• Jasleen Kukreja, Jose Luis Campo-Canaveral de la Cruz, Dirk Van Raemdonck, Edward Cantu, Hiroshi Date, Frank D'Ovidio, Matthew Hartwig, Jacob A Klapper, Rosemary F Kelly, Sandra Lindstedt, Lorenzo Rosso, Lara Schaheen, Michael Smith, Bryan Whitson, Sahar A Saddoughi, and Marcelo Cypel.
• Department of Surgery, University of California, San Francisco, Calif. Electronic address: Jasleen.kukreja@ucsf.edu.
• J. Thorac. Cardiovasc. Surg. 2025 Feb 1; 169 (2): 484504484-504.

BackgroundDonor lung procurement and preservation is critical for lung transplantation success. Unfortunately, the large variability in techniques impacts organ utilization rates and transplantation outcomes. Compounding this variation, recent developments in cold static preservation and new technological advances with machine perfusion have increased the complexity of the procedure. The objective of the American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) expert panel was to make evidence-based recommendations for best practices in donor lung procurement and preservation based on review of the existing literature.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation surgeons from 14 centers who developed a consensus document of recommendations. The panel was divided into 7 subgroups covering (1) intraoperative donor assessment, (2) surgical techniques, (3) ex situ static lung preservation methods, (4) hypothermic preservation, (5) normothermic ex vivo lung perfusion (EVLP), (6) donation after circulatory death (DCD) and normothermic regional perfusion, and (7) donor management centers, organ assessment centers, and third-party procurement teams. Following a focused literature review, each subgroup formulated recommendation statements for each subtopic, which were reviewed and further refined using a Delphi process until a 75% consensus was achieved on each final statement by the voting group.ResultsThe expert panel achieved consensus on 34 recommendations for current best practices in donor lung procurement and preservation both in brain-dead as well as DCD donation. The use of new methods of cold preservation, the role of EVLP, and DCD with and without concomitant heart donation are described in detail.ConclusionsConsistent and best practices in donor lung procurement and preservation are critical to improve both lung transplantation numbers as well as recipient outcomes. The recommendations described here provide guidance for professionals involved in the care of patients with end-stage lung disease considered for transplantation.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

23 keywords...

hide…