Snell Gregory I, Griffiths Anne, Levvey Bronwyn J, Oto Takahiro
Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia.
J Heart Lung Transplant. 2008 Jun;27(6):662-7. doi: 10.1016/j.healun.2008.03.009.
It is important to utilize all lung donor offers to maximize lung transplant (LTx) opportunities.
This report describes the results of strategies that have evolved to evaluate and optimize cadaveric donor lung function and intra- and post-operative ICU management. Ongoing interactions between the intensive care unit (ICU) staff, donor coordinators and the LTx team all contribute to this process. Data are compared with the annual reports of the 2005 USA Organ and Transplant Procurement Network and UK Transplant.
In 2001, 41% of all local (State of Victoria) multiple-organ donors referred for LTx were transplanted at the Alfred Hospital, with 36% considered functionally unusable. In 2006, 66% of Victorian donors contributed lungs for LTx (18% functionally unusable, 16% logistically unusable). Of the interstate (rest of Australia) lung donor offers, 50% (no local LTx unit present) and 32% (local LTx unit with first offer) were utilized, with 33% and 48% functionally unusable, respectively. Of the 47 resultant Alfred Hospital LTxs in 2006, survival rates were 100% at 180 days and 96% at 365 days, with no mortality directly attributable to donor quality. Overall, 54% (91 of 163) of Australian organ donor offers were used for LTx (i.e., 4.5 per million population [PMP]), compared with 17% in the USA (3.8 PMP) and 13% in the UK (2.0 LTx donors PMP) in 2005.
A strategy of peri-operative lung donor evaluation and intervention suggests the number of truly unusable donor lungs is only a small fraction of the overall donor pool. In Australia, this strategy makes a significant difference in lung retrieval and transplantation rates, despite an intrinsically low (10 PMP) national donor rate.
利用所有的肺供体机会以最大化肺移植（LTx）的可能性非常重要。
本报告描述了为评估和优化尸体供肺功能以及术中及术后重症监护病房（ICU）管理而不断发展的策略的结果。重症监护病房（ICU）工作人员、供体协调员和肺移植团队之间持续的互动都有助于这一过程。数据与2005年美国器官和移植采购网络以及英国移植的年度报告进行了比较。
2001年，转至阿尔弗雷德医院进行肺移植评估的所有本地（维多利亚州）多器官供体中，41%进行了移植，36%被认为功能不可用。2006年，维多利亚州66%的供体提供了用于肺移植的肺（18%功能不可用，16%因后勤原因不可用）。对于州际（澳大利亚其他地区）的肺供体机会，分别有50%（当地无肺移植单位）和32%（当地有首个肺移植单位）被利用，功能不可用率分别为33%和48%。2006年阿尔弗雷德医院的47例肺移植中，180天时生存率为100%，365天时为96%，没有死亡直接归因于供体质量。总体而言，澳大利亚163例器官供体机会中有54%（91例）用于肺移植（即每百万人口中有4.5例[PMP]），而2005年美国为17%（3.8 PMP），英国为13%（每百万人口中有2.0例肺移植供体）。
围手术期肺供体评估和干预策略表明，真正不可用的供肺数量仅占整个供体库的一小部分。在澳大利亚，尽管全国供体率本身较低（每百万人口中有10例），但该策略在肺获取和移植率方面产生了显著差异。
