Optimización Del Donante 2021

Optimización del donante
para trasplante pulmonar
FABIO ANDRES VARON V. MD. , MSc., Ph.D©

Director UCI - Trasplante pulmonar
Centro de investigación en ventilación mecánica
Fundación Neumológica Colombiana
Fundación Cardioinfantil
Universidad de La Sabana
Universidad del Rosario
Conflictos de interés:
Asesor/speaker: Grant de investigación:

Pfizer Colciencias
MSD Universidad La Sabana
Medtronic Universidad de Navarra
Draguer (España)
Cardinal health Fundación Neumológica
Roche Baxter
Adult and Pediatric Lung Transplants
Number of Transplants by Year and Location
5000
Otros
4500
Norte Amèrica
4000
Nùmero de trasplantes
Europa
3500
3000
2500
2000
1500
1000
500
0
19 8
19 9
19 0
19 1
19 2
19 3
19 4
19 5
19 6
19 7
19 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
20 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
17
8
8
9
9
9
9
9
9
9
9
9
9
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
19
NOTE: This figure includes only the lung transplants that are
reported to the ISHLT Transplant Registry. As such, this should
2019 not be construed as representing changes in the number of lung
transplants performed worldwide.
JHLT. 2019 Oct; 38(10): 1015-1066
Number of Transplants by Year and Procedure Type
5000 4673
Bilateral (doble pulmón) 4554
4500 41814116
4293
Unilateral
3853
Número de trasplantes
4000 3871
3587
3500 3313
29503027
3000 2813
2584
2500 2230
19842024
2000 1709
1789
1513 1568
1550
1500 1213 1391
1388
1105
924
1000 708
408
500 167
74
0
19 8
19 9
19 0
19 1
19 2
19 3
19 4
19 5
19 6
19 7
19 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
20 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
17
8
8
9
9
9
9
9
9
9
9
9
9
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
19
NOTE: This figure includes only the lung transplants that are
reported to the ISHLT Transplant Registry. As such, this should
2019 not be construed as representing changes in the number of lung
transplants performed worldwide.
JHLT. 2019 Oct; 38(10): 1015-1066
Recipient Age by Year (Transplants: January 1988 – June 2018)
0-10 11-17 18-34 35-49 50-59 60-65 66+ Median age
Mediana de edad de los receptores

100% 80
80% 64
(años, liena azul)

% of Transplants
60% 48
40% 32
20% 16
0% 0
19 8
19 9
19 0
19 1
19 2
19 3
19 4
19 5
19 6
19 7
19 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
20 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
18
8
8
9
9
9
9
9
9
9
9
9
9
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
1
19
Año del trasplante
2019
JHLT. 2019 Oct; 38(10): 1015-1066
Donor Age by Year (Transplants: January 1988 – June 2018)
0-10 11-17 18-34 35-49 50-59 60-65 66+ Median age

100% 60
Median donor age (years; blue line)

80% 48
% of Transplants
60% 36
40% 24
20% 12
0% 0
19 8
19 9
19 0
19 1
19 2
19 3
19 4
19 5
19 6
19 7
19 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
20 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
18
8
8
9
9
9
9
9
9
9
9
9
9
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
1
19
Year of Transplant
2019
JHLT. 2019 Oct; 38(10): 1015-1066
Adult Lung Transplants Major Diagnoses by Year (%)
100
EPOC A1ATD F. QUISTICA F. PULMONAR NIU F. PULMONAR NO NIU RETRASPLANTE
80
% of Transplantes
60
40
20
0
19 0
19 1
19 2
19 3
19 4
19 5
19 6
19 7
19 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
20 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
17
9
9
9
9
9
9
9
9
9
9
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
19
Año de transplante
2019
JHLT. 2019 Oct; 38(10): 1015-1066
Adult Lung Transplants
Major Diagnoses by Year (Number)
4,000
COPD A1ATD CF IIP ILD-not IIP Retransplant
3,500
Number of Transplants
3,000
2,500
2,000
1,500
1,000
500
0
19 0
19 1
19 2
19 3
19 4
19 5
19 6
19 7
19 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
20 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
17
9
9
9
9
9
9
9
9
9
9
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
19
Transplant Year
2019
JHLT. 2019 Oct; 38(10): 1015-1066
Kaplan-Meier Survival by Procedure Type for Primary
Transplant Recipients (Transplants: January 1992 – June 2017)
100
Mediana de sobrevida (Año):
Bipulmonar Lung = 7.8; Condicional = 10.2
Unilateral = 4.8; Condicional = 6.5
75
Survival (%)
p<0.0001
50
25
Bilateral/Double Lung (N=40,623)

