The Implications of Pulmonary Embolism in a Multiorgan Donor for Subsequent Pulmonary, Renal, and Cardiac Transplantation

Oto, Takahiro; Excell, L.; Griffiths, Ann; Levvey, B.; Snell, Gregory I

doi:10.1016/j.healun.2007.10.001

Cited by 30 publications

(18 citation statements)

References 21 publications

(27 reference statements)

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“…Of note, the highest risk for undiagnosed pulmonary embolism prior to organ retrieval was found in donors after trauma, suggesting other confounding causes for potential graft impairment, such as lung contusion. In a second analysis of unexpected donor emboli, the risk of developing primary graft dysfunction was significantly higher in transplant recipients receiving lungs from donors with fat‐emboli, suggesting a more deleterious effect of fat‐emboli, which are commonly seen in traumatized donors . These findings are in line with multiple case reports on fat embolism in donor lungs leading to severe graft dysfunction with often fatal outcomes .…”

Section: Discussionsupporting

confidence: 76%

Transplantation of donor lungs with pulmonary embolism - a retrospective study

et al. 2019

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Summary Lung transplantation from donors with fulminant pulmonary arterial embolism as a cause of death remains controversial. An analysis was performed comparing preoperative characteristics and outcomes of 25 donors with a primary diagnosis of pulmonary arterial embolism to 1085 recipients of donor lungs without pulmonary arterial embolism. No early functional impairment of donor lungs with pulmonary embolism was detectable as depicted by the incidence of primary graft dysfunction immediately after surgery (P = 0.66), 24 (P = 0.79), 48 (P = 0.99) and 72 h (P = 0.99) after transplantation. Pulmonary function testing at 1 year (P = 0.003) and at last outpatient control (P < 0.05) showed superior results in the cohort receiving lungs from donors with pulmonary embolism. Incidence of chronic lung allograft dysfunction (CLAD) showed no difference within the first year after lung transplantation, however, 5 year‐CLAD free survival was superior in recipients (70.4% vs. 55.1%, P = 0.006) of donor lungs with pulmonary embolism. Overall survival was similar in both groups. Lungs from donors with fulminant pulmonary embolism prior to brain death can safely be used for lung transplantation without impairing postoperative outcomes. Lung function testing shows favorable midterm results in recipients of donor lungs with pulmonary embolism.

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Section: Discussionsupporting

confidence: 76%

Transplantation of donor lungs with pulmonary embolism - a retrospective study

et al. 2019

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“…4 This is a unique report of a DCD donor with PE and subsequent successful ex vivo thrombolysis and assessment using the portable Lung OCS followed by clinical transplantation. This case differs from the previously described ex vivo thrombolysis 3 as PVR and PA pressure at full cardiac output could not be measured, yet improvement in oxygenation on the Lung OCS allowed for objective evidence of acceptable lung function for transplantation.…”

Section: Discussionmentioning

confidence: 94%

Successful Repair of Donation After Circulatory Death Lungs With Large Pulmonary Embolus Using the Lung Organ Care System for Ex Vivo Thrombolysis and Subsequent Clinical Transplantation

