Use of Cardiopulmonary Bypass for Lung Transplantation: A 10-Year Experience

Dalibon, Nicolas; Geffroy, Arnaud; Moutafis, M.; Vinatier, Isabelle; Bonnette, P.; Stern, M.; Loirat, Philippe; Bisson, A; Fischler, Marc

doi:10.1053/j.jvca.2006.01.004

“…Identified operative-related factors include single lung transplant, prolonged ischemic time, intracellular type preservation solutions, blood transfusion, and use of cardiopulmonary bypass. 10,20,29,[39][40][41]44,45,47,[50][51][52][53][54][55][56][57][58] Given the complexity of the interaction of multiple risk factors, efforts are currently under way on decision algorithms to aid donor recipientmatching aimed at reducing the incidence of PGD.…”

Section: Clinical Risk Factorsmentioning

confidence: 99%

Primary Graft Dysfunction

Suzuki

¹

,

Cantu

²

,

Christie

³

2013

Semin Respir Crit Care Med

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Primary graft dysfunction (PGD) is a syndrome encompassing a spectrum of mild to severe lung injury that occurs within the first 72 hours after lung transplantation. PGD is characterized by pulmonary edema with diffuse alveolar damage that manifests clinically as progressive hypoxemia with radiographic pulmonary infiltrates. In recent years, new knowledge has been generated on risks and mechanisms of PGD. Following ischemia and reperfusion, inflammatory and immunological injury-repair responses appear to be key controlling mechanisms. In addition, PGD has significant impact on short- and long-term outcomes; therefore, the choice of donor organ is impacted by this potential adverse consequence. Improved methods of reducing PGD risk and efforts to safely expand the pool are being developed. Ex-vivo lung perfusion is a strategy which may improve risk assessment and become a promising platform to implement treatment interventions to prevent PGD. This review will detail recent updates in the epidemiology, pathophysiology, molecular and genetic biomarkers and state-of-the-art technical developments affecting PGD. (158 words)

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“…Identified operative-related factors include single lung transplant, prolonged ischemic time, intracellular type preservation solutions, blood transfusion and use of cardiopulmonary bypass. 10,20,29,[39][40][41]44,45,47,[50][51][52][53][54][55][56][57][58] Given the complexity of the interaction of multiple risk factors, efforts are currently underway on decision algorithms to aid donor recipientmatching aimed at reducing the incidence of PGD.…”

Section: Clinical Risk Factorsmentioning

confidence: 99%

Primary Graft Dysfunction

Lee¹,

Christie²

2009

Proceedings of the American Thoracic Society

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Primary graft dysfunction (PGD) is a syndrome encompassing a spectrum of mild to severe lung injury that occurs within the first 72 hours after lung transplantation. PGD is characterized by pulmonary edema with diffuse alveolar damage that manifests clinically as progressive hypoxemia with radiographic pulmonary infiltrates. In recent years, new knowledge has been generated on risks and mechanisms of PGD. Following ischemia and reperfusion, inflammatory and immunological injury-repair responses appear to be key controlling mechanisms. In addition, PGD has significant impact on short-and long-term outcomes; therefore, the choice of donor organ is impacted by this potential adverse consequence. Improved methods of reducing PGD risk and efforts to safely expand the pool are being developed. Ex-vivo lung perfusion is a strategy which may improve risk assessment and become a promising platform to implement treatment interventions to prevent PGD. This review will detail recent updates in the epidemiology, pathophysiology, molecular and genetic biomarkers and state-of-the-art technical developments affecting PGD. (158 words) Keywords primary graft dysfunction; lung transplantation; ischemia-reperfusion injury and repair; high-risk donor lung; ex-vivo lung perfusion Definition and Clinical PresentationPrimary graft dysfunction (PGD) is a syndrome of acute lung injury that occurs within the first 72 hours after lung transplantation. PGD is characterized by pulmonary edema with diffuse alveolar damage that clinically manifests itself as progressive hypoxemia and radiographic pulmonary infiltrates without other identifiable causes. [1][2][3][4][5][6][7][8] . PGD is a form of the Acute Respiratory Distress Syndrome (ARDS), and shares characteristics with other factors predisposing to ARDS, such as trauma and sepsis. 9 Historically, various labels were applied to PGD including ischemia-reperfusion injury, re-implantation response and edema, reperfusion edema, non-cardiogenic pulmonary edema, early graft dysfunction, primary PGD develops progressively and encompasses a spectrum of acute lung injury from milder dysfunction to more severe lung injury. The lack of standard defining criteria for PGD across studies resulted in historical variability in reported incidence rates, risk factors, clinical outcomes, and treatment effects, which led to inconsistencies in reproducibility and generalizability. 1,[6][7][8][9][10][11][12][13][14][15][16][17] Therefore, in 2005, the International Society of Heart and Lung Transplantation (ISHLT) Working Group on PGD proposed a standardized definition and grading system with the intent of establishing a reproducible and robust taxonomy. 1 The proposed standardized definition of PGD was based on radiographic pulmonary infiltrates and a PaO 2 /FiO 2 (P/F) ratio assessed at several time points after lung transplantation (Table 1, Figure 1). For example, the presence of radiographic infiltrates consistent with pulmonary edema and a P/F ratio of <200 after 72 hours of final lung perfusion ...

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“…However, cardiopulmonary bypass has a high possibility of increasing the risk of pulmonary edema and lung injury caused by the administration of excessive fluid and blood transfusion due to the possibility of bleeding and by increased inflammatory response due to the extracorporeal circulation; therefore, it cause to increase the duration of mechanical ventilation after the operation, and cardiopulmonary bypass is associated with early graft dysfunction and increased mortality [14]. Because of these negative points, cardiopulmonary bypass should be avoided if it is at all possible.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic experience in patient for single lung transplantation with previous contralateral pneumonectomy -A case report-

Chung

¹

,

Cha

²

,

Hwang

³

et al. 2012

Korean J Anesthesiol

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A 48-year-old woman with cystic fibrosis and a previous left pneumonectomy had surgery planned for single lung transplantation under general anesthesia. Due to progressive dyspnea and recurrent respiratory infection, she could not maintain her normal daily life without lung transplantation. The anesthetic management and surgical procedure was expected to be difficult because of the left mediastinal shift and an asymmetric thorax after the left pneumonectomy, but the single lung transplantation was successfully done under cardiopulmonary bypass.

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Use of Cardiopulmonary Bypass for Lung Transplantation: A 10-Year Experience

Cited by 40 publications

References 19 publications

Primary Graft Dysfunction

Primary Graft Dysfunction

Primary Graft Dysfunction

Anesthetic experience in patient for single lung transplantation with previous contralateral pneumonectomy -A case report-

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