Single Lung (N=20,034)
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Years
2019
JHLT. 2019 Oct; 38(10): 1015-1066
Mean Donor-Recipient Height Difference (cm) by Diagnosis
Category and Procedure Type
A1ATD/COPD IIP/ILD-not IIP CF Other All
Year of Bilateral/ Single Bilateral/ Single Bilateral/ Single Bilateral/ Single Bilateral/ Single
TX Double Double Double Double Double
2005 4.3 6.6 -1.2 1.2 3.7 5.2 2.0 2.5 2.4 3.8
2006 5.2 5.7 -0.4 0.3 3.0 7.1 1.3 2.0 2.6 2.9
2007 5.0 5.3 -1.9 -0.5 3.1 13.8 1.8 0.6 2.2 1.8
2008 5.2 7.6 -2.8 0.1 3.8 5.3 1.1 1.4 1.9 3.1
2009 4.7 6.6 -2.1 -0.9 4.3 14.0 1.3 0.2 2.1 1.8
2010 5.7 6.1 -2.4 -1.4 4.0 6.5 0.9 1.5 2.1 1.3
2011 4.9 6.6 -2.0 -1.8 4.0 9.9 1.4 1.1 2.1 1.1
2012 5.1 7.4 -2.4 -1.3 4.4 6.4 1.0 0.6 1.8 1.4
2013 5.0 6.2 -1.8 -0.8 4.6 -3.7 1.2 0.9 2.0 1.2
2014 4.9 6.7 -2.2 -0.9 4.7 6.3 1.1 -1.0 1.6 0.8
2015 4.7 5.7 -2.3 -0.2 3.5 -0.7 1.3 2.9 1.5 1.7
2016 5.3 5.6 -1.5 -0.6 5.2 - 0.7 1.8 2.0 1.3
2017 5.4 8.7 -1.6 0.8 4.9 - 1.2 1.7 2.0 3.1
2018 5.7 8.0 -2.2 -0.3 4.7 - 2.1 -0.2 1.7 2.0
2019
JHLT. 2019 Oct; 38(10): 1015-1066
Donor Characteristics (Transplants: Jan 1992 – June 2018)
Jan 1992-Dec 2000 Jan 2001-Dec 2009 Jan 2010-Jun 2018
(N = 11,796) (N = 21,806) (N = 33,891) P-value
Geographic location:
- Europe 3,751 (31.8)% 7,818 (35.9)% 12,414 (36.6)%
<0.0001
- North America 7,324 (62.1)% 12,545 (57.5)% 18,594 (54.9)%
- Other 721 (6.1)% 1,443 (6.6)% 2,883 (8.5)%
Age (years) 30 (15 - 54) 37 (16 - 60) 40 (17 - 65) <0.0001
Male 61.9% 56.9% 56.2% <0.0001
Height (cm) 173.0 (157.0 - 188.0) 172.7 (157.0 - 188.0) 172.0 (155.0 - 188.0) <0.0001
2 1
BMI (kg/m ) 23.3 (18.2 - 31.0) 24.2 (18.8 - 33.1) 25.1 (19.2 - 35.5) <0.0001
Blood type:
-A 39.1% 38.8% 38.5%
0.1946
- AB 2.3% 2.4% 2.3%
-B 9.9% 10.0% 10.6%
-O 48.6% 48.7% 48.6%
Cause of death:
- Anoxia 3.5% 7.9% 19.8%
<0.0001
- CVA/stroke 38.4% 44.7% 41.2%
- Head trauma 49.7% 44.5% 36.0%
- Other 8.3% 2.9% 3.0%
Continuous factors are expressed as median (5th – 95th percentiles)
Summary statistics included transplants with non-missing data
1
Based on Apr 1994 – Dec 2000 transplants
2020
JHLT. 2020 Oct; 39(10): 1003-1049
Donor Characteristics (Transplants: Jan 1992- Jun 2018)
Jan 1992-Dec 2000 Jan 2001-Dec 2009 Jan 2010-Jun 2018
P-value
(N = 11,796) (N = 21,806) (N = 33,891)
CMV antibody positive 55.3% 60.4% 61.6% <0.0001
EBV antibody positive - 91.6%1 93.7% <0.0001
Hep B antibody positive 2.4% 2.5% 2.6% 0.6759
Hep C antibody positive 0.6% 0.1% 0.6% <0.0001
Smoking history 31.7% 20.7% 12.1% <0.0001
Alcohol use - 12.8%2 14.6% 0.0001
Cocaine use - 10.8% 14.3% <0.0001
Other drugs use - 28.1% 40.7% <0.0001
Diabetes 2.3%3 4.6% 7.2% <0.0001
Hypertension 12.4%3 18.4% 24.0% <0.0001
PO2 (mmHg) - 424.0 (115.0 - 578.4)4 409.0 (109.0 - 563.0) <0.0001
Summary statistics included transplants with non-missing data

2020 1 Based on Apr 2006 – Dec 2009 transplants 2
Based on Jul 2004 – Dec 2009 transplants
JHLT. 2020 Oct; 39(10): 1003-1049 3 Based on Apr 1994 – Dec 2000 transplants 4 Based on Jan 2005 – Dec 2009 transplants
Donor Sex Distribution by Location and Era
(Transplants: Jan 1992 – Jun 2018)

Donor Sex:
Female Male
100%
90%
80%
% of transplants
70%
60%
50%
40%
30%
20%
10%
0%
1992- 2001- 2010- 1992- 2001- 2010- 1992- 2001- 2010-
2000 2009 2018 2000 2009 2018 2000 2009 2018
Europe North America Other
2020
JHLT. 2020 Oct; 39(10): 1003-1049
Donor Cause of Death Distribution by Location and Era
Donor Cause of Death: Anoxia CVA/Stroke
100%
90%
80%
% of transplants
70%
60%
50%
40%
30%
20%
10%
0%
1992- 2001- 2010- 1992- 2001- 2010- 1992- 2001- 2010-
2000 2009 2018 2000 2009 2018 2000 2009 2018
Europe North America Other
2020
JHLT. 2020 Oct; 39(10): 1003-1049
Donors with History of Smoking* Donors with History of Alcohol Use*
(Transplants: Jan 1995 – Jun 2018) (Transplants: Jan 2005 – Jun 2018)
40
% *Cigarette use for more than 20 pack years
40
%*Two or more alcoholic drinks per day
35 35
30 30
25 25
% of transplants
% of transplants
20 20
15 15
10 10
5 5
0 0
199 5
199 6
199 7
199 8
209 9
200 0
200 1
200 2
200 3
200 4
200 5
200 6
200 7
200 8
200 9
201 0
201 1
201 2
201 3
201 4
201 5
201 6
201 7
18
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
20
20
20
20
20
20
20
20
20
20
20
20
20
2020
JHLT. 2020 Oct; 39(10): 1003-1049
Donors with History of Cocaine Use* Donors with History of Other Drugs Use*
*Donor ever abused or had a dependency to non-intravenous street drugs, such as
*Donor has ever abused or had a dependency to cocaine crack, marijuana or prescription narcotics, sedatives, hypnotics or stimulants
60 60 %
50 50
40 40
% of transplants
% of transplants
30 30
20 20
10 10
0 0
200 0
200 1
200 2
200 3
200 4
200 5
200 6
200 7
200 8
200 9
201 0
201 1
201 2
201 3
201 4
201 5
201 6
201 7
18
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
20 8
20 9
20 0
20 1
20 2
20 3
20 4
20 5
20 6
20 7
18
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
1
20
20
2020
JHLT. 2020 Oct; 39(10): 1003-1049
% of transplants
10
15
20
25
30
0
5
19
199 5
199 6
199 7
199 8
209 9
200 0
200 1
200 2
200 3
200 4
200 5
200 6
200 7
200 8
200 9
2020
201 0
201 1
201 2
JHLT. 2020 Oct; 39(10): 1003-1049

201 3
201 4
201 5
201 6
Donors with History of Diabetes
201 7
18
% of transplants
10
15
20
25
30
0
5
19
199 5
199 6
199 7
199 8
209 9
200 0
200 1
200 2
200 3
200 4
200 5
200 6
%
200 7
200 8
200 9
201 0
201 1
201 2
201 3
201 4
201 5
201 6
201 7
18
Donors with History of Hypertension
Kaplan-Meier Survival within 12 Months
By Donor Age (Transplants: Jan 2000 – Jun 2017)
Donor <35 years (N=22,579) Donor 35-49 years (N=15,652)
100
90
Survival (%)
80
70
All pairwise comparisons were significant at p < 0.05 except Donor <35 years vs. Donor 35-49 years
60
50 Months
0 1 2 3 4 5 6 7 8 9 10 11 12
2020
JHLT. 2020 Oct; 39(10): 1003-1049
Note: Y-axis is truncated for clearer presentation

