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Watanabe Y, Watanabe T, Hirama T, Murai S, Ueda K, Oishi H, Akiba M, Watanabe T, Suzuki T, Notsuda H, Onodera K, Togo T, Niikawa H, Noda M, Okada Y. Lobar graft evaluation in cadaveric lobar lung redo transplantation after living-donor lobar lung transplantation: a case report. Surg Case Rep 2024; 10:238. [PMID: 39441419 PMCID: PMC11499546 DOI: 10.1186/s40792-024-02046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 10/11/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Lung transplantation is a vital option for patients with end-stage lung disease. However, it faces a significant challenge due to the shortage of compatible donors, which particularly affects individuals with small chest cavities and pediatric patients. The novel approach of cadaveric lobar lung transplantation is a promising solution to alleviate the donor shortage crisis. Both the mid-term and long-term outcomes of lobar lung transplantation are comparable to those of standard lung transplantation. However, patients undergoing lobar lung transplantation reported a significantly higher rate of primary graft dysfunction compared to patients undergoing standard lung transplantation. Therefore, careful donor selection is critical to improve outcomes after lobar transplantation. However, no established method exists to evaluate each lung lobar graft of deceased donors. This case report describes a case of cadaveric lobar lung transplantation to overcome size mismatch and donor shortage, with particular emphasis on lobar graft evaluation. CASE PRESENTATION A 39-year-old woman with scleroderma-related respiratory failure was listed for deceased donor lung transplantation due to a rapidly progressing disease. Faced with a long waiting list and impending mortality, she underwent bilateral living-donor lobar lung transplantation donated by her relatives. Post-transplant complications included progressive pulmonary vein obstruction and pleural effusion, which ultimately required retransplantation. An oversized donor with pneumonia in the bilateral lower lobes was allocated. Lung ultrasound was used to evaluate each lung lobar graft during procurement. The right upper and middle lobes and left upper lobe were confirmed to be transplantable, and lobar lung redo transplantation was performed. The patient's post-transplant course was uneventful, and she was discharged home and returned to her daily activities. CONCLUSIONS This case highlights the clinical impact of cadaveric lobar lung transplantation as a feasible and effective strategy to overcome the shortage of donor lungs, especially in patients with small thoracic cavities. By establishing donor lung evaluation techniques and overcoming anatomical and logistical challenges, cadaveric lobar lung transplantation can significantly expand the donor pool and offer hope to those previously considered ineligible for transplantation.
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Affiliation(s)
- Yui Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan.
| | - Tatsuaki Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Takashi Hirama
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
- Organ Transplant Center, Tohoku University Hospital, Sendai, Japan
| | - Sho Murai
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Kazunori Ueda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Miki Akiba
- Organ Transplant Center, Tohoku University Hospital, Sendai, Japan
| | - Toshikazu Watanabe
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Takaya Suzuki
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Hirotsugu Notsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Ken Onodera
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Takeo Togo
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Hiromichi Niikawa
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8575, Japan
- Organ Transplant Center, Tohoku University Hospital, Sendai, Japan
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Ehrsam JP, Meier Adamenko O, Pannu M, Markus Schöb O, Inci I. Lung transplantation in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S119-S133. [PMID: 38584780 PMCID: PMC10995684 DOI: 10.5606/tgkdc.dergisi.2024.25806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 04/09/2024]
Abstract
Lung transplantation is a well-established treatment for children facing advanced lung disease and pulmonary vascular disorders. However, organ shortage remains highest in children. For fitting the small chest of children, transplantation of downsized adult lungs, lobes, or even segments were successfully established. The worldwide median survival after pediatric lung transplantation is currently 5.7 years, while under consideration of age, underlying disease, and peri- and posttransplant center experience, median survival of more than 10 years is reported. Timing of referral for transplantation, ischemia-reperfusion injury, primary graft dysfunction, and acute and chronic rejection after transplantation remain the main challenges.
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Affiliation(s)
- Jonas Peter Ehrsam
- School of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
- Klinik Hirslanden Zurich, Centre for Surgery, Zurich, Switzerland
| | | | | | - Othmar Markus Schöb
- School of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
- Klinik Hirslanden Zurich, Centre for Surgery, Zurich, Switzerland
| | - Ilhan Inci
- School of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
- Klinik Hirslanden Zurich, Centre for Surgery, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
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3
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Schiavon M, Mendogni P, Faccioli E, Lorenzoni G, Mazzucco A, Nosotti M, Rea F. Lobar size reduction in lung transplantation: A propensity score study. J Thorac Cardiovasc Surg 2022; 164:289-296.e2. [PMID: 34353616 DOI: 10.1016/j.jtcvs.2021.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE For small-sized recipients of lung transplantation, the time span for organ reception from standard donors is generally longer than for normal-sized patients. Despite its underuse, lobar reduction may be a concrete option for these patients. This study aims to assess early and long-term outcomes associated with lobar reduction in lung transplantation. METHODS A retrospective study was performed on 608 consecutive lung transplantations at 2 centers between January 2005 and August 2019 (559 standard lung transplantations [standard transplantation] and 49 with lobar reduction [lung transplantation group]). A propensity-score weighting approach was used to account for potential confounding related to patients' nonrandom allocation to the 2 intervention groups. The effects of the intervention on postoperative outcomes were assessed with a weighted regression approach. RESULTS The propensity score was estimated on 571 patients (522 in standard transplantation group and 49 in lung transplantation group). In terms of early outcomes, the lung transplantation group showed a higher percentage of severe primary graft dysfunction at 0 hours and reported longer intensive care unit stay than the standard transplantation group. No other differences in terms of morbidity, mortality, mechanical ventilation time, hospital stay, and anastomotic complications were observed. Although the lung transplantation group showed worse long-term pulmonary function, the 2 populations had comparable survival outcomes. CONCLUSIONS The use of lobar reduction showed early and long-term results comparable to those after standard lung transplantation. Although a higher rate of early severe primary graft dysfunction and slightly reduced respiratory function were detected in the lobar group, these did not affect patients' morbidity and survival.
