Pub Date : 2024-07-15DOI: 10.1016/j.healun.2024.07.005
Daniel J Goldstein, Manreet Kanwar, Jennifer Cowger, Snehal Patel, Dan M Meyer, Ezequiel Molina, Christopher Salerno, Ashley Elmer, Sarah Schettle, Jeffrey Teuteberg, Francis Pagani, Josef Stehlik
While notable improvements in survival, the incidence of hemocompatibility-related adverse events, hospitalizations, and cost have been demonstrated with the only commercially available durable left ventricular assist device, a category of pump malfunctions characterized by outflow graft obstruction has been noted with broader use and clinical follow-up of recipients of this technology. Of particular concern is the accumulation of acellular biodebris between the outflow graft and bend relief covering the outflow graft at its origin with the pump (which we term extrinsic outflow graft obstruction at the bend relief). This process tends to be insidious, occurs late in the postoperative course, can be challenging to diagnose, and can result in significant morbidity and mortality. Herein, we provide a review of this complication and outline diagnostic, treatment, and preventive strategies.
{"title":"Extrinsic outflow graft obstruction of the HeartMate 3 LVAD: A state-of-the-art review.","authors":"Daniel J Goldstein, Manreet Kanwar, Jennifer Cowger, Snehal Patel, Dan M Meyer, Ezequiel Molina, Christopher Salerno, Ashley Elmer, Sarah Schettle, Jeffrey Teuteberg, Francis Pagani, Josef Stehlik","doi":"10.1016/j.healun.2024.07.005","DOIUrl":"10.1016/j.healun.2024.07.005","url":null,"abstract":"<p><p>While notable improvements in survival, the incidence of hemocompatibility-related adverse events, hospitalizations, and cost have been demonstrated with the only commercially available durable left ventricular assist device, a category of pump malfunctions characterized by outflow graft obstruction has been noted with broader use and clinical follow-up of recipients of this technology. Of particular concern is the accumulation of acellular biodebris between the outflow graft and bend relief covering the outflow graft at its origin with the pump (which we term extrinsic outflow graft obstruction at the bend relief). This process tends to be insidious, occurs late in the postoperative course, can be challenging to diagnose, and can result in significant morbidity and mortality. Herein, we provide a review of this complication and outline diagnostic, treatment, and preventive strategies.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-15DOI: 10.1016/j.healun.2024.07.003
Tatsuki Koyama, Zhiguo Zhao, John R Balmes, Carolyn S Calfee, Michael A Matthay, John P Reilly, Mary K Porteous, Joshua M Diamond, Jason D Christie, Edward Cantu, Lorraine B Ware
Background: Primary graft dysfunction (PGD) contributes substantially to both short- and long-term mortality after lung transplantation, but the mechanisms that lead to PGD are not well understood. Exposure to ambient air pollutants is associated with adverse events during waitlisting for lung transplantation and chronic lung allograft dysfunction, but its association with PGD has not been studied. We hypothesized that long-term exposure of the lung donor and recipient to high levels of ambient air pollutants would increase the risk of PGD in lung transplant recipients.
Methods: Using data from 1428 lung transplant recipients and their donors enrolled in the Lung Transplant Outcomes Group observational cohort study, we evaluated the association between the development of PGD and zip-code-based estimates of long-term exposure to 6 major air pollutants (ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, particulate matter 2.5, and particulate matter 10) in both the lung donor and the lung recipient. Exposure estimates used daily EPA air pollutant monitoring data and were based on the geographic centroid of each subject's residential zip code. Associations were tested in both univariable and multivariable models controlling for known PGD risk factors.
Results: We did not find strong associations between air pollutant exposures in either the donor or the recipient and PGD.
Conclusions: Exposure to ambient air pollutants, at the levels observed in this study, may not be sufficiently harmful to prime the donor lung or the recipient to develop PGD, particularly when considering the robust associations with other established PGD risk factors.
