Lung Donation After Controlled Circulatory Determination of Death: A Review of Current Practices and Outcomes.

BACKGROUND: Since the first reported series in 1995, transplantation of lungs recovered through donation after circulatory determination of death (DCDD) has steadily increased. In some European and Australian centers, controlled DCDD accounts for 15% to 30% of all transplanted lungs. Several transplant centers have reported early and midterm outcomes similar to those associated with the use of donors after brain death. Despite these encouraging reports, less than 2% of all lung transplants in the United States are performed using donors after circulatory determination of death. METHODS: An electronic search from January 1990 to January 2014 was performed to identify series reporting lung transplant outcomes using controlled DCDD. Data from these publications were analyzed in terms of donor characteristics, donation after circulatory determination of death protocols, recipients' characteristics, and early and midterm outcomes. RESULTS: Two hundred twenty-two DCDDs were transplanted into 225 recipients. The rate of primary graft dysfunction grade 3 ranged from 3% to 36%. The need for extracorporeal membrane oxygenation support after transplantation ranged from 0% to 18%. The average intensive care unit stay ranged from 4 to 8.5 days and the average hospital stay ranged from 14 to 35 days. Thirty-day mortality ranged from 0% to 11% and 1-year survival from 88% to 100%. CONCLUSION: Under clinical protocols developed and strictly applied by several experienced lung transplant programs, lungs from controlled DCDD have produced outcomes very similar to those observed with brain death donors.

Successful lung salvage by ex vivo reconditioning of neurogenic pulmonary edema: case report.

Liberalization in donor selection criteria allowed centers to increase the number of lung transplants, yet less than 25% of all donors had lungs utilized for transplantation in the United States in 2013. Less than 5% of all transplanted donors deviate 3 or more criteria from the ideal donor. Ex vivo lung perfusion (EVLP) provides the opportunity to increase the percentage of used donors by acting on modifiable selection criteria such as oxygenation, contusion and pulmonary infiltrates. We report the pre-transplant use of EVLP in the salvage of lungs from a donor that developed neurogenic pulmonary edema -PaO2 188 mmHg-. The recipient had a lung allocation score of 69.3. The post-operative course was excellent and was discharged home after 15 days. He is alive and doing well 780 days after transplant. In this report the pre-transplant use of EVLP led not only to transplanting lungs that otherwise would not have been used by many centers, but also to a very short and typical period of post-operative mechanical ventilation and hospital stay.

Ferret lung transplant: an orthotopic model of obliterative bronchiolitis.

Obliterative bronchiolitis (OB) is the primary cause of late morbidity and mortality following lung transplantation. Current animal models do not reliably develop OB pathology. Given the similarities between ferret and human lung biology, we hypothesized an orthotopic ferret lung allograft would develop OB. Orthotopic left lower lobe transplants were successfully performed in 22 outbred domestic ferrets in the absence of immunosuppression (IS; n = 5) and presence of varying IS protocols (n = 17). CT scans were performed to evaluate the allografts. At intervals between 3-6 months the allografts were examined histologically for evidence of acute/chronic rejection. IS protects allografts from acute rejection and early graft loss. Reduction of IS dosage by 50% allowed development of controlled rejection. Allografts developed infiltrates on CT and classic histologic acute rejection and lymphocytic bronchiolitis. Cycling of IS, to induce repeated episodes of controlled rejection, promoted classic histologic hallmarks of OB including fibrosis-associated occlusion of the bronchiolar airways in all allografts of long-term survivors. In conclusion, we have developed an orthotopic lung transplant model in the ferret with documented long-term functional allograft survival. Allografts develop acute rejection and lymphocytic bronchiolitis, similar to humans. Long-term survivors develop histologic changes in the allografts that are hallmarks of OB.

TRIDENT high-energy-density facility experimental capabilities and diagnostics.

