Lung transplantation at Duke University

Area of Science:

• Thoracic surgery
• Transplant immunology
• Pulmonary medicine

Background:

• Lung transplantation is a growing field for advanced lung disease.
• US lung allocation system (LAS) shifted to disease severity, increasing transplants for sicker patients.
• Donor selection and management are crucial for transplant success.

Purpose of the Study:

• To evaluate lung transplant outcomes at a center following the implementation of the LAS.
• To assess the impact of donor lung management and preservation on primary graft dysfunction (PGD).
• To investigate the role of gastric reflux in bronchiolitis obliterans syndrome (BOS) and potential surgical interventions.

Main Methods:

• Retrospective analysis of patient outcomes before and after LAS implementation.
• Review of strategies for donor lung management and preservation.
• Investigational research into the link between gastric reflux and BOS, including Nissen fundoplication.

Main Results:

• Comparable survival rates were observed post-LAS despite transplanting sicker recipients.
• Decreased incidence of severe PGD with improved donor management; venovenous extracorporeal membrane oxygenation (VV ECMO) effective for severe PGD.
• Gastric reflux identified as a potential contributor to BOS; Nissen fundoplication shows promise in prevention.

Conclusions:

• The current LAS allows for successful lung transplantation of increasingly ill patients.
• Advances in donor management and PGD treatment improve immediate post-transplant outcomes.
• Understanding and mitigating BOS, potentially through addressing gastric reflux, is key to long-term lung transplant success.