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Affiliation(s)
- Marco Schiavon
- Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy.
| | - Paolo Mendogni
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Eleonora Faccioli
- Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giulia Lorenzoni
- Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | | | - Mario Nosotti
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Federico Rea
- Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
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4
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Pushing the Envelope for Donor Lungs. Semin Respir Crit Care Med 2021; 42:357-367. [PMID: 34030199 DOI: 10.1055/s-0041-1729859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The shortage of organ donors remains the major limiting factor in lung transplant, with the number of patients on the waiting list largely exceeding the number of available organ donors. Another issue is the low utilization rate seen in some types of donors. Therefore, novel strategies are continuously being explored to increase the donor pool. Advanced age, smoking history, positive serologies, and size mismatch are common criteria that decrease the rate of use when it comes to organ utilization. Questioning these limitations is one of the purposes of this review. Challenging these limitations by adapting novel donor management strategies could help to increase the rate of suitable lungs for transplantation while still maintaining good outcomes. A second goal is to present the latest advances in organ donation after controlled and uncontrolled cardiac death, and also on how to improve these lungs on ex vivo platforms for assessment and future specific therapies. Finally, pushing the limit of the donor envelope also means reviewing some of the recent improvements made in lung preservation itself, as well as upcoming experimental research fields. In summary, donor lung optimization refers to a global care strategy to increase the total numbers of available allografts, and preserve or improve organ quality without paying the price of early-, mid-, or long-term negative outcomes after transplantation.
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Campo-Canaveral De La Cruz JL, Dunne B, Lemaitre P, Rackauskas M, Pozniak J, Watanabe Y, Mariscal A, Yeung J, Yasufuku K, Pierre A, de Perrot M, Waddell TK, Cypel M, Keshavjee S, Donahoe L. Deceased-donor lobar lung transplant: A successful strategy for small-sized recipients. J Thorac Cardiovasc Surg 2021; 161:1674-1685. [DOI: 10.1016/j.jtcvs.2020.04.166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 03/13/2020] [Accepted: 04/04/2020] [Indexed: 02/03/2023]
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Santos Silva J, Olland A, Massard G, Falcoz PE. Does lobar or size-reduced lung transplantation offer satisfactory early and late outcomes? Interact Cardiovasc Thorac Surg 2021; 31:93-97. [PMID: 32588059 DOI: 10.1093/icvts/ivaa051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/09/2019] [Accepted: 02/26/2020] [Indexed: 11/15/2022] Open
Abstract
A best evidence topic was constructed according to a structured protocol. The question addressed was whether size-reduced or lobar lung transplantation (LLTx) offers the same benefit as classic lung transplantation (LTx). Of the 147 papers found using the reported search, 9 were selected to provide the best evidence. Details of the studies regarding authors, date, journal, country of publication, study type, group studied, relevant outcomes and results are given. All studies reported survival rates of LLTx and most compared it with classical LTx. No statistical differences were reported in medium term and long term. Two of the studies reported a higher incidence of postoperative complications, such as the need for cardiopulmonary bypass, reperfusion oedema or primary graft dysfunction, and longer intubation or intensive care unit stay times. Although the largest study showed a significantly worse 1-year survival in LLTx, a sub-analysis considering patients successfully discharged showed similar outcomes at 1, 3 and 5 years when compared with classic LTx patients. We conclude that LLTx is a valid therapeutic option for recipients with significant donor size mismatch, offering similar outcomes as classical LTx in the medium term and long term.
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Affiliation(s)
- João Santos Silva
- Service de Chirurgie Thoracique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Anne Olland
- Service de Chirurgie Thoracique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Faculté de Médecine et Pharmacie, Université de Strasbourg, Strasbourg, France
| | - Gilbert Massard
- Service de Chirurgie Thoracique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Faculté de Médecine et Pharmacie, Université de Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Service de Chirurgie Thoracique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Faculté de Médecine et Pharmacie, Université de Strasbourg, Strasbourg, France
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7
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Fujimoto R, Nakajima D, Tanaka S, Yamada Y, Yutaka Y, Ohsumi A, Hamaji M, Menju T, Date H. Efficacy of three-dimensional computed tomography volumetry for recipients in downsizing oversized grafts in brain-dead donor lung transplantation. Gen Thorac Cardiovasc Surg 2021; 69:1112-1117. [PMID: 33506436 PMCID: PMC7840616 DOI: 10.1007/s11748-021-01591-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/06/2021] [Indexed: 11/20/2022]
Abstract
Objective Brain-dead donor lung transplantation frequently requires reduction in the size of oversized lung grafts for patients with a small chest cavity. We focused on the role of three-dimensional computed tomography (3D-CT) volumetry for recipients on downsizing oversized lung grafts. Methods We performed 53 brain-dead donor bilateral lung transplantations, including 15 lobar lung transplants (Lobar group) and 38 standard lung transplants with full-sized grafts (Full group), between December 2010 and December 2018. Recipient chest volume before transplantation was measured using 3D-CT volumetry, and donor lung volume was evaluated by predicted total lung capacity. Post-transplant outcomes and pulmonary function were retrospectively compared between the groups. Results The ratio of the recipient chest volume to the donor lung volume was significantly lower in the Lobar group (0.42 ± 0.15) than in the Full group (0.77 ± 0.30, P < 0.01). The calculated size matching between the donor and recipient after downsizing the grafts was significantly correlated to the ratio of the recipient chest volume to the donor lung volume (Spearman r = 0.69; P < 0.01). Early post-transplant outcomes did not significantly differ between the groups. Although the Full group showed slightly better pulmonary function after transplantation, the 1-, 3-, and 5-year overall survival rates were similar to the Lobar group (100%, 93%, and 81% in the Lobar group vs. 92%, 78%, and 70% in the Full group; P = 0.50). Conclusions Brain-dead donor lobar lung transplantation showed favorable post-transplant outcomes. The assessment of recipient chest cavity volume using 3D-CT volumetry may help surgeons precisely downsize oversized lung grafts prior to transplantation.
