Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experienceCentral MessagePerspective
Objective: Donation after circulatory death (DCD) procurement and transplantation after thoracoabdominal normothermic regional perfusion (TA-NRP) remains a novel technique to improve cardiac and hepatic allograft preservation but may be complicated by lung allograft pulmonary edema. We present a sin...
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Elsevier
2023-12-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723003747 |
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| author | Michael T. Cain, MD Sarah Y. Park, MD Michal Schäfer, MD, PhD Emily Hay-Arthur, BA George A. Justison, CCP Qui Peng Zhan, MD, PhD David Campbell, MD John D. Mitchell, MD Simran K. Randhawa, MD Robert A. Meguid, MD Elizabeth A. David, MD T. Brett Reece, MD, MBA Joseph C. Cleveland, Jr, MD Jordan R.H. Hoffman, MD, MPH |
| author_facet | Michael T. Cain, MD Sarah Y. Park, MD Michal Schäfer, MD, PhD Emily Hay-Arthur, BA George A. Justison, CCP Qui Peng Zhan, MD, PhD David Campbell, MD John D. Mitchell, MD Simran K. Randhawa, MD Robert A. Meguid, MD Elizabeth A. David, MD T. Brett Reece, MD, MBA Joseph C. Cleveland, Jr, MD Jordan R.H. Hoffman, MD, MPH |
| author_sort | Michael T. Cain, MD |
| collection | DOAJ |
| description | Objective: Donation after circulatory death (DCD) procurement and transplantation after thoracoabdominal normothermic regional perfusion (TA-NRP) remains a novel technique to improve cardiac and hepatic allograft preservation but may be complicated by lung allograft pulmonary edema. We present a single-center series on early implementation of a lung-protective protocol with strategies to mitigate posttransplant pulmonary edema in DCD lung allografts after TA-NRP procurement. Methods: Data from all lung transplantations performed using a TA-NRP procurement strategy from October 2022 to April 2023 are presented. Donor management consisted of key factors to reduce lung allograft pulmonary edema: aggressive predonation and early posttransplant diuresis, complete venous drainage at TA-NRP initiation, and early pulmonary artery venting upon initiation of systemic perfusion. Donor and recipient characteristics, procurement characteristics such as TA-NRP intervals, and 30-day postoperative outcomes were assessed. Results: During the study period, 8 lung transplants were performed utilizing TA-NRP procurement from DCD donors. Donor ages ranged from 16 to 39 years and extubation time to declaration of death ranged from 10 to 90 minutes. Time from declaration to TA-NRP initiation was 7 to 17 minutes with TA-NRP perfusion times of 49 to 111 minutes. Median left and right allograft warm ischemia times were 55.5 minutes (interquartile range, 46.5-67.5 minutes) and 41.0 minutes (interquartile range, 39.0-53.0 minutes, respectively, with 2 recipients supported with cardiopulmonary bypass or venoarterial extracorporeal membrane oxygenation during implantation. No postoperative extracorporeal membrane oxygenation was required. There were no pulmonary-related deaths; however, 1 patient died from complications of severe necrotizing pancreatitis with a normal functioning allograft. All patients were extubated within 24 hours. Index intensive care unit length of stay ranged from 3 to 11 days with a hospital length of stay of 13 to 37 days. Conclusions: Despite concern regarding quality of DCD lung allografts recovered using the TA-NRP technique, we report initial success using this procurement method. Implementation of strategies to mitigate pulmonary edema can result in acceptable outcomes following lung transplantation. Demonstration of short- and long-term safety and efficacy of this technique will become increasingly important as the use of TA-NRP for thoracic and abdominal allografts in DCD donors expands. |
| format | Article |
