medical urgency and expected benefit.…”

mentioning

confidence: 99%

Effect of broader geographic sharing of donor lungs on lung transplant waitlist outcomes

Mooney

Bhattacharya

Dhillon

2019

The Journal of Heart and Lung Transplantation

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BACKGROUND: The United States lung allocation system prioritizes allocation based on medical urgency and benefit but does not address a federal mandate for broader geographic organ sharing. It is unknown whether broader geographic sharing of donor lungs would improve lung transplant waitlist outcomes. METHODS: A discrete event microsimulation model simulated donor lung allocation according to different geographic lung-sharing policies, including the historic local donor service area (DSA)-based policy and hypothetical policies that prioritize candidates to donors within 500-mile or 1,000-mile geographic radii. Candidate waitlist mortality, number of transplants, and 1-year survival were compared across organ allocation policies. Waitlist mortality rates were further stratified by diagnosis, Lung Allocation Score (LAS) threshold, ABO blood type, and region. RESULTS: Under broader geographic lung sharing, the proportion of chronic obstructive pulmonary disease transplant recipients decreased, whereas the proportion of pulmonary fibrosis recipients increased. Waitlist mortality decreased with broader geographic lung sharing with a 21.3% decrease in waitlist mortality with 500-mile lung sharing and a 31.8% decrease in waitlist mortality with 1,000-mile lung sharing. The decrease in waitlist deaths occured across all U.S. geographic regions and was greatest in candidates with pulmonary fibrosis and/or high medical urgency. CONCLUSIONS: Broader geographic sharing of donor lungs could reduce waitlist mortality, particularly among pulmonary fibrosis and high-medical-urgency candidates.

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“…Lung transplantation is lifesaving therapy for many end‐stage lung diseases but the current demand for suitable donor lungs outpaces the supply . There are data confirming the safety of the use of lungs obtained from ‘extended criteria’ donors (ECD) or through donation after circulatory death (DCD), suggesting that the current standard criteria for lung donation are too restrictive .…”

Section: Introductionmentioning

confidence: 99%

Prolonged extracorporeal preservation and evaluation of human lungs with portable normothermic ex vivo perfusion

Spratt

Mattison

Kerns

et al. 2020

Clinical Transplantation

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Many lung donor offers are refused despite increasing demand. Portable normothermic ex vivo lung perfusion (EVLP) could increase donor yield by monitoring and reconditioning extended criteria donor (ECD) lungs. We report its use in human lungs declined for clinical transplantation. Ten sets of such lungs were procured from brain‐dead donors and underwent 24 hours of normothermic EVLP using a perfusate based on donor whole blood. Hemodynamic and ventilatory data and P:F ratios were measured. Advanced donor age and borderline oxygenation (donor mean P:F 228 ± 73) were the most commonly cited reasons for refusal for transplantation. There was no significant worsening of pulmonary hemodynamics or compliance or significant P:F decline during preservation in the overall cohort. Mean P:F ratio in the overall cohort was 315 ± 88 mm Hg after 24 hours EVLP. At EVLP termination 5/10 lung blocks met standard EVLP thresholds for acceptability for transplant. Eventual EVLP performance was poorly predicted by donor P:F ratio but well predicted by data gathered early in EVLP. Portable normothermic EVLP is useful for transportation, monitoring, and reconditioning of ECD lungs. Early EVLP measurements are more effective than preprocurement donor P:F in predicting eventual allograft performance. We advocate an aggressive strategy of evaluation of ECD lungs using blood‐based EVLP.

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OPTN/SRTR 2017 Annual Data Report: Lung

Cited by 119 publications

References 0 publications

Continued Successful Evolution of Extended Criteria Donor Lungs for Transplantation

Continued Successful Evolution of Extended Criteria Donor Lungs for Transplantation

Effect of broader geographic sharing of donor lungs on lung transplant waitlist outcomes

Prolonged extracorporeal preservation and evaluation of human lungs with portable normothermic ex vivo perfusion

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