{"title":"Long-term air pollution exposure and the risk of primary graft dysfunction after lung transplantation.","authors":"Tatsuki Koyama, Zhiguo Zhao, John R Balmes, Carolyn S Calfee, Michael A Matthay, John P Reilly, Mary K Porteous, Joshua M Diamond, Jason D Christie, Edward Cantu, Lorraine B Ware","doi":"10.1016/j.healun.2024.07.003","DOIUrl":"10.1016/j.healun.2024.07.003","url":null,"abstract":"<p><strong>Background: </strong>Primary graft dysfunction (PGD) contributes substantially to both short- and long-term mortality after lung transplantation, but the mechanisms that lead to PGD are not well understood. Exposure to ambient air pollutants is associated with adverse events during waitlisting for lung transplantation and chronic lung allograft dysfunction, but its association with PGD has not been studied. We hypothesized that long-term exposure of the lung donor and recipient to high levels of ambient air pollutants would increase the risk of PGD in lung transplant recipients.</p><p><strong>Methods: </strong>Using data from 1428 lung transplant recipients and their donors enrolled in the Lung Transplant Outcomes Group observational cohort study, we evaluated the association between the development of PGD and zip-code-based estimates of long-term exposure to 6 major air pollutants (ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, particulate matter 2.5, and particulate matter 10) in both the lung donor and the lung recipient. Exposure estimates used daily EPA air pollutant monitoring data and were based on the geographic centroid of each subject's residential zip code. Associations were tested in both univariable and multivariable models controlling for known PGD risk factors.</p><p><strong>Results: </strong>We did not find strong associations between air pollutant exposures in either the donor or the recipient and PGD.</p><p><strong>Conclusions: </strong>Exposure to ambient air pollutants, at the levels observed in this study, may not be sufficiently harmful to prime the donor lung or the recipient to develop PGD, particularly when considering the robust associations with other established PGD risk factors.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-14DOI: 10.1016/j.healun.2024.07.004
Eva van Haren, Lukas K van Vugt, Nynke Wijbenga, Heleen van der Sijs, Merel E Hellemons
We present an exceptional case of a lung transplant recipient successfully treated by multiple courses of alemtuzumab for refractory acute cellular rejection (ACR). The patient experienced multiple episodes of ACR following the transplantation procedure. Alemtuzumab was initiated as a third-line rejection treatment and was repeated 6 times. Each treatment course resulted in complete recovery of the pulmonary function and depletion of T- and B-lymphocytes and natural killer cells (NK cells). The onset of rejection was consistently preceded by the recovery of NK cells, while T- and B-lymphocytes remained depleted. This suggests a rejection process mediated by NK cells. This case contributes to recent research findings suggesting that NK cells play a significant role in ACR in lung transplant recipients and stresses the importance to further investigate the role of NK cells in rejection. Furthermore, it demonstrates that ACR following lung transplantation can be repeatedly managed by treatment with alemtuzumab.
我们介绍了一例肺移植受者的特殊病例,患者因难治性急性细胞排斥反应接受了多个疗程的阿仑妥珠单抗治疗,并获得成功。患者在移植手术后经历了多次急性细胞排斥反应。阿来珠单抗被作为三线排斥治疗药物,并重复治疗了六次。每个疗程后,患者的肺功能完全恢复,T淋巴细胞、B淋巴细胞和NK细胞消耗殆尽。排异反应的发生始终先于 NK 细胞的恢复,而 T 淋巴细胞和 B 淋巴细胞仍在消耗。这表明排斥反应过程是由 NK 细胞介导的。最近的研究结果表明,NK细胞在肺移植受者的急性细胞排斥反应中起着重要作用,本病例有助于进一步研究NK细胞在排斥反应中的作用。此外,该病例还表明,肺移植术后的急性细胞排斥反应可通过阿利珠单抗治疗反复控制。数据可用性声明:作者确认文章中提供了支持该研究结果的数据。
