Selection and procurement of combined heart and lung grafts for transplantation

Hakim, M; Higenbottam, Tim; Bethune, D.W.; Cory-Pearce, R.; English, T. A. H.; Kneeshaw, J.; Wells, Francis C.; Wallwork, J.

doi:10.1016/s0022-5223(19)35766-6

Cited by 73 publications

(13 citation statements)

References 17 publications

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“…In the past, different methods and techniques for lung procurement and preservation have been developed and used in clinical transplantation. However, donor core cooling by means of extracorporeal circulation [5,17] and single flush perfusion of the pulmonary artery using either Euro-Collins solution [2,[6][7][8][9][10] or cold blood [4], are currently used by most lung transplant centers. The EC flush is combined with the systemic administration of prostaglandins to the donor immediately before harvesting, since Jurmann et al have demonstrated that the addition of PG{z provides pulmonary vasodilatation resulting in better distribution of the crystalloid flush and improved postoperative graft function [18].…”

Section: Discussionmentioning

confidence: 99%

“…Initially, attempts at lung transplantation failed in the early postoperative period due to the poor preservation qu~lity of the transplanted organs [1 ]. Several methods for distant organ procurement have been succesfully established [2][3][4][5]. Currently, pulmonary artery flush perfusion with Euro-Collins solution (EC) in combination with prostacyclin (PGh) pretreatment is most frequently used for lung preservation [6][7][8][9] and acceptable results are achieved clinically within ischemia times of up to 4 h [10].…”

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confidence: 99%

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Antagonisation of platelet activating factor — a new therapeutic concept for improvement of organ quality in lung preservation

Hirt

Wahlers

Jurmann

et al. 1992

Transplant International Official Journal of the European Society for Organ Transplantation

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The release of platelet activating factor (PAF) is thought to be one of the most important pathophysiological pathways in the development of ischemic lung injury. We investigated the use of a PAF antagonist (PAF-a) in a canine model in reducing PAP-mediated pulmonary dysfunction following lung preservation and transplantation. Twelve combined heterotopic heart and orthotopic left lung allotransplantations were performed after 6 h of cold ischemia. Following administration of prostacyclin (PGh), Euro-Collins solution (EC) was used for pulmonary artery flush in all donors, while in six animals the PAF-a, WEB 2170 BS, was administered to the donor (0.15 mg/kg for 30 min), to the storage solution (0.3 mg/kg) and to the recipient during reperfusion for a total of 6 h (0.3 mg/kg per h) EC/PAF-a). In all donors myocardial preservation was achieved using St. Thomas Hospital solution. Postoperatively, cardiorespiratory function was evaluated seperately for donor and recipient organs at an FiOz of 0.4 for a maximum of 12 h. The quality of lung preservation was assessed by means of postoperative oxygenation (p02), pulmonary artery pressure (PAP) and pulmonary vascular resistance index (PVRI). In the EC/PAF-a group, pOz of the donor lung was significantly elevated (P < O.ot) and PVRI was significantly lower (P < 0.05) when compared to the EC group, while PAP showed no significant differences between both groups and throughout the entire postoperative course. We concluded that a significant improvement in the current clinical standard for lung preservation could be obtained by the application of WEB 2170 BS in combination with EC flush as demonstrated by improved oxygenation and lower PVRI of the transplantated organs.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Antagonisation of platelet activating factor — a new therapeutic concept for improvement of organ quality in lung preservation

Hirt

Wahlers

Jurmann

et al. 1992

Transplant International Official Journal of the European Society for Organ Transplantation

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“…All of the heart-lung transplants were carried out between April 1984 and October 1988. Details of the operative technique for harvest and implantation have been described previously [6].…”

Section: Methodsmentioning

confidence: 99%

“…A Papworth perfusate has been developed, essentially extracellular in its constitution, which has been incorporated in a technique of preservation based on a single pulmonary artery flush previously described by this unit [6]. We have extended ischaemic times to over 4 h now and early graft function has been satisfactory.…”

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confidence: 99%

Early graft function following heart and lung transplantation

McGoldrick¹,

Scott²,

Jamieson³

et al. 1989

Transplant Int

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Fifty-one patients underwent heart-lung transplantation between April 1984 and October 1988. The first five donor organs were removed in an adjacent operating theatre. Organs were subsequently removed from distant centres. The method of preservation consisted of cold cardioplegic arrest of the heart using St. Thomas' solution, followed by a simple, cold pulmonary artery flush of a lung perfusate developed at Papworth Hospital. Administration of the solution was preceded by an infusion of prostacyclin into the pulmonary artery during preliminary dissection of the donor organs. The total ischaemic time ranged from 48 to 51 min (mean 49.6 min) for the near procurement group and from 70 to 249 min (mean 154.2 min) for the distant procurement group. There were no primary organ failures. Function of the lungs was assessed by gas exchange, pulmonary function tests, time to extubation, and survival data. Serial radiological studies were used to monitor graft performance in the postoperative period. We report here on our clinical experience of early graft function following heart and lung transplantation.

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“…The relative benefits of various preservation techniques are discussed at length in other articles. 7,[18][19][20][21][22][23][24][25][26][27][28] Most lung transplant centers use cold pulmonoplegic flush. Donor lungs are usually taken in conjunction with heat procurement.…”

Section: Procurementmentioning

confidence: 99%