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Amarelli C, Bello I, Aigner C, Berman M, Boffini M, Clark S, Dalvindt M, de Wolf J, Ensminger S, Gomez de Antonio D, Hoyos L, Palmieri L, Schweiger M, Sponga S, Wiegmann B, Neyrinck A, the ESOT Guidelines Taskforce. European Society of Organ Transplantation (ESOT) Consensus Statement on Machine Perfusion in Cardiothoracic Transplant. Transpl Int 2024; 37:13112. [PMID: 39649067 PMCID: PMC11620879 DOI: 10.3389/ti.2024.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 09/26/2024] [Indexed: 12/10/2024]
Abstract
The machine perfusion (MP) of transplantable grafts has emerged as an upcoming field in Cardiothoracic (CT) transplantation during the last decade. This technology carries the potential to assess, preserve, and even recondition thoracic grafts before transplantation, so it is a possible game-changer in the field. This technology field has reached a critical turning point, with a growing number of publications coming predominantly from a few leading institutions, but still need solid scientific evidence. Due to the increasing need to expand the donor pool, especially in Europe, where the donor age is steeply increased, a consensus has been established to address the growing need and knowledge of machine perfusion in cardiothoracic transplantation, targeting the unmet scientific need in this growing field but also, priorities for development, and regional differences in utilization rates and organizational issues. To address MP in CT, the European Society of Organ Transplantation (ESOT) convened a dedicated Working group comprised of experts in CT to review literature about MP to develop guidelines that were subsequently discussed and voted on during the Consensus Conference that took place in person in Prague during the TLJ 3.0 in November 2022. The findings and recommendations of the Cardiothoracic Working Group on MP are presented in this article.
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Affiliation(s)
- Cristiano Amarelli
- Department of Cardiac Surgery and Transplants, Monaldi, Azienda dei Colli, Naples, Italy
| | - Irene Bello
- Institut Clínic Respiratorio, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Clemens Aigner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Marius Berman
- Transplant Unit, Royal Papworth Hospital, NHS Foundation Trust, Cambridge, United Kingdom
| | - Massimo Boffini
- Cardiac Surgery Division, Surgical Sciences Department, Citta della Salute e della Scienza, University of Torino, Turin, Italy
| | - Stephen Clark
- Department Cardiothoracic Transplant, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marita Dalvindt
- Department of Cardiothoracic Surgery, Lund University, Lund, Sweden
| | - Julien de Wolf
- Department of Thoracic Surgery, Lung Heart Institute, University Hospital of Lille, Lille, France
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, Lübeck, Germany
| | - David Gomez de Antonio
- Department of Thoracic Surgery, Puerta de Hierro University Hospital Majadahonda, Madrid, Spain
| | - Lucas Hoyos
- Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Lucrezia Palmieri
- Department of Translational Medical Sciences, Monaldi Hospital, University of Campania “Luigi Vanvitelli“, Naples, Italy
| | - Martin Schweiger
- Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Bettina Wiegmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Arne Neyrinck
- Department of Cardiovascular Sciences, Anesthesiology and Algology, KU Leuven, Leuven, Belgium
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Krauss A, Pidborochynski T, Buchholz H, Urschel S, Al-Akalabi M, Freed DH, Anand V, Holinkski P, Bates A, Conway J. Ventricular assist device support following pediatric heart transplantation. Pediatr Transplant 2022; 26:e14363. [PMID: 35841596 DOI: 10.1111/petr.14363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND VAD support for early graft failure after HTx is a rare event in pediatrics. METHODS We retrospectively describe our single-center experience with post-HTx VAD support in a cohort of patients transplanted between 01/05 and 12/20. RESULTS Nine patients underwent VAD insertion in the early post-HTx period [median age 6.1 years (Range 0.3-20.3), median weight 17.6 kg (Range 3.5-65.0), and congenital heart disease (67%)]. Of the nine patients with early graft failure, almost half (44%) were implanted after 2015 and all of these patients had a pre-HTx plan for possible post-transplant VAD insertion. Time to VAD implant was a median of 0 day (Range 0-11). Total time on VAD support was a median of 12 days (Range 3.0-478.0). Two-thirds (n = 6; 67%) of the patients were weaned from support, retransplanted (11%) and two patients died (22%). In all of the patients where post-HTx VAD was anticipated there was 100% survival. CONCLUSIONS In this small patient series, post-HTx VAD was a useful measure in selected patients especially with pre-HTx planning. However, more shared experiences to verify these findings are needed.
