The Journal of thoracic and cardiovascular surgery · 2025
Impact of normothermic regional perfusion on ex vivo lung perfusion outcomes in donation after circulatory death lung donors.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Demarest Caitlin T, Zofkie Brandi Z, Popa Sam, Stokes John W, Messer Riley, von Kessler Kirby, Trindade Anil J, Schwarz Stefan, Sage Andrew, Zhou Elly, Kim Sumin, McInnis Micheal C, Keshavjee Shaf, Mallea Jorge, Bacchetta Matthew, Hoetzenecker Konrad
Аннотация
OBJECTIVES: Ex vivo lung perfusion (EVLP) is commonly used to assess extended-criteria donor lungs, particularly from donation after circulatory death (DCD) donors. Normothermic regional perfusion (NRP) is increasingly used in DCD procurement, but its impact on EVLP outcomes remains unclear.
METHODS: This study included 187 DCD lungs perfused between October 2021 and August 2024 at 2 centralized EVLP facilities. Donor demographics, EVLP characteristics, and radiographs obtained during EVLP were analyzed.
RESULTS: In total, 160 lungs were assessed by EVLP after rapid procurement; 13 of these were procured in the setting of an abdominal NRP protocol. In total, 23 DCD donor lungs underwent EVLP after thoracoabdominal (TA) NRP procurement. The primary indication for EVLP across the whole study cohort was DCD status (41%), followed by concerns about organ quality raised by the procurement team (34%), and low oxygen tension (12%). One lung from the TA-NRP group and 3 lungs from the rapid procurement group were not placed on EVLP upon arrival at the EVLP facility because of grossly abnormal appearance. Decline rates were 52% in the TA-NRP group and 50% in the rapid procurement group (P = .777). EVLP characteristics as well as radiographs were comparable across the 2 groups. In multivariate analysis, none of the available donor demographic factors or the indications for EVLP influenced EVLP outcomes. Notably, also TA-NRP was not a significant factor for EVLP conversion rates in multivariate analysis (odds ratio, 0.889; 0.338-2.339; P = .812).
CONCLUSIONS: This early experience suggests that EVLP can be safely performed after TA-NRP without increasing the risk of donor lung loss.
METHODS: This study included 187 DCD lungs perfused between October 2021 and August 2024 at 2 centralized EVLP facilities. Donor demographics, EVLP characteristics, and radiographs obtained during EVLP were analyzed.
RESULTS: In total, 160 lungs were assessed by EVLP after rapid procurement; 13 of these were procured in the setting of an abdominal NRP protocol. In total, 23 DCD donor lungs underwent EVLP after thoracoabdominal (TA) NRP procurement. The primary indication for EVLP across the whole study cohort was DCD status (41%), followed by concerns about organ quality raised by the procurement team (34%), and low oxygen tension (12%). One lung from the TA-NRP group and 3 lungs from the rapid procurement group were not placed on EVLP upon arrival at the EVLP facility because of grossly abnormal appearance. Decline rates were 52% in the TA-NRP group and 50% in the rapid procurement group (P = .777). EVLP characteristics as well as radiographs were comparable across the 2 groups. In multivariate analysis, none of the available donor demographic factors or the indications for EVLP influenced EVLP outcomes. Notably, also TA-NRP was not a significant factor for EVLP conversion rates in multivariate analysis (odds ratio, 0.889; 0.338-2.339; P = .812).
CONCLUSIONS: This early experience suggests that EVLP can be safely performed after TA-NRP without increasing the risk of donor lung loss.