Ischemia-reperfusion Injury in the Transplanted Lung: A Literature Review

Talaie, Tara; DiChiacchio, Laura; Prasad, Nikhil K.; Pasrija, Chetan; Julliard, Walker; Kaczorowski, David J.; Zhao, Yunge; Lau, Christine L.

doi:10.1097/txd.0000000000001104

Cited by 28 publications

(23 citation statements)

References 200 publications

(141 reference statements)

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“…In our study, 2 patients (No.3 and 5) underwent bilateral lung transplantation. Primary graft dysfunction, which was a very common postoperative complication, was similar to ARDS ( Talaie et al, 2021 ). However, these two patients were all on the fifth day after the operation when the esophageal balloon catheter were placed, and the chest X-ray results also showed that the infiltration in both lungs had been obviously absorbed.…”

Section: Discussionmentioning

confidence: 99%

Reverse Trigger in Ventilated Non-ARDS Patients: A Phenomenon Can Not Be Ignored!

et al. 2021

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IntroductionThe role of reverse trigger (RT) was unknown in ventilated non-acute respiratory distress syndrome (ARDS) patients. So we conducted a retrospective study to evaluate the incidence, characteristics and physiologic consequence of RT in such population.MethodSix ventilated non-ARDS patients were included, the esophageal balloon catheter were placed for measurements of respiratory mechanics in all patients. And the data were analyzed to identified the occurrence of RT, duration of the entrainment, the entrainment pattern or ratio, the phase difference (dP) and the phase angle (θ), phenotypes, Effects and clinical correlations of RT.ResultRT was detected in four patients of our series (66.7%), and the occurrence of RT varying from 19 to 88.6% of their recording time in these 4 patients. One patient (No.2) showed a stable 1:1 ratio and Mid-cycle RT was the most common phenotype. However, the remained patients showed a mixed ratios, and Late RT was the most common phenotype, followed by RT with breath stacking. The average values of mean phase delay and phase angles were 0.39s (0.32, 0.98) and 60.52° (49.66, 102.24). Mean phase delay and phase angles were shorter in early reverse triggering with early and delayed relaxation, and longer in mid, late RT and RT with breath stacking. Pmus was variable between patients and phenotypes, and larger Pmus was generated in Early RT, Delayed Relaxation and mid cycle RT. When the RT occurred, the Peso increased 17.27 (4.91, 19.71) cmH2O compared to the controlled breathing, and the average value of incremental ΔPeso varied widely inter and intra patients (Table 3B and Figure 1). Larger ΔPeso was always generated in Early RT, Delayed Relaxation and mid cycle RT, accompanied by an significant increase of PL with 19.12 (0.75) cmH2O and 16.10 (6.23) cmH2O.ConclusionRT could also be observed in ventilated non-ARDS patients. The characteristics of pattern and phenotype was similar to RT in ARDS patients to a large extent. And RT appeared to alter lung stress and delivered volumes.

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Section: Discussionmentioning

confidence: 99%

Reverse Trigger in Ventilated Non-ARDS Patients: A Phenomenon Can Not Be Ignored!

et al. 2021

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“…A phase 2a safety trial on the use of allogeneic mesenchymal stem cells for the treatment of moderate to severe ARDS was published in 2019, reporting an acceptable safety profile [124]. These promising results are generalizable to the lung transplant population and provide a basis for clinical trials evaluating the efficacy of mesenchymal stem cells in the treatment of pulmonary IRI in lung transplantation [125,126]. Recently, several mesenchymal stem cell therapies for chronic lung allograft dysfunction have been reported.…”

Section: Mesenchymal Stem Cellsmentioning

confidence: 99%

Ischemia–Reperfusion Injury in Lung Transplantation

Chen‐Yoshikawa

2021

Cells

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Lung transplantation has been established worldwide as the last treatment for end-stage respiratory failure. However, ischemia–reperfusion injury (IRI) inevitably occurs after lung transplantation. The most severe form of IRI leads to primary graft failure, which is an important cause of morbidity and mortality after lung transplantation. IRI may also induce rejection, which is the main cause of mortality in recipients. Despite advances in donor management and graft preservation, most donor grafts are still unsuitable for transplantation. Although the pulmonary endothelium is the primary target site of IRI, the pathophysiology of lung IRI remains incompletely understood. It is essential to understand the mechanism of pulmonary IRI to improve the outcomes of lung transplantation. Therefore, we reviewed the state-of-the-art in the management of pulmonary IRI after lung transplantation. Recently, the ex vivo lung perfusion (EVLP) system has been clinically introduced worldwide. Various promising therapeutic strategies for the protection of the endothelium against IRI, including EVLP, inhalation therapy with therapeutic gases and substances, fibrinolytic treatment, and mesenchymal stromal cell therapy, are awaiting clinical application. We herein review the latest advances in the field of pulmonary IRI in lung transplantation.

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“…A number of pre-transplant and donor-related risk factors are associated with LIRI and the development of PGD [14]. Studies of transplant outcomes have shown that during the first 24 h post-transplantation, donor factors predominate [15] whereas recipient risk factors are more influential beyond 24 h [16].…”

Section: Pretransplant/donor Risk Factors For Pgdmentioning

confidence: 99%

“…For this reason, ischemic durations beyond 8 h are a limitation to successful transplantation and must be factored into consideration prior to a transplant decision [10]. The aforementioned efforts to protect the lungs are helpful, but they do not protect the lungs from injury during the reperfusion phase at the time of transplantation [14].…”

Section: Procurement and Cold Static Preservation: Gold Standard Preservation Strategies Contribute To Primary Graft Dysfunctionmentioning

confidence: 99%

“…Second, the continual evaluation of the donor lung function on ESLP enables real-time assessment of cause-and-effect. Third, because the lungs are treated in isolation, the effects seen in animal models can more easily be translated into clinical trials [14]. At present, gene therapies, stem cell therapies, receptor agonists, and inhaled agents are being used as specific ESLP treatments for animal models of lung transplantation.…”

Section: Eslp As a Therapeutic Vehiclementioning

confidence: 99%

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Lung Transplantation, Pulmonary Endothelial Inflammation, and Ex-Situ Lung Perfusion: A Review

Forgie

Fialka

Freed

et al. 2021

Cells

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Lung transplantation (LTx) is the gold standard treatment for end-stage lung disease; however, waitlist mortality remains high due to a shortage of suitable donor lungs. Organ quality can be compromised by lung ischemic reperfusion injury (LIRI). LIRI causes pulmonary endothelial inflammation and may lead to primary graft dysfunction (PGD). PGD is a significant cause of morbidity and mortality post-LTx. Research into preservation strategies that decrease the risk of LIRI and PGD is needed, and ex-situ lung perfusion (ESLP) is the foremost technological advancement in this field. This review addresses three major topics in the field of LTx: first, we review the clinical manifestation of LIRI post-LTx; second, we discuss the pathophysiology of LIRI that leads to pulmonary endothelial inflammation and PGD; and third, we present the role of ESLP as a therapeutic vehicle to mitigate this physiologic insult, increase the rates of donor organ utilization, and improve patient outcomes.

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Ischemia-reperfusion Injury in the Transplanted Lung: A Literature Review

Cited by 28 publications

References 200 publications

Reverse Trigger in Ventilated Non-ARDS Patients: A Phenomenon Can Not Be Ignored!

Reverse Trigger in Ventilated Non-ARDS Patients: A Phenomenon Can Not Be Ignored!

Ischemia–Reperfusion Injury in Lung Transplantation

Lung Transplantation, Pulmonary Endothelial Inflammation, and Ex-Situ Lung Perfusion: A Review

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