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Chilvers N, Dark JH. Commentary: Total ventricular mass: Too much of a good thing? J Thorac Cardiovasc Surg 2023; 166:1155-1156. [PMID: 35610072 DOI: 10.1016/j.jtcvs.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Nicholas Chilvers
- Department and Institution, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John H Dark
- Department and Institution, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Greenhall GHB, Rous BA, Robb ML, Brown C, Hardman G, Hilton RM, Neuberger JM, Dark JH, Johnson RJ, Forsythe JLR, Tomlinson LA, Callaghan CJ, Watson CJE. Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission. JAMA Surg 2023; 158:504-513. [PMID: 36947028 PMCID: PMC10034666 DOI: 10.1001/jamasurg.2022.8419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Importance Cancer transmission is a known risk for recipients of organ transplants. Many people wait a long time for a suitable transplant; some never receive one. Although patients with brain tumors may donate their organs, opinions vary on the risks involved. Objective To determine the risk of cancer transmission associated with organ transplants from deceased donors with primary brain tumors. Key secondary objectives were to investigate the association that donor brain tumors have with organ usage and posttransplant survival. Design, Setting, and Participants This was a cohort study in England and Scotland, conducted from January 1, 2000, to December 31, 2016, with follow-up to December 31, 2020. This study used linked data on deceased donors and solid organ transplant recipients with valid national patient identifier numbers from the UK Transplant Registry, the National Cancer Registration and Analysis Service (England), and the Scottish Cancer Registry. For secondary analyses, comparators were matched on factors that may influence the likelihood of organ usage or transplant failure. Statistical analysis of study data took place from October 1, 2021, to May 31, 2022. Exposures A history of primary brain tumor in the organ donor, identified from all 3 data sources using disease codes. Main Outcomes and Measures Transmission of brain tumor from the organ donor into the transplant recipient. Secondary outcomes were organ utilization (ie, transplant of an offered organ) and survival of kidney, liver, heart, and lung transplants and their recipients. Key covariates in donors with brain tumors were tumor grade and treatment history. Results This study included a total of 282 donors (median [IQR] age, 42 [33-54] years; 154 females [55%]) with primary brain tumors and 887 transplants from them, 778 (88%) of which were analyzed for the primary outcome. There were 262 transplants from donors with high-grade tumors and 494 from donors with prior neurosurgical intervention or radiotherapy. Median (IQR) recipient age was 48 (35-58) years, and 476 (61%) were male. Among 83 posttransplant malignancies (excluding NMSC) that occurred over a median (IQR) of 6 (3-9) years in 79 recipients of transplants from donors with brain tumors, none were of a histological type matching the donor brain tumor. Transplant survival was equivalent to that of matched controls. Kidney, liver, and lung utilization were lower in donors with high-grade brain tumors compared with matched controls. Conclusions and Relevance Results of this cohort study suggest that the risk of cancer transmission in transplants from deceased donors with primary brain tumors was lower than previously thought, even in the context of donors that are considered as higher risk. Long-term transplant outcomes are favorable. These results suggest that it may be possible to safely expand organ usage from this donor group.
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Affiliation(s)
- George H B Greenhall
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
- School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Brian A Rous
- National Cancer Registration and Analysis Service, Fulbourn, United Kingdom
| | - Matthew L Robb
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Chloe Brown
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Gillian Hardman
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Rachel M Hilton
- Department of Nephrology and Transplantation, Guy's Hospital, London, United Kingdom
| | - James M Neuberger
- Liver Unit, Queen Elizabeth Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - John H Dark
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Rachel J Johnson
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - John L R Forsythe
- Department of Statistics and Clinical Research, Organ and Tissue Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, United Kingdom
| | - Laurie A Tomlinson
- Department of Noncommunicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris J Callaghan
- School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Department of Nephrology and Transplantation, Guy's Hospital, London, United Kingdom
| | - Christopher J E Watson
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
- NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, University of Cambridge, Cambridge, United Kingdom
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3
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Wang L, Dark JH. Commentary: One more obstacle knocked out. J Thorac Cardiovasc Surg 2023; 165:e82-e83. [PMID: 34454734 DOI: 10.1016/j.jtcvs.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Lu Wang
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John H Dark
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Andreasson ASI, Dark JH. Revascularisation of the bronchial arteries in pulmonary transplant; does it ever have a role? J Thorac Dis 2022; 14:4578-4581. [PMID: 36647493 PMCID: PMC9840030 DOI: 10.21037/jtd-22-1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022]
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Funston W, Ruchaud-Sparagano MH, Scott J, Powell J, Cooles FAH, Shelmerdine L, McDowell C, O’Leary D, Booth KL, Clark SC, Ledingham SJ, Rostron AJ, Dark JH, Simpson AJ. A human model of bilateral pulmonary vein sampling to assess the effects of one-lung ventilation on neutrophil function. PLoS One 2022; 17:e0271958. [PMID: 35881612 PMCID: PMC9321419 DOI: 10.1371/journal.pone.0271958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Neutrophil activation drives lung complications after cardiopulmonary bypass (CPB). Evidence suggests the healthy, ventilated lung may beneficially re-condition pro-inflammatory neutrophils. However, evidence in humans is lacking, due to a paucity of good models. CPB with simultaneous central venous and bilateral pulmonary vein sampling provides an opportunity to model effects of one-lung ventilation. The study’s primary objectives were to establish a model of intra-operative, bilateral pulmonary vein sampling and to determine whether neutrophil function differed after passing through inflated or deflated lungs. Methods Seventeen patients having “on pump” coronary artery bypass grafting (CABG) with one-lung ventilation (in two cohorts with tidal volume 2ml kg-1 and FiO2 0.21, or tidal volume 4 ml kg-1 and FiO2 0.5 respectively) were recruited. Cohort 1 consisted of 9 patients (7 male, median age 62.0 years) and Cohort 2 consisted of 8 male patients (median age 65.5 years). Recruitment was via prospective screening of scheduled elective and non-elective CABG procedures with cardiopulmonary bypass. Each patient had five blood samples taken—central venous blood pre-operatively; central venous blood pre-CPB; central venous blood post-CPB; pulmonary venous blood draining the ventilated lung post-CPB; and pulmonary venous blood draining the deflated lung post-CPB. Neutrophil phagocytosis and priming status were quantified. Plasma cytokines were measured. Results Phagocytosis and priming were not significantly different in neutrophils returning from the ventilated lung as compared to the non-ventilated lung. Plasma IL-6, IL-8 and IL-10 were significantly elevated by CPB. Conclusions The intra-operative, bilateral pulmonary vein sampling model provides unique opportunities to assess biological effects of interventions to one lung, with the other lung acting as an internal control. Single-lung ventilation during CPB had no significant effects on neutrophil function.