| id | doaj-art-93163bfab1f74d0bb55dad68bd67fc21 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-93163bfab1f74d0bb55dad68bd67fc212025-08-20T03:36:42ZengElsevierJTCVS Techniques2666-25072023-12-012235035810.1016/j.xjtc.2023.09.027Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experienceCentral MessagePerspectiveMichael T. Cain, MD0Sarah Y. Park, MD1Michal Schäfer, MD, PhD2Emily Hay-Arthur, BA3George A. Justison, CCP4Qui Peng Zhan, MD, PhD5David Campbell, MD6John D. Mitchell, MD7Simran K. Randhawa, MD8Robert A. Meguid, MD9Elizabeth A. David, MD10T. Brett Reece, MD, MBA11Joseph C. Cleveland, Jr, MD12Jordan R.H. Hoffman, MD, MPH13Address for reprints: Michael T. Cain, MD, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO 80045-2560.; Division of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoDivision of Cardiothoracic Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, ColoObjective: Donation after circulatory death (DCD) procurement and transplantation after thoracoabdominal normothermic regional perfusion (TA-NRP) remains a novel technique to improve cardiac and hepatic allograft preservation but may be complicated by lung allograft pulmonary edema. We present a single-center series on early implementation of a lung-protective protocol with strategies to mitigate posttransplant pulmonary edema in DCD lung allografts after TA-NRP procurement. Methods: Data from all lung transplantations performed using a TA-NRP procurement strategy from October 2022 to April 2023 are presented. Donor management consisted of key factors to reduce lung allograft pulmonary edema: aggressive predonation and early posttransplant diuresis, complete venous drainage at TA-NRP initiation, and early pulmonary artery venting upon initiation of systemic perfusion. Donor and recipient characteristics, procurement characteristics such as TA-NRP intervals, and 30-day postoperative outcomes were assessed. Results: During the study period, 8 lung transplants were performed utilizing TA-NRP procurement from DCD donors. Donor ages ranged from 16 to 39 years and extubation time to declaration of death ranged from 10 to 90 minutes. Time from declaration to TA-NRP initiation was 7 to 17 minutes with TA-NRP perfusion times of 49 to 111 minutes. Median left and right allograft warm ischemia times were 55.5 minutes (interquartile range, 46.5-67.5 minutes) and 41.0 minutes (interquartile range, 39.0-53.0 minutes, respectively, with 2 recipients supported with cardiopulmonary bypass or venoarterial extracorporeal membrane oxygenation during implantation. No postoperative extracorporeal membrane oxygenation was required. There were no pulmonary-related deaths; however, 1 patient died from complications of severe necrotizing pancreatitis with a normal functioning allograft. All patients were extubated within 24 hours. Index intensive care unit length of stay ranged from 3 to 11 days with a hospital length of stay of 13 to 37 days. Conclusions: Despite concern regarding quality of DCD lung allografts recovered using the TA-NRP technique, we report initial success using this procurement method. Implementation of strategies to mitigate pulmonary edema can result in acceptable outcomes following lung transplantation. Demonstration of short- and long-term safety and efficacy of this technique will become increasingly important as the use of TA-NRP for thoracic and abdominal allografts in DCD donors expands.http://www.sciencedirect.com/science/article/pii/S2666250723003747thoracoabdominal normothermic regional perfusiondonation after circulatory deathlung transplantation |
| spellingShingle | Michael T. Cain, MD Sarah Y. Park, MD Michal Schäfer, MD, PhD Emily Hay-Arthur, BA George A. Justison, CCP Qui Peng Zhan, MD, PhD David Campbell, MD John D. Mitchell, MD Simran K. Randhawa, MD Robert A. Meguid, MD Elizabeth A. David, MD T. Brett Reece, MD, MBA Joseph C. Cleveland, Jr, MD Jordan R.H. Hoffman, MD, MPH Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experienceCentral MessagePerspective JTCVS Techniques thoracoabdominal normothermic regional perfusion donation after circulatory death lung transplantation |
| title | Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experienceCentral MessagePerspective |
| title_full | Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experienceCentral MessagePerspective |
| title_fullStr | Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experienceCentral MessagePerspective |
| title_full_unstemmed | Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experienceCentral MessagePerspective |
| title_short | Lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death: The Colorado experienceCentral MessagePerspective |
| title_sort | lung recovery utilizing thoracoabdominal normothermic regional perfusion during donation after circulatory death the colorado experiencecentral messageperspective |
| topic | thoracoabdominal normothermic regional perfusion donation after circulatory death lung transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723003747 |
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