DCD lung donation: donor criteria, procedural criteria, pulmonary graft function validation, and preservation.

In an era where there is a shortage of lungs for transplantation is increased utilization of lungs from donation after circulatory death (DCD) donors. We review the reports of 11 controlled and 1 uncontrolled DCD programs focusing on donor criteria, procedural criteria, graft assessment, and preservation techniques including the use of ex vivo lung perfusion. We have formulated conclusions and recommendations for each of these areas, which were presented at the 6th International Conference on Organ Donation. A table of recommendations, the grade of recommendations, and references are provided.

Post-transplant outcomes of standard and extended criteria donation after circulatory death donor lungs categorized by donation after brain death lung criteria.

OBJECTIVES: Most transplant centres use donation after brain death (DBD) criteria to assess the quality of controlled donation after circulatory death (cDCD) lungs. However, research on the relationship between DBD extended criteria and cDCD lung transplantation outcomes is limited. We investigated the outcomes of using DBD extended criteria donor organs in cDCD lung transplantation, compared to the standard criteria cDCD lung transplantation. METHODS: A retrospective chart review of consecutive cDCD lung referrals to Hospital Universitario Puerta de Hierro-Majadahonda from June 2013 to December 2019 was undertaken. Donors were divided into standard and extended criteria groups. Early outcomes after lung transplant were compared between these groups using the Kaplan-Meier method and log-rank test. RESULTS: Thirty out of 91 cDCD donor lung offers were accepted for transplantation, of which 11 were from standard criteria donors and 19 were extended criteria donors. The baseline characteristics of the 2 recipient groups were similar. There were no differences in the rates of grade 3 primary graft dysfunction at 72 h after lung transplantation (21% vs 18%), duration of mechanical ventilation (48 h vs 36 h), total intensive care unit stay (10 days vs 7 days) and 1-year survival (89% vs 90%). CONCLUSIONS: Carefully selecting cDCD lungs from outside the standard acceptability criteria may expand the existing donor pool with no detrimental effects on lung transplantation outcomes.

Present state of nonheart-beating lung donation.

PURPOSE OF REVIEW: Indications for lung transplantation have increased through the years, and currently we have to face a lack of grafts to attend this growing demand with the subsequent increase in waiting-list deaths. Several strategies have been proposed to solve this challenging problem (living-lobe donors, extended donors, size-reduced lung grafts and so on), the use of nonheart-beating donors (NHBDs) being the most promising of them. RECENT FINDINGS: The last experimental works concerning NHBDs have focused on the improvement of graft preservation in order to minimize warm ischemic injury and the capacity of noninvasive parameters in bronchial lavage to predict good function after implantation. There have also been several reports on the clinical use of controlled and uncontrolled NHBDs with excellent results. CONCLUSION: Several methods have been effective in protecting these grafts from ischemic damage. Functional predictors will be very useful in the near future allowing us to know in a simple and noninvasive way which grafts are suitable for transplantation. Definitely, NHBDs for lung transplantation are no more a promising source of grafts but a real one, with encouraging short-term and mid-term results.

Results of surgery in small cell carcinoma of the lung.

OBJECTIVE: The experiences published by various groups have re-opened the debate on the role of surgery in the management of patients with small cell lung cancer, especially in those with early stage disease (T1-T2 N0). Our study reports the survival rate of 47 patients with small cell lung cancer treated surgically. PATIENTS AND METHODS: Ours is a prospective study that selected patients with lung cancer recommended for surgery (n=2994) between 1993 and 1997 based on operability criteria accepted by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery. We report the clinical as well as pathological stages of the patients with small cell lung cancer (n=47), later analysing the 5-year survival rate after surgery using the Kaplan-Meier method. RESULTS: In 31 patients (66%), resection was complete; 3 patients (6%) received induction treatment and 30 (64%) adjuvant treatment. Five years later, 26% (95% CI 12-40%) of the patients that received surgical treatment were still alive. When we analysed the patients that underwent complete resection, 31% (95% CI 13-49%) survived 5 years or more. In patients at stage Ip (n=15), 36% (95% CI 11-61%) were still living after 5 years. CONCLUSION: Until future studies compare surgery plus chemotherapy versus chemotherapy and radiotherapy, it seems reasonable to offer surgical treatment to those patients with early stage small cell lung cancer (T1-T2-N0).

Results of clinical lung transplant from uncontrolled non-heart-beating donors.

BACKGROUND: The scarcity of grafts for lung transplant and the growing number of candidates expecting an organ has led to an increase of deaths in patients waiting for lung transplantation. Non-heart-beating donors (NHBD) represent a promising source of grafts for those who are involved in clinical lung transplantation. We present the results of our series of 17 out-of-hospital NHBD lung transplantations performed since 2002. METHODS: We have collected data from 17 donors and recipients involved in NHBD lung transplants since 2002, as well as data referring to the type of procedure and peri-operative events. We describe the incidence of post-operative complications with special attention to primary graft disfunction (PGD), bronchial healing, bronchiolitis obliterans syndrome (BOS), and survival. We used Kaplan-Meier method to obtain the survival curve. RESULTS: G2-G3 PGD was reported in 9 patients (53%), with a complete restoration of the partial pressure of arterial oxygen/fraction of inspired oxygen ratio in 170 hours for G2 and 168 hours for G3. There were no deaths directly related to PGD. Acute rejection was detected in 7 patients (41%), 4 of which exceeded grade 1. The incidence of BOS after transplantation was 1 (7%) of 14 patients during the first year, 2 (11%) of 9 in the second year, and 2 (50%) of 4 in the third year. Hospital mortality rate was 17%. The survival rates were 82% at 3 months, 69%, at 1 year, and 58% at 3 years. CONCLUSIONS: Mid-term results confirm the adequacy of uncontrolled NHBD as a promising complementary source of lung donors for clinical transplant.