Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Lung Transplant Service, The Alfred Hospital and Monash University, Melbourne, Australia.
Lung Transplant Service, The Alfred Hospital and Monash University, Melbourne, Australia.
Ann Thorac Surg. 2021 Aug;112(2):443-449. doi: 10.1016/j.athoracsur.2020.08.042. Epub 2020 Oct 26.
Even in the extended-criteria era, the reasons for declining lung donors are not always clear. Furthermore, it has not been determined how many actual declined lungs would be retrieved by ex vivo lung perfusion (EVLP) beyond that already achieved in centers with an existing high utilization rate.
This retrospective study reviewed all lung donor referrals between 2014 and 2018, including detailed formal referrals and preliminary notifications. This study categorized reasons for lung donor non-acceptance and estimated how many declined grafts could have been theoretically retrievable by using EVLP.
In total, 966 lung donor candidates were referred, including 313 transplanted donors, 336 declined donors after detailed referrals (group A) and 258 preliminary declined. In group A, the primary reasons for refusal were lung quality issues (49%), general medical issues (25%), and organization issues (26%), combined with secondary reasons in many cases. Main lung quality issues were an extensive smoking history, abnormal chest radiography, and underlying lung disease. Although 73 declined lung donors had indications for EVLP, the retrievable lungs decreased to only 30 cases after considering the details of all clinical contraindications and organizational issues. Nevertheless, 59 intended donation after circulatory death donors did not progress to death after withdrawal of cardiorespiratory support in the required timeframe, and EVLP may have an emerging additional role here.
Based on commonly cited criteria for EVLP indication, the number of EVLP retrievable lung donors represented only a small portion of declined donor lungs referred to our center from the state donation network.
即使在扩展标准时代，拒绝肺供体的原因也并不总是明确的。此外，尚未确定在已经有高利用率的中心之外，通过体外肺灌注（EVLP）实际可以获得多少超出已有数量的实际可获取的已拒绝肺。
本回顾性研究回顾了 2014 年至 2018 年期间所有的肺供体推荐者，包括详细的正式推荐和初步通知。本研究对肺供体不接受的原因进行分类，并估计可以通过 EVLP 理论上可以获取多少已拒绝的移植物。
共有 966 例肺供体候选者被推荐，其中 313 例进行了移植，336 例经过详细推荐后被拒绝（A 组），258 例为初步拒绝。在 A 组中，拒绝的主要原因是肺质量问题（49%）、一般医疗问题（25%）和组织问题（26%），在许多情况下还存在次要原因。主要的肺质量问题是广泛的吸烟史、异常的胸部 X 线摄影和潜在的肺部疾病。尽管有 73 例已拒绝的肺供体有 EVLP 的指征，但在考虑所有临床禁忌症和组织问题的细节后，可获取的肺仅减少到 30 例。尽管如此，59 例计划进行循环死亡后捐赠的供体在规定的时间内没有在心肺支持撤出后死亡，EVLP 在这里可能有一个新的额外作用。
根据 EVLP 指征的常见标准，EVLP 可获取的肺供体数量仅代表从州捐赠网络推荐到我们中心的已拒绝肺供体的一小部分。
