Lung Procurement for Transplantation
Lung transplantation is now a realistic treatment for many patients with end-stage pulmonary diseases. Unfortunately, the demand for transplantable lungs greatly exceeds the supply; many patients die while waiting. Potential donor lungs are frequently rejected for transplantation because their quality is compromised by excess mucus and/or purulent secretions.
- Babcock W, Menza RL, Riznyk S, Prince P, Kern TJ. Results of a prospective study using high-frequency chest wall oscillation for brain dead organ donors. J Heart Lung Trans, 2002; 21(1): A239.
In this pilot study evaluating the effects HCFF/HFCWO as part of the management protocol for lung donors, the quantity and quality of transplantable lungs increased. One hundred consecutive eligible brain-dead beating heart donor patients were randomized to standard protocol or standard protocol plus HFCC/HFCWO on the basis of equipment availability. Compared with lungs recovered from the non-HFCC/HFCWO group (45 donors), HFCC/HFCWO-treated donor lungs demonstrated improved chest x-ray interpretations (p = 0.026); fewer organisms on gram stain (p = 0.031); a strong trend toward improved P/F ratios (p=0.059); and a lung recovery rate of 40% vs. 24% in the non-HFCC/HFCWO group. Results suggest that HFCC/HFCWO may be a valuable addition to the lung procurement protocol.
- Braverman JM. Increasing the quantity of lungs for transplantation using high-frequency chest wall oscillation: a proposal. Prog Transplant. 2002; 12:266-74.
The use of chest physiotherapy (CPT) in donor patient management is an established component of most lung procurement protocols. High frequency chest wall oscillation (HFCWO), which has few of the disadvantages associated with labor-intensive, technique and positioning-dependent CPT, may offer a superior alternative. Extrapolation of data from clinical studies and experience with HFCWO in a variety of patient populations suggests that HFCWO may have the potential to help increase the quantity and quality donor lungs by controlling the secretion-related complications that make them ineligible for transplantation. Effective management of obstructing pulmonary secretions in donor lungs should reduce the destructive by-products of inflammation and entrapped pathogens and improve ventilation and perfusion.
- Ganz SS, Levi DM, Nishida S, et al. Improving pulmonary function and lung recovery for transplantation using the Link TM [ high frequency chest compression] during organ donor management. Poster Presentation. Association of Organ Procurement Organizations (AOPO), Chicago, IL, June 14-18, 2004.
Sixty-one eligible lung donor patients were treated with HFCC in addition to the standard protocol for lung recovery; outcome parameters were compared with 79 historical controls. HFCC-treated donors showed 1) 87% improvement in frequency of successful lung procurement (p = 0.015); [24.7% viable lungs with HFCC vs 12.6% controls] and; 2) maintenance of P/F ratios > 300 mm Hg. (p = 0.04); HFCC appears to be a practical adjunct for increasing rates of lung procurement for transplantation.
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