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Affiliation(s)
- Ryo Fujimoto
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Satona Tanaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshito Yamada
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yojiro Yutaka
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawarahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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8
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Inci I, Schuurmans MM, Caviezel C, Hillinger S, Opitz I, Schneiter D, Weder W. Long-Term Outcomes of Cadaveric Lobar Lung Transplantation: An Important Surgical Option. Ann Thorac Cardiovasc Surg 2021; 27:244-250. [PMID: 33473053 PMCID: PMC8374092 DOI: 10.5761/atcs.oa.20-00237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cadaveric lobar lung transplantation (L-LTx) is developed to overcome donor-recipient size mismatch. Controversial short- and long-term outcomes following L-LTx have been reported compared to full-sized lung transplantation (F-LTx). This study reports long-term outcomes after L-LTx. METHODS We reviewed patients undergoing lung transplantation (LTx) between 2000 and 2016. The decision to perform L-LTx was made based mainly on donor-recipient height discrepancy and visual assessment of donor lungs. Predicted donor-recipient total lung capacity (TLC) ratio was calculated more recently. Primary outcome was overall survival. RESULTS In all, 370 bilateral LTx were performed during the study period, among those 250 (67%) underwent F-LTx and 120 (32%) underwent L-LTx, respectively. One- and 5-year survival rates were 85% vs. 90% and 53% vs. 63% for L-LTx and F-LTx, respectively (p = 0.16). Chronic lung allograft dysfunction (CLAD)-free survival at 5 years was 48% in L-LTx vs. 51% in F-LTx recipients (p = 0.89), respectively. Age, intraoperative extracorporeal membrane oxygenation (ECMO) use, intensive care unit (ICU) stay, and postoperative renal replacement therapy (RRT) were significant prognostic factors for survival using multivariate analysis. CONCLUSIONS Overall survival and CLAD-free survival following L-LTx were comparable to F-LTx. Given the ongoing donor organ shortage, cadaveric L-LTx remains as an important resource in LTx.
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Affiliation(s)
- Ilhan Inci
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Mace M Schuurmans
- Division of Pulmonology, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Caviezel
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland
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9
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Werner R, Benden C. Pediatric lung transplantation as standard of care. Clin Transplant 2020; 35:e14126. [PMID: 33098188 DOI: 10.1111/ctr.14126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 01/13/2023]
Abstract
For infants, children, and adolescents with progressive advanced lung disease, lung transplantation represents the ultimate therapy option. Fortunately, outcomes after pediatric lung transplantation have improved in recent years now producing good long-term outcomes, no less than comparable to adult lung transplantation. The field of pediatric lung transplantation has rapidly advanced; thus, this review aims to update on important issues such as transplant referral and assessment, and extra-corporal life support as "bridge to transplantation". In view of the ongoing lack of donor organs limiting the success of pediatric lung transplantation, donor acceptability criteria and surgical options of lung allograft size reduction are discussed. Post-transplant, immunosuppression is vital for prevention of allograft rejection; however, evidence-based data on immunosuppression are scarce. Drug-related side effects are frequent, close therapeutic drug monitoring is highly advised with an individually tailored patient approach. Chronic lung allograft dysfunction (CLAD) remains the Achilles' heel of pediatric lung transplant limiting its long-term success. Unfortunately, therapy options for CLAD are still restricted. The last option for progressive CLAD would be consideration for lung re-transplant; however, numbers of pediatric patients undergoing lung re-transplantation are very small and its success depends highly on the optimal selection of the most suitable candidate.
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Affiliation(s)
- Raphael Werner
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christian Benden
- Swisstransplant, Berne, Switzerland.,University of Zurich Medical Faculty, Zurich, Switzerland
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10
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Commentary: Small can be beautiful, in the right hands. J Thorac Cardiovasc Surg 2020; 161:1686-1687. [PMID: 32532500 DOI: 10.1016/j.jtcvs.2020.04.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 11/21/2022]
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Campo-Cañaveral de la Cruz JL, Gómez de Antonio D, Sánchez Calle Á, Romero Román A. Bilateral Lung Transplantation in a Patient With Severe Right Pleural Cavity Restriction. Arch Bronconeumol 2018; 55:271-272. [PMID: 30122427 DOI: 10.1016/j.arbres.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - David Gómez de Antonio
- Servicio de Cirugía Torácica y Trasplante Pulmonar, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Álvaro Sánchez Calle
- Servicio de Cirugía Torácica y Trasplante Pulmonar, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Alejandra Romero Román
- Servicio de Cirugía Torácica y Trasplante Pulmonar, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
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12
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Inci I, Hillinger S, Schneiter D, Opitz I, Schuurmans M, Benden C, Weder W. Lung Transplantation with Controlled Donation after Circulatory Death Donors. Ann Thorac Cardiovasc Surg 2018; 24:296-302. [PMID: 29962390 PMCID: PMC6300426 DOI: 10.5761/atcs.oa.18-00098] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: Utilization of donation after circulatory death (DCD) donors has the potential to decrease donor shortage in lung transplantation (LTx). This study reviews the long-term outcome of LTx from DCD donors. Methods: We included all consecutive DCD (Maastricht Category III) and all donations after brain death (DBD) donor lung transplants at our Center performed between January 2012 and February 2017. Data were analyzed comparing the two groups in regard of survival after LTx as primary outcome. Results: Median withdrawal to cardiac arrest time was 17 min (interquartile range [IQR]: 11.5–20.5). Median cardiac arrest to cold perfusion was 32 min (IQR: 24.5–36.5). Primary graft dysfunction (PGD) grade 3 at T72 occurred in three recipients. Chronic lung allograft dysfunction (CLAD) led to death in two cases. In DCD group, there was no 90-day mortality. In DCD, group 1- and 3-year survival rates were 100% and 80%. In DBD group, 1- and 3-year survival rates were 85% and 69% (p = 0.4). Conclusions: Our report confirmed the comparable outcome from DCD donors compared with DBD donors. Utility of DCD donors is a safe option to overcome donor shortage.