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Affiliation(s)
- Wendy Funston
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | | | - Jonathan Scott
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jason Powell
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Faye A. H. Cooles
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lauren Shelmerdine
- Health Education England North East, Newcastle upon Tyne, United Kingdom
| | - Cliona McDowell
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, Northern Ireland, United Kingdom
| | - Denis O’Leary
- Department of Cardiothoracic Anaesthesia, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Karen L. Booth
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Stephen C. Clark
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Faculty of Health and Life Sciences, University of Northumbria, Newcastle upon Tyne, United Kingdom
| | - Simon J. Ledingham
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Anthony J. Rostron
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John H. Dark
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cardiothoracic Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - A. John Simpson
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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6
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De Beule J, Vandendriessche K, Pengel LHM, Bellini MI, Dark JH, Hessheimer AJ, Kimenai HJAN, Knight SR, Neyrinck AP, Paredes D, Watson CJE, Rega F, Jochmans I. A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation. Transpl Int 2021; 34:2046-2060. [PMID: 34570380 DOI: 10.1111/tri.14121] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research.
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Affiliation(s)
- Julie De Beule
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | | | - Liset H M Pengel
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK
| | - Maria Irene Bellini
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - John H Dark
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Amelia J Hessheimer
- Department of General & Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simon R Knight
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, Anesthesiology and Algology, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - David Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Christopher J E Watson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,The NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Filip Rega
- Department of Cardiovascular Sciences, Cardiac Surgery, KU Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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Jochmans I, Hessheimer AJ, Neyrinck AP, Paredes D, Bellini MI, Dark JH, Kimenai HJAN, Pengel LHM, Watson CJE. Consensus statement on normothermic regional perfusion in donation after circulatory death: report from the European Society for Organ Transplantation's Transplant Learning Journey. Transpl Int 2021; 34:2019-2030. [PMID: 34145644 DOI: 10.1111/tri.13951] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/27/2022]
Abstract
Normothermic regional perfusion (NRP) in donation after circulatory death (DCD) is a safe alternative to in situ cooling and rapid procurement. An increasing number of countries and centres are performing NRP, a technically and logistically challenging procedure. This consensus document provides evidence-based recommendations on the use of NRP in uncontrolled and controlled DCDs. It also offers minimal ethical, logistical and technical requirements that form the foundation of a safe and effective NRP programme. The present article is based on evidence and opinions formulated by a panel of European experts of Workstream 04 of the Transplantation Learning Journey project, which is part of the European Society for Organ Transplantation.
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Affiliation(s)
- Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Amelia J Hessheimer
- Department of General & Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Arne P Neyrinck
- Anesthesiology and Algology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - David Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Maria Irene Bellini
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - John H Dark
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Liset H M Pengel
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Christopher J E Watson
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
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Hardman G, Sutcliffe R, Hogg R, Mumford L, Grocott L, Jerrett L, Mead-Regan SJ, Nuttall J, Dunn S, Seeley P, Quigley R, Dalzell JR, Al-Attar N, Parameshwar J, Fisher AJ, Booth K, Dark JH. Heart transplantation in the UK during the first wave of the SARS-CoV-2 pandemic. Clin Transplant 2021; 35:e14261. [PMID: 33608916 PMCID: PMC7995148 DOI: 10.1111/ctr.14261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/03/2021] [Accepted: 02/15/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND We aim to evaluate practice and understand the impact of the first wave of the SARS-CoV-2 pandemic on heart transplantation in the UK. METHODS A retrospective review of the UK Transplant Registry (UKTR) and a national survey of UK heart transplant centers have been performed. The early pandemic period is defined here as 1 March to 31 May 2020. RESULTS There was geographic variation in the prevalence of COVID-19 across the UK. All centers reported adaptations to maintain the safety of their staff, candidate, and recipient populations. The number of donors fell by 31% during the early pandemic period. Heart utilization increased to 35%, compared to 26% during the same period of 2019. The number of heart transplants was well maintained, across all centers, with 38 performed, compared to 41 during the same period of 2019, with no change in 30-day survival. Twenty-seven heart transplant recipients with confirmed COVID-19 infection were reported during the study period. CONCLUSION All UK heart transplant centers have successfully adapted their programs to overcome the challenges of staff redeployment and ICU and hospital resource limitation, associated with the pandemic, whilst continuing heart transplant activity. On-going evaluation of practice changes, with sharing of lessons learned, is required as the pandemic continues.
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Affiliation(s)
- Gillian Hardman
- Clinical Research and Clinical Audit Fellow in Cardiothoracic Transplantation, NHS Blood and Transplant, Bristol, UK.,Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ruth Sutcliffe
- Allied Health Professional representative, Cardiothoracic Advisory Group Clinical Audit Group, NHS Blood and Transplant, Bristol, UK
| | - Rachel Hogg
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Lisa Mumford
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Laura Grocott
- Heart and Lung transplant recipient coordinator, Queen Elizabeth Hospital, Birmingham, UK
| | - Lorraine Jerrett
- Heart transplant recipient coordinator, Golden Jubilee Hospital, Glasgow, UK
| | - Sarah-Jane Mead-Regan
- Heart and Lung transplant recipient coordinator, Great Ormond Street Hospital for Children, London, UK
| | - Jane Nuttall
- Recipient transplant coordinator, Wythenshawe hospital, Manchester, UK
| | - Stephanie Dunn
- Heart and Lung transplant recipient coordinator, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Philip Seeley
- Lead Nurse for Heart and Lung Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Richard Quigley
- Lead Nurse for transplantation, Royal Papworth Hospital, Cambridge, UK
| | - Johnathan R Dalzell
- Consultant cardiologist and clinical lead, Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Nawwar Al-Attar
- Chair, Cardiothoracic Advisory Group Clinical Audit Group, NHS Blood and Transplant, Bristol, UK
| | - Jayan Parameshwar
- Chair Cardiothoracic Advisory Group, NHS Blood and Transplant, Bristol, UK
| | - Andrew J Fisher
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.,Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Karen Booth
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - John H Dark
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
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9
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Hardman G, Sutcliffe R, Hogg R, Mumford L, Grocott L, Mead-Regan SJ, Nuttall J, Dunn S, Seeley P, Clark S, Quigley R, Al-Attar N, Booth K, Dark JH, Fisher AJ. The impact of the SARS-CoV-2 pandemic and COVID-19 on lung transplantation in the UK: Lessons learned from the first wave. Clin Transplant 2021; 35:e14210. [PMID: 33368697 PMCID: PMC7883175 DOI: 10.1111/ctr.14210] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022]
Abstract
Background Lung transplantation is particularly susceptible to the impact of the severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) pandemic, and evaluation of changes to practice is required to inform future decision‐making. Methods A retrospective review of the UK Transplant Registry (UKTR) and national survey of UK lung transplant centers has been performed. Results There was geographic variation in the prevalence of COVID‐19 infection across the UK. The number of donors fell by 48% during the early pandemic period. Lung utilization fell to 10% (compared with 24% for the same period of 2019). The number of lung transplants performed fell by 77% from 53, March to May 2019, to 12. Seven (58%) of these were performed in a single‐center, designated “COVID‐light.” The number of patients who died on the lung transplant waiting list increased, compared to the same period of 2019 (p = .0118). Twenty‐six lung transplant recipients with confirmed COVID‐19 infection were reported during the study period. Conclusion As the pandemic continues, reviewing practice and implementing the lessons learned during this period, including the use of robust donor testing strategies and the provision of “COVID‐light” hospitals, are vital in ensuring the safe continuation of our lung transplant program.
