Report of the International Society for Heart and Lung Transplantation Working Group on Primary Lung Graft Dysfunction, part II: Epidemiology, risk factors, and outcomes—A 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation

Diamond, Joshua M.; Arcasoy, Selim M.; Kennedy, Cassie C.; Eberlein, Michael; Singer, Jonathan P.; Patterson, Glenda M.; Edelman, Jeffrey D.; Dhillon, Gundeep; Peña, Tahuanty; Kawut, Steven M.; Lee, James C.; Girgis, Reda E.; Dark, John H.; Thabut, Gabriel

doi:10.1016/j.healun.2017.07.020

Cited by 133 publications

(116 citation statements)

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“…The lack of association suggests that different inflammatory and immune pathways lead to PGD and ACR after lung and heart transplantation. The incidence of PGD in this study is similar to previous reports . According to the ISHLT Registry, 27.3% of lung transplant recipients were treated for at least 1 episode of ACR in the 1st year post‐transplant .…”

Section: Discussionsupporting

confidence: 89%

Comparison of outcomes in lung and heart transplant recipients from the same multiorgan donor

Takahashi

Terada

Pasque

et al. 2019

Clinical Transplantation

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Primary graft dysfunction (PGD) is a clinical manifestation of ischemic-reperfusion injury (IRI) and the most important cause of early morbidity and mortality after lung and heart transplantation. 1,2 Furthermore, in spite of advances in immunosuppression, acute cellular rejection (ACR) remains a common complication after lung and heart transplantation. 3,4 The International Society for Heart and Lung Transplantation (ISHLT) created a standardized definition and grading system for PGD after heart transplantation in 2014. 2 Similarly, the ISHLT developed a definition for PGD after lung transplantation in 2005 and subsequently refined the criteria in 2016. 5,6 The standardization of PGD definitions has provided a more consistent approach for scoring PGD and created a platform to evaluate potential risk factors. 7,8 The pathogenesis of PGD represents both inflammatory and ischemia-reperfusion-related mechanisms. 9 Although new mechanistic insights of ACR have been recently reported, especially after lung transplantation, 10 there has been little work examining the influence of donor factors. Brain death is associated with systemic inflammatory responses characterized by the release of proinflammatory cytokines, such as interleukin-6 and tumor necrosis factor-alpha, which could lead to allograft injury. 11 Abstract Background: Primary graft dysfunction (PGD) and acute cellular rejection (ACR) are important causes of early morbidity and mortality following lung and heart transplantation. While many studies have elucidated donor-related risk factors of PGD and ACR, these complications often occur even with "ideal" donors. Therefore, we investigated potential associations of PGD and ACR between bilateral lung and heart transplant recipients from the same multiorgan donor, respectively. Methods: Between 2011 and 2017, 100 donors contributed 100 bilateral lung transplants and 100 heart transplants performed. Logistic regression analysis for PGD and Cox proportional hazards regression analysis for ACR were used to estimate the relationship of heart and lung transplants.Results: The incidence of PGD was 33% among lung and 17% among heart transplant recipients. Similarly, the incidence of ACR grade ≥ A2 for lung recipients was 38% (30/80), and the incidence of ACR grade ≥ 2R for heart recipients was 19% (15/80).There was no association between the development of PGD and ACR in lung and heart transplant recipients from the same donor, respectively.Conclusions: These findings suggest that inherent donor factors are not critical to the development of PGD and ACR after lung and heart transplantation. K E Y W O R D Sacute, donation after brain death (DBD), donors and donation, organ procurement, rejection

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Section: Discussionsupporting

confidence: 89%

Comparison of outcomes in lung and heart transplant recipients from the same multiorgan donor

Takahashi

Terada

Pasque

et al. 2019

Clinical Transplantation

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“…The primary endpoint was 1‐year survival post‐LTx. Secondary endpoints were primary graft dysfunction (PGD) at 72 hours post‐LTx, the use of circulatory assistance, invasive ventilation duration, length of intensive care unit (ICU), and hospital stays, pulmonary function with the forced expiratory volume in 1 second (FEV1) at 6 and 12 months and 5‐year survival post‐LTx.…”

Section: Methodsmentioning

confidence: 99%

Hanging donor lungs give good short‐, mid‐ and long‐term results in lung transplantation

Wolf

Renard

Lehouerou

et al. 2019

Clinical Transplantation

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Background:Hanging donors are considered as marginal donors and frequently unsuitable for lung transplantation. However, there is no evidence of higher lung transplantation (LTx) morbidity-mortality with lungs providing by hanging donor. Methods:Between January 2010 and July 2015, we performed a retrospective study at Foch hospital. We aimed to assess whether hanging donor grafts are suitable for lung transplantation. Results: A total of 299 LTx were performed. Subjects were allocated to a hanging group (HG) (n = 20) and a control group (CG) (n = 279). Donor and recipient characteristics did not differ. Primary graft dysfunction (PGD) at 72 hours was comparable in both groups (P = .75). The median duration of postoperative mechanical ventilation (1 [range, 0-84] vs 1 [range, 0-410] day, P = .35), the hospital length of stay (31 days [20-84] vs 32 days [12-435], P = .36) did not differ between the two groups. No statistically significant difference was found in 1-year and 5-year survival between the HG (83% and 78%) and the CG (86% and 75%), P = .85. Conclusion: We believe that hanging donors should be considered as conventional donors with particular caution in the final evaluation of the graft and in perioperative management. K E Y W O R D S extended donors, hanging donors, lung transplantation, marginal donors, primary graft dysfunction R E FE R E N C E S

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“…This patient had a number of interesting challenges. Pulmonary hypertension is a major predictor of early lung dysfunction [3], as is the use of cardiopulmonary bypass for the transplantation [4]. There is also the debate as to whether an ASD should be closed at the time of transplantation or can be left to a later stage.…”

Section: Commentmentioning

confidence: 99%

Novel Management of Atrial Septal Defect at Time of Lung Transplantation

Urban

Booth

O’Sullivan

et al. 2018

The Annals of Thoracic Surgery

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We present a case of a young female patient with end-stage lung failure because of pulmonary arterial hypertension who was failing maximal medical therapy and was listed for a single sequential lung transplantation. The challenge of the case was a concomitant presence of a large atrial septal defect. The novelty of our approach was a device closure of atrial septal defect before performing transplantation with the use of intraoperative venoarterial extracorporeal membrane oxygenation.

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Report of the International Society for Heart and Lung Transplantation Working Group on Primary Lung Graft Dysfunction, part II: Epidemiology, risk factors, and outcomes—A 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation

Cited by 133 publications

References 100 publications

Comparison of outcomes in lung and heart transplant recipients from the same multiorgan donor

Comparison of outcomes in lung and heart transplant recipients from the same multiorgan donor

Hanging donor lungs give good short‐, mid‐ and long‐term results in lung transplantation

Novel Management of Atrial Septal Defect at Time of Lung Transplantation

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