Pitfalls in donor lung procurements: How should the procedure be taught to transplant trainees?

Shigemura, Norihisa; Bhama, Jay K.; Nguyen, Duc; Thacker, Jnanesh; Bermúdez, C.; Toyoda, Yoshiya

doi:10.1016/j.jtcvs.2009.04.002

Cited by 17 publications

(8 citation statements)

References 24 publications

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“…The outcomes, even at our high‐volume center, of patients with prior CTS did not equal those seen in patients without prior CTS, though there were no significant differences in long‐term survival. Regardless of recent advances in organ protection and immunosuppression techniques (4,9), we noted that the incidence of major complications including bleeding requiring reexploration, nerve injury, renal insufficiency and respiratory complications was higher in patients with prior CTS. It is well recognized that renal insufficiency requiring dialysis after LTx carries substantial morbidity and diminishes patient quality of life (10).…”

Section: Discussionmentioning

confidence: 88%

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Lung Transplantation in Patients With Prior Cardiothoracic Surgical Procedures

Shigemura

Bhama

Gries

et al. 2012

American Journal of Transplantation

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The full spectrum of prior cardiothoracic procedures in lung transplant candidates and the impact of prior procedures on outcomes after lung transplantation (LTx) remain unknown, though the impact is considered to be large. Patients transplanted at our institution from 2004 to 2009 were identified (n = 554) and divided into two groups: patients who had undergone cardiothoracic surgical (CTS) procedures prior to LTx (n = 238) and patients who had not (non-CTS: n = 316). Our primary endpoint was survival. Secondary endpoints included allograft function and the incidence of major complications including reexploration due to bleeding, prolonged ventilation, renal insufficiency and primary graft dysfunction. Long-term survival was not significantly different between the groups whereas postoperative bleeding, nerve injury, respiratory and renal complications were higher in the CTS group. Posttransplant peak FEV1 was lower in the CTS group (73.4% vs. 86.9%, p < 0.05). In multivariate analysis, performance of a chemical pleurodesis procedure and prolonged cardiopulmonary bypass were significantly associated with mortality (OR, 1.7; CI, 1.5-2.0; p < 0.005). Our results suggest that patients with LTx and prior CTS remain technically challenging and experience worse outcomes than patients without prior CTS. A surgical strategy to minimize cardiopulmonary bypass time is critical for these challenging LTx patients.

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Section: Discussionmentioning

confidence: 88%

“…In all patients, LTx was performed using standardized techniques and our current lung protection protocol, which have been reported in detail elsewhere (3,4). A standardized care pathway for postoperative care was also utilized in all patients.…”

Section: Methodsmentioning

confidence: 99%

Lung Transplantation in Patients With Prior Cardiothoracic Surgical Procedures

Shigemura

Bhama

Gries

et al. 2012

American Journal of Transplantation

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“…33 By contrast, lung donor procurement performed by beginners with limited experience or other professionals with no intensive care background was frequently marred by technical errors, which may lead to serious complications after transplant. 34 Angel et al increased the lung donation rate by introducing educational strategies and a trained team to treat donors at any center. 7 However, the protocol described here can easily be implemented at any center, and without prior training.…”

Section: Discussionmentioning

confidence: 99%

Lung donor treatment protocol in brain dead-donors: A multicenter study

Miñambres

Pérez-Villares

Chico‐Fernández

et al. 2015

The Journal of Heart and Lung Transplantation

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“…The potential for surgical injuries or lack of experience in evaluating lung allografts may greatly impact the current and increasing shortage of lungs for transplant. Retrospective study by Shigemura et al [2] concluded donor lung procurements performed by trainees with limited transplant experience, frequently included technical errors with regards to graft preservation, which may have had an effect on transplant outcome, despite the study showing no significant difference in PGD, between the trainee and the attending surgeon groups at 72 hours post-transplant, as defined by the International Society for Heart and Lung Transplantation [3–5]. …”

Section: Commentmentioning

confidence: 99%

Physician Assistant Model for Lung Procurements: A Paradigm Worth Considering

Costa

D’Ovidio

Bacchetta

et al. 2013

The Annals of Thoracic Surgery

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Background Thoracic procurements have traditionally been performed by surgical fellows or attending cardiothoracic surgeons. Donor lung procurement protocols are well established and fairly standardized; however, specific procurement training and judgment are essential to optimizing donor utilization. Although the predicted future deficits of cardiothoracic surgeons are based on a variety of analytical models and scenarios, it appears evident that there will not be a sufficient number of trained cardiothoracic surgeons over the next two decades. Over the past five years in our institution, lung procurements have been performed by a specifically trained physician assistant; as the lead donor surgeon. This model may serve as a cost effective, reproducible and safe alternative to using surgical fellows and attending surgeons, assuring continuity, ongoing technical expertise, and teaching, while addressing future workforce issues as related to transplant. Methods This is a single institution review of 287 consecutive lung procurements performed by either a physician assistant or fellow over five years. This study was approved by the Institutional Review Board of Columbia University, which waived the need for informed consent (IRB#AAAL7107). Results From 2008 to 2012, fellows served as senior surgeon in 90 cases (31.4%) vs. 197 cases (68.6%) by the physician assistant, including 12 Donations after Cardiac Death and 6 re-operative donors. Injury rate was significantly lower for the physician assistant compared to the resident cohort (1/197 (0.5%) vs. 22/90 (24%) respectively. (Rates for pulmonary graft dysfunction grade 2&3 were found to be significantly lower in cases where the physician assistant served as senior surgeon (combined rates of 32.2% (29/90) vs. 9.6% (19/197) in physician assistant group) (p<0.01). Conclusions Use of experienced physician assistants in donor lung procurements is a safe and viable alternative offering continuity of technical expertise and evaluation of lung allografts.

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Pitfalls in donor lung procurements: How should the procedure be taught to transplant trainees?

Cited by 17 publications

References 24 publications

Lung Transplantation in Patients With Prior Cardiothoracic Surgical Procedures

Lung Transplantation in Patients With Prior Cardiothoracic Surgical Procedures

Lung donor treatment protocol in brain dead-donors: A multicenter study

Physician Assistant Model for Lung Procurements: A Paradigm Worth Considering

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