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Affiliation(s)
- Gillian Hardman
- Clinical Research and Clinical Audit Fellow in Cardiothoracic Transplantation, NHS Blood and Transplant, Bristol, UK.,Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Ruth Sutcliffe
- Allied Health Professional representative, Cardiothoracic Advisory Group Clinical Audit Group, NHS Blood and Transplant, Bristol, UK.,Recipient Transplant Coordinator, Wythenshawe Hospital, Manchester, UK
| | - Rachel Hogg
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Lisa Mumford
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Laura Grocott
- Heart and Lung transplant recipient coordinator, Queen Elizabeth Hospital, Birmingham, UK
| | - Sarah-Jane Mead-Regan
- Heart and Lung Transplant Recipient Coordinator, Great Ormond Street Hospital for Children, London, UK
| | - Jane Nuttall
- Recipient Transplant Coordinator, Wythenshawe Hospital, Manchester, UK
| | - Stephanie Dunn
- Heart and Lung transplant recipient coordinator, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Philip Seeley
- Lead Nurse for Heart and Lung Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Stephen Clark
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Richard Quigley
- Lead Nurse for transplantation, Royal Papworth Hospital, Cambridge, UK
| | - Nawwar Al-Attar
- Chair, Cardiothoracic Advisory Group Clinical Audit Group, NHS Blood and Transplant, Bristol, UK
| | - Karen Booth
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - John H Dark
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Andrew J Fisher
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.,Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
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Dark JH, Mehew J, Venkateswaran R. Prolongation of time from brain death to retrieval is beneficial to the donor heart. J Thorac Cardiovasc Surg 2020; 161:e311-e312. [PMID: 33218762 DOI: 10.1016/j.jtcvs.2020.06.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 01/19/2023]
Affiliation(s)
- John H Dark
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jenny Mehew
- Statistics and Clinical Studies, National Health System Blood and Transplant, Bristol, United Kingdom
| | - Rajamiyer Venkateswaran
- Transplant Unit, Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
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11
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Wang L, MacGowan GA, Ali S, Dark JH. Ex situ heart perfusion: The past, the present, and the future. J Heart Lung Transplant 2020; 40:69-86. [PMID: 33162304 DOI: 10.1016/j.healun.2020.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 01/06/2023] Open
Abstract
Despite the advancements in medical treatment, mechanical support, and stem cell therapy, heart transplantation remains the most effective treatment for selected patients with advanced heart failure. However, with an increase in heart failure prevalence worldwide, the gap between donor hearts and patients on the transplant waiting list keeps widening. Ex situ machine perfusion has played a key role in augmenting heart transplant activities in recent years by enabling the usage of donation after circulatory death hearts, allowing longer interval between procurement and implantation, and permitting the safe use of some extended-criteria donation after brainstem death hearts. This exciting field is at a hinge point, with 1 commercially available heart perfusion machine, which has been used in hundreds of heart transplantations, and a number of devices being tested in the pre-clinical and Phase 1 clinical trial stage. However, no consensus has been reached over the optimal preservation temperature, perfusate composition, and perfusion parameters. In addition, there is a lack of objective measurement for allograft quality and viability. This review aims to comprehensively summarize the lessons about ex situ heart perfusion as a platform to preserve, assess, and repair donor hearts, which we have learned from the pre-clinical studies and clinical applications, and explore its exciting potential of revolutionizing heart transplantation.
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Affiliation(s)
- Lu Wang
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Guy A MacGowan
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Simi Ali
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John H Dark
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
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12
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Wang L, Thompson E, Bates L, Pither TL, Hosgood SA, Nicholson ML, Watson CJ, Wilson C, Fisher AJ, Ali S, Dark JH. Flavin Mononucleotide as a Biomarker of Organ Quality-A Pilot Study. Transplant Direct 2020; 6:e600. [PMID: 32904032 PMCID: PMC7447496 DOI: 10.1097/txd.0000000000001046] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Flavin mononucleotide (FMN), released from damaged mitochondrial complex I during hypothermic liver perfusion, has been shown to be predictive of 90-day graft loss. Normothermic machine perfusion (NMP) and normothermic regional perfusion (NRP) are used for organ reconditioning and quality assessment before transplantation. This pilot study aimed to investigate the changes of FMN levels during normothermic reperfusion of kidneys, livers, and lungs and examine whether FMN could serve as a biomarker to predict posttransplant allograft quality. METHODS FMN concentrations, in perfusates collected during NMP of kidneys, abdominal NRP, and ex vivo lung perfusion, were measured using fluorescence spectrometry and correlated to the available perfusion parameters and clinical outcomes. RESULTS Among 7 transplanted kidneys out of the 11 kidneys that underwent NMP, FMN levels at 60 minutes of NMP were significantly higher in the allografts that developed delayed graft function and primary nonfunction (P = 0.02). Fifteen livers from 23 circulatory death donors that underwent NRP were deemed suitable for transplantation. Their FMN levels at 30 minutes of NRP were significantly lower than those not procured for transplantation (P = 0.004). In contrast, little FMN was released during the 8 lung perfusions. CONCLUSIONS This proof of concept study suggested that FMN in the perfusates of kidney NMP has the potential to predict posttransplant renal function, whereas FMN at 30 minutes of NRP predicts whether a liver would be accepted for transplantation. More work is required to validate the role of FMN as a putative biomarker to facilitate safe and reliable decision-making before embarking on transplantation.