The newly upgraded TRIDENT high-energy-density (HED) facility provides high-energy short-pulse laser-matter interactions with powers in excess of 200 TW and energies greater than 120 J. In addition, TRIDENT retains two long-pulse (nanoseconds to microseconds) beams that are available for simultaneous use in either the same experiment or a separate one. The facility's flexibility is enhanced by the presence of two separate target chambers with a third undergoing commissioning. This capability allows the experimental configuration to be optimized by choosing the chamber with the most advantageous geometry and features. The TRIDENT facility also provides a wide range of standard instruments including optical, x-ray, and particle diagnostics. In addition, one chamber has a 10 in. manipulator allowing OMEGA and National Ignition Facility (NIF) diagnostics to be prototyped and calibrated.

[Etiology of acute respiratory infections in 87 hospitalized children]. / Etiología de las infecciones respiratorias agudas en 87 niños hospitalizados.

OBJECTIVE: The aim of this study was to assess the effectiveness of two microbiologic methods: viral culture and serology for the etiologic study of acute respiratory infections in children under 14 years of age admitted to our hospital. PATIENTS: From January 1992 to December 1993, a prospective study was carried out in 87 patients with a mean age of two years with the following diagnosis: upper respiratory tract infections (URTI) 19, laryngitis 3, bronchitis 18, bronchiolitis 18, and pneumonia 29. METHOD: Nasopharyngeal aspirates were collected for virologic culture on cell monolayers in 87 patients. Serologic studies by complement fixation test were carried out in 42 patients older than six months. RESULTS: The etiologic agent was detected in 54 (62%) of the 87 patients, being the most frequent the respiratory sincitial virus (VRS) with 18 cases (20%), followed by adenovirus (ADV) in 17 (19%) and Mycoplasma pneumoniae in 9 cases (11%). Viral culture was positive in 32 (37%), being ADV in 14 (41%), and RSV in 9 (26%). Significative serologic studies were obtained in 25 (60%) of the 42 studied patients, with VRS in 9 (32%) and M. pneumoniae in 9 (32%). Concerning clinical diagnosis, the major effectiveness corresponded to serology in pneumonia (76%), and to viral culture in URTI (63%). CONCLUSION: Viral culture and serology are useful methods for the detection of etiologic agents in acute respiratory infections. The serology effectiveness increases with age (p < 0.01) and the severity of the clinical diagnosis. Both methods have limited usefulness from clinical point of view.

Urinary doubly refractile lipid bodies in nonglomerular renal diseases.

Urinary doubly refractile lipid bodies (DRLB) are a characteristic finding in patients with glomerular renal diseases causing heavy proteinuria. DRLB are felt to be an uncommon finding in glomerular diseases without heavy proteinuria, and a rare finding in nonglomerular renal diseases. In order to determine whether DRLB are found in nonglomerular renal diseases, we reviewed the medical records of all patients who had urinalyses performed in our laboratory from February 1975 to June 1983. Three hundred sixty one patients demonstrated less than or equal to +2 proteinuria, and at least two DRLB. Of these, 290 were identified as having a single renal diagnosis. One hundred forty eight patients (51%) had a variety of acute and chronic glomerular diseases, and 125 patients (43.2%) had nonglomerular renal diseases, including acute tubular necrosis (ATN), prerenal azotemia, chronic interstitial nephritis, polycystic kidney disease, acute interstitial nephritis, renal neoplasia, and acute myeloma kidney. Ten patients had transient proteinuria associated with acute illness, and seven patients had no renal disease at all. Only two patients with nonglomerular renal disease had more than five DRLB per 20 high power microscopic fields. The frequency of DRLB in patients with nonglomerular renal diseases was: chronic interstitial nephritis, 26%; polycystic kidney disease, 38%; prerenal azotemia, 20%; ATN, 15%; and acute interstitial nephritis, 33%. These data suggest that at lower levels of proteinuria, DRLB are found frequently in nonglomerular renal diseases, and that DRLB do not differentiate glomerular from nonglomerular renal diseases unless more than five DRLB are found on urinary sediment examination.