Donor quality assessment and size match in lung transplantation.

Careful donor quality assessment and size match can impact long-term survival in lung transplantation. With this article, we review the conceptual and practical aspects of the preoperative donor lung quality assessment and size matching.

Current precautions and future directions in lung transplantation during the COVID-19 pandemic - a single center cohort study.

The unprecedented public health emergency caused by the acute viral respiratory coronavirus disease (COVID-19) has drastically changed current practices in solid organ transplantation, markedly so for transplantation of the lungs, the major target of the virus. Although national and state authorities do not recommend postponing transplant procedures, most specialists are reluctant to proceed due to substantial uncertainty and increased risks in the midst of the pandemic. There is an urgent need for evidence-based directions to move forward. Here, we offer our insights as specialists at a high-volume center located in a geographical area with high infection rates.

ECMO Support in Lung Transplantation: A Contemporary Analysis of Hospital Charges in the United States.

BACKGROUND: There is little in the literature pertaining to cost associated with the use of extracorporeal membrane oxygenation (ECMO) in lung transplantation. We sought to evaluate charges associated with the index hospitalization among recipients of a lung transplant who required ECMO to identify factors that increase hospital charges in these patients. METHODS: With the use of the Nationwide Inpatient Sample, we reviewed data pertaining to patients who received a lung transplant between 2000 and 2011 and stratified them into ECMO and non-ECMO groups based on use of ECMO. Regression modeling was used to identify differences in charges. RESULTS: Data pertaining to 15,596 recipients of a lung transplant were evaluated, 658 (4.2%) of whom required ECMO. ECMO recipients were more likely to have a diagnosis of idiopathic pulmonary fibrosis (3.5% versus 1.3%, p = 0.007) or pulmonary hypertension (PH) (9.1% versus 3.0%, p < 0.001). Patients who received a bilateral lung transplant had 32.1% (95% confidence interval [CI]: 26.2% to 37.9%, p < 0.001) higher charges. Recipients with PH had 28.7% (95% CI: 14.9% to 42.4%, p = 0.001) higher charges. Median charges for recipients of a lung transplant who required ECMO were $780,391.50 versus $324,279.80 for non-ECMO recipients of a lung transplant and were 50.3% (95% CI: 33.0% to 67.5%, p < 0.001) higher. Hospital charges among Medicare enrollees were 6.6% (95% CI: 0.7% to 12.5%, p = 0.028) higher than privately insured recipients of a lung transplant. Black recipients had approximately 34.2% (95% CI: 3.2% to 65.0%, p = 0.030) higher charges. The ECMO group had longer median length of stay (LOS) (25 versus 15 days, p < 0.001). CONCLUSIONS: Recipients of a lung transplant who required ECMO support had longer LOS and higher hospital charges, specifically among black recipients, recipients with PH, and Medicare enrollees.

Postoperative Swallowing Assessment After Lung Transplantation.

BACKGROUND: Dysphagia, aspiration, and potential pneumonia represent a major source of morbidity in patients undergoing lung transplantation. Conditions that potentiate dysphagia and aspiration include frailty and prolonged intubation. Our group of speech-language pathologists has been actively involved in performance of a bedside evaluation of swallowing, and instrumental evaluation of swallowing with modified barium swallow, and postoperative management in patients undergoing lung transplantation. METHODS: All lung transplant patients from April 2009 to September 2012 were evaluated retrospectively. A clinical bedside examination was performed by the speech-language pathology team, followed by a modified barium swallow or fiberoptic endoscopic evaluation of swallowing. RESULTS: A total of 321 patients were referred for evaluation. Twenty-four patients were unable to complete the evaluation. Clinical signs of aspiration were apparent in 160 patients (54%). Deep laryngeal penetration or aspiration were identified in 198 (67%) patients during instrumental testing. A group of 81 patients (27%) had an entirely normal clinical examination, but were found to have either deep penetration or aspiration. CONCLUSIONS: The majority of patients aspirate after lung transplantation. Clinical bedside examination is not sensitive enough and will fail to identify patients with silent aspiration. A standard of practice following lung transplantation has been established that helps avoid postoperative aspiration associated with complications.

Pitfalls in donor lung procurements: how should the procedure be taught to transplant trainees?

OBJECTIVE: The current trend in lung transplantation has led to liberalized lung donor selection criteria and use of marginal donors, with a corresponding requirement for improved procurement techniques to obtain high-quality donor grafts. Few reports, however, have provided recommendations for successful lung procurement procedures. METHODS: We retrospectively studied 47 lung procurements performed by the University of Pittsburgh Medical Center team from January 2007 to December 2007. From those findings, we compared outcomes, as well as technical errors encountered, between procurements performed by trainees with limited transplant experience and by experienced transplant surgeons. RESULTS: Twenty-two of the procurements (47%) were performed by experienced transplant surgeons and 25 (53%) by supervised trainees. Patient characteristics and technical difficulties were comparable between the two groups. The trainees took more time to complete the procedure than did the experienced surgeons, although the difference was not significant. Furthermore, 21 of the cases performed by trainees (84%) had one or more technical errors in the sequential steps of the procurement, including inadequate placement of the perfusion cannula in the main pulmonary artery (60%), insufficient topical cooling (56%), and inadequate timing of the start of pulmonary artery perfusion (44%). CONCLUSION: Donor lung procurements performed by beginners with limited transplant experience included frequent technical errors with regard to adequate graft preservation, which may lead to serious complications after transplant. Sequential steps in lung procurement techniques and better understanding of organ preservation should be an integral part of a lung transplant training program.