Does Donor Age and Double Versus Single Lung Transplant Affect Survival of Young Recipients?

Whited, William M.; Henley, Paul; Schumer, Erin M.; Trivedi, Jaimin R.; Berkel, Victor H. van; Fox, Matthew P.

doi:10.1016/j.athoracsur.2017.07.030

Cited by 20 publications

(15 citation statements)

References 16 publications

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“…In fact, several studies have shown that lungs from older donors can be used safely for transplantation. [222324] Another common reason for exclusion of donors for lung transplantation with the ideal criteria is an abnormal chest radiograph. Up to 41%–61% of lung donors can have abnormal chest radiographs.…”

Section: Discussionmentioning

confidence: 99%

Underutilization of potential donors for lung transplantation at a tertiary care center in North India

et al. 2019

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Objective: Lung transplantation is infrequently performed in India due to several constraints, and whether the poor lung transplantation rates in India are due to a lack of eligible lung donors is unclear. In this study, we explored the availability of donors for lung transplantation. Materials and Methods: This was a retrospective analysis of all brain-dead participants who underwent assessment of eligibility for lung donation between August 2015 and June 2018. All participants underwent a detailed clinical evaluation that included history, physical examination, arterial blood gas analysis, chest radiograph, and bronchoscopy. The final eligibility for lung donation was assessed using the existing “ideal” criteria and the less stringent “extended” criteria. Results: A total of 55 brain-dead participants (41 [74.5%] males) were assessed for eligibility for lung donation. The mean (standard deviation [SD]) age of the participants was 38.4 (17.2) years. The mean (SD) duration of prior invasive mechanical ventilation at the time of assessment was 4 (3.1) days, with a mean (SD) partial pressure of arterial oxygen: inspired oxygen fraction ratio (PaO 2 :FiO 2 ) of 326.6 (153.5). The proportion of participants who were found suitable for lung donation was 16 (29.1%) and 35 (63.6%) on employing the ideal and the extended criteria, respectively. Inadequate oxygenation status, abnormal chest radiograph, and sepsis were the most common reasons for excluding participants using either criteria. Despite the availability of adequate lung donors, only one lung transplantation could be performed. Conclusion: Even with the most stringent criteria for lung assessment, nearly one-third of the brain-dead participants had lungs suitable for lung transplantation. Lack of eligible lung donors is not a reason for the poor lung transplantation rates in India.

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Section: Discussionmentioning

confidence: 99%

Underutilization of potential donors for lung transplantation at a tertiary care center in North India

et al. 2019

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“…29 A further study by Whited and colleagues demonstrated similar findings, in that reasonable transplant outcomes were achieved across all recipient age groups with the use of donors aged over 60 years. 30…”

Section: Candidate Listingmentioning

confidence: 99%

Lung transplantation: a review of the optimal strategies for referral and patient selection

Mitchell

Glanville

2019

Ther Adv Respir Dis

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One of the great challenges of lung transplantation is to bridge the dichotomy between supply and demand of donor organs so that the maximum number of potential recipients achieve a meaningful benefit in improvements in survival and quality of life. To achieve this laudable goal is predicated on choosing candidates who are sufficiently unwell, in fact possessing a terminal respiratory illness, but otherwise fit and able to undergo major surgery and a prolonged recuperation and rehabilitation stage combined with ongoing adherence to complex medical therapies. The choice of potential candidate and the timing of that referral is at times perhaps more art than science, but there are a number of solid guidelines for specific illnesses to assist the interested clinician. In this regard, the relationship between the referring clinician and the lung transplant unit is a critical one. It is an ongoing and dynamic process of education and two way communication, which is a marker of the professionalism of a highly performing unit. Lung transplantation is ultimately a team effort where the recipient is the key player. That principle has been enshrined in the three consensus position statements regarding selection criteria for lung and heart-lung transplantation promulgated by the International Society for Heart and Lung Transplantation over the last two decades. During this period, the number of indications for lung transplantation have broadened and the number of contraindications reduced. Risk management is paramount in the pre- and perioperative period to effect early successful outcomes. While it is not the province of this review to reiterate the detailed listing of those factors, an overview position will be developed that describes the rationale and evidence for selected criteria where that exists. Importantly, the authors will attempt to provide an historical and experiential basis for making these important and life-determining decisions. The reviews of this paper are available via the supplementary material section.

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“…The PCC group received a median dose of 703 units pre-CPB and 1405 units post-CPB, for a median total dose of 2108 units. [5][6][7][8][9][10]; P < .001), and packed red cells (5 [3][4][5][6][7] vs 2 [1.25-2.75]; P < .001) and had a shorter time to chest closure (619 vs 548 minutes; P = .008). There were no differences in platelet transfusion, ICU stay or hospital LOS, acute kidney injury (AKI), or mortality.…”

Section: Prothrombin Complex Concentrate (Pcc)mentioning

confidence: 99%

“…Costa et al 21 Villavicencio et al 23 Barbero et al 24 Inci et al 25 DCD results in transplantable organs at a rate near that of DBD; 24-hour PGD is worse in DCD but resolves by 72 hours Survival outcomes identical to DBD Survival rates are comparable Survival trended worse in DCD Survival trended better in DCD Procurement: donor age Whited et al 4 Older grafts had worse survival outcomes in single lung transplant with young recipients Procurement: TBI Crawford et al 19 No difference in survival Procurement: IVDU Whited et al 18 IVDU donors more common; no difference in survival for recipients Procurement: naloxone Dhar et al 30 No protection from development of hypoxia in grafts treated with naloxone vs saline Procurement: volatile vapor…”

Section: Procurement: Dcdmentioning

confidence: 99%

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

Tawil

Adams

Nicoara

et al. 2019

Semin Cardiothorac Vasc Anesth

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Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.

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Does Donor Age and Double Versus Single Lung Transplant Affect Survival of Young Recipients?

Abstract: Reasonable posttransplant outcomes can be achieved with use of advanced age donors in all recipient groups. Double lung transplantation should be performed when older donors (age more than 60) are used in young recipients (age 50 or less).

Cited by 20 publications

References 16 publications

Underutilization of potential donors for lung transplantation at a tertiary care center in North India

Underutilization of potential donors for lung transplantation at a tertiary care center in North India

Lung transplantation: a review of the optimal strategies for referral and patient selection

Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation

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