Successful Transplantation of Lungs From an Uncontrolled Donor After Circulatory Death Preserved In Situ by Alveolar Recruitment Maneuvers and Assessed by Ex Vivo Lung Perfusion

Valenza, Franco; Citerio, Giuseppe; Palleschi, Alessandro; Vargiolu, Alessia; Fakhr, Bijan Safaee; Confalonieri, A; Nosotti, Mario; Gatti, Stefano; Ravasi, Saula; Vesconi, S.; Pesenti, Antonio; Blasi, Francesco; Santambrogio, Luigi; Gattinoni, Luciano

doi:10.1111/ajt.13612

Cited by 69 publications

(73 citation statements)

References 27 publications

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“…A remarkable outcome was a substantial extension of uninjured ex vivo perfusion to 180 min in the absence of pharmacological interventions. This successful achievement stems from our expertise in both clinical [12–14] and pre-clinical [15, 16] use of the isolated lung. The meticulous procedure description includes videos that show how critical steps were managed and solved.…”

Section: Discussionmentioning

confidence: 99%

Ex Vivo Lung Perfusion in the Rat: Detailed Procedure and Videos

et al. 2016

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Ex vivo lung perfusion (EVLP) is a promising procedure for evaluation, reconditioning, and treatment of marginal lungs before transplantation. Small animal models can contribute to improve clinical development of this technique and represent a substantial platform for bio-molecular investigations. However, to accomplish this purpose, EVLP models must sustain a prolonged reperfusion without pharmacological interventions. Currently available protocols only partly satisfy this need. The aim of the present research was accomplishment and optimization of a reproducible model for a protracted rat EVLP in the absence of anti-inflammatory treatment. A 180 min, uninjured and untreated perfusion was achieved through a stepwise implementation of the protocol. Flow rate, temperature, and tidal volume were gradually increased during the initial reperfusion phase to reduce hemodynamic and oxidative stress. Low flow rate combined with open atrium and protective ventilation strategy were applied to prevent lung damage. The videos enclosed show management of the most critical technical steps. The stability and reproducibility of the present procedure were confirmed by lung function evaluation and edema assessment. The meticulous description of the protocol provided in this paper can enable other laboratories to reproduce it effortlessly, supporting research in the EVLP field.

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Section: Discussionmentioning

confidence: 99%

Ex Vivo Lung Perfusion in the Rat: Detailed Procedure and Videos

et al. 2016

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“…≥55 years, cardiopulmonary bypass, severe SPH, PGD G3, NIMV, ECLS, AR, and underlying lung disease. Warm ischemic time was 4 hours 48 min, and then, 6 hours of EVLP was performed to assess graft viability.They reported an intraoperative cardiogenic shock in a cystic fibrosis patient that required venoarterial instauration of ECMO, PGD G2 at 72 hours, and a difficult weaning from mechanical ventilation due to preoperative deconditioning of the recipient 37. The authors emphasized that a program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes.A group from Milan has recently reported their first case of uDCD lung transplantation.…”

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confidence: 99%

Expanding the horizons: Uncontrolled donors after circulatory death for lung transplantation—First comparison with brain death donors

Valdivia

Antonio

Hoyos

et al. 2019

Clinical Transplantation

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Uncontrolled donation after cardiac death is an appealing source of organs for lung transplantation. We compare early and long-term outcomes of lung transplantation with these donors with a cohort of transplants from brain death donors at our institution. Retrospective analysis of all lung transplantations was performed from 2002 to 2012. We collected variables regarding recipients, donors, recover and transplant procedures, early and late complications, and survival. We included 292 lung transplants from brain death donors and 38 from uncontrolled donors after cardiac death.Both groups were comparable except for sex mismatch (male recipient-female donor was more frequent in the brain death cohort, 17.8% vs 0%, P 0.002), total ischemic time (longer for donors after cardiac death, 657 minutes for the first lung and 822 minutes for the second vs 309 and 425 minutes, P < 0.001), and ex vivo evalua-

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“…14,15,17 Although the results of early experiences with uDCD lung transplantation appeared to be inferior to DBD transplants, 14,15 due to the higher rates of graft dysfunction compared to donors with brain death, 18 recent studies conducted in Spain (which has the largest worldwide experience in lung transplantation from uDCD donors) have shown no differences in survival rates compared to transplants from DBD donors. 20,21 Despite the huge differences between countries in terms of logistics, legal frameworks, preservation methods, and inclusion criteria, lung recovery from uDCD appears to offer a potentially very large supply for transplantation. 20,21 Despite the huge differences between countries in terms of logistics, legal frameworks, preservation methods, and inclusion criteria, lung recovery from uDCD appears to offer a potentially very large supply for transplantation.…”

Section: Introductionmentioning

confidence: 99%

Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death

Suberviola

Mons

Ballesteros

et al. 2019

American Journal of Transplantation

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We aimed to propose a simple and effective preservation method in lungs procured for transplantation from uncontrolled donation after circulatory death (uDCD) associated with excellent long-term results. Outcome measures for lung recipients were survival and primary graft dysfunction (PGD) grade 3. Survival was estimated using the Kaplan-Meier method. A total of 9 lung uDCDs were evaluated and 8 lung transplants were performed. Mean no-flow time was 9.8 minutes (standard deviation [SD] 8.6). Mean time from cardiac arrest to topical cooling was 96.8 minutes (SD 16.8).Preservation time was 159 minutes (SD 31). Ex vivo lung perfusion was used to assess lung function prior to transplantation in 2 cases. Mean recipient age was 60.8 years (SD 3.1), and mean total ischemic time was 678 minutes (SD 132). PGD grade 3 was observed in 2 cases (25%). The 1-month, 1-year, and 5-year survival rates were 100%, 87.5%, and 87.5%, respectively. Mean follow-up was 52 months. The logistic complexity of procuring lungs from uDCDs for transplantation requires the development of new strategies designed to facilitate this type of donation. A program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes. K E Y W O R D Sclinical research/practice, donation after circulatory death (DCD), donors and donation, lung transplantation/pulmonology, organ perfusion and preservation, organ procurement, organ procurement and allocation, transplant coordinator

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Successful Transplantation of Lungs From an Uncontrolled Donor After Circulatory Death Preserved In Situ by Alveolar Recruitment Maneuvers and Assessed by Ex Vivo Lung Perfusion

Cited by 69 publications

References 27 publications

Ex Vivo Lung Perfusion in the Rat: Detailed Procedure and Videos

Ex Vivo Lung Perfusion in the Rat: Detailed Procedure and Videos

Expanding the horizons: Uncontrolled donors after circulatory death for lung transplantation—First comparison with brain death donors

Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death

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