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Affiliation(s)
- Lu Wang
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emily Thompson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lucy Bates
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas L. Pither
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah A. Hosgood
- Department of Surgery, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Colin Wilson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew J. Fisher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Simi Ali
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John H. Dark
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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13
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Wang L, Wang T, Rushton SN, Parry G, Dark JH, Sheerin NS. The impact of severe acute kidney injury requiring renal replacement therapy on survival and renal function of heart transplant recipients - a UK cohort study. Transpl Int 2020; 33:1650-1666. [PMID: 32542834 DOI: 10.1111/tri.13675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/30/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023]
Abstract
Severe acute kidney injury (AKI), defined as requiring renal replacement therapy (RRT), is associated with higher mortality postheart transplantation, but its long-term renal consequences are not known. Anonymized data of 3365 patients, who underwent heart transplantation between 1995 and 2017, were retrieved from the UK Transplant Registry. Multivariable binary logistic regression was performed to identify risk factors for severe AKI requiring RRT, Kaplan-Meier analysis to compare survival and renal function deterioration of the RRT and non-RRT groups, and multivariable Cox regression model to identify predicting factors of mortality and end-stage renal disease (ESRD). 26.0% of heart recipients received RRT post-transplant. The RRT group has lower survival rates at all time points, especially in the immediate post-transplant period. However, conditional on 3 months survival, older age, diabetes and coronary heart disease, but not post-transplant RRT, were the risk factors for long-term survival. The predicting factors for ESRD were insulin-dependent diabetes, renal function at transplantation, eGFR decline in the first 3 months post-transplant, post-transplant severe AKI and transplantation era. Severe AKI requiring RRT post-transplant is associated with worse short-term survival, but has no impact on long-term mortality. It also accelerates recipients' renal function deterioration in the long term.
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Affiliation(s)
- Lu Wang
- Newcastle upon Tyne Hospitals NHS Foundation Turst, Newcastle upon Tyne, UK.,Translational and Cinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tengyao Wang
- Statistics Science, University College London, London, UK
| | - Sally N Rushton
- Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
| | - Gareth Parry
- Newcastle upon Tyne Hospitals NHS Foundation Turst, Newcastle upon Tyne, UK
| | - John H Dark
- Translational and Cinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Neil S Sheerin
- Newcastle upon Tyne Hospitals NHS Foundation Turst, Newcastle upon Tyne, UK.,Translational and Cinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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14
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Hardman G, Dark JH. Commentary: The end of the beginning? J Thorac Cardiovasc Surg 2020; 162:1489-1490. [PMID: 32164948 DOI: 10.1016/j.jtcvs.2020.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Gillian Hardman
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - John H Dark
- Department of Cardiothoracic Surgery, Newcastle University, Newcastle Upon Tyne, United Kingdom.
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15
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Booth K, Dark JH. Reply: Commentary on do not forget late aneurysm after heart transplantation: More evidence for computed tomography screening. J Thorac Cardiovasc Surg 2019; 159:e128. [PMID: 31562009 DOI: 10.1016/j.jtcvs.2019.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Karen Booth
- Adult Cardiac and Cardiothoracic Transplant, Freeman Hospital, Newcastle, United Kingdom
| | - John H Dark
- Institute of Cellular Medicine, Newcastle University, Newcastle, United Kingdom
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16
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Khushnood A, Butt TA, Jungschleger J, Henderson P, Smith JH, De Rita F, Nassar M, Page A, Messer S, Large S, Dark JH, Parry G, Reinhardt Z, Hasan A. Paediatric donation after circulatory determined death heart transplantation using donor normothermic regional perfusion and ex situ heart perfusion: A case report. Pediatr Transplant 2019; 23:e13536. [PMID: 31273913 DOI: 10.1111/petr.13536] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 12/15/2022]
Abstract
This is a report of a unique DCD paediatric heart transplant whereby normothermic regional perfusion was used to assess DCD heart function after death followed by ex situ heart perfusion of the graft during transportation from donor to recipient hospitals. The DCD donor was a 9-year-old boy weighing 84 kg. The recipient was 7-year-old boy with failing Fontan circulation and weighed 23 kg. It was an ABO-compatible heart transplantation. The DCD heart was reperfused and assessed using normothermic regional perfusion followed by portable ex situ heart perfusion during transportation. The orthotopic heart transplantation was successful with good graft function and no evidence of rejection on endomyocardial biopsy at 30 days post-transplant. At 1-year follow-up, excellent graft function is maintained, and he is attending school with a good quality of life. DCD heart transplantation in children is a promising solution to reducing paediatric waiting times. The case demonstrates the feasibility of using normothermic regional perfusion in the donor and ex situ heart perfusion during graft transportation. This combination allowed a functional assessment whilst minimizing warm ischaemia resulting in a successful outcome. More research and long-term follow-up are needed in order to benefit from the huge potential that paediatric DCD heart transplantation has to offer.
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Affiliation(s)
- Abbas Khushnood
- Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Tanveer A Butt
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jerome Jungschleger
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Paul Henderson
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jonathan H Smith
- Department of Cardiac Anaesthesia and Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Fabrizio De Rita
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Mohamed Nassar
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Aravinda Page
- Department of Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridgeshire, UK
| | - Simon Messer
- Department of Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridgeshire, UK
| | - Stephen Large
- Department of Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridgeshire, UK
| | - John H Dark
- Department of Cardiothoracic Surgery, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Gareth Parry
- Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Zdenka Reinhardt
- Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Asif Hasan
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
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17
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MacGowan GA, Dark JH, Corris PA, Nair AR. Effects of drug abuse, smoking and alcohol on donor hearts and lungs. Transpl Int 2019; 32:1019-1027. [PMID: 31172575 DOI: 10.1111/tri.13468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/04/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022]
Abstract
Potential heart and lung donors with a history of illicit drugs and/or smoking and alcohol are frequently offered, though there is no clear guidance on when it is safe to use these organs. A review of the literature on effects of drugs, alcohol and smoking on donor outcomes, and the effects of these on the intact heart and lung was undertaken. There has been a marked increase in deaths from opioid abuse in many developed countries, though recent evidence suggests that outcomes after cardiothoracic transplantation are equivalent to nonopioid donor causes of death. For donor smoking, there is an increased risk with lung transplantation; however, that risk is less when compared to further waiting on the transplant list for a nonsmoking alternative. Heavy alcohol consumption does not adversely affect heart transplantation, and there is no clear evidence of adverse outcomes after lung transplantation. There are no overall effects of cannabis or cocaine on survival after heart or lung transplantation. In all these cases, careful donor assessment can establish if a particular organ can be used. In most cases, use of drugs requires careful assessment, but is not in of itself a contraindication to cardiothoracic transplantation.