et al. 2015

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T he boundary of marginal lung utilization is expanding with the development of ex vivo lung perfusion to improve donor lung function. 1 We report the use of the Transmedics Lung Organ Care System (OCS) to lyse pulmonary embolus (PE) from a set of donation after circulatory death (DCD) lungs with subsequent clinical transplantation. CASE PRESENTATIONA 29-year-old woman who presented with Medical Research Council 5 dyspnea resulting from end-stage respiratory disease secondary to cystic fibrosis was placed on the lung transplant waiting list. Medical history was significant for chronic upper lobar collapse and widespread bronchiectasis resulting in hyperinflation of the lower lobes, with a lung ventilation perfusion (V/Q) split of 30% left lung and 70% right lung.The patient underwent bilateral lung transplantation without cardiopulmonary bypass. Lungs were procured from a DCD donor with anoxic brain injury caused by PE with unsuccessful thrombolysis during cardiac arrest and resuscitation. Subsequent computed tomographic scan revealed peripheral residual PE with borderline oxygenation PaO 2 / FIO 2 of less than 350 mm Hg before withdrawal of lifesustaining treatment. The warm ischemic time was 27 minutes. Gross evidence of PE in distal pulmonary arteries (PAs) was mechanically removed and 5 mg of Alteplase was added to the Lung OCS perfusion circuit for ongoing ex vivo thrombolysis of residual PE over 2.5 hours. Pulmonary vascular resistance (PVR) of 190 to 230 dyne · s · cm −5 was not significantly elevated during perfusion in part owing to the rate of flow being 40% of cardiac output. The device is not suited for flow at 100% cardiac output; thus, the true PVR is unable to be determined. Thus, we rely on the oxygenation of the lungs, which was marginal based on the initial PaO 2 /FIO 2 of 202 and continued to improve during ex vivo thrombolysis to a final PaO 2 /FIO 2 of 486. The improvement in oxygenation indicated a decrease in V/Q mismatch correlating to a decrease in embolic burden, thus providing evidence that the lungs were suitable for transplantation. During Lung OCS perfusion of 300 and 353 minutes for the left and the right lungs, respectively, peak airway pressure remained stable (12-15 mm Hg), PA pressures were low (approximately 6 mm Hg), whereas dynamic compliance improved significantly (42-400 mL/cm H 2 O). The patient was transferred to the intensive care unit, and the chest radiograph after transplantation was clear ( Figure 1A). Pulmonary artery catheter showed low PVR (151-181 dyne · s · cm −5 ) and PA pressures (26/17-23/9 mm Hg). Her primary graft dysfunction (PGD) score improved within the first 24 hours after transplantation ( Figure 1B), 2 and she was extubated on postoperative day 1 and transferred to the ward on postoperative day 5. She had an uneventful postoperative course and was discharged. Her forced vital capacity was 4.18 L, and her forced expiratory volume was 3.53 L at 4 months after discharge. DISCUSSIONThe use of a stationary ex vivo lung platform and treatment of donor lung...

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“…26 Deep vein thrombosis is a well-known complication of trauma. In addition, significant pulmonary emboli in the donor lungs may not be reliably diagnosed by arterial blood gas testing or chest radiography 31 and put the recipient who receives such lungs at risk for primary graft dysfunction. The use of anticoagulant therapy is usually avoided in individuals with severe brain injuries to reduce the likelihood of cerebral hemorrhage.…”

Section: Pulmonary Embolimentioning

confidence: 99%

Management of the pediatric organ donor to optimize lung donation

Mallory

Schecter

Elidemir

2009

Pediatric Pulmonology

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Lung transplantation in childhood is a highly specialized clinical practice confined to a few centers around the world. Organ availability remains an important limiting factor in extending the application of this procedure to more infants, children and adolescents. The lungs are the organ most vulnerable to injury, infection and dysfunction among transplantable organs in the brain dead deceased donor. In this manuscript, we review the pathophysiology of the most common and important disease states that affect the lungs in potential donors. Furthermore, we herein provide recommendations for optimal management of the pediatric organ donor with an emphasis on strategies to improve the opportunity for the lungs to be placed in candidates on the transplant list.

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The Implications of Pulmonary Embolism in a Multiorgan Donor for Subsequent Pulmonary, Renal, and Cardiac Transplantation

Cited by 30 publications

References 21 publications

Transplantation of donor lungs with pulmonary embolism - a retrospective study

Transplantation of donor lungs with pulmonary embolism - a retrospective study

Successful Repair of Donation After Circulatory Death Lungs With Large Pulmonary Embolus Using the Lung Organ Care System for Ex Vivo Thrombolysis and Subsequent Clinical Transplantation

Management of the pediatric organ donor to optimize lung donation

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