Kaplan-Meier Survival within 12 Months by Donor and Recipient Age
(Transplants: Jan 2000 - Jun 2017)
Donor <35 Years Donor 35-49 Years
100 100 100
90 90 90
80 80 80
Survival (%)
70 70 70
No pairwise comparisons were All pairwise comparisons were All pairwise comparisons were
significant at p < 0.05 significant at p < 0.05 except Donor 35- significant at p < 0.05 except Donor
60 60 60
49 Years vs. Donor ≥50 Years <35 Years vs. Donor 35-49 Years
50 50 50
0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12
Months Months Months
Recipients ≥60 Years
Recipients 18-39 Years Recipients 40-59 Years
2020
JHLT. 2020 Oct; 39(10): 1003-1049
By Donor History of Smoking* By Donor History of Alcohol Use*
*Cigarette use for more than 20 pack years *Two or more alcoholic drinks per day
100 100
90 90
Survival (%)
Survival (%)
80 80
70 70
p < 0.0001 p = 0.63
60 Donor with History of Smoking 60 Donor with History of Alcohol Use

(N=4,907) (N=3,317)
50 50
0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12
Months Months
2020
JHLT. 2020 Oct; 39(10): 1003-1049
By Donor History of Cocaine Use* By Donor History of Other Drug Use*
*Donor ever abused or had a dependency to non-intravenous street drugs, such as
*Donor has ever abused or had a dependency to cocaine crack, marijuana or prescription narcotics, sedatives, hypnotics or stimulants
100 100
90 90
Survival (%)
Survival (%)
80 80
p = 0.0414 p = 0.1299
70 70
60 Donor with History of Cocaine Use 60 Donor History of Other Drug Use
(N=3,267) (N=9,376)
50 50
0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12
Months
2020 Months
JHLT. 2020 Oct; 39(10): 1003-1049 Note: Y-axis is truncated for clearer presentation
By Donor History of Diabetes By Donor History of Hypertension
(Transplants: Jan 2000 – Jun 2017) (Transplants: Jan 2000 - Jun 2017)
100 100
90 90
Survival (%)
Survival (%)
80 80
p <0.0001 p <0.0001
70 70
Donor with History of Diabetes Donor with History of Hypertension

60 (N=1,780) 60 (N=6,529)
50 50
0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12
Months Months
2020 Note: Y-axis is truncated for clearer presentation
JHLT. 2020 Oct; 39(10): 1003-1049
Kaplan-Meier Survival within 12 Months by Ischemic Time
100
90
Survival (%)
80
p <0.0001
70
Ischemic Time <4 hours (N = 8,694)

60
Ischemic Time ≥4 hours (N = 26,176)
50
0 1 2 3 4 5 6 7 8 9 10 11 12
Months
2020
JHLT. 2020 Oct; 39(10): 1003-1049
Freedom from BOS Conditional on Survival to Discharge
By Donor Age (Transplants: Jan 2000 – Jun 2017)
Donor <35 years(N=12,742) Donor 35-49 years (N=6,349)
100
90
Freedom from BOS (%)
80
70
60
50
40
30
20 No pairwise comparisons were not significant at p < 0.05 except
Donor <35 yrs vs. Donor ≥50 yrs
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Years
2020
JHLT. 2020 Oct; 39(10): 1003-1049
OBJETIVOS DEL CUIDADO
n Promover que los órganos rescatados
sean óptimos para un trasplante
n Maximizar el número de órganos
potencialmente trasplantados
n Optimizar las variables fisiológicas del
donante
Management of the Adult Brain Dead Potential Organ
and Tissue Donor
GUIDELINE
n Satisfacer5los deseos del donante-familia

REFERENCES
1. Malinoski DJ, Daly MC, Patel MS, Oley-Graybill C, Foster CE 3rd, Salim A. Achieving
donor management goals before deceased donor procurement is associated with
more organs transplanted per donor. J Trauma. 2011; 71:990-5.
2. Franklin GA, Santos AP, Smith JW, Galbraith S, Harbrecht BG, Garrison RN.
Orgános no aceptados
Causas de no aceptación %
Tipo de donante Ventilación mecánica Manejo de líquidos Diabetes insípida Otros

PEEP: 6 FIO2 50% VT 8 ML/KG PEEP: 10 FIO2 30% VT 8 ML/KG
PEEP: 5 FIO2 100% VT 8 ML/KG
Seminars in Respiratory and Critical Care Medicine Vol. 34 No. 3/2013
Tipos de donante …..

Selection and Management Snell et al.
Ideal DBD, DCD,

Accepted living-related
Donor lungs donors
~50%
Extended donors
Not Accepted
p Unfavorable logistics
Donor lungs
~50% Consent not sought:
Including DCD Categories1 & 2 & 3
Lungs ttruly
L l
unusable
schema of the 2012 view of the total pool of donor lungs offered for transplantation. DBD, donation after brain death; DCD, donat
iac death.
experiences states that between 24 and 77% of donor lungs score (a mar
have atSeminars
least one extended and
in Respiratory criterion, and Medicine
Critical Care 8 to 38% Vol.
of cases
34 No. show that t
3/2013
38
transplanted have two or more extended criteria. Of the quent 5-yea
Donante ideal….. donors and
worse dono
Table 2 “Ideal” donor lung selection criteria6,35,36 donor score
describe and
1. Age < 55 years ical areas.48
2. ABO blood group compatible Further
3. Donation after brain death donor donor pools
4. Appropriate size match work for O
5. Clear chest radiograph
degree of co
6. PaO2:FiO2 > 300 on 5 cm H2O positive end
expiratory pressure and the imp
7. Tobacco history < 20 pack-years on survival.
8. Absence of chest trauma plants since
9. No evidence of aspiration or sepsis guideline (4
10. Absence of purulent secretions at bronchoscopy
> 20 pack y
11. Absence of organisms on sputum Gram stain
12. No history of primary pulmonary disease or active ly, the use
pulmonary infection down to 230
etc.) was no

tality. However, overall survival was reduced when a donor define a poor outcome from LTx, remain to be clarified by
with a smoking history was used (adjusted hazard ratio for future lung donor scoring studies.46 As always, the clinical
Seminars in Respiratory
death at 3 years 1.36, 95% CI 1.11–1.67). These effects on
and Critical Care Medicine Vol. 34 No. 3/2013
judgment of proceeding into transplantation with a set of
survival were predominantly related to intermediate and potentially suboptimal lungs needs to consider the potential
long-term outcomes and were not associated with PGD. recipient’s 30-day and 5-year survival with and without
Y el donante aceptable
Survival did worsen when donors with a heavy history of transplantation.
Table 3 “Acceptable” donor lung selection criteria in 2012
1. Age < 70 years

2. ABO blood group compatible
3. Donation after brain death or donation after cardiac death donor
4. Approximate size match with minor surgical trimming or lobectomy as needed
5. Minor diffuse and moderate focal chest radiographic changes acceptable if good, stable/improving function
6. PaO2:FiO2 > 250 on 5 cm H2O positive end-expiratory pressure
7. Tobacco history < 40 pack-years
8. Chest trauma not relevant if good function
9. Aspiration or minor sepsis acceptable if good, stable/improving function
10. Purulent secretions not relevant if good, stable/improving function
11. Organisms on Gram stain and ventilation time not relevant
12. Primary donor pulmonary disease not acceptable, unless asthma
13. Lungs deemed initially unacceptable but are resuscitated with ex vivo lung perfusion
Future acceptability considerations:
1. Age acceptance up to 75 years