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Affiliation(s)
- Ilhan Inci
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
| | - Sven Hillinger
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
| | - Macé Schuurmans
- Division of Pulmonary Medicine, Zurich University Hospital, Switzerland
| | - Christian Benden
- Division of Pulmonary Medicine, Zurich University Hospital, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, Zurich University Hospital, Switzerland
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13
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Surgical management of bronchial stumps in lobar lung transplantation. J Thorac Cardiovasc Surg 2018; 156:451-460. [DOI: 10.1016/j.jtcvs.2017.10.150] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 09/13/2017] [Accepted: 10/27/2017] [Indexed: 11/17/2022]
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14
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Lancaster TS, Eghtesady P. State of the Art in Pediatric Lung Transplantation. Semin Thorac Cardiovasc Surg 2018; 30:166-174. [PMID: 29702179 DOI: 10.1053/j.semtcvs.2018.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 12/23/2022]
Abstract
Pediatric lung transplantation is a highly specialized therapy for end-stage pulmonary disease in children, and is performed in only a handful of transplant centers around the world. Advancement in the field has been made on many fronts in recent years, including in public policy and organ allocation strategies, donor selection and management, emerging technologies for donor lung rehabilitation and bridge-to-transplant support of listed candidates, and ongoing refinement of surgical techniques. Despite this progress, children continue to suffer discrepant waitlist mortality and longer waiting times than their adult counterparts, and face special challenges of donor availability and size matching. Here, we assess the current state of the art in pediatric lung transplantation, reviewing progress made to date and further opportunities to improve care for this unique group of patients.
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Affiliation(s)
- Timothy S Lancaster
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri.
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15
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Sugimoto S, Yamane M, Otani S, Kurosaki T, Okahara S, Hikasa Y, Toyooka S, Kobayashi M, Oto T. Airway complications have a greater impact on the outcomes of living-donor lobar lung transplantation recipients than cadaveric lung transplantation recipients. Surg Today 2018; 48:848-855. [PMID: 29680912 DOI: 10.1007/s00595-018-1663-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/02/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Airway complications (ACs) after living-donor lobar lung transplantation (LDLLT) could have different features from those after cadaveric lung transplantation (CLT). We conducted this study to compare the characteristics of ACs after LDLLT vs. those after CLT and investigate their impact on outcomes. METHODS We reviewed, retrospectively, data on 163 recipients of lung transplantation, including 83 recipients of LDLLT and 80 recipients of CLT. RESULTS The incidence of ACs did not differ between LDLLT and CLT. The initial type of AC after LDLLT was limited to stenosis in all eight patients, whereas that after CLT consisted of stenosis in three patients and necrosis in ten patients (p = 0.0034). ACs after LDLLT necessitated significantly earlier initiation of treatment than those after CLT (p = 0.032). The overall survival rate of LDLLT recipients with an AC was significantly lower than that of those without an AC (p = 0.030), whereas the overall survival rate was comparable between CLT recipients with and those without ACs (p = 0.25). CONCLUSION ACs after LDLLT, limited to bronchial stenosis, require significantly earlier treatment and have a greater adverse impact on survival than ACs after CLT.
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Affiliation(s)
- Seiichiro Sugimoto
- Department of General Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Masaomi Yamane
- Department of General Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinji Otani
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Takeshi Kurosaki
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Shuji Okahara
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Yukiko Hikasa
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Motomu Kobayashi
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Oto
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan
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16
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Gautier SV, Golovinskiy SB, Poptsov VN, Tsiroulnikova OM, Nechaev NB, Spirina EA, Krasovskiy SA. First pediatric bilateral lobar lung transplantation for cystic fibrosis in Russian Federation. ACTA ACUST UNITED AC 2018. [DOI: 10.15825/1995-1191-2017-4-11-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lung transplantation is not a routine treatment option of the pediatric lung diseases. Nowadays, there are performed not more than 100 of these operations per year worldwide due to the obvious diffi culty of obtaining the pediatric donor organs. One of the ways to solve this problem is using the adult donor lungs which have been previously reduced or anatomically partitioned. This is not a standard method of pediatric lung transplantation, but in case of the donor organs defi ciency it takes its place in the world medical practice. In this case we report the fi rst successful pediatric lung transplantation from adult donor in Russian Federation.
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Affiliation(s)
- S. V. Gautier
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation; I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Department of transplantology and artifi cial organs (Sechenovskiy University)
| | - S. B. Golovinskiy
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation
| | - V. N. Poptsov
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation
| | - O. M. Tsiroulnikova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Department of transplantology and artifi cial organs (Sechenovskiy University); V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation
| | - N. B. Nechaev
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation
| | - E. A. Spirina
- V.I. Shumakov National Medical Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation
| | - S. A. Krasovskiy
- Federal State Budgetary Institution «Research Institution of Pulmonology» Federal medical and Biological Agency of the Russian Federation
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17
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Hoetzenecker K, Klepetko W. Is it really dumb to leave a stump? J Thorac Cardiovasc Surg 2018; 156:461-462. [PMID: 29305030 DOI: 10.1016/j.jtcvs.2017.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Konrad Hoetzenecker
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
| | - Walter Klepetko
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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18
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Cosgun T, Tomaszek S, Opitz I, Wilhelm M, Schuurmans MM, Weder W, Inci I. Single-center experience with intraoperative extracorporeal membrane oxygenation use in lung transplantation. Int J Artif Organs 2017; 41:0. [PMID: 29027193 DOI: 10.5301/ijao.5000645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies have shown that survival after lung transplantation is impaired if extracorporeal membrane oxygenation (ECMO) support is implemented. We investigated the outcome and potential independent risk factors on survival in recipients undergoing lung transplantation with intraoperative ECMO support. MATERIALS AND METHODS Medical records of recipients were retrospectively evaluated (January 2000-December 2014). Retransplantation and bridge to transplantation on ECMO were excluded. Recipients (n = 291) were divided into 2 groups: those who needed intraoperative ECMO support (Group 1, n = 134) and those who did not receive intraoperative ECMO support (Group 2, n = 157). Independent risk factors were identified by a stepwise backward regression analysis. RESULTS 1-year survival was 84.2% in Group 1 vs. 90.4% in Group 2, and 5-year survival was 52.8% in Group 1 vs. 70.5% in Group 2 (p = 0.002). Multivariate analysis indicated that recipient age (p = 0.001), renal replacement therapy (p = 0.001) and intraoperative ECMO support (p = 0.03) were significant risk factors for overall survival. The rate of postoperative early surgical complications was comparable between the two groups (p = 0.09). The number of patients requiring renal replacement therapy and experiencing late pulmonary complications was significantly higher in Group 1 (p = 0.02). CONCLUSIONS Our data showed that lung transplantation with intraoperative ECMO support is associated with poor outcomes.
