Real-time lung weight measurement during clinical ex vivo lung perfusion.

Background: Real-time lung weight (LW) measurement is a simple and noninvasive technique for detecting extravascular lung water during ex vivo lung perfusion (EVLP). We investigated the feasibility of real-time LW measurement in clinical EVLP as a predictor of transplant suitability and post-transplant outcomes.

Methods: In our clinical acellular EVLP protocol, real-time LW was measured in 117 EVLP cases from June 2019 to June 2022.

Valve-Preserving Root Reimplantation Combined with Arch Procedure: Optimizing Patient Selection.

Patients with thoracic aortic disease commonly present with concomitant multisegment pathology. We describe the patient population, analyze outcomes, and define the patient selection strategy for valve-preserving aortic root reimplantation (VPARR) combined with the arch procedure. From 2008 to 2018, 98 patients underwent VPARR combined with the aortic arch procedure (hemi-arch, 50% [ = 49, limited repair]; total arch, 50% [ = 49, complete repair] including 39 with elephant trunk).

Clinical significance of donor lung weight at procurement and during ex vivo lung perfusion.

Background: Elevated donor lung weight may adversely affect donor lung transplant suitability and post-transplant outcomes. The objective of this study is to investigate the impact of lung weight after procurement and ex vivo lung perfusion (EVLP) on transplant suitability, post-transplant graft dysfunction, and clinical outcomes and define the donor lung weight range most relevant to clinical outcomes.

Methods: From February 2016 to August 2020, 365 human lung donors to a single transplant center were retrospectively reviewed.

Evolution of Recipient Characteristics Over 3 Decades and Impact on Survival After Lung Transplantation.

Background: Lung transplantation (LTx) is a definitive treatment for end-stage lung disease. Herein, we reviewed our center experience over 3 decades to examine the evolution of recipient characteristics and contemporary predictors of survival for LTx.

Methods: We retrospectively reviewed the data of LTx procedures performed at our institution from January 1990 to January 2019 (n = 1819).

Significance of Lung Weight in Cellular Ex Vivo Lung Perfusion.

Background: Currently, pulmonary edema is evaluated via surgical inspection and palpation in donor lungs, and there is no quantitative standard diagnostic tool for evaluating pulmonary edema in donor procurement and ex vivo lung perfusion (EVLP). The purpose of this study was to investigate the significance of lung weight at the donor hospital and lung weight during EVLP as a complementary parameter of transplant suitability in EVLP.

Materials And Methods: Twenty-one of rejected human lungs were perfused in cellular EVLP.

Serious Gastrointestinal Complications After Cardiac Surgery and Associated Mortality.

Background: Severe gastrointestinal (GI) complications (GICs) after cardiac surgery are associated with poor outcomes. Herein, we characterize the severe forms of GICs and associated risk factors of mortality.

Methods: We retrospectively analyzed the clinically significant postoperative GICs after cardiac surgical procedures performed at our institution from January 2010 to April 2017.

Comparison of mechanical cardiopulmonary support strategies during lung transplantation.

Introduction: Lung transplantation outcomes are influenced by the intraoperative mechanical cardiopulmonary support strategy used. This surgery was historically done either on cardiopulmonary bypass (CPB) or off pump. Recently, there has been increased interest in intraoperative support with veno-arterial (VA) or veno-venous (VV) extracorporeal membrane oxygenation (ECMO).

Ventricular assist device bridging with gender-mismatch increases rejection and decreases survival following a heart transplant.

Objectives: Survival is poor following an orthotopic heart transplant with gender-mismatched donors and recipients. Patients bridged to an orthotopic heart transplant with a ventricular assist device (VAD) frequently become sensitized. We hypothesized that the combination of VAD bridging and gender-mismatch may result in greater rejection and poorer survival.

A CLUE for better assessment of donor lungs: Novel technique in clinical ex vivo lung perfusion.

Background: The direCt Lung Ultrasound Evaluation (CLUE) technique was proven to be an accurate method for monitoring extravascular lung water in donor lungs during ex vivo lung perfusion (EVLP) in an experimental model. The aim of this study was to examine the application of CLUE in the clinical setting.

Methods: Lungs were evaluated using acellular EVLP protocol.

Hyperinflation With Pulmonary Dysfunction in Donor Lungs With Smoking History During Lung Perfusion.

Background: Donor lungs with smoking history are perfused in ex vivo lung perfusion (EVLP) to expand donor lung pool. However, the impact of hyperinflation of perfused lungs in EVLP remains unknown. The aim of this study was to investigate the significance of hyperinflation, using an ex vivo measurement delta V, during EVLP in smoker's lungs.

Human Lungs Airway Epithelium Upregulate MicroRNA-17 and MicroRNA-548b in Response to Cold Ischemia and Ex Vivo Reperfusion.

