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CASE REPORT article
Front. Transplant.
Sec. Thoracic Transplantation
Volume 3 - 2024 |
doi: 10.3389/frtra.2024.1450376
Case Report: Optimal Utilization of Marginal Lung Allografts by considering Donor-Recipient PGD Risk Compatibility and by Mitigating Allograft and Recipient Inflammatory Risk
Provisionally accepted- 1 University Medical Center Utrecht, Utrecht, Netherlands
- 2 St. Antonius Hospital, Nieuwegein, Netherlands
Reducing the risk of high-grade primary graft dysfunction (PGD) is vital in order to achieve acceptable short-and long-term outcome for recipients following lung transplantation. The utilization of injured lung allografts, which may confer a higher risk of PGD, must be considered however, due to the disparity between the increasing numbers of patients requiring lung transplantation and the limited donor pool.We describe a case in which highly marginal lung allografts were utilized with good posttransplant outcome. Donor-recipient PGD risk compatibility was taken into consideration.Normothermic ex vivo lung perfusion (EVLP) was utilized to functionally interrogate the allografts. A second cold ischemia time following EVLP was avoided by converting the EVLP mode to a hypothermic oxygenated perfusion set-up from which the lungs were transplanted directly. We attempted to mitigate for lung ischemia-reperfusion injury in the recipient by employing cytokine adsorption both during the EVLP and intraoperatively during the implant procedure.In this case report we describe our hypothermic oxygenated perfusion set-up on EVLP for the first time. Furthermore we describe the utilization of cytokine adsorption in two phases of the same transplant process.
Keywords: Primary Graft Dysfunction, EVLP, Cytokine adsorption, Lung transplantation outcome, hypothermic oxygenated lung perfusion, lung transplant continuum, lung ischemia reperfusion injury
Received: 17 Jun 2024; Accepted: 09 Sep 2024.
Copyright: © 2024 Braithwaite, Jennekens, Berg, De Heer, Ramjankhan, De Jong, Luc Charlier, Dessing, Veltkamp, Scheren Msc, Ruigrok, Schönwetter, Buhre and Van Der Kaaij. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Sue A. Braithwaite, University Medical Center Utrecht, Utrecht, Netherlands
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