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Affiliation(s)
- Guy A MacGowan
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - John H Dark
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Paul A Corris
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Arun R Nair
- Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK
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18
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Booth K, Dark JH. Commentary: Pseudoaneurysm aortopathy after heart transplantation-A link too far? J Thorac Cardiovasc Surg 2019; 158:e187-e188. [PMID: 31029450 DOI: 10.1016/j.jtcvs.2019.03.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Karen Booth
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, United Kingdom
| | - John H Dark
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom.
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19
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Abstract
Bronchial anastomotic breakdown was a major complication in the early days of lung transplantation. Their solution, achieved through an understanding of airway ischemia from the laboratory, was key to the initial clinical success. Subsequently, risk factors, such as prolonged ventilation in both donor and recipient, primary graft dysfunction, and recipient age, have emerged. Innovations, such as local tissue wrapping, telescoping the anastomosis, and bronchial artery revascularization, have not stood the test of time. The short donor bronchus, with a suture line at the level of the lobar bronchus carina, is a proven technique that should be adopted by surgeons.
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Affiliation(s)
- John H Dark
- Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, 1st floor William Leech Building, Medical School, Framlington Place, Newcastle NE2 4HH, UK.
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20
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Dark JH. Interleukin-10 transfection and the donor lung—A still-evolving story. J Thorac Cardiovasc Surg 2018; 156:1303-1304. [DOI: 10.1016/j.jtcvs.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
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21
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Birch J, Sunny SS, Hester KLM, Parry G, Kate Gould F, Dark JH, Clark SC, Meachery G, Lordan J, Fisher AJ, Corris PA, De Soyza A. Outcomes of lung transplantation in adults with bronchiectasis. BMC Pulm Med 2018; 18:82. [PMID: 29789006 PMCID: PMC5964693 DOI: 10.1186/s12890-018-0634-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 04/25/2018] [Indexed: 11/17/2022] Open
Abstract
Background Lung transplantation is a well-established treatment for end-stage non-cystic fibrosis bronchiectasis (BR), though information regarding outcomes of transplantation remains limited. Our results of lung transplantation for Br are reported here. Methods A retrospective review of case notes and transplantation databases was conducted for patients that had underwent lung transplantation for bronchiectasis at the Freeman Hospital between 1990 and 2013. Results Fourty two BR patients underwent lung transplantation, the majority (39) having bilateral sequential lung transplantation. Mean age at transplantation was 47.1 years. Pre-transplantation osteoporosis was a significant non-pulmonary morbidity (48%). Polymicrobial infection was common, with Pseudomonas aeruginosa infection frequently but not universally observed (67%). Forced expiratory volume in 1 second (% predicted) improved from a pre-transplantation mean of 0.71 L (22% predicted) to 2.56 L (79 % predicted) at 1-year post-transplantation. Our survival results were 74% at 1 year, 64% at 3 years, 61% at 5 years and 48% at 10 years. Sepsis was a common cause of early post-transplantation deaths. Conclusions Lung transplantation for end-stage BR is a useful therapeutic option, with good survival and lung function outcomes. Survival values were similar to other bilateral lung transplants at our centre. Pre-transplantation Pseudomonas infection is common.
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Affiliation(s)
- Jodie Birch
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Syba S Sunny
- Sir William Leech Centre for lung research, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Katy L M Hester
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Sir William Leech Centre for lung research, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Gareth Parry
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - F Kate Gould
- Department of Medical Microbiology, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - John H Dark
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Stephen C Clark
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Gerard Meachery
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - James Lordan
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Andrew J Fisher
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Paul A Corris
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Anthony De Soyza
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. .,Sir William Leech Centre for lung research, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK.
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22
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Dark JH, Hasan A. Back to the future. Ann Cardiothorac Surg 2018; 7:2. [PMID: 29492378 DOI: 10.21037/acs.2018.01.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- John H Dark
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Asif Hasan
- Department of Paediatric Cardiac Surgery, Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK.
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23
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Affiliation(s)
- Jérôme G M Jungschleger
- Institute of Transplantation, Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sergey Yu Boldyrev
- Department of Adult Cardiac Surgery, Ochapowski Regional Hospital #1, Krasnodar, Russia.,Division of Cardiac Surgery and Cardiology, Kuban State Medical University, Krasnodar, Russia
| | - Vasily I Kaleda
- Department of Adult Cardiac Surgery, Ochapowski Regional Hospital #1, Krasnodar, Russia
| | - John H Dark
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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24
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Dark JH. "Ex" becomes "in": A new direction for ex vivo lung perfusion? J Thorac Cardiovasc Surg 2017; 155:438-439. [PMID: 29089091 DOI: 10.1016/j.jtcvs.2017.09.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John H Dark
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
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25
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Andreasson ASI, Karamanou DM, Gillespie CS, Özalp F, Butt T, Hill P, Jiwa K, Walden HR, Green NJ, Borthwick LA, Clark SC, Pauli H, Gould KF, Corris PA, Ali S, Dark JH, Fisher AJ. Profiling inflammation and tissue injury markers in perfusate and bronchoalveolar lavage fluid during human ex vivo lung perfusion. Eur J Cardiothorac Surg 2017; 51:577-586. [PMID: 28082471 PMCID: PMC5400024 DOI: 10.1093/ejcts/ezw358] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/12/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES: Availability of donor lungs suitable for transplant falls short of current demand and contributes to waiting list mortality. Ex vivo lung perfusion (EVLP) offers the opportunity to objectively assess and recondition organs unsuitable for immediate transplant. Identifying robust biomarkers that can stratify donor lungs during EVLP to use or non-use or for specific interventions could further improve its clinical impact. METHODS: In this pilot study, 16 consecutive donor lungs unsuitable for immediate transplant were assessed by EVLP. Key inflammatory mediators and tissue injury markers were measured in serial perfusate samples collected hourly and in bronchoalveolar lavage fluid (BALF) collected before and after EVLP. Levels were compared between donor lungs that met criteria for transplant and those that did not. RESULTS: Seven of the 16 donor lungs (44%) improved during EVLP and were transplanted with uniformly good outcomes. Tissue and vascular injury markers lactate dehydrogenase, HMGB-1 and Syndecan-1 were significantly lower in perfusate from transplanted lungs. A model combining IL-1β and IL-8 concentrations in perfusate could predict final EVLP outcome after 2 h assessment. In addition, perfusate IL-1β concentrations showed an inverse correlation to recipient oxygenation 24 h post-transplant. CONCLUSIONS: This study confirms the feasibility of using inflammation and tissue injury markers in perfusate and BALF to identify donor lungs most likely to improve for successful transplant during clinical EVLP. These results support examining this issue in a larger study.