{"title":"Recurrent treatment of refractory acute cellular rejection with alemtuzumab after lung transplantation.","authors":"Eva van Haren, Lukas K van Vugt, Nynke Wijbenga, Heleen van der Sijs, Merel E Hellemons","doi":"10.1016/j.healun.2024.07.004","DOIUrl":"10.1016/j.healun.2024.07.004","url":null,"abstract":"<p><p>We present an exceptional case of a lung transplant recipient successfully treated by multiple courses of alemtuzumab for refractory acute cellular rejection (ACR). The patient experienced multiple episodes of ACR following the transplantation procedure. Alemtuzumab was initiated as a third-line rejection treatment and was repeated 6 times. Each treatment course resulted in complete recovery of the pulmonary function and depletion of T- and B-lymphocytes and natural killer cells (NK cells). The onset of rejection was consistently preceded by the recovery of NK cells, while T- and B-lymphocytes remained depleted. This suggests a rejection process mediated by NK cells. This case contributes to recent research findings suggesting that NK cells play a significant role in ACR in lung transplant recipients and stresses the importance to further investigate the role of NK cells in rejection. Furthermore, it demonstrates that ACR following lung transplantation can be repeatedly managed by treatment with alemtuzumab.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-11DOI: 10.1016/S1053-2498(24)01718-2
{"title":"Information for Readers","authors":"","doi":"10.1016/S1053-2498(24)01718-2","DOIUrl":"https://doi.org/10.1016/S1053-2498(24)01718-2","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-08DOI: 10.1016/j.healun.2024.07.001
{"title":"Of rivers, recipients and rejection: Revelations from deep immune phenotyping of lung allograft transbronchial biopsy tissue","authors":"","doi":"10.1016/j.healun.2024.07.001","DOIUrl":"10.1016/j.healun.2024.07.001","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053249824017315/pdfft?md5=7171635db5a81e070571c8ba264628be&pid=1-s2.0-S1053249824017315-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-05DOI: 10.1016/j.healun.2024.06.016
{"title":"Balloon pulmonary angioplasty: Not quite the fountain of youth in chronic thromboembolic pulmonary hypertension","authors":"","doi":"10.1016/j.healun.2024.06.016","DOIUrl":"10.1016/j.healun.2024.06.016","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.healun.2024.06.017
{"title":"Pediatric lung transplantation: A new landscape following the height of the COVID-19 pandemic","authors":"","doi":"10.1016/j.healun.2024.06.017","DOIUrl":"10.1016/j.healun.2024.06.017","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-29DOI: 10.1016/j.healun.2024.06.014
Background
Prior studies have shown reduced development of cardiac allograft vasculopathy (CAV) in multiorgan transplant recipients. The aim of this study was to compare the incidence of CAV between isolated heart transplants and simultaneous multiorgan heart transplants in the contemporary era.
Methods
We utilized the Scientific Registry of Transplant Recipients to perform a retrospective analysis of first-time adult heart transplant recipients between January 1, 2010 and December 31, 2019 in the United States. The primary end-point was the development of angiographic CAV within 5 years of follow-up.
Results
Among 20,591 patients included in the analysis, 1,279 (6%) underwent multiorgan heart transplantation (70% heart-kidney, 16% heart-liver, 13% heart-lung, and 1% triple-organ), and 19,312 (94%) were isolated heart transplant recipients. The average age was 53 years, and 74% were male. There were no significant between-group differences in cold ischemic time. The incidence of acute rejection during the first year after transplant was significantly lower in the multiorgan group (18% vs 33%, p < 0.01). The 5-year incidence of CAV was 33% in the isolated heart group and 27% in the multiorgan group (p < 0.0001); differences in CAV incidence were seen as early as 1 year after transplant and persisted over time. In multivariable analysis, multiorgan heart transplant recipients had a significantly lower likelihood of CAV at 5 years (hazard ratio = 0.76, 95% confidence interval: 0.66-0.88, p < 0.01).
Conclusions
Simultaneous multiorgan heart transplantation is associated with a significantly lower long-term risk of angiographic CAV compared with isolated heart transplantation in the contemporary era.