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Affiliation(s)
- Tugba Cosgun
- Department of Thoracic Surgery, Zurich University Hospital, Zurich - Switzerland
| | - Sandra Tomaszek
- Department of Thoracic Surgery, Zurich University Hospital, Zurich - Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, Zurich University Hospital, Zurich - Switzerland
| | - Markus Wilhelm
- Department of Cardiovascular Surgery, Zurich University Hospital, Zurich - Switzerland
| | - Macé M Schuurmans
- Division of Respiratory Medicine, Zurich University Hospital, Zurich - Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, Zurich University Hospital, Zurich - Switzerland
| | - Ilhan Inci
- Department of Thoracic Surgery, Zurich University Hospital, Zurich - Switzerland
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Abstract
Pediatric lung transplantation has been undertaken since the 1980s, and it is today considered an accepted therapy option in carefully selected children with end-stage pulmonary diseases, providing carefully selected children a net survival benefit and improved health-related quality of life. Nowadays, >100 pediatric lung transplants are done worldwide every year. Here, specific pediatric aspects of lung transplantation are reviewed such as the surgical challenge, effects of immunosuppression on the developing pediatric immune system, and typical infections of childhood, as it is vital to comprehend that children undergoing lung transplants present a real challenge as children are not 'just small adults'. Further, an update on the management of the pediatric lung transplant patient is provided in this review, and future challenges outlined. Indications for lung transplantation in children are different compared to adults, the most common being cystic fibrosis (CF). However, the primary diagnoses leading to pediatric lung transplantation vary considerably by age group. Furthermore, there are regional differences regarding the primary indication for lung transplantation in children. Overall, early referral, careful patient selection and appropriate timing of listing are crucial to achieve real survival benefit. Although allograft function is to be preserved, immunosuppressant-related side effects are common in children post-transplantation. Strategies need to be put into practice to reduce drug-related side effects through careful therapeutic drug monitoring and lowering of target levels of immunosuppression, to avoid acute-reversible and chronic-irreversible renal damage. Instead of a "one fits all approach", tailored immunosuppression and a personalized therapy is to be advocated, particularly in children. Further, infectious complications are a common in children of all ages, accounting for almost 50% of death in the first year post-transplantation. However, chronic lung allograft dysfunction (CLAD) remains the major obstacle for improved long-term survival.
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Affiliation(s)
- Christian Benden
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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20
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Eberlein M, Reed RM, Chahla M, Bolukbas S, Blevins A, Van Raemdonck D, Stanzi A, Inci I, Marasco S, Shigemura N, Aigner C, Deuse T. Lobar lung transplantation from deceased donors: A systematic review. World J Transplant 2017; 7:70-80. [PMID: 28280698 PMCID: PMC5324031 DOI: 10.5500/wjt.v7.i1.70] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/12/2016] [Accepted: 12/28/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To systematically review reports on deceased-donor-lobar lung transplantation (ddLLTx) and uniformly describe size matching using the donor-to-recipient predicted-total lung-capacity (pTLC) ratio.
METHODS We set out to systematically review reports on ddLLTx and uniformly describe size matching using the donor-to-recipient pTLC ratio and to summarize reported one-year survival data of ddLLTx and conventional-LTx. We searched in PubMed, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley (CDSR), Database of Abstracts of Reviews of Effects via Wiley (DARE), Cochrane Central Register of Controlled Trials via Wiley (CENTRAL), Scopus (which includes EMBASE abstracts), and Web of Science for original reports on ddLLTx.
RESULTS Nine observational cohort studies reporting on 301 ddLLTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The ddLLTx-group was often characterized by high acuity; however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pTLC ratio was available for 242 ddLLTx (80%). The mean pTLCratio before lobar resection was 1.25 ± 0.3 and the transplanted pTLCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddLLTx-group ranged from 50%-100%, compared to 72%-88% in the conventional-LTx group. In the largest study ddLLTx (n = 138) was associated with a lower one-year-survival compared to conventional-LTx (n = 539) (65.1% vs 84.1%, P < 0.001).
CONCLUSION Further investigations of optimal donor-to-recipient size matching parameters for ddLLTx could improve outcomes of this important surgical option.
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Lung retransplantation in an adult 13 years after single lobar transplant in childhood. Gen Thorac Cardiovasc Surg 2017; 65:539-541. [DOI: 10.1007/s11748-016-0732-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
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22
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Mahesh B, Bhama JK, Odell DD, Hayanga AJ, Bermudez CA, Morrell MR, Crespo MM, Pilewski JM, Johnson BA, Luketich JD, D'Cunha J, Shigemura N. Surgical Strategy for Lung Transplantation in Adults With Small Chests: Lobar Transplant Versus a Pediatric Donor. Transplantation 2016; 100:2693-2698. [PMID: 26760568 DOI: 10.1097/tp.0000000000001048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Adult lung transplant recipients with small chests have traditionally received lungs from pediatric donors, placing an additional strain on the already restricted pediatric donor pool. Performing lobar lung transplantation (LLT) can circumvent issues with donor-recipient size mismatch; however, LLT imparts additional risks. Here, we review our experience using LLT and standard lung transplantation using a pediatric donor (PDLT) for adults with small chests. METHODS We retrospectively reviewed consecutive patients with end-stage lung disease and a height of 65 inches or less who underwent LLT (n = 15) or PDLT (n = 15) between 2006 and 2012 at our institution, a high-volume lung transplant center. RESULTS Lobar lung transplantation recipients were older (54 ± 10 vs 48 ± 8 years) and had higher pulmonary pressure (57 ± 11 vs 52 ± 27 mmHg) and higher lung allocation scores (70 ± 9 vs 51 ± 8) than PDLT recipients (all P < 0.05). Mean waiting time was 62 days for PDLT and 9 days for LLT. Postoperatively, the incidence of severe primary graft dysfunction and the incidence of acute renal insufficiency were higher, and the mean intensive care unit stay was longer in the LLT group, but the incidence of bronchial anastomotic complications was higher in the PDLT group because of significant size discrepancy in the main bronchus (P < 0.05). Interestingly, long-term functional outcomes and survival rates were similar between the groups. CONCLUSIONS Both LLT and PDLT are viable surgical options for adult patients with small chests. Because of the potential impact on posttransplant outcomes, the technical complexity of transplantation, decisions regarding the best surgical approach should be made by experienced surgeons.
