Donation after circulatory death in lung transplantation—five-year follow-up from ISHLT Registry

Raemdonck, Dirk Van; Keshavjee, S.; Levvey, B.; Cherikh, Wida S.; Snell, Greg; Erasmus, Michiel E.; Simon, Andrè; Glanville, Allan R.; Clark, Stephen; D’Ovidio, Frank; Catarino, Pedro; McCurry, Kenneth R.; Hertz, Marshall I.; Venkateswaran, Rajamiyer; Hopkins, P.; İnci, İlhan; Walia, Rajat; Kreisel, Daniel; Mascaro, Jorge; Dilling, Daniel F.; Camp, P.; Mason, David P.; Musk, M.; Burch, Michael; Fisher, Andrew J.; Yusen, Roger D.; Stehlik, Josef; Cypel, Marcelo

doi:10.1016/j.healun.2019.09.007

Cited by 126 publications

(110 citation statements)

References 27 publications

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“…Due to graft shortage, approximately 10-13% of lung transplant candidates die while on the waiting list every year [1][2][3] Additionally, there is a low lung utilization rate of 15-20% from eligible multiorgan donors [4]. This utilization rate is lower than in other solid organs such as liver and kidney because the donor lung is very susceptible to injury [5] The use of marginal donors [6], lobar transplantation [7], living-related donors [8], donation after cardiac death (DCD) donors [9,10] and ex vivo lung perfusion [11] are alternatives to alleviate donor shortage in lung transplantation.…”

Section: Introductionmentioning

confidence: 99%

Functional, Metabolic and Morphologic Results of Ex Vivo Donor Lung Perfusion with a Perfluorocarbon-Based Oxygen Carrier Nanoemulsion in a Large Animal Transplantation Model

İnci

Arni

Çıtak

et al. 2020

Cells

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Background: Ex vivo lung perfusion (EVLP) is a technology that allows the re-evaluation of questionable donor lung before implantation and it has the potential to repair injured donor lungs that are otherwise unsuitable for transplantation. We hypothesized that perfluorocarbon-based oxygen carrier, a novel reconditioning strategy instilled during EVLP would improve graft function. Methods: We utilized perfluorocarbon-based oxygen carrier (PFCOC) during EVLP to recondition and improve lung graft function in a pig model of EVLP and lung transplantation. Lungs were retrieved and stored for 24 h at 4 °C. EVLP was done for 6 h with or without PFCOC. In the transplantation groups, left lung transplantation was done after EVLP with or without PFCOC. Allograft function was assessed by means of pulmonary gas exchange, lung mechanics and vascular pressures, histology and transmission electron microscopy (TEM). Results: In the EVLP only groups, physiological and biochemical markers during the 6-h perfusion period were comparable. However, perfusate lactate potassium levels were lower and ATP levels were higher in the PFCOC group. Radiologic assessment revealed significantly more lung infiltrates in the controls than in the PFCOC group (p = 0.04). In transplantation groups, perfusate glucose consumption was higher in the control group. Lactate levels were significantly lower in the PFCOC group (p = 0.02). Perfusate flavin mononucleotide (FMN) was significantly higher in the controls (p = 0.008). Post-transplant gas exchange was significantly better during the 4-h reperfusion period in the PFCOC group (p = 0.01). Plasma IL-8 and IL-12 levels were significantly lower in the PFCOC group (p = 0.01, p = 0.03, respectively). ATP lung tissue levels at the end of the transplantation were higher and myeloperoxidase (MPO) levels in lung tissue were lower in the PFCOC group compared to the control group. In the PFCOC group, TEM showed better tissue preservation and cellular viability. Conclusion: PFCOC application is safe during EVLP in lungs preserved 24 h at 4 °C. Although this strategy did not significantly affect the EVLP physiology, metabolic markers of the donor quality such as lactate production, glucose consumption, neutrophil infiltration and preservation of mitochondrial function were better in the PFCOC group. Following transplantation, PFCOC resulted in better graft function and TEM showed better tissue preservation, cellular viability and improved gas transport.

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Section: Introductionmentioning

confidence: 99%

Functional, Metabolic and Morphologic Results of Ex Vivo Donor Lung Perfusion with a Perfluorocarbon-Based Oxygen Carrier Nanoemulsion in a Large Animal Transplantation Model

İnci

Arni

Çıtak

et al. 2020

Cells

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“…Although a fairly large experience with cDCD donation for lung transplant has been achieved and demonstrated outcomes at least comparable to DBD, the experience with uncontrolled DCD has been small and mostly from centers in Spain with a case report from Italy . In the Spanish protocol, typically, the potential donor is transported to the hospital where death is certified after cardiac massage is interrupted; chest compressions are resumed to preserve the opportunity for donation.…”

