Transplantation of donor lungs with pulmonary embolism - a retrospective study

Sommer, W.; Kirschner, Helmut; Ius, F.; Salman, J.; Siemeni, T.; Bobylev, D.; Avşar, M.; Kuehn, C.; Greer, Mark; Gottlieb, Jens; Rahmel, Axel; Welte, Tobias; Haverich, Axel; Tudorache, I.; Warnecke, G.

doi:10.1111/tri.13407

Cited by 14 publications

(13 citation statements)

References 27 publications

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“…Presence of emboli is mainly observed during the retrograde flush at the back table, with detection of emboli in the perfusion fluid (Figure S1). This led to suspicion of persistent emboli by the transplant surgeon and reluctance to accept the offered donor lungs due to a potential increased risk of primary graft failure, although recently the safe use of lungs from donors with pulmonary emboli was reported …”

Section: Discussionmentioning

confidence: 99%

Histopathologic and radiologic assessment of nontransplanted donor lungs

Vanstapel

Dubbeldam

Weynand

et al. 2020

American Journal of Transplantation

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Donor organ shortage results in significant waiting list mortality. Donor lung assessment is currently based on donors’ history, gas exchange, chest X‐ray, bronchoscopy findings, and ultimately in situ inspection but remains subjective. We correlated histopathology and radiology in nontransplanted donor lungs with the clinical indications to decline the offered organ. Sixty‐two donor lungs, not used for transplantation (2010‐2019), were procured, air‐inflated, frozen, scanned with computed tomography, systematically sampled, and histologically and radiologically assessed. Thirty‐nine (63%) lungs were declined for allograft‐related reasons. In 13/39 (33%) lungs, histology could not confirm the reason for decline, in an additional 8/39 (21%) lungs, histologic abnormalities were only considered mild. In 16/39 (41%) lungs, radiology could not confirm the reason for decline. Twenty‐three (37%) donor lungs were not transplanted due to extrapulmonary causes, of which three (13%) lungs displayed severe histologic abnormalities (pneumonia, n = 2; emphysema, n = 1), in addition to mild emphysema in 9 (39%) lungs and minor bronchopneumonia in 1 (4%). Radiology revealed ground‐glass opacities in 8/23 (35%) and emphysema in 4/23 (17%) lungs. Histopathologic and radiologic assessment of nontransplanted donor lungs revealed substantial discrepancy with the clinical reason for decline. Optimization of donor lung assessment is necessary to improve current organ acceptance rates.

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Section: Discussionmentioning

confidence: 99%

Histopathologic and radiologic assessment of nontransplanted donor lungs

Vanstapel

Dubbeldam

Weynand

et al. 2020

American Journal of Transplantation

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“…Most studies on the subject have focused on recipients who have received donor lungs identified to have clots on the pre-transplant exploratory flush; these have yielded variable results with respect to effect on survival and lung function. [4][5][6][7] In the posttransplant setting, symptomatic PE has been shown to be associated with a worse prognosis, as would be expected in the non-transplant setting. 8,9 Our program performs routine ventilation-perfusion (VQ) scans at 3-months post-transplant for all recipients to establish baseline airway and vascular function.…”

Section: Introductionmentioning

confidence: 85%

“…The long‐term implications of early PE in the transplanted lungs are also poorly understood. Most studies on the subject have focused on recipients who have received donor lungs identified to have clots on the pre‐transplant exploratory flush; these have yielded variable results with respect to effect on survival and lung function 4–7 . In the post‐transplant setting, symptomatic PE has been shown to be associated with a worse prognosis, as would be expected in the non‐transplant setting 8,9 …”

Section: Introductionmentioning

confidence: 99%

Mismatched perfusion defects on routine ventilation‐perfusion scans after lung transplantation

Abele

Sunner

et al. 2022

Clinical Transplantation

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Background: Incidental pulmonary embolism (PE) is a challenging entity with unclear treatment implications. Our program performs routine ventilation-perfusion (VQ) scans at 3-months post-transplant to establish airway and vascular function. We sought to determine the prevalence and prognostic implications of mismatched perfusion defects (MMPD) found on these studies, hypothesizing they would be associated with a benign prognosis. Methods:We studied VQ scans obtained routinely at 3-months post-transplant from double lung transplant recipients 2005-2016 for studies with MMPD interpreted as high or intermediate probability for PE. We tested the relationship between MMPD and 1-year survival via chi square testing, overall survival via Kaplan Meier analysis with log rank testing and peak forced expiratory volume in 1 second (FEV1) percent predicted via t-testing.Results: Three hundred and seventy-three patients met inclusion criteria, of whom 35 (9%) had VQ scans with MMPDs interpreted by radiologists as high or intermediate probability for PE. Baseline recipient and donor characteristics were similar between groups. Seven patients (20%) in the MMPD group were treated with therapeutic anticoagulation. Patients with MMPD had similar 1-year survival (100% vs. 98%, P = 1.00), overall survival (log rank P = .90) and peak FEV1% predicted (94% [SD 20%] vs. 92% [SD 21%]; P = .58). Anticoagulation did not affect these relationships. Conclusion:Mismatched perfusion defects on routine post-transplant VQ scan were not associated with a difference in survival or lung function. A conservative approach to these changes may be a viable option in the absence of other anticoagulation indications.

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“…The retrograde flush in the pulmonary veins resulted in removal of residual thrombi. Without postoperative anticoagulation, transplantation of such lungs resulted in equivalent short and long-term results [94]. Another option is to assess such lungs with EVLP first, allowing further removal of thrombi if deemed necessary.…”

Section: Extended Criteria Donorsmentioning

confidence: 99%

Developments in lung transplantation over the past decade

2020

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With an improved median survival of 6.2 years, lung transplantation has become an increasingly acceptable treatment option for end-stage lung disease. Besides survival benefit, improvement of quality of life is achieved in the vast majority of patients. Many developments have taken place in the field of lung transplantation over the past decade. Broadened indication criteria and bridging techniques for patients awaiting lung transplantation have led to increased waiting lists and changes in allocation schemes worldwide. Moreover, the use of previously unacceptable donor lungs for lung transplantation has increased, with donations from donors after cardiac death, donors with increasing age and donors with positive smoking status extending the donor pool substantially. Use of ex vivo lung perfusion further increased the number of lungs suitable for lung transplantation. Nonetheless, the use of these previously unacceptable lungs did not have detrimental effects on survival and long-term graft outcomes, and has decreased waiting list mortality. To further improve long-term outcomes, strategies have been proposed to modify chronic lung allograft dysfunction progression and minimise toxic immunosuppressive effects. This review summarises the developments in clinical lung transplantation over the past decade.

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Transplantation of donor lungs with pulmonary embolism - a retrospective study

Cited by 14 publications

References 27 publications

Histopathologic and radiologic assessment of nontransplanted donor lungs

Histopathologic and radiologic assessment of nontransplanted donor lungs

Mismatched perfusion defects on routine ventilation‐perfusion scans after lung transplantation

Developments in lung transplantation over the past decade

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