Influence of lung donor agonal and warm ischemic times on early mortality: Analyses from the ISHLT DCD Lung Transplant Registry

Levvey, Bronwyn; Keshavjee, Shaf; Cypel, Marcelo; Robinson, Ann; Erasmus, M.E.; Glanville, Allan R.; Hopkins, Peter; Musk, M.; Hertz, Marshall I.; McCurry, Kenneth R.; Raemdonck, Dirk Van; Snell, Gregory I

doi:10.1016/j.healun.2018.08.006

Cited by 68 publications

(63 citation statements)

References 19 publications

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“…The allowable duration of the agonal phase (the time after WLST[s] in DCD, a time variable period including progressive hypoxia and hypotension, until circulatory arrest occurs and death is defined) or warm ischemic time is unknown, but current evidence suggests that it is up to at least 60 minutes. 84 Because of the apparent tolerance of lungs to warm ischemia, many programs extend the time for WLST to death out to 90 minutes, and in some programs, 120 to 180 minutes. Death is declared when there is a lack of pulsatility on the arterial line with or without electrical activity.…”

Section: Donation After Circulatory Death For Lung Procurementmentioning

confidence: 99%

Donor heart and lung procurement: A consensus statement

Copeland

Hayanga

Neyrinck

et al. 2020

The Journal of Heart and Lung Transplantation

121

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Section: Donation After Circulatory Death For Lung Procurementmentioning

confidence: 99%

Donor heart and lung procurement: A consensus statement

Copeland

Hayanga

Neyrinck

et al. 2020

The Journal of Heart and Lung Transplantation

121

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“…Recently, LTx from DCD has been aggressively performed as a solution to the donor organ shortage, especially in high-volume centers [14][15][16]. LTx from DCD has been shown to provide similar outcomes to LTx from DBD, including in terms of the incidence of primary graft dysfunction, frequency of acute rejection, and the 1-year survival rate [17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Prolonged warm ischemia exacerbated acute rejection after lung transplantation from donation after cardiac death in a mouse

Hirano

Sugimoto

Yamamoto

et al. 2019

Gen Thorac Cardiovasc Surg

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Objective: In lung transplantation (LTx) from donation after cardiac death (DCD), the donor lungs are inevitably exposed to warm ischemic time (WIT) between the cardiac arrest and the initiation of cold preservation. We conducted this study to examine the effect of prolonged WIT on lung allograft rejection in a murine model of LTx from DCD. Methods: Allogeneic BALB/c→ B6 LTx from DCD was performed with a WIT of 15 minutes (WIT15 group, n = 5) or 60 minutes (WIT60 group, n = 5). Recipients were immunosuppressed by perioperative costimulatory blockade. The lung allografts were analyzed by histology and flow cytometry on day 7 after the LTx. Results: Histologically, the rejection grade in the WIT60 group was significantly higher than that in the WIT15 group (3.4 ± 0.4 vs. 2.2 ± 0.2, P = 0.0278). Moreover, the intragraft CD8+ to CD4+ T cell ratio in the WIT60 group was significantly higher than that in the WIT15 group (2.3 ± 0.12 vs. 1.2 ± 0.11, P < 0.0001). Conclusions: Prolonged WIT could exacerbate the severity of lung allograft rejection after LTx from DCD. Minimization of the WIT could improve the outcomes after LTx from DCD.

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“…It is generally accepted that warm ischaemia should be limited to less than 60 min [59]. However, small studies have suggested that longer warm ischaemic time may not be associated with worse post-transplantation outcomes [60,61]. If this holds true, however, and longer intervals from withdrawal of life sustaining treatments to arrest result in acceptable transplant outcomes, it may be possible to significantly expand the donor pool [58].…”

Section: Donor Graft Preparation and Allograft Ischaemia Timementioning

confidence: 99%

Review 1: Lung transplant—from donor selection to graft preparation

et al. 2020

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For various end-stage lung diseases, lung transplantation remains one of the only viable treatment options. While the demand for lung transplantation has steadily risen over the last few decades, the availability of donor grafts is limited, which have resulted in progressively longer waiting lists. In the early years of lung transplantation, only the 'ideal' donor grafts are considered for transplantation. Due to the donor shortages, there is ongoing discussion about the safe use of 'suboptimal' grafts to expand the donor pool. In this review, we will discuss the considerations around donor selection, donor-recipient matching, graft preparation and graft optimisation.

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Influence of lung donor agonal and warm ischemic times on early mortality: Analyses from the ISHLT DCD Lung Transplant Registry

Cited by 68 publications

References 19 publications

Donor heart and lung procurement: A consensus statement

Donor heart and lung procurement: A consensus statement

Prolonged warm ischemia exacerbated acute rejection after lung transplantation from donation after cardiac death in a mouse

Review 1: Lung transplant—from donor selection to graft preparation

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