ABSTRACT Lung transplantation is indicated for patients with cystic fibrosis, emphysema, pulmonary fibrosis or pulmonary hypertension whose life expectancy is less than two years. Criteria of severity are detailed. Three types of transplantation can be proposed: single lung transplant for fibrosis and dry emphysema; bilateral lung transplant for cystic fibrosis, and certain types of emphysema and pulmonary hypertension; heart-lung transplant for pulmonary hypertension and Eisenmenger syndrome. Due to insufficient supply of donor organs, one quarter of the candidates die on the waiting list and the limit for inscription is often 60 years. Postoperative mortality at two months is about 15% and is related to graft dysfunction, infection, bronchial complications,... Acute rejection usually occurs during the first year. Chronic rejection is expressed by obliterating bronchiolitis, the leading cause of death after one year. There is a risk of cancer (EBV-induced lymphoproliferative syndromes and skin cancer). Five-year survival is still only about 50%. Immunosuppressor treatments still cause numerous adverse effects (hypertension, renal toxicity...); function and quality-of-life have however greatly improved.
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ABSTRACT: Because of the shortage of lungs for transplantation, finding the suitable lungs in brain-dead donors is an important issue. Recruitment maneuver is a strategy aimed at re-expanding collapsed and edematous lung tissue. The aim of this study was to assess the efficacy of this maneuver on improving marginal lungs for transplantation. From 127 brain-dead potential donor which were evaluated for lung donation in Masih Daneshvari Organ Procurement Unit of Tehran, Iran, 31 (25%) had marginal lungs for transplantation. These donors had normal chest X ray or bilateral infiltration and had PaO2 200-300 mm Hg with FIO2 100%. The recruitment maneuver was performed and arterial blood gas was obtained before and after maneuver. The maneuver lasts for 2 hours with continuous check of O2 saturation and patient's hemodynamic during. Finally, patients with normal bronchoscopy and PaO2/FIO2 >300 mm Hg were considered good candidates for lung transplantation. The frequency (%) and mean ± SD were used for description of variables and the Wilcoxon test was used for comparison between pre- and post-maneuver PaO2 with FIO2 100%. The mean ± SD of PaO2/FIO2 with 100% FIO2 of patients before and after recruitment were 239 ± 62 and 269 ± 91, respectively. Recruitment maneuver could convert 10 marginal lungs (32%) to appropriate ones (PaO2 > 300) and finally 8 lungs were transplanted. Findings of this study showed that recruitment maneuver could convert inappropriate lungs to appropriate ones in one third of brain-dead patients who had marginal lung condition. So, it is recommended that this maneuver is considered in the assessment protocol of lungs for donation.Transplantation Proceedings 12/2013; 45(10):3531-3. DOI:10.1016/j.transproceed.2013.09.001 · 0.95 Impact Factor
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ABSTRACT: INTRODUCTION: Many potential lung transplants are lost because of hypoxemia during donor management. We hypothesized that the apnea test, necessary to confirm the diagnosis of brain death in potential lung donors, was involved in the decrease in the ratio of partial pressure of arterial O2 to fraction of inspired O2 (PaO2/FiO2) and that a single recruitment maneuver performed just after the apnea test can reverse this alteration. METHODS: In this case-control study, we examined the effectiveness of the recruitment maneuver with a comparison cohort of brain dead patients who did not receive the maneuver. Patients were matched one-to-one on the basis of initial PaO2/FiO2 and on the duration of mechanical ventilation before the apnea test. PaO2/FiO2 was measured before (T1), at the end (T2) and two hours after apnea test (T3). RESULTS: Twenty-seven patients were included in each group. The apnea test was associated with a significant decrease in PaO2/FiO2 from 284 ± 98 to 224 ± 104 mmHg (P < 0.001). The decrease in PaO2/FiO2 between T1 and T3 was significantly lower in the recruitment maneuver group than in the control group (-4 (-68-57) vs -61 (-110--18) mmHg, P = 0.02). The number of potential donors with PaO2/FiO2 > 300 mmHg decreased by 58% (95% CI: 28-85%) in the control group vs 0% (95% CI: 0-34%) in the recruitment maneuver group (P < 0.001). CONCLUSIONS: The apnea test induced a decrease in PaO2/FiO2 in potential lung donors. A single recruitment maneuver performed immediately after the apnea test can reverse this alteration and may prevent the loss of potential lung donors.Critical care (London, England) 07/2012; 16(4):R116. DOI:10.1186/cc11408