Prasad Kuruswamy Thurai, Sehgal Inderpaul Singh, Dhooria Sahajal, Muthu Valliappan, Agarwal Ritesh, Behera Digambar, Aggarwal Ashutosh Nath
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Lung India. 2019 Sep-Oct;36(5):399-403. doi: 10.4103/lungindia.lungindia_299_18.
Lung transplantation is infrequently performed in India due to several constraints, and whether the poor lung transplantation rates in India are due to a lack of eligible lung donors is unclear. In this study, we explored the availability of donors for lung transplantation.
This was a retrospective analysis of all brain-dead participants who underwent assessment of eligibility for lung donation between August 2015 and June 2018. All participants underwent a detailed clinical evaluation that included history, physical examination, arterial blood gas analysis, chest radiograph, and bronchoscopy. The final eligibility for lung donation was assessed using the existing "ideal" criteria and the less stringent "extended" criteria.
A total of 55 brain-dead participants (41 [74.5%] males) were assessed for eligibility for lung donation. The mean (standard deviation [SD]) age of the participants was 38.4 (17.2) years. The mean (SD) duration of prior invasive mechanical ventilation at the time of assessment was 4 (3.1) days, with a mean (SD) partial pressure of arterial oxygen: inspired oxygen fraction ratio (PaO:FiO) of 326.6 (153.5). The proportion of participants who were found suitable for lung donation was 16 (29.1%) and 35 (63.6%) on employing the ideal and the extended criteria, respectively. Inadequate oxygenation status, abnormal chest radiograph, and sepsis were the most common reasons for excluding participants using either criteria. Despite the availability of adequate lung donors, only one lung transplantation could be performed.
Even with the most stringent criteria for lung assessment, nearly one-third of the brain-dead participants had lungs suitable for lung transplantation. Lack of eligible lung donors is not a reason for the poor lung transplantation rates in India.
由于多种限制因素，印度很少进行肺移植，目前尚不清楚印度肺移植率低是否是因为缺乏合适的肺供体。在本研究中，我们探讨了肺移植供体的可获得性。
这是一项对2015年8月至2018年6月期间所有接受肺捐赠资格评估的脑死亡参与者的回顾性分析。所有参与者均接受了详细的临床评估，包括病史、体格检查、动脉血气分析、胸部X光片和支气管镜检查。使用现有的“理想”标准和不太严格的“扩展”标准评估肺捐赠的最终资格。
共有55名脑死亡参与者（41名[74.5%]男性）接受了肺捐赠资格评估。参与者的平均（标准差[SD]）年龄为38.4（17.2）岁。评估时先前有创机械通气的平均（SD）持续时间为4（3.1）天，动脉血氧分压：吸入氧分数比（PaO:FiO）的平均（SD）值为326.6（153.5）。分别采用理想标准和扩展标准时，被发现适合肺移植的参与者比例分别为16名（29.1%）和35名（63.6%）。氧合状态不佳、胸部X光片异常和脓毒症是使用任何一种标准排除参与者的最常见原因。尽管有足够的肺供体，但仅进行了一例肺移植。
即使采用最严格的肺评估标准，近三分之一的脑死亡参与者的肺仍适合肺移植。缺乏合适的肺供体并非印度肺移植率低的原因。