Section: Discussionmentioning

confidence: 99%

“…The use of controlled donation after death (DCD) by circulatory determination (cDCD) (Maastricht categories 3‐4) has significantly increased the donor pool for LT. Importantly, patient outcomes have been comparable to those of patients receiving organs from brain death donors (DBDs) . However, the use of uncontrolled DCD (uDCD) (Maastricht categories 1‐2) for lung transplant has been limited to a few series of cases from Spain and Italy, and there have been no reports in North America with the exception of 1 case from a consented cDCD from a patient who had a cardiac arrest before the planned organ recovery procedure .…”

Section: Introductionmentioning

confidence: 99%

Initial lung transplantation experience with uncontrolled donation after cardiac death in North America

Healey

Watanabe

Mills

et al. 2020

American Journal of Transplantation

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contributed equally to the study.Abbreviations: CIT, cold ischemic time; COPD, chronic obstructive pulmonary disease; DBD, donation after brain death; ECMO, extracorporeal membrane oxygenation; EVLP, ex vivo lung perfusion; FEV 1 , forced expiratory volume in the first second; ICU, intensive care unit; IPF, interstitial pulmonary fibrosis; IT, implant time; LT, lung transplant; MRP, most responsible physician; NRP, normothermic regional perfusion; ODO, organ donation organization; PGD, primary graft dysfunction; PH, pulmonary hypertension; TGLN, Trillium Gift of Life Network; uDCD, uncontrolled donation after circulatory death; WIT, warm ischemic time.

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“…Since DCD LTx is still confined only to certain countries, there is a limited experience regarding clinical events which are specific for the DCD [2]. Recently, ISHLT DCD Registry report [5] showed similar favorable long‐term survival in DCD‐III and DBD lung recipients (5‐year survival 63% vs. 61%). It also included the results from our center.…”

Section: Discussionmentioning

confidence: 99%

“…However, persistent donor shortage resulting in increased waiting list mortality remains one of the major limitations in LTx [1,2]. Among various strategies to expand the donor pool, the use of lungs from donation after circulatory death (DCD) is becoming established in several countries [3‐7]. It is still argued whether LTx using DCD organs is associated with differences in clinical outcomes compared with organs procured following donation after brain death (DBD) [6,8‐12].…”

Section: Introductionmentioning

confidence: 99%

Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience

Sef

Mohite

et al. 2020

Transpl. Int.

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Summary Donation after circulatory death (DCD) has the potential to expand the lung donor pool. We aimed to assess whether DCD affected the need for perioperative extracorporeal membrane oxygenation (ECMO) and perioperative outcomes in lung transplantation (LTx) as compared to donation after brain death (DBD). All consecutive LTxs performed between April 2017 and March 2019 at our tertiary center were analyzed. Donor and recipient preoperative characteristics, utilization of ECMO, and perioperative clinical outcomes were compared between DCD and DBD LTx. Multivariate models (frequentist and Bayes) were fitted to evaluate an independent effect of DCD on the intra‐ and postoperative need for ECMO. Out of 105 enrolled patients, 25 (23.8%) were DCD LTx. Donors’ and preoperative recipients’ characteristics were comparable between the groups. Intraoperatively, mechanical circulatory support (MCS) was more common in DCD LTx (56.0% vs. 36.2%), but the adjusted difference was minor (RR = 1.16, 95% CI 0.64–2.12; P = 0.613). MCS duration, and first and second lung ischemia time were longer in the DCD group. Postoperatively, DCD recipients more commonly required ECMO (32.0% vs. 7.5%) and the difference remained considerable after adjustment for the pre‐ and intraoperative covariates: RR = 4.11 (95% CI 0.95–17.7), P = 0.058, Bayes RR = 4.15 (95% CrI 1.28–13.0). Sensitivity analyses (two DCD‐DBD matching procedures) supported a higher risk of postoperative ECMO need in DCD patients. Incidence of delayed chest closure, postoperative chest drainage, and renal replacement therapy was higher in the DCD group. Early postoperative outcomes after DCD LTx appeared generally comparable to those after DBD LTx. DCD was associated with a higher need for postoperative ECMO which could influence clinical outcomes. However, as the DCD group had a significantly higher use of EVLP with more common ECMO preoperatively, this might have contributed to worse outcomes in the DCD group.

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Donation after circulatory death in lung transplantation—five-year follow-up from ISHLT Registry

Cited by 126 publications

References 27 publications

Functional, Metabolic and Morphologic Results of Ex Vivo Donor Lung Perfusion with a Perfluorocarbon-Based Oxygen Carrier Nanoemulsion in a Large Animal Transplantation Model

Functional, Metabolic and Morphologic Results of Ex Vivo Donor Lung Perfusion with a Perfluorocarbon-Based Oxygen Carrier Nanoemulsion in a Large Animal Transplantation Model

Initial lung transplantation experience with uncontrolled donation after cardiac death in North America

Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2‐year single‐center experience

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