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Affiliation(s)
- Balakrishnan Mahesh
- 1 Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.2 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
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23
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Schmid FA, Inci I, Bürgi U, Hillinger S, Schneiter D, Opitz I, Huber LC, Isenring BD, Jungraithmayr W, Schuurmans MM, Weder W, Benden C. Favorable outcome of children and adolescents undergoing lung transplantation at a European adult center in the new era. Pediatr Pulmonol 2016; 51:1222-1228. [PMID: 26773327 DOI: 10.1002/ppul.23383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/28/2015] [Accepted: 12/20/2015] [Indexed: 01/27/2023]
Abstract
Lung transplantation (LTx) is an accepted therapy in children with end-stage lung diseases. Pediatric-specific experience is considered important in pediatric LTx. We present our institutional experience and its outcome since the year 2000, asking whether different treatment strategies produce comparable outcomes in pediatric lung transplant recipients at our predominantly adult center. This is a retrospective analysis of children and adolescents aged ≤20 years, undergoing LTx between January 2001 and December 2013. Minimum follow-up was 12 months. Primary endpoints were re-transplantation or death. We performed 33 lung transplant procedures in 29 patients. Survival 1 month post-operatively was 96.6%, at 3 months 93.1% and at 12 months 82.8%, respectively. At the end of our follow up, 72.4% of our pediatric cohort was still alive - median post-transplant survival was 59 months (range 0-159). 72.4% of the children were transplanted with support of extracorporeal membrane oxygenation (ECMO), size-reduced donor grafts were used in 69.0%. The differences between post-transplant survival of the "non-ECMO-group" versus the "ECMO-group" (137 vs. 28 months, P=0.7) and "full size" versus "size-reduced bilateral transplants" (61 vs. 28 months, P = 0.7) were not significant, though. There were no anastomotic complications, also not in size-reduced lungs. Our results are well comparable to the international data and show excellent short- and mid-term outcomes. We advocate ECMO-bridge to be considered as a valuable treatment option to prolong time on the waiting list in highly selected patients, as well as size reduction and lobar transplants as a strong strategy to increase the donor pool and reduce donor-recipient size-mismatches. Pediatr Pulmonol. 2016;51:1222-1228. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Florian A Schmid
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Ilhan Inci
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Urs Bürgi
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland
| | - Sven Hillinger
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Didier Schneiter
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Lars C Huber
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland
| | - Bruno D Isenring
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland.
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Sabashnikov A, Zeriouh M, Mohite PN, Patil NP, García-Sáez D, Schmack B, Soresi S, Dohmen PM, Popov AF, Weymann A, Simon AR, De Robertis F. Moving Back to the Future: Use of Organ Care System Lung for Lobectomy Before Lobar Lung Transplantation. Med Sci Monit Basic Res 2016; 22:70-4. [PMID: 27425199 PMCID: PMC4955408 DOI: 10.12659/msmbr.900200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Lung transplantation remains the gold standard treatment for patients with end-stage lung disease. Lobar lung transplantation allows for transplantation of size-mismatch donor lungs in small recipients; however, donor lung volume reduction represents a challenging surgical technique. In this paper we present our initial experience with bilateral lobectomy in donor lungs before lobar lung transplantation using normothermic perfusion on the Organ Care System (OCS) Lung. MATERIAL AND METHODS Specifics of the surgical technique for donor lung instrumentation on the OCS, lobar dissection on the OCS, and right and left donor lobectomies are presented in detail. RESULTS Potential advantages of the use of the OCS for lobectomy for lobar lung transplantation are described in this section. Donor lung volume reduction utilizing OCS appeared to be easier and safer compared to the conventional cold storage technique, due to continuous perfusion of the lungs with blood and well-distended vessels that offer the feel of live lobectomy. Moreover, the OCS represents a platform for donor organ assessment and optimization of its function before transplantation. CONCLUSIONS Donor lung volume reduction was safe and feasible utilizing the OCS, which could be a useful tool for volume reduction in cases of size mismatch. Further research is needed to evaluate early and long-term results after lobar lung transplantation using the OCS in clinical studies.
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Affiliation(s)
- Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Mohamed Zeriouh
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Prashant N Mohite
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Nikhil P Patil
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Diana García-Sáez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Bastian Schmack
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Simona Soresi
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Pascal M Dohmen
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Alexander Weymann
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - André R Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
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Schmid FA, Benden C. Special considerations for the use of lung transplantation in pediatrics. Expert Rev Respir Med 2016; 10:655-62. [PMID: 26998955 DOI: 10.1586/17476348.2016.1168298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lung transplantation has become an accepted therapy in infants, children and adolescents suffering from end-stage lung diseases, an impaired quality of life as well as a reduced life expectancy. Within Europe, pediatric lung transplantation is largely performed in predominantly adult centers due to a relatively low overall case volume. Children do represent a specific and challenging cohort facing a transplant procedure, where the selection of potential candidates becomes a crucial step to maximize net survival benefit. Therefore, interdisciplinary evaluation and early listing in view of current indications and contraindications, adequate preoperative education of the child and family members, discussion of possibly required bridging procedures in case of deterioration, appropriate technical planning of the operation, adherence to postoperative medical treatment and follow-up are all crucial steps in this demanding puzzle. In this article, the authors review recent advances in the field of pediatric lung transplantation and outline challenges in the future.