2. ABO incompatible transplant acceptable if low titer recipient and antibody removal and monitoring plan
3. Lobar cut-downs of larger donor acceptable
4. Moderate and/or one-sided chest radiographic changes acceptable with good, stable/ improving function
5. Novel predictive donor factor recognition: donor diabetes, recent smoking history, etc.
Source: Adapted from Snell et al,6 Sundaresan et al,35 and Orens et al.36

of procurements are donations after neurologic determi- University of Silesia, S
RESULTS actual
nation of death. Suchoccurrence
donors andoftheirdeath. Amongface
physicians themany
independent
Skłodowskiej-Curie 9
It was decided to assess how the parameters of surgery and
challenges, variables
as brain mentioned
death hasabove, onlyeffects
adverse the typeonofthe
surgery was
þ48667288893. E-mai
hospitalization differ for patients operated on in 2018 to significantly associated with an increase in the chance of
2019 and before 2018. Analyses were performed using ª 2020 death within
theThe Authors. 30 days.
Published PatientsInc.
by Elsevier who underwent
This is an openSLT had a
Mann-Whitney U test, comparing hospital stay,access 20.217 times greater chance of dying
surgeryarticle under the CC BY-NC-ND license (http:// within 30 days than https://do
patients after DLT (interquartile range, 2.116-193.125).
time, extubation time, and total ischemia time creativecommons.org/licenses/by-nc-nd/4.0/).
in these
Donor-related
groups. The analysis was performed only Risk Factors
230 Park
on patients Associated
who Avenue, New results
Detailed With
York, NY
are10169Increased
presented in Table 3.Mortality After
underwent DLT, Lung Transplant
excluding retransplantation. Transplantation
Detailed
2
Nagelkerke’s R hospital mortality model was 0.33. This
Proceedings, 52, 2133e2137 (2020)
results are provided in Table 2. indicates a moderate link between the prediction and actual
Maciej Urlika, Tomasz Stącela, Magdalena Latosa,b,*, Remigiusz Anton !czyka,b, Marta Ferensb,
Fryderyk Zawadzki , Bogumiła Król , Piotr Pasek , Piotr Przybyłowskia,c, Marian Zembalaa,b,
a,b a a
Table a3., and

Mirosław Nęcki Logistic Regression
Marek Ochman a,b
Coefficients Predicting Death Within 30 Days
a 95% CI
Silesian Center for Heart Diseases, Zabrze, Poland; bDepartment of Cardiac, Vascular, and Endovascular Surgery and Transplantology,
B Katowice, Poland;
Medical University of Silesia, SE and cFirst Chair
OR of General Surgery,
LL UL
Jagiellonian University, P Value Kraków,
Medical College,
Coefficients Poland "1.16 3.22
Donor PO2/FiO2 0.00 0.01 0.999 0.988 1.009 .837
Donor PO2 0.00 0.00 1.000 0.994 1.006 .909
Donor age ABSTRACT "0.02 0.04 0.981 0.905 1.063 .638
Donor time spent in ICU Background.
"0.12 Lung transplant
0.17 is a surgical
0.888 procedure for end-stage lung
0.640 disease. Many
1.232 .476
DLT vs SLT factors related
"1.50 0.58 0.049 0.005 0.472
to lung donors influence the outcome of transplant. The main aim of this .009
Donor sudden cardiac arrest "0.02 0.62 0.961 0.084 11,007 .974
single-center study was to assess which donor-related and procedure-related factors
wouldDLT,
Abbreviations: b, regression coefficient; influence
double lungthe 30-dayFiOor
transplant; hospital
2, fraction mortality
of inspired oxygen;of the
ICU, recipients.
intensive care unit; LL, lower limit; OR, odds ratio; SE,
standard error; SLT, single lung transplant; UL, upper limit.
2136 Methods. This retrospective study group consisted of 110 URLIK, donor-recipient pairsET AL
STĄCEL, LATOS
undergoing lung transplant between 2012 and 2017 (group 1) and 2018 and 2019 (group
2)Table
in Silesian Center
4. Logistic for Heart
Regression Diseases.
Coefficients Both groups
Predicting of donor-
In-hospital Death and procedure-related
factors were included in the analysis: oxygenation index at reporting of the donor, time
95% CI
donor spent in the intensive care unit (ICU), presence of cardiac arrest while being in
Variables B SE OR LL UL P Value
the ICU, donor age, type of transplant, cumulative ischemia time, duration of the
Coefficients operation, 1.34 3.91
and time of mechanical ventilation.
Donor PO2/FiO2 0.01 0.01 1.006 0.988 1.024 .530
Donor PO2
Results. The
0.00
type of surgery
0.00
was significantly
0.998
associated0.990
with an increase1.006
in the chance of.587
Donor age death within 30
!0.12 days. Patients
0.06 who underwent
0.884 single lung transplant
0.789 had a 20.217 times.033
0.990
Donor time spent in ICU greater chance
!0.35 of dying within
0.22 30 days than
0.707patients after double lung transplant
0.458 1.091 (inter-.117
DLT vs SLT quartile range,
!0.98 2.116-193.125).
0.64 0.141 0.012 1.703 .123
Donor sudden cardiac arrest Conclusions.!0.29 Single lung 0.68
transplant increases0.556 the risk 0.039
of death during 7.995 the first 30 days.666
afterDLT,
Abbreviations: b, regression coefficient; lungdouble
transplant, and FiO
lung transplant; using lungsof from
2, fraction inspiredolder donors
oxygen; may care
ICU, intensive increase
unit; LL,the rate
lower limit;of hospital
OR, odds ratio; SE,
standard error; SLT, single lung transplant; UL, upper limit.
mortality. Oxygenation index, sudden cardiac arrest of the donors, and donor time spent in
occurrence of death. Of the the independent
ICU do not impact variables thelisted
short-term mortality
[10]. of lung graft
It was established that recipients.
the cutoff age for lung donors was
above, only donor age was significantly associated with 55 years or younger. Therefore, more liberal criteria regarding
Suboptimal Donors Do Not Mean Worse Results: A Single-Center
Study of Extending Donor Criteria for Lung Transplant
Maciej Urlika, Magdalena Latosa,b,*, Remigiusz Anton !czyka,b, Mirosław Nęckia, Emilia Kaczura,b,
Marcelina Miernik , Fryderyk Zawadzki , Bogumiła Króla, Piotr Paseka, Piotr Przybyłowskia,c,
a,b a,b
a,b a,b a
Marian
Journal of Thoracic Zembala
Disease, Vol 12, No, Marek Ochman
10 October 2020 , and Tomasz Stącel 5489
a
Silesian Center for Heart Diseases, Zabrze, Poland; bDepartment of Cardiac, Vascular, and Endovascular Surgery and Transplantology,
Medical University of Silesia, Katowice, Poland; and cFirst Chair of General Surgery, Jagiellonian University, Medical College, Kraków,
A Poland
B C
1.5 1.5 1.5
ABSTRACT
1.0 1.0 1.0
Background. Lung transplant remains the only viable treatment for most of the end-stage
lung diseases. It is believed that extending criteria for donor lungs would increase the
Spline
Spline
Spline
0.5 number of lung transplants.
0.5 The aim of the study was to compare0.5the graft function by
means of oxygenation index among recipients who received the lungs from donors of
extended criteria with those whose received lungs from donors who met the standard
0.0 0.0 0.0
criteria.
Methods. This retrospective study analyzed 71 donors whose lungs where transplanted
−0.5 into 71 first-time double
−0.5 lung recipients of 2 groups: patients who −0.5received transplants
before and after 2018. The objective was to assess whether there is a significant difference
in quality of the donor pool after applying extended criteria. The second objective was to
0 20 40 60 compare
80 results of recipients100 300 from500
with lungs donors of oxygenation index 20
> 40040mm Hg 60 80
Smoking history (pack years) PAO2-FiO2 ratio Donor age
with those obtained among recipients with this parameter < 400 mm Hg.
effects usingInsplines
Figure 1 Additive non-linear Results. the case of continuous
of the transplantsvariables
performed in 2018
in multiple to regression
Cox 2019, oxygenation
models. (A)indices were
Smoking history, (B)
PaO2/FiO2-ratio and (C) donorsignificantly
age. lower in donors but significantly higher in recipients on the first day than those
observed in 2015 to 2017. The number of transplants increased from 9 per year to 22 per
year. IrrespectiveJournal
of whetherof the
Thoracic Disease,
donor had Vol 12,
PaO2/fraction No 10 oxygen
of inspired October above2020
or
below 400 mm Hg, recipients showed similar oxygenation index values after transplant
significant pulmonary infection, diabetes mellitus,
(mean oxygenation index, PAO / 412 mm
462 2vs donor and
Hg, receiver information
respectively). Short-termseem to be did
mortality almost
not equally
FiO2-ratio (in categories with breaks
differ at 300 and 150 mmHg),
either. important, but as time passes, recipient and surgical
smoking history (in categories with breaks at 20 Aand of lungs
procedure B
Conclusions. Extended criteria suitabilityinformation
as a potentialfrom
grafts baseline become more
not only increases
Original Article
Economic evaluation of the specialized donor care facility for

