Expanding the horizons: Uncontrolled donors after circulatory death for lung transplantation-First comparison with brain death donors.

Uncontrolled donation after cardiac death is an appealing source of organs for lung transplantation. We compare early and long-term outcomes of lung transplantation with these donors with a cohort of transplants from brain death donors at our institution. Retrospective analysis of all lung transplantations was performed from 2002 to 2012. We collected variables regarding recipients, donors, recover and transplant procedures, early and late complications, and survival. We included 292 lung transplants from brain death donors and 38 from uncontrolled donors after cardiac death. Both groups were comparable except for sex mismatch (male recipient-female donor was more frequent in the brain death cohort, 17.8% vs 0%, P 0.002), total ischemic time (longer for donors after cardiac death, 657 minutes for the first lung and 822 minutes for the second vs 309 and 425 minutes, P < 0.001), and ex vivo evaluation (more frequent in cardiac death donors, 21.1% vs 1.4%, P < 0.001). Early and late outcomes were not different (ICU stay [9 vs 10.5 days], hospital stay [33.5 vs 35 days], primary graft dysfunction G3 [24 vs 34.2%], and chronic graft dysfunction HR 1.19 [0.61-2.32]), but overall survival was significantly lower for patients transplanted from cardiac death donors [HR 1.67 (1.06-2.64)]. Lung transplantation after uncontrolled cardiac death offers poorer results in terms of survival compared to brain death donation. Refinement of current strategies for graft preservation and evaluation is essential to improve outcomes with this source of grafts.

Management of Bronchial Complications After Lung Transplantation and Sequelae.

Airway complication (AC) after lung transplant, although rare nowadays, leads to increased costs, greater morbidity, and decreased quality of life of patients. Over the years, many risk factors have been described, ranging from surgical technique to immunosuppressive regimen. There are essentially 6 major airway complications (necrosis/dehiscence, infection, bronchial stenosis, granulomas, tracheo-bronchomalacia, and fistula) all of which require a multidisciplinary approach based on the performance status of patients. In this article, the authors review the risk factors, clinical presentation, diagnosis methods, and management options in the most common AC after lung transplantation.