www.fundacionfavaloro.org 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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Brain Death Lung Donors Procurement And Prediction Of Primary Graft Dysfunction ISHLT
Favaloro Foundation University Hospital, Buenos Aires, Argentina
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Report of the ISHLT Working Group on Primary Graft Dysfunction (2005)
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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
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J Heart Lung Transplant 2005;24:1460–67
• 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
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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
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• 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
Methods
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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
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Indications for Transplantation
13; 16%
36; 45%
19; 23%
4; 5%
5; 6%
1; 1%
3; 4%
Bronchiectasis CF
COPD IPF
Pulmonary hypertension Others
Re-Tx
81 Transplants on 77 Recipients
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PopulationType of Transplant Procedure
57%
43%
SLT BLT
Clinical Status at Transplant
68%
12%
19%
1%
Elective Hospitalized+NIV Ventilated ECMO
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Population
Cardiopulmonary By pass Requirement
26%
Off Pump CPB
Preservation Solution LPDS (Perfadex™) 100%
Ischemic Time (mean±SD) 340±88 min (max.: 465 min)
CPB Time (mean±SD) 183±89 min (max.: 367 min)
Lung Donor Managment at Harvesting Procedure:•Bronchoscopy•Albumin iv 500 mg + Metilprednisolone bolus•Antegrade and retrograde flush of preservation solution (60 ml/kg)