thoracic organ donor management
1
Journal of Thoracic Disease, VolM.
Jason 12,Gauthier
No 10 October B. Majella Doyle2, William C. Chapman2, Gary Marklin3, Chad A. Witt4,
, Maria2020 5711
Elbert P. Trulock , Derek E. Byers 4, Ramsey R. Hachem 4, Michael K. Pasque 1, Bryan F. Meyers 1,
4
G. Alexander Patterson1, Ruben G. Nava1, Benjamin D. Kozower1, Daniel Kreisel1,5, Su-Hsin Chang6,
Varun Puri1 Brain dead potential multiorgan
1
donor
Division of Cardiothoracic Surgery, 2Division of Abdominal Organ Transplantation, Department of Surgery, 3Mid-America Transplant, 4Division of
Pulmonary and Critical Care Medicine, Department of Medicine, 5Department of Pathology and Immunology, 6Division of Public Health Sciences,
Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
Contributions: (I) Conception and design: JM Gauthier, MBM Doyle, WC Chapman, G Marklin, D Kreisel, SH Chang, V Puri; (II) Administrative
support: G Marklin, D Kreisel, SH Chang, V Puri; (III) Provision of study materials or patients: JM Gauthier, G Marklin, SH Chang; (IV) Collection
Conventional
and model
assembly of data: SDCF
JM Gauthier, G Marklin, SH Chang, V Puri; (V) Data analysis and interpretation: JM model
Gauthier, MBM Doyle, WC Chapman,
• DonorG care at hospital
Marklin, MK Pasque,where brain BD Kozower, SH Chang, V Puri; (VI) Manuscript
D Kreisel, • writing:
Donor All
transported to Final
authors; (VII) SDCF approval of manuscript: All
deathauthors.
occurs • Donor directed care to optimize
• No transportation
Correspondence to:required organ
Jason M. Gauthier, MD. Division of Cardiothoracic Surgery, Washington yield School of Medicine, Campus Box 8109, 660
University
• Managed
South by donor
Euclid hospital
Avenue, ICUMO 63110, USA. Email: gauthier.jason.m@wustl.edu.
St. Louis,
team with OPO staff assisting
Background: Over the last decade two alternative models of donor care have emerged in the United
States: the conventional model, whereby donors are managed at the hospital where brain death occurs, and
the specialized donor care facility (SDCF), in which brain dead donors are transferred to a SDCF for medical
Procuring surgical teams travel to Procuring surgical teams travel to
optimization and organ procurement. Despite increasing use of the SDCF model, its cost-effectiveness in
hospital SDCF
comparison to the conventional model remains unknown.
Methods: We performed an economic evaluation of the SDCF and conventional model of donor care from
the perspective of U.S. transplant centers over a 2-year study period. In this analysis, we utilized nationwide
data from the Scientific Registry of Transplant Recipients and controlled for donor characteristics and
patterns of organ sharing across the nation’s organ procurement organizations (OPOs). Subgroup analysis
was performed to determineMultiorgan
the impact ofprocurement
the SDCF model on thoracic organ transplants.
operation were performed in the U.S. during the study period from
Results: A total of 38,944 organ transplants
13,539 donors with an observed total organ cost of $1.36 billion. If every OPO assumed the cost and
effectiveness of the SDCF model, a predicted 39,155 organ transplants (+211) would have been performed
Figure 1 Illustration of the specialized donor care facility (SDCF) model of donor care. In the conventional model of hospital-based donor
Journal
revealed that the SDCF model would lead of Thoracic
to a predicted Disease,
156 additional Vol with
transplants 12, aNo
cost10 October
saving of 2020
donor care and workup between the $24.6 million.
referring hospital, OPO, and transplant centers. In the SDCF model, the OPO transports brain
Original Article

