Brain Death Lung Donors Procurement And Prediction Of Primary Graft Dysfunction ISHLT Grade 3 After ...
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Brain Death Lung Donors Procurement And Prediction Of Primary Graft Dysfunction ISHLT Grade 3 After Lung Transplantation In Argentina. Bertolotti, A; Gomez , B; Absi, D; Osses, J; Caneva, J; Ahumada, R; Wagner, G; Favaloro, RR. Favaloro Foundation University Hospital, Buenos Aires, Argentina.

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Bertolotti, A; Gomez , B; Absi, D; Osses, J; Caneva, J; Ahumada, R; Wagner, G; Favaloro, RR.

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Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

Brain Death Lung Donors Procurement And Prediction Of Primary Graft Dysfunction ISHLT Grade 3 After Lung Transplantation In Argentina

Bertolotti, A; Gomez , B; Absi, D; Osses, J; Caneva, J; Ahumada, R; Wagner, G; Favaloro, RR.

Favaloro Foundation University Hospital, Buenos Aires, Argentina


Report of the ishlt working group on primary graft dysfunction 2005

Report of the ISHLT Working Group on Primary Graft Dysfunction (2005)


Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

Grading of Severity for PGD

Classification according to different time-points

  • T-zero (T0): Defined as within 6 hours of final lung reperfusion.

  • T24, T48 and T72:Times will be measured after T0±6 hours


Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

  • Clinical Markers

  • Biological Markers

  • Lung Preservation

  • Methods of Preservation

  • Temperature and Volume of Preservation Solution

  • Inflation or Ventilation

  • Storage Temperature

  • Oxygenation

  • Preservation Solution

  • Retrograde Flush

  • Ischemic Time

J Heart Lung Transplant 2005;24:1460–67


Objectives

Objectives:

  • To analyze characteristics and maintenance of brain death lung donors (BDLD) and their relationship with the development of postoperative primary graft dysfunction ISHLT grade 3 (PGD3) at a single center in Argentina


Methods

Methods

  • Since 2007 the ISHLT grading system was adopted and data were collected prospectively at a single institution in Argentina.

  • Retrospective / Single Institution: January 2007 to June 2011

  • Lung Transplant Recipients: 81 lung transplants were performed in 77 recipients


Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

Methods

  • Incidence and Clasification of Primary Graft Disfunction:

    • Grade 0 to 3 (T0-72)

  • Univariate analysis to identify potential predictors of PGD 3 at T zero (t student; Wilcoxon Mann Whitney; Chi square or Pearson)

    • Pre-harvest BDLD maintenance and demographic variables were analysed

  • In-hospital mortality


Indications for transplantation

Indications for Transplantation

81 Transplants on 77 Recipients


Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

Population


Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

Population

  • Lung Donor Managment at Harvesting Procedure:

  • Bronchoscopy

  • Albumin iv 500 mg + Metilprednisolone bolus

  • Antegrade and retrograde flush of preservation solution (60 ml/kg)

Implant Procedure:


Results

Results

Brain Death Lung Donors: General Characteristics


Results1

Results

BDL Donors: Respiratory Parameters


Results2

Results:

BDL Donors: Hemodynamic Parameters During Maintenance


Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

Incidence of PGD T0 to T72 (ISHLT Grading System)

(81 transplant/77 patients)

Nº of transplants

PGD Grade

18%

25%

17%

40%

Results


Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

Results

In-hospital Mortality: PGD 3 (T0)vs. PGD < 3 (T0)

53%

p<0,005

17%


Results3

Results:

Prediction of PGD 3 T0: Univariate Analysis


Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

Discussion:Limits of the stydy

  • Retrospective analysis in a small population

  • There is a bias on donor selection ( most of them were “optimal donors”)

  • The findings in the univariate analysis of PGD prediction ( hypotension, cardiac arrest and CPR) failed in a multivariate analysis.


Conclusions

Conclusions

  • BDLD characteristics and maintenance of cadaveric donors didn’t show a relationship with the development of PGD3 in this cohort of patients

  • PGD 3 T0 is related to a high early mortality and is mandatory to identified predictors to avoid or diminish its incidence.


Bertolotti a gomez b absi d osses j caneva j ahumada r wagner g favaloro rr

Thank you for your attention…


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