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Affiliation(s)
- Florian A Schmid
- a Department of Surgery , University Hospital Zurich , Zurich , Switzerland
| | - Christian Benden
- b Division of Pulmonary Medicine , University Hospital Zurich , Zurich , Switzerland
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26
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Mangiameli G, Arame A, Boussaud V, Petitti T, Rivera C, Pricopi C, Badia A, Achouh P, Legras A, Guillemain R, Riquet M, Cholley B, Sermet I, Le Pimpec Barthes F. Lung transplantation in childhood and adolescence: unicentric 14-year experience with sex matching as the main prognosticator. Eur J Cardiothorac Surg 2016; 49:810-817. [DOI: 10.1093/ejcts/ezv243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Abstract
PURPOSE OF REVIEW The number of patients listed for lung transplantation largely exceeds the number of available transplantable organs because of a shortage of organ donors and a low utilization rate of lungs from those donors who are available. In recent years, novel strategies have been developed to increase the donor lung pool: improved donor management, the use of lungs from donations after cardiac death (DCD), the use of lobar lung living-donors (LLLD) and the use of ex-vivo lung perfusion (EVLP) to assess and repair injured donor lungs. RECENT FINDINGS An adapted donor management strategy could expand the donor pool up to 20%. DCD lung transplant is an increasing part of the donor pool expansion. Outcomes after controlled DCD seem to be similar to donation after brain death. LLLD transplantation has excellent results for small and critically ill patients. EVLP treatment allows for a significant increase in the rate of suitable lungs and represents an optimal platform for lung reconditioning and specific lung therapies. SUMMARY A significant increase in the number of available lungs for transplantation is expected in the future because of the wider use of lungs from controlled or uncontrolled DCD and LLLD lungs, and with organ-specific EVLP treatment strategies.
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28
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Luc JGY, Nagendran J. The evolving potential for pediatric ex vivo lung perfusion. Pediatr Transplant 2016; 20:13-22. [PMID: 26694514 DOI: 10.1111/petr.12653] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 11/28/2022]
Abstract
Despite the rise in the number of adult lung transplantations performed, rates of pediatric lung transplantation remain low. Lung transplantation is an accepted therapy for pediatric end-stage lung disease; however, it is limited by a shortage of donor organs. EVLP has emerged as a platform for assessment and preservation of donor lung function. EVLP has been adopted in adult lung transplantation and has successfully led to increased adult lung transplantations and donor lung utilization. We discuss the future implications of EVLP utilization, specifically, its potential evolving role in overcoming donor shortages in smaller children and adolescents to improve the quality and outcomes of lung transplantation in pediatric patients.
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Affiliation(s)
- Jessica G Y Luc
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.,Alberta Transplant Institute, Edmonton, AB, Canada.,Canadian National Transplant Research Program, Edmonton, AB, Canada
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Keeshan BC, Rossano JW, Beck N, Hammond R, Kreindler J, Spray TL, Fuller S, Goldfarb S. Lung transplant waitlist mortality: height as a predictor of poor outcomes. Pediatr Transplant 2015; 19:294-300. [PMID: 25406495 DOI: 10.1111/petr.12390] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2014] [Indexed: 12/27/2022]
Abstract
The LAS was designed to minimize pretransplant mortality while maximizing post-transplant outcome. Recipients <12 are not allocated lungs based on LAS. Waitlist mortality has decreased for those >12, but not <12, suggesting this population may be disadvantaged. To identify predictors of waitlist mortality, a retrospective analysis of the UNOS database was performed since implementation of the LAS. There were 16,973 patients listed for lung transplant in the United States; 12,070 (71.1%) were transplanted, and 2498 (14.7%) patients died or were removed from the wait list. Significantly more pediatric patients died or were removed compared with adults (22.0% vs. 14.4%, p < 0.01). In multivariate analysis, in addition to higher LAS at time of listing (adj. HR1.058, 1.055-1.060), shorter height (1.008, 1.006-1.010), male gender (1.210, 1.110-1.319), and requiring ECMO (1.613, 1.202-2.163) were associated with pretransplant mortality. Post-transplant survival was not affected by height. The current age cutoff may impose limitations within the current lung allocation system in the United States. Height is an independent predictor of waitlist mortality and may be a valuable factor for the development of a comprehensive lung allocation system.
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Affiliation(s)
- Britton C Keeshan
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Lynch JP, Sayah DM, Belperio JA, Weigt SS. Lung transplantation for cystic fibrosis: results, indications, complications, and controversies. Semin Respir Crit Care Med 2015; 36:299-320. [PMID: 25826595 PMCID: PMC4780574 DOI: 10.1055/s-0035-1547347] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Survival in patients with cystic fibrosis (CF) has improved dramatically over the past 30 to 40 years, with mean survival now approximately 40 years. Nonetheless, progressive respiratory insufficiency remains the major cause of mortality in CF patients, and lung transplantation (LT) is eventually required. Timing of listing for LT is critical, because up to 25 to 41% of CF patients have died while awaiting LT. Globally, approximately 16.4% of lung transplants are performed in adults with CF. Survival rates for LT recipients with CF are superior to other indications, yet LT is associated with substantial morbidity and mortality (∼50% at 5-year survival rates). Myriad complications of LT include allograft failure (acute or chronic), opportunistic infections, and complications of chronic immunosuppressive medications (including malignancy). Determining which patients are candidates for LT is difficult, and survival benefit remains uncertain. In this review, we discuss when LT should be considered, criteria for identifying candidates, contraindications to LT, results post-LT, and specific complications that may be associated with LT. Infectious complications that may complicate CF (particularly Burkholderia cepacia spp., opportunistic fungi, and nontuberculous mycobacteria) are discussed.
