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Organ procurement for pulmonary transplantation.
M Zenati1, R D Dowling, J M Armitage
1Department of Surgery, University of Pittsburgh, Pennsylvania.
The Annals of Thoracic Surgery
|December 1, 1989
Summary
Selecting suitable lung donors is crucial for successful pulmonary transplantation. Rigorous evaluation, including bronchoscopy and cultures, helps identify acceptable lungs, though prophylactic donor antibiotics may be needed to prevent recipient infections.
Area of Science:
- Medicine
- Transplantation Surgery
- Pulmonology
Background:
- Successful lung transplantation relies heavily on donor selection.
- Donor lung evaluation involves assessing function, imaging, and microbiological status.
- Organ shortages necessitate careful consideration of donor acceptance criteria.
Purpose of the Study:
- To review donor selection criteria and management for lung transplantation.
- To identify key factors for assessing lung donor suitability.
- To evaluate the impact of donor microbial colonization on recipient outcomes.
Main Methods:
- Review of 70 heart-lung, 8 double-lung, and 2 single-lung transplants performed since 1982.
- Analysis of donor evaluation parameters: hyperoxygenation studies, chest roentgenograms, tracheal secretions (Gram stain, culture), and bronchoscopy.
- Assessment of organ preservation methods.
Main Results:
- Rigorous donor selection criteria were applied.
- Despite strict criteria, 76% of accepted donors had positive tracheal cultures.
- Oropharyngeal flora in donors correlated with early recipient intrathoracic infections.
Conclusions:
- Careful donor evaluation is essential for successful lung transplantation.
- Prophylactic donor antibiotic treatment is recommended to mitigate infection risks.
- Accepting marginal donors, despite organ scarcity, is generally ill-advised due to potential recipient complications.