{"title":"Comparison of cardiac allograft vasculopathy incidence between simultaneous multiorgan and isolated heart transplant recipients in the United States","authors":"","doi":"10.1016/j.healun.2024.06.014","DOIUrl":"10.1016/j.healun.2024.06.014","url":null,"abstract":"<div><h3>Background</h3><p>Prior studies have shown reduced development of cardiac allograft vasculopathy (CAV) in multiorgan transplant recipients. The aim of this study was to compare the incidence of CAV between isolated heart transplants and simultaneous multiorgan heart transplants in the contemporary era.</p></div><div><h3>Methods</h3><p>We utilized the Scientific Registry of Transplant Recipients to perform a retrospective analysis of first-time adult heart transplant recipients between January 1, 2010 and December 31, 2019 in the United States. The primary end-point was the development of angiographic CAV within 5 years of follow-up.</p></div><div><h3>Results</h3><p>Among 20,591 patients included in the analysis, 1,279 (6%) underwent multiorgan heart transplantation (70% heart-kidney, 16% heart-liver, 13% heart-lung, and 1% triple-organ), and 19,312 (94%) were isolated heart transplant recipients. The average age was 53 years, and 74% were male. There were no significant between-group differences in cold ischemic time. The incidence of acute rejection during the first year after transplant was significantly lower in the multiorgan group (18% vs 33%, <em>p</em> < 0.01). The 5-year incidence of CAV was 33% in the isolated heart group and 27% in the multiorgan group (<em>p</em> < 0.0001); differences in CAV incidence were seen as early as 1 year after transplant and persisted over time. In multivariable analysis, multiorgan heart transplant recipients had a significantly lower likelihood of CAV at 5 years (hazard ratio = 0.76, 95% confidence interval: 0.66-0.88, <em>p</em> < 0.01).</p></div><div><h3>Conclusions</h3><p>Simultaneous multiorgan heart transplantation is associated with a significantly lower long-term risk of angiographic CAV compared with isolated heart transplantation in the contemporary era.</p></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053249824017066/pdfft?md5=1b8cc9374d7670161d737d42997e2340&pid=1-s2.0-S1053249824017066-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-28DOI: 10.1016/j.healun.2024.06.015
Background
In 2016, we initiated a quality improvement endeavor to increase pediatric heart offer acceptance. This study assessed the effect of these interventions at our center.
Methods
We evaluted pre- and postimplementation cohorts (January 1, 2008-December 31, 2016 vs January 1, 2017-July 1, 2023) comparing donor heart utilization. Six interventions were iterated over time to increase offer acceptance (“extended criteria”): ABO-incompatible transplant, ex vivo perfusion for distanced donors, 3-dimensional total cardiac volume (TCV) assessment, acceptance of hepatitis-C or Severe Acute Respiratory Syndrome Coronavirus 2 infected donors, and institutional culture change favoring consideration of donors previously considered unacceptable. Outcomes studied included annual HT volume, median waitlist duration, sequence number at acceptance, and post-transplant clinical outcomes.
Results
During the study period, annual transplant volume increased from 16/year to 25/year pre- and postimplementation. Three hundred thirteen of 389 (80%) listed patients were transplanted. Waitlist duration shortened postimplementation (p = 0.01), as did the percentage of accepted heart offers utilizing at least 1 extended criterion (p < 0.001). Institutional culture change and TCV assessment had the largest impact on donor heart utilization (p = 0.04 and p < 0.001). There was no difference in post-HT intubation or intensive care unit days (p = 0.05-0.9), though post-transplant hospitalization duration (p < 0.001) increased. Post-transplant survival was unaffected by the use of extended criteria hearts (p = 0.3).
Conclusions
We report a successful longitudinal, multifaceted effort to increase organ offer utilization, with institutional culture change and TCV assessments most impactful. The use of extended criteria hearts was not associated with inferior survival.
{"title":"A comprehensive, multifaceted strategy to increase pediatric donor heart utilization","authors":"","doi":"10.1016/j.healun.2024.06.015","DOIUrl":"10.1016/j.healun.2024.06.015","url":null,"abstract":"<div><h3>Background</h3><p>In 2016, we initiated a quality improvement endeavor to increase pediatric heart offer acceptance. This study assessed the effect of these interventions at our center.</p></div><div><h3>Methods</h3><p><span>We evaluted pre- and postimplementation cohorts (January 1, 2008-December 31, 2016 vs January 1, 2017-July 1, 2023) comparing donor heart utilization. Six interventions were iterated over time to increase offer acceptance (“extended criteria”): ABO-incompatible transplant, ex vivo perfusion for distanced donors, 3-dimensional total </span>cardiac volume<span> (TCV) assessment, acceptance of hepatitis-C or Severe Acute Respiratory Syndrome Coronavirus 2<span> infected donors, and institutional culture change favoring consideration of donors previously considered unacceptable. Outcomes studied included annual HT volume, median waitlist duration, sequence number at acceptance, and post-transplant clinical outcomes.