Jason M. Gauthier1, Maria B. Majella Doyle2, William C. Chapman2, Gary Marklin3, Chad A. Witt4,
Elbert P. Trulock 4, Derek E. Byers 4, Ramsey R. Hachem 4, Michael K. Pasque 1, Bryan F. Meyers 1,
Varun Puri1
1
support: G Marklin, D Kreisel, SH Chang, V Puri; (III) Provision of study materials or patients: JM Gauthier, G Marklin, SH Chang; (IV) Collection
and assembly of data: JM Gauthier, G Marklin, SH Chang, V Puri; (V) Data analysis and interpretation: JM Gauthier, MBM Doyle, WC Chapman,
G Marklin, MK Pasque, D Kreisel, BD Kozower, SH Chang, V Puri; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All
authors.
Correspondence to: Jason M. Gauthier, MD. Division of Cardiothoracic Surgery, Washington University School of Medicine, Campus Box 8109, 660
South Euclid Avenue, St. Louis, MO 63110, USA. Email: gauthier.jason.m@wustl.edu.
data from the Scientific Registry of Transplant Recipients and controlled for donor characteristics and
patterns of organ sharing across the nation’s organ procurement organizations (OPOs). Subgroup analysis
was performed to determine the impact of the SDCF model on thoracic organ transplants.
Figure S1 Flow diagram of OPOs and transplants included in the study. Of the 58 OPOs in the U.S., 45 had complete cost and effectiveness
Results: A total of 38,944 organ transplants were performed in the U.S. during the study period from
data for the 2-year study period. Due to their rarity, small bowel transplants were excluded from the study. Single and double lung
13,539 donors with an observed total organ cost of $1.36 billion. If every OPO assumed the cost and
transplants are counted as one organ, while kidney transplants are counted separately. Data taken from SRTR reports (5). OPOs, organ
effectiveness of the SDCF model, a predicted 39,155 organ transplants (+211) would have been performed
Journal
transplants 12, aNo
cost10 October
saving of 2020
$24.6 million.
Original Article

Jason M. Gauthier1, Maria B. Majella Doyle2, William C. Chapman2, Gary Marklin3, Chad A. Witt4,
Elbert P. Trulock 4, Derek E. Byers 4, Ramsey R. Hachem 4, Michael K. Pasque 1, Bryan F. Meyers 1,
Varun Puri1
Journal of Thoracic Disease, Vol 12, No 10 October 2020 5715
1
A B
1.40 300
support: G Marklin, D Kreisel, SH Chang, V Puri; (III) Provision of study materials or patients: JM Gauthier,Observed
G Marklin, SH Chang; (IV) Collection
Total cost (millions of $)

Total cost (billions of $)
Observed
1.35 and assembly of data: JM Gauthier, G Marklin, SH Chang, V Puri; (V) Data analysis and interpretation: JM Gauthier, MBM Doyle, WC Chapman,
280 writing: All authors; (VII) Final approval of manuscript: All
G Marklin, MK Pasque, D Kreisel, BD Kozower, SH Chang, V Puri; (VI) Manuscript
authors.
1.30
Correspondence to: Jason M. Gauthier, MD. Division of Cardiothoracic Surgery, Washington University School of Medicine, Campus Box 8109, 660
Predicted
260
South Euclid Avenue, St. Louis, MO 63110, USA. Email: gauthier.jason.m@wustl.edu.
Predicted
1.25
1.20 240
38500 39000 39500 40000 7000 7200 7400
Total transplants
Total transplants
Figure 3 Observed and predicted overall cost and effectiveness of the specialized donor care facility (SDCF) model of care compared to the
conventional model. Overall total costs
datanationwide are shown
from the Scientific in ofbillions
Registry andRecipients
Transplant millionsand
of controlled
U.S. dollars for all
for donor organs (A)and
characteristics and thoracic organs
patterns
(B), respectively. Overall total transplants of organ sharing
nationwide referacross the nation’s
to the sum oforgan procurement organizations
all transplants done by the (OPOs). Subgroup
45 organ analysis
procurement organizations
was performed to determine the impact of the SDCF model on thoracic organ transplants.
(OPOs) in this study for the 5 organs of interest (heart, liver, lung, kidney, pancreas). Thoracic organs represent the sum of lung and heart
Results: A total of 38,944 organ transplants were performed in the U.S. during the study period from
transplants alone. The observed data point
13,539 is based
donors onanthe
with actualtotal
observed outcomes during
organ cost thebillion.
of $1.36 studyIf period, while
every OPO the predicted
assumed the cost anddata point is based
on nationwide adoption of the SDCF effectiveness
model during of thethe study
SDCF period.
model, a predicted 39,155 organ transplants (+211) would have been performed
Journal
transplants 12, aNo
cost10 October
saving of 2020
$24.6 million.
£34,000 suggesting that an EVLP service might be con- lung recovery as this information was not available. In-
sidered cost-effective. cluding the costs of retrieving lungs that were not used
The increase in standard R E S Etransplants
ARCH ARTIC LE
during the for standard LTx could potentially Open Access
alter the ICER be-
DEVELOP-UK study suggests that having access to the tween the two transplant procedures. The conversion
Incorporating ex-vivo lung perfusion into
EVLP procedure increased recovery rates for what would rate for EVLP witnessed during the DEVELOP-UK study
previously have been deemed substandard lungs but (53:18) was lower than the anticipated (40–50%) and
the UK adult lung transplant service: an
were subsequently found to be suitable for standard lower than the two previous largest EVLP trials, which
economic evaluation and decision analytic
transplant. The lesson is that many lungs that might ini- had conversion rates of 86% [30] from 58 EVLP assess-
tially be deemed unusable on referral may be deemed ments and 82% from 125 assessments [31]. The low con-
model
suitable on closer inspection using standard methods version rate is likely a result of issues with donor lung
N. McMeekin1* , A. E. Chrysos2,3 , L. Vale2 and A. J. Fisher4,5
Abstract
Background: An estimated 20–30% of end-stage lung disease patients awaiting lung transplant die whilst on the
waiting list due to a shortage of suitable donor lungs. Ex-Vivo Lung Perfusion is a technique that reconditions donor
lungs initially not deemed usable in order to make them suitable for transplantation, thereby increasing the donor
pool. In this study, an economic evaluation was conducted as part of DEVELOP-UK, a multi-centre study assessing the
clinical and cost-effectiveness of the Ex-Vivo Lung Perfusion technique in the United Kingdom.
Methods: We estimated the cost-effectiveness of a UK adult lung transplant service combining both standard and Ex-
Vivo Lung Perfusion transplants compared to a service including only standard lung transplants. A Markov model was
developed and populated with a combination of DEVELOP-UK, published and clinical routine data, and extrapolated to
a lifetime horizon. Probabilistic sensitivity and scenario analyses were used to explore uncertainty in the final outcomes.
Results: Base-case model results estimated life years gained of 0.040, quality-adjusted life-years (QALYs) gained of 0.045
and an incremental cost per QALY of £90,000 for Ex-Vivo Lung Perfusion. Scenario analyses carried out suggest that an
improved rate of converting unusable donor lungs using Ex-Vivo Lung Perfusion, similar resource use post-transplant
for both standard and EVLP lung transplant and applying increased waiting list costs would reduce ICERs to
approximately £30,000 or below.
Conclusion: DEVELOP-UK base-case results suggest that incorporating Ex-Vivo Lung Perfusion into the UK adult lung
transplant service is more effective, increasing the number of donor lungs available for transplant, but would not
currently be considered cost-effective in the UK using the present NICE threshold. However, results were sensitive to
change in some model parameters and in several plausible scenario analyses results indicate that a service incorporating
Ex-vivo lung perfusion would be considered cost-effective .
Fig. 4 Cost-effectiveness acceptability curve: varying conversion rates
Trial registration: ISRCTN registry number: ISRCTN44922411.
McMeekin et al. BMC Health Services Research
Date of registration: 06/02/2012. (2019) 19:326
Retrospectively registered.
Keywords: Ex-vivo lung perfusion, EVLP, Lung transplantation, Lung transplant waiting list, Cost-effectiveness, Cost utility
analysis, Markov model, Decision analytic model, Economic evaluation
Transplantation Publish Ahead of Print
DOI: 10.1097/TP.0000000000003646
Overcoming the Limits of Reconditioning: Seventeen Hours of Ex-Vivo Lung Perfusion
(EVLP) with Successful Transplantation from Uncontrolled Circulatory Death Donor
Alessandro Palleschi MD 1,2.*, Lorenzo Rosso MD, PhD, Professor 1,2, Giulia Maria Ruggeri
Transplantation Publish Ahead of Print
MD 3, Giorgio Alberto Croci MD 2,4, Valeria Rossetti MD 5, Giuseppe Citerio MD, Professor
6,7
DOI: 10.1097/TP.0000000000003646
, Giacomo Grasselli MD, Professor 2,3, Mario Nosotti MD, Professor 1,2, Alberto Zanella MD,
D
Overcoming the Limits of Reconditioning: Seventee
Professor 2,3
(EVLP) with Successful Transplantation from Unco
E
1. Thoracic Surgery and Lung Transplantation Unit, F a IRCCS Ca G a a
Alessandro Palleschi MD 1,2.*, Lorenzo Rosso MD, Ph
Ospedale Maggiore Policlinico of Milan, Milan, Italy.
MD 3, Giorgio Alberto Croci MD 2,4, Valeria Rossetti
TE T
2. University of Milan, Milan, Italy.
6,7
, Giacomo Grasselli MD, Professor 2,3, Mario Nosotti
3. Anesthesia, Intensive Care and Emergency, F a IRCCS Ca G a a
EP
Ospedale Maggiore Policlinico of Milan, Milan, Italy.
Professor 2,3
D
1. Thoracic Surgery and Lung Transplantation Un
4. Pathology Unit, F a IRCCS Ca G a a Ospedale Maggiore Policlinico of
Ospedale Maggiore Policlinico of Milan, Milan
Milan, Milan, Italy.
2. University of Milan, Milan, Italy.
C
5. Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center,
3. Anesthesia, Intensive Care and Emergency, F
P
F a IRCCS Ca G a a Ospedale Maggiore Policlinico of Milan, Milan,
C
Ospedale Maggiore Policlinico of Milan, Milan