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Affiliation(s)
- Joseph P. Lynch
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David M. Sayah
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John A. Belperio
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
| | - S. Sam Weigt
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology and Allergy, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
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Abstract
PURPOSE OF REVIEW Every year, thousands of heart and lung transplants are performed worldwide. As experience and clinical acumen advance, both fields are continually evolving. This review elucidates and describes many of the recent changes in practice and future directions of heart and lung transplantation. Preoperative, intraoperative and postoperative developments are presented with supporting evidence in these continually evolving fields. RECENT FINDINGS The field of heart transplantation is continually adapting to the growing use of mechanical circulatory support devices as bridge to transplant and for postoperative support. Recent modifications in surgical technique have contributed to improved outcomes.Lung transplantation advancements include the increasing use of extracorporeal membrane oxygenation during the perioperative period. Lobar transplantation and ex-vivo lung perfusion techniques may aid in providing successful lung grafts to those with potentially long wait list times.Rates of rejection continue to decline in both fields as immunosuppression regimens are improved and modified. SUMMARY This review investigates and summarizes the recent changes and advancements in heart and lung transplantation. Mechanical circulatory support and extracorporeal membrane oxygenation are increasingly used in the perioperative setting, and continuing research will evaluate their safety profiles. Optimizing and tailoring immunosuppression regimens for transplant recipients continue to be the subject of ongoing investigation.
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Hayanga JWA, D'Cunha J. The surgical technique of bilateral sequential lung transplantation. J Thorac Dis 2014; 6:1063-9. [PMID: 25132973 DOI: 10.3978/j.issn.2072-1439.2014.07.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/19/2014] [Indexed: 11/14/2022]
Abstract
Since the first successful lung transplant performed three decades ago, the technique of lung transplantation has evolved with acceptable short- and long-term outcomes such that it has become the standard for those with end stage pulmonary disease. Herein, we describe our current favored approach and discuss some of the current areas in need of further investigation as they relate to the technical aspects of the operation.
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Affiliation(s)
- J W Awori Hayanga
- 1 Spectrum Health, Richards DeVos Heart & Lung Transplantation Program, Grand Rapids, MI, USA ; 2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan D'Cunha
- 1 Spectrum Health, Richards DeVos Heart & Lung Transplantation Program, Grand Rapids, MI, USA ; 2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Slama A, Ghanim B, Klikovits T, Scheed A, Hoda MA, Hoetzenecker K, Jaksch P, Matilla J, Taghavi S, Klepetko W, Aigner C. Lobar lung transplantation--is it comparable with standard lung transplantation? Transpl Int 2014; 27:909-16. [PMID: 24810771 DOI: 10.1111/tri.12348] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/17/2014] [Accepted: 05/05/2014] [Indexed: 01/05/2023]
Abstract
Lobar lung transplantation is used mainly for urgent small recipients who are less likely to obtain size matched lungs in due time. Only limited numbers have been published, and we herewith report the largest series of lobar-LuTX. We analyzed our LuTX database from 1/2001 to 12/2012 and compared the outcome of lobar-LuTX recipients with those receiving standard LuTX. Seven hundred and seventy-eighty LuTX (group 1) were performed either in standard technique by implanting the whole lungs (n = 539) or with downsizing by wedge resection of the right middle lobe and/or the left lingula (n = 239). One hundred and thirty-eight LuTX were performed in lobar technique (group 2) to overcome more pronounced size discrepancies. Patients in group 1 had a different spectrum of diagnoses and were less frequently bridged to LuTX (P < 0.001). Intubation time, ICU stay, and hospital stay were shorter in group 1 (P < 0.001). One-year survival was 84.8% vs. 65.1%, and 5-years survival 69.9% vs. 54.9% (P < 0.001). In multivariate analyzes, procedure, diagnosis, and pre-operative bridging were shown to be significant prognostic factors in survival. Early postoperative outcome in Lobar LuTX was significantly inferior to standard LuTX recipients. However, survival rates of successfully dismissed patients were comparable with standard LuTX (P = 0.168); thereby, Lobar-LuTX remains an important option in the management of urgent small recipients.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Yeginsu A, Kutlu C, Kalamanoğlu M, Taşçı A, Erdoğan B. First brain dead donor bilateral lobar lung transplant in Turkey. EXP CLIN TRANSPLANT 2014; 12:569-71. [PMID: 24844322 DOI: 10.6002/ect.2013.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 57-year-old woman with severe bilateral bronchiectasis was evaluated for lung transplant. She was 148 cm tall and weighed 46 kg. Her FEV(1) was 0.63 liters (32% of predicted). Her PAO(2) was 64.6 mm Hg, and her Pa(CO2) was 44 mm Hg. All of her cardiac functions were within normal ranges. Her mean pulmonary arterial pressure was 32 mm Hg. She had no infections and no other systemic diseases. She was psychologically well and eager to undergo the lung transplant. She underwent a bilateral brain dead donor lobar lung transplant. After the recipient pneumo-nectomies had been performed, bilateral lower lobes were implanted sequentially. She was given extracorporeal membrane support during the operation. Her postoperative course was uneventful. Chest drains were removed after 8 days. She went to the general ward on the fifth postoperative day, and was discharged on the 15th day. As of this writing, she has had no problems through the ninth month follow-up. To the best of our knowledge, she is the first case of successful bilateral brain dead donor lung transplant in our country.
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Affiliation(s)
- Ali Yeginsu
- From the Kartal Kosuyolu Yuksek Ihtisas Training and Research Hospital, Thoracic Surgery and Lung Transplantation Clinic, Kartal Koşuyolu Yüksek Ihtisas EAH, Kartal, Istanbul, Turkey
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Pérez-Carrión M, Baeza-Brotons F, Payá J, Saval JM, Zornoza E, Borrachero MV, Garcés P. Potential use of sewage sludge ash (SSA) as a cement replacement in precast concrete blocks. ACTA ACUST UNITED AC 2014. [DOI: 10.3989/mc.2014.06312] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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37
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Inci I, Weder W. Reply to Eberlein et al. Eur J Cardiothorac Surg 2013; 44:395-6. [PMID: 23423914 DOI: 10.1093/ejcts/ezt006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eberlein M, Bolukbas S, Reed RM. Bilateral lobar lung transplantation and size mismatch by pTLC-ratio. Eur J Cardiothorac Surg 2013; 44:394-5. [DOI: 10.1093/ejcts/ezt004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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