Aggressive pursuit and utilization of non‐ideal donor lungs does not compromise post‐lung transplant survival

Halpern, Samantha E.; Jawitz, Oliver K.; Raman, Vignesh; Choi, Ashley Y.; Haney, John C.; Klapper, Jacob A.; Hartwig, Matthew G.

doi:10.1111/ctr.14414

Cited by 6 publications

(2 citation statements)

References 39 publications

(46 reference statements)

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“…Questions remain however, regarding the limits of acceptability, as to what degree “extended-criteria” donor lungs can be used for transplantation without compromising recipient outcomes. Retrospective analyses have already demonstrated no adverse outcomes when using donor lungs with acute pulmonary embolism ( 17 , 18 ) impaired oxygenation ( 19 , 20 ), or contusion ( 21 ). Regarding donor age, multiple analyses have shown good results for lungs from donors >55 years of age ( 22 , 23 ) however, the upper donor age limit in lung transplantation remains under discussion.…”

Section: Discussionmentioning

confidence: 99%

Lungs From Donors ≥70 Years of Age for Transplantation—Do Long-Term Outcomes Justify Their Use?

Sommer

Franz²,

Aburahma³

et al. 2023

Transpl Int

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Donor shortages have led transplant centers to extend their criteria for lung donors. Accepting lung donors ≥70 years of age has previously shown good short-term outcomes; however, no mid- and long-term outcome data on these extended criteria donors has been published to date. In this study, all patients who underwent lung transplantation between 06/2010 and 12/2019 were included in the analysis, and the outcomes were compared between patients receiving organs from donors <70 years of age and patients transplanted with lungs from donors ≥70 years of age. Among the 1,168 lung-transplanted patients, 62 patients received lungs from donors ≥70 years of age. The recipient age of those receiving older organs was significantly higher, and they were more likely to suffer from obstructive lung disease. Older donors were exposed to significantly shorter periods of mechanical ventilation prior to donation, had higher Horowitz indices, and were less likely to have smoked. The postoperative time on mechanical ventilation, time on ICU, and total hospital stay were comparable. The overall survival as well as CLAD-free survival showed no differences between both groups in the follow-up period. Utilization of lungs from donors ≥70 years of age leads to excellent mid- and long-term results that are similar to organs from younger donors when the organs from older donors are carefully preselected.

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Section: Discussionmentioning

confidence: 99%

Lungs From Donors ≥70 Years of Age for Transplantation—Do Long-Term Outcomes Justify Their Use?

Sommer

Franz²,

Aburahma³

et al. 2023

Transpl Int

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“…[8][9][10] This remains the case despite evidence that utilization of extended-criteria donor organs does not necessarily alter posttransplant outcomes. [11][12][13][14][15] It is therefore critical to develop a complete understanding of the immunological events that determine which lungs are amenable for EVLP reconditioning.…”

Section: Introductionmentioning

confidence: 99%

Modeling the Effects of IL-1β-mediated Inflammation During Ex Vivo Lung Perfusion Using a Split Human Donor Model

et al. 2023

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Background. The association between interleukin-1β (IL-1β) concentrations during ex vivo lung perfusion (EVLP) with donor organ quality and post-lung transplant outcome has been demonstrated in several studies. The mechanism underlying IL-1β-mediated donor lung injury was investigated using a paired single-lung EVLP model. Methods. Human lung pairs were dissected into individual lungs and perfused on identical separate EVLP circuits, with one lung from each pair receiving a bolus of IL-1β. Fluorescently labeled human neutrophils isolated from a healthy volunteer were infused into both circuits and quantified in perfusate at regular timepoints. Perfusates and tissues were subsequently analyzed, with perfusates also used in functional assays. Results. Neutrophil numbers were significantly lower in perfusate samples collected from the IL-1β-stimulated lungs consistent with increased neutrophil adhesion (P = 0.042). Stimulated lungs gained significantly more weight than controls (P = 0.046), which correlated with soluble intercellular adhesion molecule-1 (R2 = 0.71, P = 0.0043) and von-Willebrand factor (R2 = 0.39, P = 0.040) in perfusate. RNA expression patterns for inflammatory genes were differentially regulated via IL-1β. Blockade of IL-1β significantly reduced neutrophil adhesion in vitro (P = 0.025). Conclusion. These data illustrate the proinflammatory functions of IL-1β in the context of EVLP, suggesting this pathway may be susceptible to therapeutic modulation before transplantation.

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A call to action in thoracic transplant surgical training

Siddique

Parekh

Huddleston

et al. 2023

The Journal of Heart and Lung Transplantation

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Aggressive pursuit and utilization of non‐ideal donor lungs does not compromise post‐lung transplant survival

Cited by 6 publications

References 39 publications

Lungs From Donors ≥70 Years of Age for Transplantation—Do Long-Term Outcomes Justify Their Use?

Lungs From Donors ≥70 Years of Age for Transplantation—Do Long-Term Outcomes Justify Their Use?

Modeling the Effects of IL-1β-mediated Inflammation During Ex Vivo Lung Perfusion Using a Split Human Donor Model

A call to action in thoracic transplant surgical training

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