Italy.
4. Pathology Unit, F a IRCCS Ca G a
6. San Gerardo Hospital, ASST-Monza, Monza, Italy.
Milan, Milan, Italy.
the risk of the
supplyTable
of donor
1.3 lungs. Although the gap
ently primary
between [donors and those
Contemporary Reviews waiting for Medicine ]
in Critical Care FOR EDITORIAL COMMENT SEE PAGE 4
Potential
Lunghas
transplant
mentsStudies
in lunghave Soporte ventilatorio…..
Transplant
narrowed, Protocols
donation
showncould
further advance-
result
that with theinimplementation may of obviate
a these detrimental effects and
specifiin
c and
bothaggressive lung donor on patient thereby enhance the procurement of donor
management
reductionsMechanical time and Ventilatory
mortality Support
the
previouslylungs
in Potential Lung
protocol,
waiting list. In many
2011, of theabout
only lungs 21%that were
of lungs deemed for transplantation.
rvested, poten- Donor Patients
unsuitable may be salvageable. A few pertinent studies
oped pulmonaryfrom donors were transplanted. However,
1
depicting this are Esan, MD, FCCP; Dean Hess, PhD, Pathophysiologic
summarized. RRT, FCCP; Luis F. Angel, MD; Changes Affecting
26-28
ory responses the majority of donor lungs (64.4%) were
Ruchi Bansal , MD ; Adebayo
the Lungs After Brain Death

Stephanie M. Levine, MD, FCCP; Tony George, MD; and Suhail Raoof, MD, FCCP
r brain death deemed incompatible because of the lung
he donor lungs todamage that1generally
TABLE ] Principles predates but in some
oftransplantation
Lung Mechanical Ventilation
reduces Prior
mortality in in towith
patients brain death,
end-stage donorhowever,
lung disease; lungsonlymay have
approximately 21% of lungs from potential donor patients undergo transplantation. A large
turn may instances supervenesPotential Lung Donor death.
following Patients
number of brain been damaged from trauma,asresuscitation
1
donor lungs become categorized as unsuitable for lung transplantation a result
xemic respira- Objective of lung injury around the time of brain death. Limiting this injury is key to increasing the
Parameters Adjusted
number of successful lung procurements and subsequent transplants. This narrative review
procurement
Prevention of Tidalgroup
by a working volume 6-8 mL/kgrespiratory
of pulmonologists, IBW, therapists, and lung transplant specialists
rly and long- overdistention elucidatesplateauprinciples ofpressure
mechanical 30 cm Hsupport
,ventilatory 2O
that can be used to limit lung injury in
received
rease in November 9, 2012; revision accepted November
potential 15 ,
lung donor CORRESPONDENCE
patients and examines the Suhail Raoof,
TO:implementation of MD, FCCP,strategies
protocolized New York in Methodist
Maintain alveolar enhancing Adequate PEEPof8-10
Hospital,
the procurement donor cm Hfor
Pulmonary
lungs 2O & Critical Care
transplantation. CHESTMedicine,
2014; 146506 Sixth
(1):220 -227St, Brooklyn,
donor recruitment
NS: From the Division of Pulmonary and Critical ABBREVIATIONS
Care Med- : APRV 5 NY 11215; e-mail: suhailraoof@gmail.com
airway pressure release ventilation; IBW 5 ideal body weight; NPE 5 neurogenic
how
ansal,low the
Esan, Prevention
George, and Raoof), New Yorkof Methodist Hos-Lowest FIO©2 (2014
pulmonary edema ; PCV 5 ! 0.5) to keep COLLEGE
pressure-control
AMERICAN ventilation; PEEP 5 positive end expiratory
OF CHEST pressure; Phigh
PHYSICIANS. Reproduction
5 of
high airway pressure; PIP 5 peak inspiratory pressure; Plow 5 low airway pressure; SALT 5 San Antonio
yn,
lantNY; Respiratory
outcome, as Care Services (Dr Hess), Massachusetts
oxygen toxicity Sp O 92%-95%
Lung Transplant;2VCV 5 this article is prohibited
volume-control ventilation; Vt without written permission from the American
5 tidal volume
spital, Boston,
11,12 Nonetheless,MA; and the Division of Pulmonary and College of Chest Physicians. See online for more details.
IBW ideal body weight; PEEP
e Medicine (Drs Angel and Levine), University of Texas
5 5 positive end-expiratory pressure;
DOI: 10.1378/chest.12-2745
ng
ncedonor
Center,patients SpO2 5 oxygen saturation Lung
San Antonio, TX. by pulse oximetry. has proven to be a
transplantation This effect may be compounded by complica-
lifesaving procedure and an established tions emanating during the treatment of
therapeutic option for patients with end-stage potential lung donor patients, including the
lung disease. Until recently, the demand for mechanical ventilation strategies selected.
emporary Reviews in Critical Care Medicine lung transplantation greatly exceeded the 221 [
Advances in lung1 donor 1 C Hmanagement
4 6 # patient E S T J U LY 2014 ]
supply of donor lungs. Although the gap
between donors and those waiting for FOR EDITORIAL COMMENT SEE PAGE 4
by a Hinari User on 07/26/2014
tp://journal.publications.chestnet.org/ by a Hinari User
transplant on 07/26/2014
has narrowed, further advance-
ments in lung donation could result in may obviate these detrimental effects and
reductions in both time and mortality on the thereby enhance the procurement of donor
waiting list. In 2011, only about 21% of lungs lungs for transplantation.
from donors were transplanted.1 However,
nal strategy. It may without increasing hospital or ICU length of stay and
ilator strategy with without
temporary Reviews in Critical Care Medicine [ 146#1
compromising the lung function or survival C H E S T J U LY 2014 ]
ht (IBW) and PEEP
Soporte ventilatorio …..
rates of the lung transplant recipients.26
ehttp://journal.publications.chestnet.org/
used in potential by a Hinari User on 07/26/2014
TABLE 3 ] SALT Protocol Criteria26: Absolute and

