BACKGROUND Traditional limitations of cold static storage(CSS)on ice at 4℃during lung transplantation have necessitated limiting cold ischemic time(CIT)to 4-6 hours.Ex vivo lung perfusion(EVLP)can extend this preserv...BACKGROUND Traditional limitations of cold static storage(CSS)on ice at 4℃during lung transplantation have necessitated limiting cold ischemic time(CIT)to 4-6 hours.Ex vivo lung perfusion(EVLP)can extend this preservation time through the suspension of CIT and normothermic perfusion.As we continue to further expand the donor pool in all aspects of lung transplantation,teams are frequently traveling further distances to procure organs.AIM To determine the effect of CSS or EVLP on donors with extended travel distance[>750 nautical miles(NM)]to recipient.METHODS Lung transplants,whose donor traveled greater than 750 NM,were identified from the United Network for Organ Sharing Database.Recipients were stratified into either:CSS or EVLP,based on preservation method.Groups were assessed with comparative statistics and survival was assessed by Kaplan-Meier methods.A 3:1 propensity match was then created,and same analysis was repeated.RESULTS Prior to matching,those in the EVLP group had significantly increased postoperative morbidity to include dialysis,ventilator use,acute rejection,and treated rejection in the first year(P<0.05 for all).However,there were no significant differences in midterm survival(P=0.18).Following matching,those in the EVLP group again had significantly increased post-operative morbidity to include dialysis,extracorporeal membrane oxygenation use,ventilator use,and treated rejection in the first year(P<0.05 for all).As before,there were no significant differences in midterm survival following matching(P=0.08).CONCLUSION While there was no significant difference in survival,EVLP patients had increased peri-operative morbidity.With the advent of changes in CSS with 10℃storage further analysis is necessary to evaluate the best methods for utilizing organs from increased distances.展开更多
BACKGROUND The utilization of hearts from older donors has increased,particularly for older recipients.However,the impact of older donor hearts on recipients of different ages is less known.AIM To determine the impact...BACKGROUND The utilization of hearts from older donors has increased,particularly for older recipients.However,the impact of older donor hearts on recipients of different ages is less known.AIM To determine the impact of older donor hearts on post-transplant outcomes across different recipient age groups.METHODS The Organ Procurement and Transplant Network database was queried from 2006 to March 2024.Four groups were created stratifying by donor age(>55 years)and recipient age(>60 years).Kaplan-Meier curves and Cox regression models were used.RESULTS One thousand fifty out of 39868 transplants(2.6%)were performed utilizing hearts from older donors.The rate of older donor hearts in younger recipients was only 1.8%,while the older donor hearts were used 4.0%in older recipients(P<0.001).Old donor/old recipient and young donor/old recipient combinations were associated with post-transplant mortality[hazard ratio(HR):1.64(95%CI:1.42-1.90)and 1.42(95%CI:1.34-1.51)],while old donor/young recipient was not.Within each recipient age group,the older recipient groups showed greater differences in 1-and 5-year survival probabilities(80.4%and 67.4%with old donors,89.2%and 76.8%with young donors)than younger recipient groups(90.3%and 77.5%with old donors,92.2%and 80.3%with young donors).CONCLUSION This study demonstrates the higher utilization of older donor hearts(aged more than 55)in older recipients.Paradoxically,the combination of older donor hearts with older recipients is associated with a higher risk of mortality.However,these organs remain valuable options across all recipient age groups in current context of organ shortage.展开更多
Solid organ transplantation is limited by suitable donor organ availability and the geographic limitations that lead to prolonged ischemic times. Ex vivo organ perfusion is an evolving technology that enables assessme...Solid organ transplantation is limited by suitable donor organ availability and the geographic limitations that lead to prolonged ischemic times. Ex vivo organ perfusion is an evolving technology that enables assessment of organ function prior to transplantation. As a byproduct, overall out of body organ times are able to be extended. The future implications organ assessment and repair centers utilizing this technology are discussed.展开更多
Heart transplantation is commonplace, the supply is limited. Many exciting changes in the field of mechanical circulatory support have occurred in the past few years, including the axial flow pump. Left ventricular as...Heart transplantation is commonplace, the supply is limited. Many exciting changes in the field of mechanical circulatory support have occurred in the past few years, including the axial flow pump. Left ventricular assist device(LVAD) therapy is ever evolving. As the use of LVAD therapy increases it is important to understand the indications, surgical considerations and outcomes.展开更多
Lung transplantation is the only definitive ther-apy for end-stage pulmonary disease.Less than 20%of offered lungs are successfully transplanted due to a limited ischemic time window and poor donor lung quality man-ife...Lung transplantation is the only definitive ther-apy for end-stage pulmonary disease.Less than 20%of offered lungs are successfully transplanted due to a limited ischemic time window and poor donor lung quality man-ifested by pulmonary edema,hypoxia,or trauma.Therefore,poor donor organ recovery and utilization are significant barriers to wider implementation of the life-saving therapy of transplantation.While ischemia reperfusion injury(IRI)is often identified as the underlying molecular insult leading to immediate poor lung function in the post-operative period,this injury encompasses several pathways of cellular injury in addition to the recruitment of the innate immune system to the site of injury to propagate this inflammatory cascade.Pyroptosis is a central molecular inflammatory pathway that is the most significant contributor to injury in this early post-operative phase.Pyroptosis is another form of pro-grammed cell death and is often associated with IRI.The mitigation of pyroptosis in the early post-operative period following lung transplantation is a potential novel way to prevent poor allograft function and improve outcomes for all recipients.Here we detail the pyroptotic pathway,its importance in lung transplantation,and several therapeutic modalities that can mitigate this harmful inflammatory pathway.展开更多
基金Supported by The Jewel and Frank Benson Family Endowmentand The Jewel and Frank Benson Research Professorship.
