Download PDF
Thorac Cardiovasc Surg 2017; 65(05): 395-402
DOI: 10.1055/s-0035-1564447
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Does Traumatic Donor Cause of Death Influence Outcome after Lung Transplantation? A Single-Centre Analysis

Kevin Pilarczyk
1   Department of Intensive Care Medicine, Imland Klinik Rendsburg, Rendsburg, Germany
,
Jens Heckmann
2   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
,
Henning Carstens
2   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
,
Jura Lubarski
2   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
,
Heinz Jakob
2   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
,
Nikolaus Pizanis
2   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
,
Markus Kamler
2   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
› Author Affiliations
Further Information

Publication History

04 March 2015

27 July 2015

Publication Date:
24 September 2015 (online)

    Permissions and Reprints All articles of this category

Abstract

Background Owing to the shortage of donor organs in lung transplantation (LuTX), liberalization of donor selection criteria has been proposed. However, some studies suggested that donor traumatic brain damage might influence posttransplantation allograft function. This article aimed to investigate the association of donor cause of death (DCD) and outcome after LuTX.

Methods A retrospective analysis of 186 consecutive double LuTXs at our institution from January 2000 to December 2008 was performed. DCD was categorized into traumatic brain injury (TBI) and nontraumatic brain injury (NTBI). In addition, NTBI was sub classified as spontaneous intracerebral bleeding (B), hypoxic brain damage (H), and intracerebral neoplasia (N).

Results DCD was classified as TBI in 50 patients (26.9%) and NTBI in 136 patients (73.1%): B in 112 patients (60.2%), H in 21 patients (11.3%), and N in 3 patients (1.6%). Young male donors predominated in group TBI (mean age 36.0 ± 14.5 vs. 42.8 ± 10.7, p < 0.01; 29 males in the TBI group [58.0%] vs. 48 males in the NTBI group [35.3%], p < 0.01). Groups of DCD did not differ significantly by recipient age or gender, recipient diagnosis, donor ventilation time, or paO2/FiO2 before harvesting. TBI donors received significantly more blood (3.4 ± 3.8 vs. 1.8 ± 1.9, p = 0.03). A chest trauma was evident only in group T (n = 7 [3.7%] vs. 0 [0%], p < 0.001). Mode of donor death did not affect the following indices of graft function: length of postoperative ventilation, paO2/FiO2 ratio up to 48 hours, and lung function up to 36 months. One- and three-year survival was comparable with 84.4 and 70.4% for TBI donors versus 89.4% and 69.2% for NTBI donors. Five-year survival tended to be lower in the TBI group but did not reach statistical significance (43.4 vs. 53.9%).

Conclusion This study indicates that traumatic DCD does not affect outcome after LuTX. These results can be achieved with an ideal donor management combined with an individual case-to-case evaluation by an experienced LuTX surgeon.