</span></span></p></div><div><h3>Results</h3><p>During the study period, annual transplant volume increased from 16/year to 25/year pre- and postimplementation. Three hundred thirteen of 389 (80%) listed patients were transplanted. Waitlist duration shortened postimplementation (<em>p</em> = 0.01), as did the percentage of accepted heart offers utilizing at least 1 extended criterion (<em>p</em> < 0.001). Institutional culture change and TCV assessment had the largest impact on donor heart utilization (<em>p</em> = 0.04 and <em>p</em><span> < 0.001). There was no difference in post-HT intubation<span> or intensive care unit days (</span></span><em>p</em> = 0.05-0.9), though post-transplant hospitalization duration (<em>p</em> < 0.001) increased. Post-transplant survival was unaffected by the use of extended criteria hearts (<em>p</em> = 0.3).</p></div><div><h3>Conclusions</h3><p>We report a successful longitudinal, multifaceted effort to increase organ offer utilization, with institutional culture change and TCV assessments most impactful. The use of extended criteria hearts was not associated with inferior survival.</p></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-27DOI: 10.1016/j.healun.2024.06.013
Ichiro Sakanoue, Toshihiro Okamoto, Kamal S Ayyat, James J Yun, Abdel Moneim Tantawi, Kenneth R McCurry
Background: Real-time lung weight (LW) measurement is a simple and noninvasive technique for detecting extravascular lung water during ex vivo lung perfusion (EVLP). We investigated the feasibility of real-time LW measurement in clinical EVLP as a predictor of transplant suitability and post-transplant outcomes.
Methods: In our clinical acellular EVLP protocol, real-time LW was measured in 117 EVLP cases from June 2019 to June 2022. The estimated LW gain at each time point was calculated using a scale placed under the organ chamber. The lungs were classified into 4 categories based on LW adjusted for height and compared between suitable and unsuitable cases. The relationship between estimated LW gain and primary graft dysfunction was also investigated.
Results: The estimated LW gain during the EVLP significantly correlated with the LW gain (post-EVLP LW and pre-EVLP LW) measured on the back table (R2 = 0.61, p < 0.01). In the adjusted LW categories 2 to 4, the estimated LW gain at 0-1 hour after EVLP was significantly higher in unsuitable cases than in suitable cases. The area under the curve for the estimated LW gain was ≥0.80. Primary graft dysfunction grades 0 to 1 had a significantly lower estimated LW gain at 60 minutes than grades 2 to 3 (-43 vs 1 g, p < 0.01).
Conclusions: Real-time lung measurements can predict transplant suitability and post-transplant outcomes by the early detection of extravascular lung water during the initial 1 hour of EVLP.
{"title":"Real-time lung weight measurement during clinical ex vivo lung perfusion.","authors":"Ichiro Sakanoue, Toshihiro Okamoto, Kamal S Ayyat, James J Yun, Abdel Moneim Tantawi, Kenneth R McCurry","doi":"10.1016/j.healun.2024.06.013","DOIUrl":"10.1016/j.healun.2024.06.013","url":null,"abstract":"<p><strong>Background: </strong>Real-time lung weight (LW) measurement is a simple and noninvasive technique for detecting extravascular lung water during ex vivo lung perfusion (EVLP). We investigated the feasibility of real-time LW measurement in clinical EVLP as a predictor of transplant suitability and post-transplant outcomes.</p><p><strong>Methods: </strong>In our clinical acellular EVLP protocol, real-time LW was measured in 117 EVLP cases from June 2019 to June 2022. The estimated LW gain at each time point was calculated using a scale placed under the organ chamber. The lungs were classified into 4 categories based on LW adjusted for height and compared between suitable and unsuitable cases. The relationship between estimated LW gain and primary graft dysfunction was also investigated.</p><p><strong>Results: </strong>The estimated LW gain during the EVLP significantly correlated with the LW gain (post-EVLP LW and pre-EVLP LW) measured on the back table (R<sup>2</sup> = 0.61, p < 0.01). In the adjusted LW categories 2 to 4, the estimated LW gain at 0-1 hour after EVLP was significantly higher in unsuitable cases than in suitable cases. The area under the curve for the estimated LW gain was ≥0.80. Primary graft dysfunction grades 0 to 1 had a significantly lower estimated LW gain at 60 minutes than grades 2 to 3 (-43 vs 1 g, p < 0.01).</p><p><strong>Conclusions: </strong>Real-time lung measurements can predict transplant suitability and post-transplant outcomes by the early detection of extravascular lung water during the initial 1 hour of EVLP.</p>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}