Bipulmonary transplants with lungs obtained from two non–heart-beating donors who died out of hospital

Abstract

bronchial tree or after endoscopic dilatation of a benign anastomotic stricture. Other causative factors have only been reported as solitary cases. 4 Among these, we have found in the literature just 1 other case in which the tracheogastric fistula presented in association with an auto-expandable esophageal wall-stent prosthesis. 5 Symptoms at presentation may range from mild to life-threatening. 3,4 Yet the possibility of a rapid deterioration of the patient's general condition should always be kept in mind. Just on suspicion, a barium esophagogram should promptly be performed for diagnosis. Treatment is always challenging and has to be individually tailored. It will depend on the severity of symptoms, on the size and location of the fistula, and on accompanying conditions. If surgery is required, the procedure of choice is excision of the fistula and closure of the tracheal and esophageal defects. Interposition of a pedicled pleural, omental, or muscle flap has proved to be useful in preventing recurrence of the fistula. The gastric tube should be left in place unless judged as an unviable option. In such case, colonic interposition is indicated to restore the continuity of the gastrointestinal tract. If mediastinitis is present, elimination of the septic focus and extensive drainage of the mediastinum are mandatory. 3,4

Early effects of the ex vivo evaluation system on graft function after swine lung transplantation

“…Two assessment techniques have been reported for clinical DCD lung transplantation. One is the pulmonary artery flush technique using a solution based on the donor's blood [15][16][17], and the other is the ex vivo reperfusion technique [1,2]. The ex vivo evaluation technique is considered promising and is currently performed in several transplant institutions worldwide.…”

The Suppression of Proinflammatory Cytokines Improves Heart Function From Non-Heart-Beating Donors Following Transplantation in a Canine Model

“…Therefore, NHBDs could be an excellent source of organs for transplantation. NHBDs are being increasingly accepted clinically as kidney, liver, lung, and pancreas donors, [14][15][16][17][18] while cardiac transplantation with NHBD allografts has not proceeded beyond the laboratory. In those NHBD experiments, the hearts were damaged by a combination of hypoxia and warm ischemia of at least 15-30 minutes in situ.…”

Lung transplantation from donation after cardiac death (non-heart-beating) donors

“…17 Here, two chest tubes are inserted and the lungs are cooled to 18°C inside the body with cold Perfadex solution for 2 h. The effi cacy of this technique has been investigated by several groups, 21,23,25,26,34 and topical in situ cooling has been used for clinical uncontrolled DCD (NHBD) cases. 17,[27][28][29] The preprocurement interval could be safely extended by topical in situ cooling up to 6 h postmortem allowing distant organ procurement or next of kin to spend more time with the deceased relatives.…”

“…Administration of heparin after certifi ed death is possible with chest compressions to distribute the heparin around the circulatory system. 17,[27][28][29][30][31][32][33] In all the transplant centers in Table 1, except Cleveland, heparin was administered after death certifi cation. Investigators from the Okayama University have demonstrated the effi cacy of postmortem administration of heparin, 35 addition of a fi brinolytic agent (urokinase) 36 or recombinant tissue-type plasma to …”

“…Then arterial blood gas analysis, corrected by temperature, is performed on the effl uent of the left atrium. [27][28][29] The ex vivo reperfusion technique was developed by the Lund group. Ex vivo reperfusion for assessment without additional edema formation on the graft has been achieved with a specially developed solution (Steen solution) and additional pure red blood cells.…”