Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
Service of Thoracic Surgery, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
Am J Transplant. 2019 Apr;19(4):1195-1201. doi: 10.1111/ajt.15237. Epub 2019 Jan 22.
We aimed to propose a simple and effective preservation method in lungs procured for transplantation from uncontrolled donation after circulatory death (uDCD) associated with excellent long-term results. Outcome measures for lung recipients were survival and primary graft dysfunction (PGD) grade 3. Survival was estimated using the Kaplan-Meier method. A total of 9 lung uDCDs were evaluated and 8 lung transplants were performed. Mean no-flow time was 9.8 minutes (standard deviation [SD] 8.6). Mean time from cardiac arrest to topical cooling was 96.8 minutes (SD 16.8). Preservation time was 159 minutes (SD 31). Ex vivo lung perfusion was used to assess lung function prior to transplantation in 2 cases. Mean recipient age was 60.8 years (SD 3.1), and mean total ischemic time was 678 minutes (SD 132). PGD grade 3 was observed in 2 cases (25%). The 1-month, 1-year, and 5-year survival rates were 100%, 87.5%, and 87.5%, respectively. Mean follow-up was 52 months. The logistic complexity of procuring lungs from uDCDs for transplantation requires the development of new strategies designed to facilitate this type of donation. A program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes.
我们旨在提出一种简单有效的保存方法，用于从与良好长期结果相关的无控制的循环死亡后捐献（uDCD）中获取用于移植的肺。肺受者的预后指标是存活和原发性移植物功能障碍（PGD）3 级。使用 Kaplan-Meier 方法估计存活率。共评估了 9 例 uDCD 肺，进行了 8 例肺移植。无血流时间的平均值为 9.8 分钟（标准差 [SD] 8.6）。从心脏骤停到局部冷却的平均时间为 96.8 分钟（SD 16.8）。保存时间为 159 分钟（SD 31）。在 2 例中使用体外肺灌注在移植前评估肺功能。受体平均年龄为 60.8 岁（SD 3.1），总缺血时间平均为 678 分钟（SD 132）。2 例（25%）观察到 PGD 3 级。1 个月、1 年和 5 年的存活率分别为 100%、87.5%和 87.5%。平均随访时间为 52 个月。从 uDCD 中获取用于移植的肺的逻辑复杂性需要开发旨在促进这种类型捐赠的新策略。基于严格选择标准的方案，使用简单有效的保存技术，可以恢复具有出色长期移植后结果的肺移植物。
