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Original Articles: General Thoracic

Early Donor Management Increases the Retrieval Rate of Lungs for Transplantation

^a Department of Cardiothoracic Surgery Heart and Lung Transplantation Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
^b Department of Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
^c Department of Physiology, University of Birmingham, Birmingham, United Kingdom

Accepted for publication July 31, 2007.

^_* Address correspondence to Prof Bonser, Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TH, United Kingdom (Email: robert.bonser{at}uhb.nhs.uk).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: Lung transplantation activity is frustrated by donor lung availability. We sought to examine the effect of active donor management and hormone administration on pulmonary function and yield in cadaveric heart-beating potential lung donors.

Methods: We studied 182 potential lung donors (arterial oxygen tension [PaO ₂]/fractional inspired oxygen [FIO ₂] ratio 230). From this group, 60 patients (120 lungs) were allocated, within a randomized trial, to receive methylprednisolone (1 g), triiodothyronine (0.8 µg/kg bolus and 0.113 µg/kg/h infusion), both methylprednisolone and triiodothyronine, or placebo as soon as feasible after consent and initial assessment. Trial donors underwent protocol-guided optimization of ventilation and hemodynamics, lung water assessment, and bronchoscopy. Function was assessed by PaO ₂/FIO ₂ ratio, extravascular lung water index (EVLWI), and pulmonary vascular resistance (PVR). A nontrial group of 122 donors (244 lungs) received similar management without bronchoscopy, pulmonary artery flotation catheter monitoring, or lung water assessment.

Results: Within the trial, management commenced within a median of 2 hours (interquartile range, 0.5 to 3.5 hours) of consent and continued for an average of 6.9 ± 1.2 hours. The PaO ₂/FIO ₂ ratio deteriorated (p = 0.028) from 397 ± 78 (95% CL, 376 to 417) to 359 ± 126 (95% CL, 328 to 390) and EVLWI from 9.7 ± 4.5 mL/kg (95% CL, 8.6 to 10.9 mL/kg) to 10.8 ± 5.2 mL/kg (95% CL, 9.4 to 12.2 mL/kg; p = 0.009). PVR remained unchanged (p = 0.28). At end management, 48 of 120 trial lungs (40%) were transplanted versus 66 of 244 nontrial lungs (27%; p = 0.016). Neither methylprednisolone and triiodothyronine nor T3 increased lung yield or affected PaO ₂/FIO ₂ or EVLWI; however, methylprednisolone attenuated the increase in EVLWI (p = 0.009).

Conclusions: Early active management of lung donors increases yield. Steroid administration reduces progressive lung water accumulation.

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