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Lung transplantation following controlled hypothermic storage with a portable lung preservation device: first multicenter European experience

AL. Provoost, R. Novysedlak, D. Van Raemdonck, J. Van Slambrouck, E. Prisciandaro, CM. Vandervelde, A. Barbarossa, X. Jin, K. Denaux, P. De Leyn, H. Van Veer, L. Depypere, Y. Jansen, J. Pirenne, A. Neyrinck, S. Bouneb, C. Ingels, B. Jacobs, L....

. 2024 ; 11 (-) : 1370543. [pub] 20240606

Status neindexováno Jazyk angličtina Země Švýcarsko

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc24012588

INTRODUCTION: Compared with traditional static ice storage, controlled hypothermic storage (CHS) at 4-10°C may attenuate cold-induced lung injury between procurement and implantation. In this study, we describe the first European lung transplant (LTx) experience with a portable CHS device. METHODS: A prospective observational study was conducted of all consecutively performed LTx following CHS (11 November 2022 and 31 January 2024) at two European high-volume centers. The LUNGguard device was used for CHS. The preservation details, total ischemic time, and early postoperative outcomes are described. The data are presented as median (range: minimum-maximum) values. RESULTS: A total of 36 patients underwent LTx (i.e., 33 bilateral, 2 single LTx, and 1 lobar). The median age was 61 (15-68) years; 58% of the patients were male; 28% of the transplantations had high-urgency status; and 22% were indicated as donation after circulatory death. In 47% of the patients, extracorporeal membrane oxygenation (ECMO) was used for perioperative support. The indications for using the CHS device were overnight bridging (n = 26), remote procurement (n = 4), rescue allocation (n = 2), logistics (n = 2), feasibility (n = 1), and extended-criteria donor (n = 1). The CHS temperature was 6.5°C (3.7°C-9.3°C). The preservation times were 11 h 18 (2 h 42-17 h 9) and 13 h 40 (4 h 5-19 h 36) for the first and second implanted lungs, respectively, whereas the total ischemic times were 13 h 38 (4 h 51-19 h 44) and 15 h 41 (5 h 54-22 h 48), respectively. The primary graft dysfunction grade 3 (PGD3) incidence rates were 33.3% within 72 h and 2.8% at 72 h. Intensive care unit stay was 8 (4-62) days, and the hospital stay was 28 (13-87) days. At the last follow-up [139 (7-446) days], three patients were still hospitalized. One patient died on postoperative day 7 due to ECMO failure. In-hospital Clavien-Dindo complications of 3b were observed in six (17%) patients, and 4a in seven (19%). CONCLUSION: CHS seems safe and feasible despite the high-risk recipient and donor profiles, as well as extended preservation times. PGD3 at 72 h was observed in 2.8% of the patients. This technology could postpone LTx to daytime working hours. Larger cohorts and longer-term outcomes are required to confirm these observations.

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$a Lung transplantation following controlled hypothermic storage with a portable lung preservation device: first multicenter European experience / $c AL. Provoost, R. Novysedlak, D. Van Raemdonck, J. Van Slambrouck, E. Prisciandaro, CM. Vandervelde, A. Barbarossa, X. Jin, K. Denaux, P. De Leyn, H. Van Veer, L. Depypere, Y. Jansen, J. Pirenne, A. Neyrinck, S. Bouneb, C. Ingels, B. Jacobs, L. Godinas, L. De Sadeleer, R. Vos, M. Svorcova, J. Vajter, J. Kolarik, J. Tavandzis, J. Havlin, Z. Ozaniak Strizova, J. Pozniak, J. Simonek, J. Vachtenheim, R. Lischke, LJ. Ceulemans
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$a INTRODUCTION: Compared with traditional static ice storage, controlled hypothermic storage (CHS) at 4-10°C may attenuate cold-induced lung injury between procurement and implantation. In this study, we describe the first European lung transplant (LTx) experience with a portable CHS device. METHODS: A prospective observational study was conducted of all consecutively performed LTx following CHS (11 November 2022 and 31 January 2024) at two European high-volume centers. The LUNGguard device was used for CHS. The preservation details, total ischemic time, and early postoperative outcomes are described. The data are presented as median (range: minimum-maximum) values. RESULTS: A total of 36 patients underwent LTx (i.e., 33 bilateral, 2 single LTx, and 1 lobar). The median age was 61 (15-68) years; 58% of the patients were male; 28% of the transplantations had high-urgency status; and 22% were indicated as donation after circulatory death. In 47% of the patients, extracorporeal membrane oxygenation (ECMO) was used for perioperative support. The indications for using the CHS device were overnight bridging (n = 26), remote procurement (n = 4), rescue allocation (n = 2), logistics (n = 2), feasibility (n = 1), and extended-criteria donor (n = 1). The CHS temperature was 6.5°C (3.7°C-9.3°C). The preservation times were 11 h 18 (2 h 42-17 h 9) and 13 h 40 (4 h 5-19 h 36) for the first and second implanted lungs, respectively, whereas the total ischemic times were 13 h 38 (4 h 51-19 h 44) and 15 h 41 (5 h 54-22 h 48), respectively. The primary graft dysfunction grade 3 (PGD3) incidence rates were 33.3% within 72 h and 2.8% at 72 h. Intensive care unit stay was 8 (4-62) days, and the hospital stay was 28 (13-87) days. At the last follow-up [139 (7-446) days], three patients were still hospitalized. One patient died on postoperative day 7 due to ECMO failure. In-hospital Clavien-Dindo complications of 3b were observed in six (17%) patients, and 4a in seven (19%). CONCLUSION: CHS seems safe and feasible despite the high-risk recipient and donor profiles, as well as extended preservation times. PGD3 at 72 h was observed in 2.8% of the patients. This technology could postpone LTx to daytime working hours. Larger cohorts and longer-term outcomes are required to confirm these observations.
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$a Van Raemdonck, Dirk $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Van Slambrouck, Jan $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Prisciandaro, Elena $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Vandervelde, Christelle M $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Barbarossa, Annalisa $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Jin, Xin $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Denaux, Karen $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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$a De Leyn, Paul $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Van Veer, Hans $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Depypere, Lieven $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Jansen, Yanina $u Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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$a Pirenne, Jacques $u Laboratory of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium $u Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
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$a Ingels, Catherine $u Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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$a Godinas, Laurent $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium $u Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
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$a De Sadeleer, Laurens $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium $u Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
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$a Vos, Robin $u Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium $u Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
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$a Svorcova, Monika $u Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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$a Ozaniak Strizova, Zuzana $u Department of Immunology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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