Eduardo Miñambres1, Elisabeth Coll2, Jorge Duerto3, Borja Suberviola3, Roberto Mons4, José Manuel Cifrian5, Maria Angeles Ballesteros3. 1. Service of Intensive Care, University Hospital Marqués de Valdecilla-Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Spain; Transplant Coordination Unit, University Hospital Marqués de Valdecilla-Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Spain. Electronic address: eminambres@yahoo.es. 2. Organización Nacional de Trasplantes, Madrid, Spain. 3. Service of Intensive Care, University Hospital Marqués de Valdecilla-Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Spain. 4. Service of Thoracic Surgery, University Hospital Marqués de Valdecilla-Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Spain. 5. Service of Respiratory, University Hospital Marqués de Valdecilla-Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Spain.
Abstract
BACKGROUND: An intensive lung donor-management protocol based on a strict protocol would increase the lung procurement rate. The aim of this study was to determine the effect of such a protocol on the rate of lung grafts available for transplant. METHODS: A lung-management protocol for donors after brain death (DBD) was implemented in 2009. Lung donors from 2009 to 2011 were the prospective cohort, and those from 2003 to 2008 formed the historical control. We analyzed the synergic effect of several measures, such as protective ventilation, ventilator recruitment maneuvers, high positive end-expiratory pressure, fluid restriction with reduced extravascular lung water values, and hormonal resuscitation therapy in multiorgan DBD. The number of lungs available for transplantation was the main outcome measure. For recipients, early survival and the rate of primary graft dysfunction (PGD) grade 3 were the main outcome measures. RESULTS: The DBD rate was more than 40 donors per 1 million population in both periods. The rate of lung donors increased from 20.1% to 50% (p < 0.001), quadrupling the number of lung donors (p < 0.001), grafts retrieved (p = 0.02), and patients who received a lung transplant (p < 0.01). No differences were observed in the survival of early recipients (p = 0.203) or in the rate of PGD grade 3 (p = 0.835). CONCLUSION: The management of multiorgan DBDs should be approached as a global treatment requiring attentive bedside management. Implementing an intensive lung donor-management protocol based on synergic measures increases lung procurement rates, negative effect on early survival of lung recipients or PGD grade 3.
BACKGROUND: An intensive lung donor-management protocol based on a strict protocol would increase the lung procurement rate. The aim of this study was to determine the effect of such a protocol on the rate of lung grafts available for transplant. METHODS: A lung-management protocol for donors after brain death (DBD) was implemented in 2009. Lung donors from 2009 to 2011 were the prospective cohort, and those from 2003 to 2008 formed the historical control. We analyzed the synergic effect of several measures, such as protective ventilation, ventilator recruitment maneuvers, high positive end-expiratory pressure, fluid restriction with reduced extravascular lung water values, and hormonal resuscitation therapy in multiorgan DBD. The number of lungs available for transplantation was the main outcome measure. For recipients, early survival and the rate of primary graft dysfunction (PGD) grade 3 were the main outcome measures. RESULTS: The DBD rate was more than 40 donors per 1 million population in both periods. The rate of lung donors increased from 20.1% to 50% (p < 0.001), quadrupling the number of lung donors (p < 0.001), grafts retrieved (p = 0.02), and patients who received a lung transplant (p < 0.01). No differences were observed in the survival of early recipients (p = 0.203) or in the rate of PGD grade 3 (p = 0.835). CONCLUSION: The management of multiorgan DBDs should be approached as a global treatment requiring attentive bedside management. Implementing an intensive lung donor-management protocol based on synergic measures increases lung procurement rates, negative effect on early survival of lung recipients or PGD grade 3.
Authors: Glauco A Westphal; Elisabeth Coll; Rafael L de Souza; Silvana Wagner; Artur Montemezzo; Fernanda Carolina Cani de Souza; Gabriel Torres; Stefan Halla; Tiago C Carnin; Míriam C Machado; Eduardo Berbigier; Fernando Busetto; Ivonei Bittencourt; Karine Gerent; Bruno S de Souza; Manoel Tassinari; Joel de Andrade Journal: Crit Care Date: 2016-10-11 Impact factor: 9.097
Authors: Samantha E Halpern; Oliver K Jawitz; Vignesh Raman; Ashley Y Choi; John C Haney; Jacob A Klapper; Matthew G Hartwig Journal: Clin Transplant Date: 2021-07-14 Impact factor: 3.456