The past, present, and future of lung transplantation

Grover, Frederick L.; Fullerton, David A.; Zamora, Martin R.; Mills, Catherine M.; Ackerman, Bob; Badesch, David B.; Brown, James M.; Campbell, David N.; Chetham, Paul M.; Dhaliwal, Avninder; Diercks, Maren; Kinnard, Theresa L.; Niejadlik, Kenneth; Ochs, Michael F.

doi:10.1016/s0002-9610(97)00004-4

Cited by 44 publications

(24 citation statements)

References 24 publications

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“…This problem has led to consideration of possible alternatives to cadaveric lung donation including xenotransplantation, non-heart beating donors (post-cardiac arrest), and living donor lobar transplantation. 12 Only the last of these alternatives is currently available, and although there is much ongoing research, it offers no solution to the problem in the foreseeable future. Living donor lobar transplantation is being used in highly selected recipients where it can be successful, but the technique is not suitable for the majority of patients on the lung transplant waiting list.…”

Section: Discussionmentioning

confidence: 99%

Objective assessment of criteria for selection of donor lungs suitable for transplantation

Fisher

Donnelly²,

Pritchard³

et al. 2004

Thorax

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Background: Donor organ shortage severely limits lung transplantation as a therapeutic option, yet many potential donor lungs are deemed unsuitable by clinical selection criteria. Methods: Of 39 consecutive potential donor lungs, 14 were accepted and 25 excluded by clinical selection criteria. All were evaluated prospectively by clinical assessment, bronchoscopy, and bronchoalveolar lavage (BAL) to evaluate objectively the discrimination of pulmonary infection and injury. Results: Accepted donors were significantly younger than those excluded (mean (SD) age 36.7 (15.3) years v 49.5 (13.2) years; p = 0.009, unpaired t test) and were more likely to have suffered traumatic brain death (50% v 20%; p = 0.07, Fisher's exact test). Oxygenation (PaO 2 :FiO 2 ) was higher in accepted donors than in excluded donors (median (range) 63.2 (48-82.5) kPa v 43.1 (7.7-71.7) kPa; p = 0.0001, Mann-Whitney test). Positive formal BAL culture was more frequent in accepted donors (75%) than in those excluded (43%; p = 0.1, Fisher's exact test). There was no significant difference in the percentage and concentration of neutrophils in BAL fluid between accepted and excluded donors (median (range) 37.9 (0-96.9)% and 44.6 (0-1190)610 3 /ml v 36 (1-98.1)% and 46 (0.2-1457)610 3 /ml), nor in the BAL fluid concentration of tumour necrosis factor-a (140 (0-340) pg/ml v 160 (0-760) pg/ml) or interleukin 8 (810 (33-17 600) pg/ml v 540 (0-15 110) pg/ml). Conclusion: Current selection criteria are poor discriminators of pulmonary injury and infection and lead to the exclusion of potentially usable donor lungs.

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Section: Discussionmentioning

confidence: 99%

Objective assessment of criteria for selection of donor lungs suitable for transplantation

Fisher

Donnelly²,

Pritchard³

et al. 2004

Thorax

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“…5 The long ischemic time also causes donor lung damage, which directly correlates with primary graft failure. 6 Another disadvantage of a lung transplant is the need for life-long administration of immunosuppression drugs in the recipients, which increases the risks of infections and cancer. 7 The biggest problem, however, is the acute shortage of transplantable organs.…”

Section: Introductionmentioning

confidence: 99%

Future prospects for tissue engineered lung transplantation

et al. 2014

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“…[9][10][11] Advantages of bilateral lung transplantation include less ventilation-perfusion mismatch, less risk of reperfusion pulmonary edema, and higher overall survival rates. 12 Indeed, the number of single-lung transplantations has held steady, whereas the number of bilateral lung transplantations has increased. Bilateral lung transplantation is more commonly performed sequentially rather than en bloc.…”

Section: Surgical Aspectsmentioning

confidence: 99%

Anesthetic Considerations for Lung Transplantation

Baez

Castillo

2008

Semin Cardiothorac Vasc Anesth

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Lung transplantation is the definitive treatment for end-stage lung disease. The number of lung transplantations performed is limited by the number of donors available and is far outnumbered by the potential recipients on the waiting list. Advances in surgical methods, organ preservation, and immunosuppression have decreased the morbidity and mortality associated with this procedure during the last few decades. Specific anesthetic concerns are associated with lung transplantation, including careful preoperative assessment of pulmonary and cardiac function, adequate venous access and monitors, and ventilation techniques, such as 1-lung ventilation and lung-protective strategies to decrease the risks of reperfusion injury, barotrauma, and re-expansion pulmonary edema. Intraoperative transesophageal echocardiography, cardiopulmonary bypass, and inhaled nitric oxide can also be important tools for the anesthesiologist to optimize patient care during this challenging procedure.

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The past, present, and future of lung transplantation

Cited by 44 publications

References 24 publications

Objective assessment of criteria for selection of donor lungs suitable for transplantation

Objective assessment of criteria for selection of donor lungs suitable for transplantation

Future prospects for tissue engineered lung transplantation

Anesthetic Considerations for Lung Transplantation

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