Background: Lung ischemia-reperfusion injury after transplantation is associated with worse clinical outcomes. MicroRNA (miR) are critical regulators of gene expression that could provide potential targets for novel gene therapy. Herein, we aim to examine the feasibility of using the ex vivo lung perfusion (EVLP) platform to examine the changes in miR expression in human lungs in response to cold ischemia and ex vivo reperfusion (CI/EVR).

Successful Lung Transplantation After Acellular Ex Vivo Lung Perfusion With Prone Positioning.

Use of prone positioning during ex vivo lung perfusion (EVLP) with the Toronto protocol reduced pulmonary edema in marginal human donor lungs. This report describes 2 cases in which prone positioning during EVLP significantly reduced lung weight. One of the 2 cases resulted in successful double-lung transplantation.

Cellular Ex Vivo Lung Perfusion Beyond 1 Hour May Improve Marginal Donor Lung Assessment.

Background: Ex vivo lung perfusion (EVLP) permits extended evaluation of donor lungs for transplant. However, the optimal EVLP duration of Lund protocol is unclear. Using human lungs rejected for clinical transplant, we sought to compare the results of 1 versus 2 h of EVLP using the Lund protocol.

Combined Coronary Artery Bypass Surgery With Bone Marrow Stem Cell Transplantation: Are We There Yet?

Background: Although the safety and feasibility of combined coronary artery bypass grafting (CABG) and bone marrow stem cell (BMSC) transplantation have been proven, the efficacy of this approach remains controversial. Therefore, we conducted an updated meta-analysis of randomized controlled trials to evaluate the efficacy of this procedure.

Methods: Electronic databases were systematically searched for randomized trials comparing 4-month to 6-month follow-up outcomes in patients who underwent isolated CABG (CABG group) and patients who received BMSC transplantation with CABG (BMSC group).

Selective Recruitment of Large Lower Lobe Atelectasis on Donor Back Table in Rejected Donor Lungs.

Background: Large atelectatic areas in donor lungs are frequently resistant to standard recruitment maneuvers, producing a tenaciously low PO/FiO ratio. The aim of this study is to investigate the optimal protocol for the recruitment of large atelectatic areas in the context of ex vivo lung perfusion (EVLP).

Methods: Seventeen rejected lungs with large lower lobe atelectasis (≥40%) were divided into 2 groups: manual resuscitation (n = 5) and selective recruitment (n = 12).

DireCt Lung Ultrasound Evaluation (CLUE): A novel technique for monitoring extravascular lung water in donor lungs.

Background: Extravascular lung water (EVLW) could change in donor lungs in a time-dependent fashion during procurement or ex-vivo lung perfusion (EVLP) and may vary across different zones. Current techniques for EVLW assessment are either subjective, general estimation, or not feasible in the clinical setting. An accurate and non-invasive diagnostic tool for EVLW would be desirable for donor lung assessment and management.

A novel concept for evaluation of pulmonary function utilizing PaO2/FiO2 difference at the distinctive FiO2 in cellular ex vivo lung perfusion-an experimental study.

For more accurate lung evaluation in ex vivo lung perfusion (EVLP), we have devised a new parameter, PaO /FiO ratio difference (PFD); PFD  = P/F ratio at FiO 1.0 - P/F ratio at FiO 0.4.

Significant parameters in the evaluation of donor lungs in single-lung cellular ex vivo lung perfusion.

Objectives: Typically, single-lung ex vivo lung perfusion (SL-EVLP) is preferred when there is concern of contamination from the opposite lung. However, a comprehensive assessment of the SL-EVLP has not been completed. The purpose of this study is to compare the physiological parameters of SL-EVLP and double-lung EVLP (DL-EVLP) in the assessment of transplant suitability.

The protective effect of prone lung position on ischemia-reperfusion injury and lung function in an ex vivo porcine lung model.

Objective: Prone positioning has been shown to improve oxygenation in patients with lung injury. We hypothesized that prone positioning of lungs during ex vivo lung perfusion (EVLP) can not only improve oxygenation but also diminish ischemia-reperfusion injury (IRI). The aim of our study was to evaluate the potential benefits of prone positioning of lungs during EVLP compared with the standard supine position.

High positive end-expiratory pressure during ex vivo lung perfusion: recruiting rejected donor lungs.

We present an innovative method for recruiting clinically rejected donor lungs using positive end-expiratory pressure titration during ex vivo lung perfusion. Currently, ex vivo lung perfusion protocols are using a standard positive end-expiratory pressure of 5 cmH2O for all cases. Individualized positive end-expiratory pressure titration combined with recruitment manoeuvres has been found to significantly improve pulmonary functions in mechanically ventilated patients.