Pulmonary reimplantation response in single-lung transplantation

Abstract

P Pu ul lm mo on na ar ry y r re ei im mp pl la an nt ta at ti io on n r re es sp po on ns se e i in n s si in ng gl le e--l lu un ng g t tr ra an ns sp pl la an nt ta at ti io on n In 40% of the cases hypoxaemia was severe, precluding weaning and requiring prolonged mechanical ventilation with high fractional inspiratory oxygen (FIO 2 ). The mean duration of ventilation was 7 days (range 1-19 days). Clearing of the chest radiographs was progressive, with complete resolution between 6 and 21 days. In all cases, the pulmonary arterial wedge pressure was normal (6±2 mmHg) suggesting low pressure oedema. Sampling of the pulmonary oedema fluid revealed that the ratio of protein concentration in oedema fluid to that in serum exceeded 0.5. In patients with severe PRR (40% of cases) clinical, radiographic and haemodynamic abnormalities were identical to adult respiratory distress syndrome (ARDS), but the prognosis was more favourable with no death directly related to PRR in our patients. The mean duration of graft ischaemia of the oedematous grafts (241 ±103 min) was significantly longer than that of nonoedematous grafts (155±71 min).These date suggest that prolongation of graft ischaemia increased the incidence of PRR.

High Donor Age, Low Donor Oxygenation, and High Recipient Inotrope Requirements Predict Early Graft Dysfunction in Lung Transplant Recipients

“…Infection in the donor is another potential target; however, this has previously been shown to have an inconsistent relationship with graft function, having been predictive in some studies 4,5 and not in others 23 . Pre-operative optimization of donors has been reported before and has been shown to increase donor numbers 23 and improve recipient allograft function.…”

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

“…This result is in agreement with studies by our team and others that support the impact of graft ischemic time on early gas exchange and short-and long-term survival. [23][24][25][26] When examining standard lung transplant criteria, some propositions can be made on their extension on the basis of the findings of this study and of previous ones. The extension of donor age was not associated with lower gas exchange or long-term survival in our study; the extension of this criterion is advocated by Pierre et al 13 and Bhorade et al 12 However, one should be cautious when graft ischemic time is expected to be high because the interaction between donor age and graft ischemic time has been shown to be associated with a lower 1-year survival in the UNOS/ISHLT Registry.…”

Nitric Oxide Mediates Lung Injury Induced by Ischemia-Reperfusion in Rats

“…It has been observed in lung transplantation [20] and thrombolysis after pulmonary embolism [23], and in extreme cases, it may lead to acute respiratory distress syndrome [12]. I/R injury results from a temporary interruption of blood flow to an organ, followed by reperfusion of the previously ischemic area [12].…”