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Affiliation(s)
- Anders S I Andreasson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Danai M Karamanou
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Colin S Gillespie
- School of Mathematics & Statistics, Newcastle University, Newcastle upon Tyne, UK
| | - Faruk Özalp
- Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Tanveer Butt
- Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Paul Hill
- Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Kasim Jiwa
- Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hannah R Walden
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Nicola J Green
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Lee A Borthwick
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen C Clark
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Henning Pauli
- Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Kate F Gould
- Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Paul A Corris
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Simi Ali
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - John H Dark
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
| | - Andrew J Fisher
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Cardiopulmonary Transplantation, Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK
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26
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Andreasson ASI, Dark JH, Fisher AJ. Reply to Mohamed S.A. Mohamed. Eur J Cardiothorac Surg 2017; 52:607-608. [PMID: 28430998 DOI: 10.1093/ejcts/ezx111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 03/23/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anders S I Andreasson
- Institute of Transplantation, Newcastle University, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - John H Dark
- Institute of Transplantation, Newcastle University, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew J Fisher
- Institute of Transplantation, Newcastle University, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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27
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Andreasson ASI, Borthwick LA, Gillespie C, Jiwa K, Scott J, Henderson P, Mayes J, Romano R, Roman M, Ali S, Fildes JE, Marczin N, Dark JH, Fisher AJ. The role of interleukin-1β as a predictive biomarker and potential therapeutic target during clinical ex vivo lung perfusion. J Heart Lung Transplant 2017; 36:985-995. [PMID: 28551353 PMCID: PMC5578478 DOI: 10.1016/j.healun.2017.05.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/09/2017] [Accepted: 05/09/2017] [Indexed: 11/23/2022] Open
Abstract
Background Extended criteria donor lungs deemed unsuitable for immediate transplantation can be reconditioned using ex vivo lung perfusion (EVLP). Objective identification of which donor lungs can be successfully reconditioned and will function well post-operatively has not been established. This study assessed the predictive value of markers of inflammation and tissue injury in donor lungs undergoing EVLP as part of the DEVELOP-UK study. Methods Longitudinal samples of perfusate, bronchoalveolar lavage, and tissue from 42 human donor lungs undergoing clinical EVLP assessments were analyzed for markers of inflammation and tissue injury. Levels were compared according to EVLP success and post-transplant outcomes. Neutrophil adhesion to human pulmonary microvascular endothelial cells (HPMECs) conditioned with perfusates from EVLP assessments was investigated on a microfluidic platform. Results The most effective markers to differentiate between in-hospital survival and non-survival post-transplant were perfusate interleukin (IL)-1β (area under the curve = 1.00, p = 0.002) and tumor necrosis factor-α (area under the curve = 0.95, p = 0.006) after 30 minutes of EVLP. IL-1β levels in perfusate correlated with upregulation of intracellular adhesion molecule-1 in donor lung vasculature (R2 = 0.68, p < 0.001) and to a lesser degree upregulation of intracellular adhesion molecule-1 (R2 = 0.30, p = 0.001) and E-selectin (R2 = 0.29, p = 0.001) in conditioned HPMECs and neutrophil adhesion to conditioned HPMECs (R2 = 0.33, p < 0.001). Neutralization of IL-1β in perfusate effectively inhibited neutrophil adhesion to conditioned HPMECs (91% reduction, p = 0.002). Conclusions Donor lungs develop a detectable and discriminatory pro-inflammatory signature in perfusate during EVLP. Blocking the IL-1β pathway during EVLP may reduce endothelial activation and subsequent neutrophil adhesion on reperfusion; this requires further investigation in vivo.
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Affiliation(s)
- Anders S I Andreasson
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lee A Borthwick
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Colin Gillespie
- School of Mathematics & Statistics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kasim Jiwa
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Jonathan Scott
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul Henderson
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Jonny Mayes
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | | | - Simi Ali
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - James E Fildes
- University Hospital of South Manchester, Manchester, United Kingdom; Manchester Collaborative Centre for Inflammation Research, University of Manchester, Manchester, United Kingdom
| | | | - John H Dark
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew J Fisher
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Dark JH, Egan TM. Lungs From the Controlled Donation After Circulatory Determination of Death Donor: Perspectives From the United States and Beyond. Am J Transplant 2016; 16:1047-8. [PMID: 26844809 DOI: 10.1111/ajt.13600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 10/13/2015] [Accepted: 11/01/2015] [Indexed: 01/25/2023]
Affiliation(s)
- J H Dark
- Newcastle University, Newcastle upon Tyne, UK
| | - T M Egan
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Dark JH. 50th Anniversary Perspective on Volume 1: Trummer MJ. Experimental Transplantation of the Lung. Ann Thorac Surg 1965;1:203-19. Ann Thorac Surg 2015; 100:773-4. [PMID: 26354617 DOI: 10.1016/j.athoracsur.2015.07.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 11/17/2022]
Affiliation(s)
- John H Dark
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Affiliation(s)
- John H Dark
- Institute of Cellular Medicine, Medical School Newcastle University, Newcastle upon Tyne, UK
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Andreasson A, Karamanou DM, Perry JD, Perry A, Ӧzalp F, Butt T, Morley KE, Walden HR, Clark SC, Prabhu M, Corris PA, Gould K, Fisher AJ, Dark JH. The effect of ex vivo lung perfusion on microbial load in human donor lungs. J Heart Lung Transplant 2014; 33:910-6. [DOI: 10.1016/j.healun.2013.12.023] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/13/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022] Open
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Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, Lederer DJ, Mulligan MJ, Patterson GA, Singer LG, Snell GI, Verleden GM, Zamora MR, Glanville AR. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2014; 34:1-15. [PMID: 25085497 DOI: 10.1016/j.healun.2014.06.014] [Citation(s) in RCA: 870] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/18/2014] [Indexed: 02/06/2023] Open
Abstract
The appropriate selection of lung transplant recipients is an important determinant of outcomes. This consensus document is an update of the recipient selection guidelines published in 2006. The Pulmonary Council of the International Society for Heart and Lung Transplantation (ISHLT) organized a Writing Committee of international experts to provide consensus opinion regarding the appropriate timing of referral and listing of candidates for lung transplantation. A comprehensive search of the medical literature was conducted with the assistance of a medical librarian. Writing Committee members were assigned specific topics to research and discuss. The Chairs of the Writing Committee were responsible for evaluating the completeness of the literature search, providing editorial support for the manuscript, and organizing group discussions regarding its content. The consensus document makes specific recommendations regarding the timing of referral and of listing for lung transplantation. These recommendations include discussions not present in previous ISHLT guidelines, including lung allocation scores, bridging to transplant with mechanical circulatory and ventilator support, and expanded indications for lung transplantation. In the absence of high-grade evidence to support decision making, these consensus guidelines remain part of a continuum of expert opinion based on available studies and personal experience. Some positions are immutable. Although transplant is rightly a treatment of last resort for end-stage lung disease, early referral allows proper evaluation and thorough patient education. Subsequent waiting list activation implies a tacit agreement that transplant offers a significant individual survival advantage. It is both the challenge and the responsibility of the transplant community globally to ensure organ allocation maximizes the potential benefits of a scarce resource, thereby achieving that advantage.
