The Changing Landscape of Lung Donation for Transplantation

Snell, Gregory I; Levvey, Bronwyn; Westall, Glen P.

doi:10.1111/ajt.13128

Cited by 9 publications

(7 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…By contrast extended criteria donors (ECD) are donors that fail to fulfill at least one of these previous criteria. The ECD have been progressively used to the extent that they now make up the majority of all LTx performed in the world [24]. LTx results using ECD continues to be the subject of much debate and world practice varies considerably.…”

Section: Ideal Vs Extended Criteria Donorsmentioning

confidence: 99%

The evolution of lung transplantation for cystic fibrosis: A 2017 update

Snell

Reed

Stern

et al. 2017

Journal of Cystic Fibrosis

View full text Add to dashboard Cite

Lung transplantation (LTx) is an established therapy for patients with end-stage cystic fibrosis (CF). Indeed, CF is the commonest indication for those aged<50years of age needing LTx. CF LTx is associated with a 45% 10year survival - according to the world's largest registry. It is important all otherwise suitable CF patients with severe lung disease have a timely referral for discussion and consideration of the possibility of LTx. LTx discussions must carefully consider colonisation or infection with Burkholderia cenocepacia, Mycobacterium abscessus and Scediosporium - as good LTx outcomes cannot be guaranteed. A bridge to LTx with extra-corporeal lung support is a realistic option, but remains a relative contraindication to LTx. Improvements in LTx matching technology and post-operative management are steadily improving overall long-term outcomes, although chronic allograft rejection remains problematic. Expert multidisciplinary life-long post-LTx care remains the key to success.

show abstract

Section: Ideal Vs Extended Criteria Donorsmentioning

confidence: 99%

The evolution of lung transplantation for cystic fibrosis: A 2017 update

Snell

Reed

Stern

et al. 2017

Journal of Cystic Fibrosis

View full text Add to dashboard Cite

show abstract

“…The use of lungs and kidneys donated after circulatory death have been widely adopted in Australia. 13 , 14 More recently, the first successful transplant of a normothermically perfused DCD heart was performed by our colleagues at St Vincent’s Hospital in Sydney. 15 Unfortunately, the experience with DCD donor livers is rather different.…”

Section: Discussionmentioning

confidence: 99%

The Implications of the Shift Toward Donation After Circulatory Death in Australia

Reiling

Forrest

Bridle

et al. 2017

Transplantation Direct

View full text Add to dashboard Cite

BackgroundIn recent years, an increasing number of donor livers are being declined for transplantation in Australia. The aim of this study was to evaluate the impact of donation after cardiac death and other factors associated with organ quality on liver utilization rates in Australia.MethodsData on organ donors who donated at least 1 organ between 2005 and 2014 were obtained from the Australia and New Zealand organ donation registry. Temporal changes in donor characteristics were assessed and a logistical regression analysis was performed to evaluate their association with liver nonuse.ResultsThe number of organ donors increased from 175 in 2005 to 344 in 2014, with overall 19% being donation after cardiac death donors (P < 0.001). The percentage of livers deemed unsuitable for transplantation increased from 24% in 2005 to 41% in 2014 (P < 0.001). Donation after cardiac death was identified as the most important risk factor for nonuse with an odds ratio of 25.88 (95% confidence interval, 18.84-35.56), P < 0.001) followed by donor age, obesity, and diabetes.DiscussionThis study shows that livers donated after circulatory death are an underused resource in Australia. Better use of these currently available organs would be a highly cost-effective way of reducing waiting list mortality in liver transplantation.

show abstract

“…EVLP is designed to simulate an in vivo lung environment. While research continues to evaluate the true utility of EVLP, 65 current standard practice (often with anecdotal or minimal evidence 66 ) in many international centers includes the following: evaluation of organs from controlled and uncontrolled DCD, buying time where there is insufficient time prior to procurement due to donor instability, as well as assessment of extended or imperfect DCD or DBD donor lungs, where ongoing in vivo interrogation or modification is not feasible.…”

Section: Role Of Ex Vivo Lung Perfusion As Standard Current Practicementioning

confidence: 99%

“…The process of EVLP is expensive, resource intense, and might stress or even damage some lungs that would have been already acceptable without EVLP. 66,96…”

Section: Future Directions In Lung Donor Managementmentioning

confidence: 99%

Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues

Snell

Levvey

Levin

et al. 2018

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Lung transplantation (LTx) has traditionally been limited by a lack of suitable donor lungs. With the recognition that lungs are more robust than initially thought, the size of the donor pool of available lungs has increased dramatically in the past decade. Donation after brain death (DBD) and donation after circulatory death (DCD) lungs, both ideal and extended are now routinely utilized. DBD lungs can be damaged. There are important differences in the public's understanding, legal and consent processes, intensive care unit strategies, lung pathophysiology, logistics, and potential-to-actual donor conversion rates between DBD and DCD. Notwithstanding, the short- and long-term outcomes of LTx from any of these DBD versus DCD donor scenarios are now similar, robust, and continue to improve. Large audits suggest there remains a large untapped pool of DCD (but not DBD) lungs that may yet further dramatically increase lung transplant numbers. Donor scoring systems that might predict the donor conversion rates and lung quality, the role of ex vivo lung perfusion as an assessment and lung resuscitation tool, as well as the potential of donor lung quality biomarkers all have immense promise for the clinical field.

show abstract

The Changing Landscape of Lung Donation for Transplantation

Cited by 9 publications

References 5 publications

The evolution of lung transplantation for cystic fibrosis: A 2017 update

The evolution of lung transplantation for cystic fibrosis: A 2017 update

The Implications of the Shift Toward Donation After Circulatory Death in Australia

Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues

Contact Info

Product

Resources

About