A donor PaO2/FiO2 < 300 mm Hg does not determine graft function or survival after lung transplantation
A donor arterial PO2/FiO2 (P/F ratio) of less than the 300 threshold would frequently result in either exclusion of the donor or placement of the lungs on ex vivo lung perfusion (EVLP). The aim was to investigate the veracity of the P/F ratio threshold of 300 for donor lung acceptability.
Current ex vivo lung perfusion (EVLP) protocols aim to achieve perfusion flows of 40% of cardiac output or more. We hypothesized that a lower target flow rate during EVLP would improve graft function and decrease inflammation of donation after circulatory death (DCD) lungs.
We present two cases of circulatory death donor (DCD) hearts recovered using NMP.
A donor arterial PO2/FiO2 (P/F ratio) less than the 300 threshold would frequently result in either exclusion of the donor or placement of the lungs on ex-vivo lung perfusion (EVLP). The aim was to investigate the veracity of the P/F ratio threshold of 300 for donor lung acceptability.
Heart Transplantation (HT) from donation after circulatory death (DCD) is a promising alternative to expand the heart donor pool. Cold storage can be used in a strategy to successfully retrieve and transplant DCD hearts after reconditioning using normothermic regional perfusion for distant procurement. Herein, we present the first report of a pediatric DCD heart reconditioned with normothermic regional perfusion, preserved using only cold storage while being transported to a neighboring center, and then successfully transplanted after nearly 2 hours of cold static storage.
The field of heart transplantation continues to evolve, with major changes in allocation systems, and increasing use of extended-criteria donor hearts, including hearts from donation after circulatory death (DCD) donors, hearts supported with ex-vivo perfusion, and hearts from hepatitis C viremic donors. Use of such non-traditional donor hearts has made transplantation available to a larger number of recipients, but the demand continues to outpace the supply. Given this persistent donor heart shortage, much attention has been given to the topic of donor-recipient size matching.
Publication date: Available online 1 August 2019Source: The Lancet Respiratory MedicineAuthor(s): Gabriel Loor, Gregor Warnecke, Mauricio A Villavicencio, Michael A Smith, Jasleen Kukreja, Abbas Ardehali, Matthew Hartwig, Mani A Daneshmand, Marshall I Hertz, Stephen Huddleston, Axel Haverich, Joren C Madsen, Dirk Van RaemdonckSummaryBackgroundDonor lung use for transplantation is the lowest among solid organ tranplants because of several complex and multifactorial reasons; one area that could have a substantial role is the limited capabilities of cold ischaemic storage. The aim of the EXPAND trial was to evaluate the effic...
Abstract BACKGROUND: Thrombocytopenia is a common disorder after heart or lung transplantation. Platelet transfusion is often required to maintain haemostasis but represents a specific cause of morbidity and mortality in this setting including alloimmunisation and graft rejection. STUDY DESIGN AND METHODS: As part of a health-care quality improvement project, in a single-centre before-after pilot study, the relevance of a platelet transfusion saving strategy based on romiplostim administration after transplantation was assessed in patients with platelet count
The application of mesenchymal stromal cell (MSC)-based therapy during ex vivo lung perfusion (EVLP) could repair injured donor lungs prior to transplantation. The aim of this study was to determine the efficacy of MSC therapy performed during EVLP on ischemia-reperfusion injury using a pig lung transplant model.
In this study, we identify a link between members of the genus Veillonella and exercise performance. We observed an increase in Veillonella relative abundance in marathon runners postmarathon and isolated a strain of Veillonella atypica from stool samples. Inoculation of this strain into mice significantly increased exhaustive treadmill run time. Veillonella utilize lactate as their sole carbon source, which prompted us to perform a shotgun metagenomic analysis in a cohort of elite athletes, finding that every gene in a major pathway metabolizing lactate to propionate is at higher relative abundance postexercise. Us...
In this study we describe 2 cases of successful adult DCD HT performed at our institution using an original protocol.