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Affiliation(s)
- Annemarie Krauss
- Division of Pediatric Cardiology at the University of Alberta, Edmonton, Alberta, Canada
| | - Tara Pidborochynski
- Division of Pediatric Cardiology at the University of Alberta, Edmonton, Alberta, Canada
| | - Holger Buchholz
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Urschel
- Division of Pediatric Cardiology at the University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed Al-Akalabi
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.,Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Darren H Freed
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada.,Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Vijay Anand
- Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada
| | - Paula Holinkski
- Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada
| | - Angela Bates
- Pediatric Critical Care, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Division of Pediatric Cardiology at the University of Alberta, Edmonton, Alberta, Canada
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Ungerman E, Jayaraman AL, Patel B, Khoche S, Subramanian H, Bartels S, Knight J, Gelzinis TA. The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2020 Part II: Cardiac Transplantation. J Cardiothorac Vasc Anesth 2021; 36:390-402. [PMID: 34657796 DOI: 10.1053/j.jvca.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Ungerman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Arun L Jayaraman
- Department of Anesthesiology and Perioperative Medicine, Department of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Bhoumesh Patel
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Swapnil Khoche
- Department of Anesthesiology, University of California, San Diego, CA
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Steven Bartels
- Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, IL
| | - Joshua Knight
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
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Kolodziej AR, Vaidya GN, Reddy N, Birks EJ. Mechanical circulatory support in pre and postheart transplant period. Curr Opin Organ Transplant 2021; 26:273-281. [PMID: 33938463 DOI: 10.1097/mot.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Progression of heart failure (HF) and its unpredictable and volatile nature, often requires advanced therapies including heart transplant. Mechanical circulatory support plays an integral part in the advanced treatment options. This technology can be deployed in several ways, particularly in the preparation and patient optimization for heart transplants. This article discusses the use of temporary and durable devices and their deployment strategies in the pre and posttransplant period. RECENT FINDINGS Recently temporary mechanical support devices have allowed us to improve survival to transplant as well as posttransplant. Early implementation of temporary devices both for stabilization of advanced HF patients being considered for transplant as well as those with posttransplant primary graft dysfunction (although utilization of extracorporeal membrane oxygenation has repeatedly shown to be associated with worse outcomes compared to the other devices discussed), is reflective of the degree of disease progression in these patients. The outcomes of patients supported with durable devices have significantly improved with advancing technology. HeartMate 3 device has not only been shown to improve survival as well as the quality of life but in comparison to its predecessor, has been shown to decrease the morbidity associated with this technology. SUMMARY Both temporary and durable devices are now associated with improved survival and allow us to transplant patients in a more stable and safer manner with fewer adverse events. Based on the new United Network of Organ Sharing allocation system, it allows us to upgrade those who do not have the luxury of time to wait for a transplant. Primary graft dysfunction now also can be assisted with those devices, which is reflected in improved survival of posttransplant patients.
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Groff LT, Reed EE, Coe KE, El Boghdadly Z, Keller BC, Whitson BA, Burcham PK. Effectiveness of short vs long-course perioperative antibiotics in lung transplant recipients with donor positive respiratory cultures. Transpl Infect Dis 2020; 23:e13518. [PMID: 33217132 DOI: 10.1111/tid.13518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022]
Abstract
Lung transplant recipients are at increased risk for infection in the early postoperative phase, thus perioperative antibiotics are employed. This retrospective study evaluated the efficacy of short- vs long-course perioperative antibiotics in lung transplant patients. Lung transplant patients with donor positive cultures between August 2013 and September 2019 were evaluated, excluding those with cystic fibrosis, death within 14 days and re-transplants. The primary outcome was 30-day freedom from donor-derived respiratory infection. A total of 147 patients were included (57 short vs 90 long-course). Median perioperative antibiotic duration was 6 days in the short-course vs 14 days in the long-course group (P < .0001). Thirty-day freedom from donor-derived respiratory infection was present in 56 (98%) patients in the short-course vs 85 (94%) patients in the long-course group (P = .41). There was no difference in development of Clostridioides difficile infections (P = .41), while cumulative ventilator time and time to post-op extubation were longer in the long-course group (P = .001 and .004, respectively). Among lung transplant recipients with positive donor respiratory cultures, short-course perioperative antibiotics were as effective as long-course antibiotics in preventing donor-derived bacterial respiratory infections.
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Affiliation(s)
- Lindsey T Groff
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erica E Reed
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kelci E Coe
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zeinab El Boghdadly
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian C Keller
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pamela K Burcham
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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