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Affiliation(s)
| | | | - Paul A Corris
- Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - John H Dark
- Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | | | | | | | | | | | | | - Greg I Snell
- The Alfred Hospital, Melbourne, Victoria, Australia
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Mownah OA, Khurram MA, Ray C, Kanwar A, Stamp S, Rees D, Brassil J, Majo J, Dark JH, Carter NM, Talbot D. Development of an ex vivo technique to achieve reanimation of hearts sourced from a porcine donation after circulatory death model. J Surg Res 2014; 189:326-34. [DOI: 10.1016/j.jss.2014.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 01/02/2014] [Accepted: 02/22/2014] [Indexed: 10/25/2022]
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Ausania F, Hipps D, Manas DM, Haugk B, Dark JH, Jaques BC. Simultaneous liver resection and double cardiac valve replacement. A case report. Int J Surg Case Rep 2014; 5:256-8. [PMID: 24705636 DOI: 10.1016/j.ijscr.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 01/26/2014] [Accepted: 02/05/2014] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION We present a rare case in which both a double cardiac valve replacement was performed as well as a hepatic resection. PRESENTATION OF CASE We report the case of a 36 year old patient who presented with intra abdominal bleeding thought to have been caused by a liver haemangioma she also had severe autoimmune cardiac valve disease. She underwent a simultaneous right hepatectomy with cardiac valve replacement. DISCUSSION Management of this challenging case is discussed. CONCLUSION We advocate the possibility of performing combined operations where both valve replacement and hepatic resection is required.
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Affiliation(s)
- F Ausania
- Hepato-Pancreato-Biliary and Transplant Surgery Unit, Freeman Hospital, Newcastle Upon Tyne, UK.
| | - D Hipps
- Hepato-Pancreato-Biliary and Transplant Surgery Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - D M Manas
- Hepato-Pancreato-Biliary and Transplant Surgery Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - B Haugk
- Histopathology Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - J H Dark
- Cardiothoracic and Transplant Surgery Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - B C Jaques
- Hepato-Pancreato-Biliary and Transplant Surgery Unit, Freeman Hospital, Newcastle Upon Tyne, UK
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Ali AS, Vasdev N, Shanmuganathan S, Paez E, Dark JH, Manas D, Thomas DJ. The surgical management and prognosis of renal cell cancer with IVC tumor thrombus: 15-Years of experience using a multi-specialty approach at a single UK referral center. Urol Oncol 2013; 31:1298-304. [DOI: 10.1016/j.urolonc.2011.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/31/2011] [Accepted: 11/02/2011] [Indexed: 10/14/2022]
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Siddique A, Bose AK, Özalp F, Butt TA, Muse H, Morley KE, Dark JH, Parry G, Clark SC. Vascular anastomotic complications in lung transplantation: a single institution's experience. Interact Cardiovasc Thorac Surg 2013; 17:625-31. [PMID: 23788195 DOI: 10.1093/icvts/ivt266] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Lung transplant recipients were reviewed to compare our early and current experience of vascular complications. Since 1995, we have had a policy of early identification and intervention. METHODS We undertook a retrospective review of all adult lung transplants performed at our centre. Patients with pulmonary vascular complications before and after 1995 were identified and reviewed to determine changes in management and outcome. RESULTS We identified a total of 13 patients with either pulmonary artery or venous obstruction out of a total of 720 adult lung transplants (1.8%). There were 9 females and 4 males with an age range of 25-64 years. Complications were more common in patients with fibrotic lung disease and involved 15 vascular anastomoses, most commonly the pulmonary arterial anastomosis. Prior to 1995, 5 cases were identified, all postoperatively. In this group, the mean time for identification of the complication was 9.4 (range 4-14) days. Only 1 patient survived to discharge. After 1995, vascular complications were identified intraoperatively in 4 cases and corrected immediately. Four cases were identified postoperatively (at <1-17 days) by a computed tomography pulmonary angiogram. Three were treated surgically within 24 h of diagnosis (using cardiopulmonary bypass with cold preservation). One patient was managed conservatively. Among patients identified after 1995, 5 survived to discharge. CONCLUSIONS Though rare, pulmonary vascular complications after lung transplantation carry high mortality. In our opinion, early identification and intervention improves outcome. Intraoperative assessment by pressure gradient measurement and transoesophageal echocardiography is recommended. Despite this, mortality remains high and prevention is better than cure.
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Affiliation(s)
- Aleem Siddique
- Department of Cardiothoracic Transplantation and Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Peng EWK, Simpson J, Thirugnanasothy L, Kesteven P, Dark JH. Surgical embolectomy is underused. BMJ 2013; 346:f1955. [PMID: 23550073 DOI: 10.1136/bmj.f1955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND The risk that a positive smoking history in lung donors could adversely affect survival of transplant recipients causes concern. Conversely, reduction of the donor pool by exclusion of donors with positive smoking histories could compromise survival of patients waiting to receive a transplant. We examined the consequences of donor smoking on post-transplantation survival, and the potential effect of not transplanting lungs from such donors. METHODS We analysed the effect of donor smoking on 3 year survival after first adult lung transplantation from brain-dead donors done between July 1, 1999, and Dec 31, 2010, by Cox regression modelling of data from the UK Transplant Registry. We estimated the effect of acceptance of lungs from donors with positive smoking histories on survival and compared it with the effect of remaining on the waiting list for a potential transplant from a donor with a negative smoking history donor, by analysing all waiting-list registrations during the same period with a risk-adjusted sequentially stratified Cox regression model. FINDINGS Of 1295 lung transplantations, 510 (39%) used lungs from donors with positive smoking histories. Recipients of such lungs had worse 3 year survival after transplantation than did those who received lungs from donors with negative smoking histories (unadjusted hazard ratio [HR] 1·46, 95% CI 1·20-1·78; adjusted HR 1·36, 1·11-1·67). Independent factors affecting survival were recipient's age, donor-recipient cytomegalovirus matching, donor-recipient height difference, donor's sex, and total ischaemic time. Of 2181 patients registered on the waiting list, 802 (37%) died or were removed from the list without receiving a transplant. Patients receiving lungs from donors with positive smoking histories had a lower unadjusted hazard of death after registration than did those who remained on the waiting list (0·79, 95% CI 0·70-0·91). Patients with septic or fibrotic lung disease registered in 1999-2003 had risk-adjusted hazards of 0·60 (95% CI 0·42-0·87) and 0·39 (0·28-0·55), respectively. INTERPRETATION In the UK, an organ selection policy that uses lungs from donors with positive smoking histories improves overall survival of patients registered for lung transplantation, and should be continued. Although lungs from such donors are associated with worse outcomes, the individual probability of survival is greater if they are accepted than if they are declined and the patient chooses to wait for a potential transplant from a donor with a negative smoking history. This situation should be fully explained to and discussed with patients who are accepted for lung transplantation. FUNDING National Health Service Blood and Transplant.