Extended Criteria
of Ventilatory
ung Donor Absolute Criteria Extended Criteria
Pao2/FIO2 ratio . 300 mm Hg Age . 55 y

Protective No radiographically visible Cumulative smoking
infiltrates history . 20 pack-y
8 mL/kg IBW
No evidence of copious History of pulmonary
of 8-10 cm H2O
purulent secretions disease
a tests performed
Severe chest trauma
using CPAP
No evidence of aspiration . 4 d on mechanical
on bronchoscopy ventilation
d circuit for airway Positive results of Gram
tion staining of tracheal or
BAL fluids
sion of other
SALT 5 San Antonio Lung Transplant.
Medicine [ 1 4 6 # 1 C H E S T J U LY 2014 ]
et.org/ by a Hinari User on 07/26/2014
It applies a high airway pressure (Phigh) over a pro- time for the low CPAP level) were not reported. None-
longed inspiratory time with brief pressure releases to a theless, patients on APRV had a higher mean Pao2/Fio2
(498 ! 43 mm Hg vs 334 ! 104 mm Hg) following a
low airway pressure (Plow), causing progressive lung
temporary Reviews in Critical Care Medicine [ 1 4 6 # 1 C H E S T J U LY 2014 ]
Flujograma…..
recruitment and enhancing oxygenation.35,37 In transi- 45-min 100% oxygen challenge, which the authors
tioning from more conventional ventilator modes to attributed to improved alveolar recruitment and resolution
http://journal.publications.chestnet.org/
APRV, the initialbysettings
a Hinari Userlung
in adult on 07/26/2014
donor patients of pulmonary atelectasis. They further suggest that this
Figure 1 – Algorithmic approach in lung donor candidate. IBW = ideal body weight; PC = pressure above positive end-expiratory pressure; PCV = pressure-
control ventilation; PEEP = positive end-expiratory pressure; P/F = Pao2/Fio2; Pplat = plateau pressure; SpO2 = oxygen saturation by pulse oximetry;
VCV = volume-control ventilation; VT = tidal volume.
224 Contemporary Reviews in Critical Care Medicine [ 1 4 6 # 1 C H E S T J U LY 2014 ]

Y el donante …..
Gracias
fvaron@neumologica.org
fvaron@cardioinfantil.org
@FABIOVARON

Optimización Del Donante 2021

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Optimización Del Donante 2021

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Optimización del donante

para trasplante pulmonar

FABIO ANDRES VARON V. MD. , MSc., Ph.D©

Asesor/speaker: Grant de investigación:

0-10 11-17 18-34 35-49 50-59 60-65 66+ Median age

Mediana de edad de los receptores

(años, liena azul)

Año del trasplante

0-10 11-17 18-34 35-49 50-59 60-65 66+ Median age

Median donor age (years; blue line)

Bilateral/Double Lung (N=40,623)

CMV antibody positive 55.3% 60.4% 61.6% <0.0001

EBV antibody positive - 91.6%1 93.7% <0.0001

Hep B antibody positive 2.4% 2.5% 2.6% 0.6759

Hep C antibody positive 0.6% 0.1% 0.6% <0.0001

Smoking history 31.7% 20.7% 12.1% <0.0001

Alcohol use - 12.8%2 14.6% 0.0001

Cocaine use - 10.8% 14.3% <0.0001

Other drugs use - 28.1% 40.7% <0.0001

Diabetes 2.3%3 4.6% 7.2% <0.0001

Hypertension 12.4%3 18.4% 24.0% <0.0001

PO2 (mmHg) - 424.0 (115.0 - 578.4)4 409.0 (109.0 - 563.0) <0.0001

Summary statistics included transplants with non-missing data

(Transplants: Jan 1992 – Jun 2018)

Europe North America Other

JHLT. 2020 Oct; 39(10): 1003-1049

Note: Y-axis is truncated for clearer presentation

60 Donor with History of Smoking 60 Donor with History of Alcohol Use

Donor with History of Diabetes Donor with History of Hypertension

Ischemic Time <4 hours (N = 8,694)

n Satisfacer5los deseos del donante-familia

Tipo de donante Ventilación mecánica Manejo de líquidos Diabetes insípida Otros

Tipos de donante …..

Ideal DBD, DCD,

Seminars in Respiratory and Critical Care Medicine Vol. 34 No. 3/2013

Table 3 “Acceptable” donor lung selection criteria in 2012

1. Age < 70 years

1. Age acceptance up to 75 years

Seminars in Respiratory and Critical Care Medicine Vol. 34 No. 3/2013

Table a3., and

Economic evaluation of the specialized donor care facility for

Economic evaluation of the specialized donor care facility for

Economic evaluation of the specialized donor care facility for

Total cost (millions of $)

Overcoming the Limits of Reconditioning: Seventeen Hours of Ex-Vivo Lung Perfusion

(EVLP) with Successful Transplantation from Uncontrolled Circulatory Death Donor

Ospedale Maggiore Policlinico of Milan, Milan

the Lungs After Brain Death

TABLE 3 ] SALT Protocol Criteria26: Absolute and

Pao2/FIO2 ratio . 300 mm Hg Age . 55 y

224 Contemporary Reviews in Critical Care Medicine [ 1 4 6 # 1 C H E S T J U LY 2014 ]

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