ABSTRACT
During the novel coronavirus pneumonia (COVID-19) pandemic from 2020 to 2021, lung transplantation entered a new stage of development worldwide. Globally, more than 70 000 cases of lung transplantation have been reported to the International Society for Heart and Lung Transplantation (ISHLT). With the development of medical techniques over time, the characteristics of lung transplant donors and recipients and the indications of pediatric lung transplantation recipients have undergone significant changes. Application of lung transplantation in the treatment of COVID-19-related acute respiratory distress syndrome (ARDS) has also captivated worldwide attention. Along with persistent development of lung transplantation, it will be integrated with more novel techniques to make breakthroughs in the fields of artificial lung and xenotransplantation. In this article, research progresses on the characteristics of lung transplant donors and recipients around the world were reviewed and the development trend was predicted, enabling patients with end-stage lung disease to obtain more benefits from the development of lung transplantation technique.Copyright © 2022 Organ Transplantation. All rights reserved.
ABSTRACT
Lung transplantation has been advanced for nearly half a century around the globe, and it has been developed rapidly for over 20 years in China. The field of lung transplantation in China has been gradually integrated into the international community. The outbreak of novel coronavirus pneumonia (COVID-19) in 2020 brought big challenges, as well as diverted the worldwide attention to the development of lung transplantation in China, accelerating international communication and cooperation. With the steadily deepening of clinical and basic research on lung transplantation for severe cases of COVID-19, organ transplant physicians have deepened the understanding and thinking of the maintenance of donors, selection of elderly and pediatric candidates, and perioperative management of recipients, as the future perspective of lung transplantation in China. For interdisciplinary research related to lung transplantation, it is necessary to carry out multi-center clinical trials with qualified study design and constantly promote the theoretic and practical innovation.Copyright © 2021 The authors.
ABSTRACT
Background: Ex vivo lung perfusion (EVLP) is a safe and effective technique for lung evaluation and reconditioning of marginal donor lungs (DLs). The assessment of the DLs during EVLP is crucial for the transplantability decision making. There are a limited number of studies regarding the radiographic analysis of EVLP lungs. Furthermore, there are only few Xray grading scores available. The Brixia score is a proven radiological score for the severity grading of lung abnormalities with confirmed predictive power of the clinical outcome that was successfully used in pneumonia patients during the COVID-19 pandemic. It was the aim of our study to evaluate the X-ray findings of DLs within EVLP and investigate the prognostic potential of this score regarding transplantability and clinical outcome. Method(s): This is a retrospective observational pilot study. Between 2016 and 2022, a total of 277 double-lung transplantations (DLTx) were performed in our department. X-Rays of the last ten consecutive EVLP-DLs were blindly evaluated regarding the severity of interstitial and alveolar infiltrates and the Brixia score was calculated. Furthermore, the results (transplantability, severe primary graft dysfunction PGD, survival, hospital stay) and EVLP parameters (delta pO2) of these EVLP-DLs cases were analyzed and compared with the Brixia score for each case. Result(s): A range of Brixia score values from min 4 to max 18 was determined. Seven DLs were transplanted (mean delta pO 391 mm Hg, mean Brixia score 6.7) while three were rejected (mean delta pO 211 mm Hg, mean Brixia score 6). The two EVLP-DLs cases with the higher Brixia score (mean 15) were transplanted after EVLP. Postoperative PGD Grade 3 at 48 hours was recorded in one case without correlation to the Brixia score (Brixia score 4). All patients survived hospital discharge with a mean ICU and hospital stay of 9 and 30 days, respectively. Conclusion(s): In our pilot study, the Brixia score did not predict transplantability or postoperative function during EVLP. Additional studies are needed to further evaluate the use and clinical prognostic power of radiologic assessment with this or other scores in the EVLP lung assessment.
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Extracorporeal Circulation , Lung Transplantation , Organ Preservation/methods , Animals , HumansABSTRACT
During the novel coronavirus pneumonia (COVID-19) pandemic from 2020 to 2021, lung transplantation entered a new stage of development worldwide. Globally, more than 70 000 cases of lung transplantation have been reported to the International Society for Heart and Lung Transplantation (ISHLT). With the development of medical techniques over time, the characteristics of lung transplant donors and recipients and the indications of pediatric lung transplantation recipients have undergone significant changes. Application of lung transplantation in the treatment of COVID-19-related acute respiratory distress syndrome (ARDS) has also captivated worldwide attention. Along with persistent development of lung transplantation, it will be integrated with more novel techniques to make breakthroughs in the fields of artificial lung and xenotransplantation. In this article, research progresses on the characteristics of lung transplant donors and recipients around the world were reviewed and the development trend was predicted, enabling patients with end-stage lung disease to obtain more benefits from the development of lung transplantation technique. © 2022 Organ Transplantation. All rights reserved.
ABSTRACT
This special article focuses on the highlights in cardiothoracic transplantation literature in the year 2020. Part I encompasses the recent literature on lung transplantation, including the advances in preoperative assessment and optimization, donor management, including the use of ex-vivo lung perfusion, recipient management, including those who have been infected with coronavirus disease 2019, updates on the perioperative management, including the use of extracorporeal membrane oxygenation, and long-term outcomes.