Keywords

transplantation - lung - airway - benign or congenital lesions
 

  • References

  • 1 Christie JD, Edwards LB, Kucheryavaya AY. , et al; International Society of Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant 2012; 31 (10) 1073-1086
    CrossrefPubMedSearch in Google Scholar
  • 2 Yeung JC, Cypel M, Waddell TK, van Raemdonck D, Keshavjee S. Update on donor assessment, resuscitation, and acceptance criteria, including novel techniques—non-heart-beating donor lung retrieval and ex vivo donor lung perfusion. Thorac Surg Clin 2009; 19 (02) 261-274
    CrossrefPubMedSearch in Google Scholar
  • 3 Botha P. Extended donor criteria in lung transplantation. Curr Opin Organ Transplant 2009; 14 (02) 206-210
    CrossrefPubMedSearch in Google Scholar
  • 4 Avlonitis VS, Wigfield CH, Kirby JA, Dark JH. The hemodynamic mechanisms of lung injury and systemic inflammatory response following brain death in the transplant donor. Am J Transplant 2005; 5 (4, Pt 1): 684-693
    CrossrefPubMedSearch in Google Scholar
  • 5 Cohen O, De La Zerda DJ, Beygui R, Hekmat D, Laks H. Donor brain death mechanisms and outcomes after heart transplantation. Transplant Proc 2007; 39 (10) 2964-2969
    CrossrefPubMedSearch in Google Scholar
  • 6 Busson M, N'Doye P, Benoit G. , et al. Donor factors influencing organ transplant prognosis. Transplant Proc 1995; 27 (02) 1662-1664
    PubMedSearch in Google Scholar
  • 7 Waller DA, Thompson AM, Wrightson WN. , et al. Does the mode of donor death influence the early outcome of lung transplantation? A review of lung transplantation from donors involved in major trauma. J Heart Lung Transplant 1995; 14 (02) 318-321
    PubMedSearch in Google Scholar
  • 8 Ciccone AM, Stewart KC, Meyers BF. , et al. Does donor cause of death affect the outcome of lung transplantation?. J Thorac Cardiovasc Surg 2002; 123 (03) 429-434 , discussion 434–436
    CrossrefPubMedSearch in Google Scholar
  • 9 Ganesh JS, Rogers CA, Banner NR, Bonser RS. ; Steering Group of the UK Cardiothoracic Transplant Audit. Donor cause of death and mid-term survival in lung transplantation. J Heart Lung Transplant 2005; 24 (10) 1544-1549
    CrossrefPubMedSearch in Google Scholar
  • 10 Simonetti VA, Basha MA, Allenspach L, Klosterman KG, Nakhleh R, Higgins RS. Donor cerebral tissue pulmonary emboli in a functioning transplanted lung. Clin Transplant 1998; 12 (06) 504-507
    PubMedSearch in Google Scholar
  • 11 Taviloglu K, Yanar H. Fat embolism syndrome. Surg Today 2007; 37 (01) 5-8
    PubMedSearch in Google Scholar
  • 12 Huber-Wagner S, Qvick M, Mussack T. , et al; Working Group on Polytrauma of German Trauma Society (DGU). Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society. Vox Sang 2007; 92 (01) 69-78
    CrossrefPubMedSearch in Google Scholar
  • 13 Lang H, Kamler M, Herold U, Malagó M, Jakob H, Broelsch CE. Donor organ harvesting [in German]. Chirurg 2002; 73 (05) 517-535 , quiz 536–537
    CrossrefPubMedSearch in Google Scholar
  • 14 Sommerwerck U, Rabis T, Fleimisch P, Carstens H, Teschler H, Kamler M. Lung transplantation [in German]. Herz 2014; 39 (01) 74-83
    CrossrefPubMedSearch in Google Scholar
  • 15 Christie JD, Carby M, Bag R, Corris P, Hertz M, Weill D. ; ISHLT Working Group on Primary Lung Graft Dysfunction. Report of the ISHLT Working Group on Primary Lung Graft Dysfunction part II: definition. A consensus statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2005; 24 (10) 1454-1459
    CrossrefPubMedSearch in Google Scholar
  • 16 Estenne M, Maurer JR, Boehler A. , et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant 2002; 21 (03) 297-310
    CrossrefPubMedSearch in Google Scholar
  • 17 Avlonitis VS, Fisher AJ, Kirby JA, Dark JH. Pulmonary transplantation: the role of brain death in donor lung injury. Transplantation 2003; 75 (12) 1928-1933
    CrossrefPubMedSearch in Google Scholar
  • 18 Carter YM, Davis RD. Primary graft dysfunction in lung transplantation. Semin Respir Crit Care Med 2006; 27 (05) 501-507
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Singhal AK, Sheng X, Drakos SG, Stehlik J. Impact of donor cause of death on transplant outcomes: UNOS registry analysis. Transplant Proc 2009; 41 (09) 3539-3544
    CrossrefPubMedSearch in Google Scholar
  • 20 Moiz B, Sharif H, Bawany FA. Transfusion related acute lung injury—TRALI: an under diagnosed entity. J Pak Med Assoc 2009; 59 (01) 39-41
    PubMedSearch in Google Scholar
  • 21 Whitson BA, Hertz MI, Kelly RF. , et al. Use of the donor lung after asphyxiation or drowning: effect on lung transplant recipients. Ann Thorac Surg 2014; 98 (04) 1145-1151
    CrossrefPubMedSearch in Google Scholar
  • 22 Castleberry AW, Worni M, Osho AA. , et al. Use of lung allografts from brain-dead donors after cardiopulmonary arrest and resuscitation. Am J Respir Crit Care Med 2013; 188 (04) 466-473
    CrossrefPubMedSearch in Google Scholar
  • 23 Pilarczyk K, Osswald BR, Pizanis N. , et al. Use of donors who have suffered cardiopulmonary arrest and resuscitation in lung transplantation. Eur J Cardiothorac Surg 2011; 39 (03) 342-347
    CrossrefPubMedSearch in Google Scholar
  • 24 Wauters S, Verleden GM, Belmans A. , et al. Donor cause of brain death and related time intervals: does it affect outcome after lung transplantation?. Eur J Cardiothorac Surg 2011; 39 (04) e68-e76
    CrossrefPubMedSearch in Google Scholar
  • 25 Bermudez CA, Shiose A, Esper SA. , et al. Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation. Ann Thorac Surg 2014; 98 (06) 1936-1942 , discussion 1942–1943
    CrossrefPubMedSearch in Google Scholar
  • 26 Ius F, Kuehn C, Tudorache I. , et al. Lung transplantation on cardiopulmonary support: venoarterial extracorporeal membrane oxygenation outperformed cardiopulmonary bypass. J Thorac Cardiovasc Surg 2012; 144 (06) 1510-1516
    CrossrefPubMedSearch in Google Scholar
  • 27 Fatt MA, Horton KM, Fishman EK. Transmission of metastatic glioblastoma multiforme from donor to lung transplant recipient. J Comput Assist Tomogr 2008; 32 (03) 407-409
    CrossrefPubMedSearch in Google Scholar
  • 28 Schweitzer T, Vince GH, Herbold C, Roosen K, Tonn JC. Extraneural metastases of primary brain tumors. J Neurooncol 2001; 53 (02) 107-114
    CrossrefPubMedSearch in Google Scholar