Preimplantation retrograde pneumoplegia in clinical lung transplantation

Venuta, Federico; Rendina, Erino Angelo; Bufi, M.; Rocca, Giorgio Della; Giacomo, Tiziano De; Costa, M. G.; Pugliese, Francesco; Coccia, Cecilia; Ciccone, Anna Maria; Coloni, Giorgio F.

doi:10.1016/s0022-5223(99)70149-2

Cited by 65 publications

(41 citation statements)

References 14 publications

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“…Retrograde flush has been described for lung and heart-lung preservation and has been found to achieve better clearance of red blood cells, better distribution of the flush solution along the tracheobronchial tree, and better preservation of the surfactant function [33][34][35][36]. Several centres currently perform a retrograde flush after the anterograde flush [37,38]. The retrograde flush can be performed in situ after the heart has been removed while the lungs are still ventilated, or later on the back table.…”

Section: Methods Of Lung Preservationmentioning

confidence: 99%

“…The retrograde flush can be performed in situ after the heart has been removed while the lungs are still ventilated, or later on the back table. In a group of 14 patients, VENUTA et al [38] showed that the association of a retrograde flush to the anterograde flush can improve lung function after reperfusion of the transplanted lung.…”

Section: Methods Of Lung Preservationmentioning

confidence: 99%

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Strategies to increase limited donor resources

Perrot¹,

Weder²,

Patterson³

et al. 2004

Eur Respir J

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A number of strategies have been advocated to increase the number of lung donors including: 1) improvement in donor resuscitation; 2) better methods of lung preservation; 3) extension of the lung donor selection criteria; 4) development of a living-related lung donor programme; and 5) utilisation of nonheart beating donors.Other strategies such as the split-lung technique and techniques of lung reduction to accommodate large lungs into a small-size recipient have also been used successfully. In this article, each of these strategies have been reviewed and some recommendations are suggested based on the authors9 own experience and that of the literature.

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Section: Methods Of Lung Preservationmentioning

confidence: 99%

Section: Methods Of Lung Preservationmentioning

confidence: 99%

Strategies to increase limited donor resources

Perrot¹,

Weder²,

Patterson³

et al. 2004

Eur Respir J

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“…Recently, the innovative approach of retrograde preservation of lung grafts has been shown to be very effective in the elimination of different kinds of thrombi from the pulmonary vasculature [6,[25][26][27][28]. Furthermore, the quality of organ preservation in terms of post-ischemic lung function was significantly improved following retrograde lung preservation [8,9,28,29,30].…”

Section: Commentmentioning

confidence: 99%

Lung Retrieval from Non-Heart-Beating Donors: First Experience with an Innovative Preservation Strategy in a Pig Lung Transplantation Model

et al. 2004

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Objective: Lung transplantation is limited by the scarcity of donor organs. Lung retrieval from non-heart-beating donors (NHBD) might extend the donor pool and has been reported recently. However, no studies in NHBD exist using the novel approach of retrograde preservation with Perfadex solution. Methods: Heparinized asystolic pigs (n = 5, 30–35 kg) were ventilated for 90 min. The lungs were retrogradely preserved with Perfadex solution and stored inflated at 4°C for 3 h. Left lung transplantation in the recipient was followed by exclusion of the right lung. Results were compared to sham-operated animals. Oxygenation, hemodynamics and dynamic compliance were monitored for 4 h. Infiltration of polymorphonuclear cells (PMNs) and stereological quantification of alveolar edema was performed. Statistical analysis comprised Kruskal-Wallis and Mann-Whitney tests and ANOVA analysis with repeated measures. Results: No mortality was observed. During preservation, continuous elimination of blood clots via the pulmonary artery venting site was observed. Oxygenation and compliance were similar between groups, but sham controls showed significantly lower pulmonary vascular resistance. Stereological quantification revealed higher volume fractions of intra-alveolar edema in NHBD grafts, while PMN infiltration was comparable to sham controls. Conclusions: Use of NHBD lungs results in excellent outcome after 90 min of warm ischemia followed by retrograde preservation with Perfadex solution. This novel approach can optimize lung preservation by eliminating clots from the pulmonary circulation and might clinically be considered in brain-dead organ donors who become hemodynamically unstable prior to organ harvest. Further trials with longer warm and cold ischemic periods are necessary to further elucidate this promising approach to donor pool expansion.

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“…In addition, experimental work suggests that nitric oxide added to the flush solution or inhaled at the time of harvest provides a preservation advantage [45,46]. Combination of an antegrade and a retrograde [47,48] pulmonary vascular flush achieves more uniform distribution of flush solution and superior graft cooling. Lung hyperinflation is an excellent model of pulmonary oedema.…”

Section: Reperfusion Injurymentioning

confidence: 99%

Current status of lung transplantation

Lau¹,

Patterson²

2003

European Respiratory Journal

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Two decades have passed since the first successful clinical lung transplant was performed in 1983, and, in the interim, lung transplantation has become the preferred treatment option for a variety of end-stage pulmonary diseases. Remarkable progress has been made in the field through refinement of technique and improved understanding of transplant immunology and microbiology.Unfortunately, donor shortages continue to limit the more widespread application of lung transplantation. In order to address this issue, marginal donors, living lobar and split lung donor techniques, and nonheartbeating donors have been used clinically to increase the number of donor lungs available.Chronic rejection of the lung allograft is currently the major hurdle limiting longterm survival. To date, prevention of known risk factors and treatment strategies have not lessened the devastating toll this process has on lung transplant survival. Better understanding of the cause of chronic rejection is needed in order to develop novel strategies for its treatment. Promotion of immune tolerance is a promising area that could potentially eliminate chronic rejection.The present article discusses recent advances in lung transplantation. It also details the major issues facing the field today. Only through continued clinical and experimental investigation will lung transplantation eventually reach its full potential. Eur Respir J 2003; 22: Suppl. 47, 57s-64s.

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Preimplantation retrograde pneumoplegia in clinical lung transplantation

Abstract: Preimplantation retrograde flushing is not detrimental and helps to improve early graft function.

Cited by 65 publications

References 14 publications

Strategies to increase limited donor resources

Strategies to increase limited donor resources

Lung Retrieval from Non-Heart-Beating Donors: First Experience with an Innovative Preservation Strategy in a Pig Lung Transplantation Model

Current status of lung transplantation

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