文摘BACKGROUND Traditional limitations of cold static storage(CSS)on ice at 4℃during lung transplantation have necessitated limiting cold ischemic time(CIT)to 4-6 hours.Ex vivo lung perfusion(EVLP)can extend this preservation time through the suspension of CIT and normothermic perfusion.As we continue to further expand the donor pool in all aspects of lung transplantation,teams are frequently traveling further distances to procure organs.AIM To determine the effect of CSS or EVLP on donors with extended travel distance[>750 nautical miles(NM)]to recipient.METHODS Lung transplants,whose donor traveled greater than 750 NM,were identified from the United Network for Organ Sharing Database.Recipients were stratified into either:CSS or EVLP,based on preservation method.Groups were assessed with comparative statistics and survival was assessed by Kaplan-Meier methods.A 3:1 propensity match was then created,and same analysis was repeated.RESULTS Prior to matching,those in the EVLP group had significantly increased postoperative morbidity to include dialysis,ventilator use,acute rejection,and treated rejection in the first year(P<0.05 for all).However,there were no significant differences in midterm survival(P=0.18).Following matching,those in the EVLP group again had significantly increased post-operative morbidity to include dialysis,extracorporeal membrane oxygenation use,ventilator use,and treated rejection in the first year(P<0.05 for all).As before,there were no significant differences in midterm survival following matching(P=0.08).CONCLUSION While there was no significant difference in survival,EVLP patients had increased peri-operative morbidity.With the advent of changes in CSS with 10℃storage further analysis is necessary to evaluate the best methods for utilizing organs from increased distances.
基金Supported by The Jewel and Frank Benson Family Endowment.
文摘BACKGROUND The utilization of hearts from older donors has increased,particularly for older recipients.However,the impact of older donor hearts on recipients of different ages is less known.AIM To determine the impact of older donor hearts on post-transplant outcomes across different recipient age groups.METHODS The Organ Procurement and Transplant Network database was queried from 2006 to March 2024.Four groups were created stratifying by donor age(>55 years)and recipient age(>60 years).Kaplan-Meier curves and Cox regression models were used.RESULTS One thousand fifty out of 39868 transplants(2.6%)were performed utilizing hearts from older donors.The rate of older donor hearts in younger recipients was only 1.8%,while the older donor hearts were used 4.0%in older recipients(P<0.001).Old donor/old recipient and young donor/old recipient combinations were associated with post-transplant mortality[hazard ratio(HR):1.64(95%CI:1.42-1.90)and 1.42(95%CI:1.34-1.51)],while old donor/young recipient was not.Within each recipient age group,the older recipient groups showed greater differences in 1-and 5-year survival probabilities(80.4%and 67.4%with old donors,89.2%and 76.8%with young donors)than younger recipient groups(90.3%and 77.5%with old donors,92.2%and 80.3%with young donors).CONCLUSION This study demonstrates the higher utilization of older donor hearts(aged more than 55)in older recipients.Paradoxically,the combination of older donor hearts with older recipients is associated with a higher risk of mortality.However,these organs remain valuable options across all recipient age groups in current context of organ shortage.
文摘Solid organ transplantation is limited by suitable donor organ availability and the geographic limitations that lead to prolonged ischemic times. Ex vivo organ perfusion is an evolving technology that enables assessment of organ function prior to transplantation. As a byproduct, overall out of body organ times are able to be extended. The future implications organ assessment and repair centers utilizing this technology are discussed.
文摘Heart transplantation is commonplace, the supply is limited. Many exciting changes in the field of mechanical circulatory support have occurred in the past few years, including the axial flow pump. Left ventricular assist device(LVAD) therapy is ever evolving. As the use of LVAD therapy increases it is important to understand the indications, surgical considerations and outcomes.
基金supported through the National Institute of Health (NIH)grant R01 HL143000 and serves on the Clinical Events Committee of Trans Medics OCSsupported by the NIH grants:HL153876,EY030621,EY032583 and the American Heart Association grant:23TPA1142638supported through the Jewel and Frank Benson Family Endowment and The Jewel and Frank Benson Research Professorship at The Ohio State University.
文摘Lung transplantation is the only definitive ther-apy for end-stage pulmonary disease.Less than 20%of offered lungs are successfully transplanted due to a limited ischemic time window and poor donor lung quality man-ifested by pulmonary edema,hypoxia,or trauma.Therefore,poor donor organ recovery and utilization are significant barriers to wider implementation of the life-saving therapy of transplantation.While ischemia reperfusion injury(IRI)is often identified as the underlying molecular insult leading to immediate poor lung function in the post-operative period,this injury encompasses several pathways of cellular injury in addition to the recruitment of the innate immune system to the site of injury to propagate this inflammatory cascade.Pyroptosis is a central molecular inflammatory pathway that is the most significant contributor to injury in this early post-operative phase.Pyroptosis is another form of pro-grammed cell death and is often associated with IRI.The mitigation of pyroptosis in the early post-operative period following lung transplantation is a potential novel way to prevent poor allograft function and improve outcomes for all recipients.Here we detail the pyroptotic pathway,its importance in lung transplantation,and several therapeutic modalities that can mitigate this harmful inflammatory pathway.
