• J. Heart Lung Transplant. · Feb 2014

    Effect of an intensive lung donor-management protocol on lung transplantation outcomes.

    • Eduardo Miñambres, Elisabeth Coll, Jorge Duerto, Borja Suberviola, Roberto Mons, José Manuel Cifrian, and Maria Angeles Ballesteros.
    • Service of Intensive Care, University Hospital Marqués de Valdecilla-Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Spain; Transplant Coordination Unit, University Hospital Marqués de Valdecilla-Instituto de Formación e Investigación Marqués de Valdecilla, Santander, Spain. Electronic address: eminambres@yahoo.es.
    • J. Heart Lung Transplant. 2014 Feb 1;33(2):178-84.

    BackgroundAn intensive lung donor-management protocol based on a strict protocol would increase the lung procurement rate. The aim of this study was to determine the effect of such a protocol on the rate of lung grafts available for transplant.MethodsA lung-management protocol for donors after brain death (DBD) was implemented in 2009. Lung donors from 2009 to 2011 were the prospective cohort, and those from 2003 to 2008 formed the historical control. We analyzed the synergic effect of several measures, such as protective ventilation, ventilator recruitment maneuvers, high positive end-expiratory pressure, fluid restriction with reduced extravascular lung water values, and hormonal resuscitation therapy in multiorgan DBD. The number of lungs available for transplantation was the main outcome measure. For recipients, early survival and the rate of primary graft dysfunction (PGD) grade 3 were the main outcome measures.ResultsThe DBD rate was more than 40 donors per 1 million population in both periods. The rate of lung donors increased from 20.1% to 50% (p < 0.001), quadrupling the number of lung donors (p < 0.001), grafts retrieved (p = 0.02), and patients who received a lung transplant (p < 0.01). No differences were observed in the survival of early recipients (p = 0.203) or in the rate of PGD grade 3 (p = 0.835).ConclusionThe management of multiorgan DBDs should be approached as a global treatment requiring attentive bedside management. Implementing an intensive lung donor-management protocol based on synergic measures increases lung procurement rates, negative effect on early survival of lung recipients or PGD grade 3.© 2014 International Society for Heart and Lung Transplantation Published by International Society for the Heart and Lung Transplantation All rights reserved.

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