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Affiliation(s)
- Robert S Bonser
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
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Burdett C, Butt T, Lordan J, Dark JH, Clark SC. Comparison of single lung transplant with and without the use of cardiopulmonary bypass. Interact Cardiovasc Thorac Surg 2012; 15:432-6; discussion 436. [PMID: 22714587 DOI: 10.1093/icvts/ivs264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Many centres avoid using cardiopulmonary bypass (CPB) for lung transplant due to concerns over aggravated lung reperfusion injury and excessive blood loss. We reviewed our 23-years' experience of single lung transplantation. METHODS A retrospective review of single lung transplants at our institution (1987-2010), examining differences in allograft function and postoperative complications between CPB and non-bypass (non-CPB) cases. RESULTS Two hundred and fifty-nine single lung transplants were undertaken. Fifty-three (20.5%) with CPB. There was no difference demographically between the two groups. No difference existed in preoperative PO(2)/FiO(2). At 1 and 24 h, the postoperative PO(2)/FiO(2) ratio was no different (mean 2.95 and 3.24 in non-CPB cases; 3.53 and 3.75 in CPB patients, P = 0.18 and P = 0.34, respectively). Extubation time was not influenced by the use of CPB. Postoperative blood loss was greater in the CPB group. The usage of fresh frozen plasma and platelets was similar (P = 0.64 and 0.41, respectively). More blood was transfused during postoperative care of CPB patients (P = 0.02). CONCLUSIONS Fears of poor postoperative lung function after CPB appear unfounded. We could detect no difference in function or extubation time. Although the use of CPB increases postoperative bleeding and the need for transfusion, it may be used safely to facilitate lung transplantation.
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Abstract
Over the course of the last century, organ transplantation has overcome major technical limitations to become the success it is today. The breakthroughs include developing techniques for vascular anastomoses, managing the immune response (initially by avoiding it with the use of identical twins and subsequently controlling it with chemical immunosuppressants), and devising preservation solutions that enable prolonged periods of ex vivo storage while preserving function. One challenge that has remained from the outset is to overcome the shortage of suitable donor organs. The results of organ transplantation continue to improve, both as a consequence of the above innovations and the improvements in peri- and postoperative management. This review describes some of the achievements and challenges of organ transplantation.
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Affiliation(s)
- C J E Watson
- University Department of Surgery, NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
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Affiliation(s)
- Antonia J Cronin
- NIHR Biomedical Research Centre, Guy's and St. Thomas' NHS Foundation Trust, MRC Centre for Transplantation, King's College London, London SE1 9RT, UK.
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Robertson AGN, Krishnan A, Ward C, Pearson JP, Small T, Corris PA, Dark JH, Karat D, Shenfine J, Griffin SM. Anti-reflux surgery in lung transplant recipients: outcomes and effects on quality of life. Eur Respir J 2011; 39:691-7. [PMID: 21778169 DOI: 10.1183/09031936.00061811] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fundoplication may improve survival after lung transplantation. Little is known about the effects of fundoplication on quality of life in these patients. The aim of this study was to assess the safety of fundoplication in lung transplant recipients and its effects on quality of life. Between June 1, 2008 and December 31, 2010, a prospective study of lung transplant recipients undergoing fundoplication was undertaken. Quality of life was assessed before and after surgery. Body mass index (BMI) and pulmonary function were followed up. 16 patients, mean ± sd age 38 ± 11.9 yrs, underwent laparoscopic Nissen fundoplication. There was no peri-operative mortality or major complications. Mean ± SD hospital stay was 2.6 ± 0.9 days. 15 out of 16 patients were satisfied with the results of surgery post fundoplication. There was a significant improvement in reflux symptom index and DeMeester questionnaires and gastrointestinal quality of life index scores at 6 months. Mean BMI decreased significantly after fundoplication (p = 0.01). Patients operated on for deteriorating lung function had a statistically significant decrease in the rate of lung function decline after fundoplication (p = 0.008). Laparoscopic fundoplication is safe in selected lung transplant recipients. Patient benefit is suggested by improved symptoms and satisfaction. This procedure is acceptable, improves quality of life and may reduce deterioration of lung function.
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Affiliation(s)
- A G N Robertson
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
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Irving CA, Kirk R, Parry G, Hamilton L, Dark JH, Wrightson N, Griselli M, Hasan A. Outcomes following more than two decades of paediatric cardiac transplantation. Eur J Cardiothorac Surg 2011; 40:1197-202. [PMID: 21493085 DOI: 10.1016/j.ejcts.2011.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 02/03/2011] [Accepted: 02/08/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE There have been significant changes in the field of paediatric cardiac transplantation over the last two decades. We report experience of over 22 years from a single UK transplant centre. METHODS A total of 189 orthotopic cardiac transplants were performed in 182 children aged <18 years between March 1987 and March 2009 in our institution. Patients were identified and outcomes reviewed using the cardiopulmonary transplant database and hospital medical records. RESULTS 182 patients underwent cardiac transplantation, mean age 8.3 years (0.1-17.9 years), 91 (50%) male. Mean follow-up time was 9.0 years (0.3-22.3 years). 117 patients (64%) had a diagnosis of cardiomyopathy, 65 (36%) had congenital heart disease. There was no significant difference in age at transplant between the group with cardiomyopathy and the group with congenital heart disease. 32 patients (17.6%) were on mechanical support prior to transplant. Three (1.6%) patients have required long-term renal replacement therapy post transplant, and 16 (8.8%) developed post-transplant lymphoproliferative disease. Survival was 93% at 30 days, 89% at 1 year, 85% at 5 years, 70% at 10 years and 67% at 15 years with a decrease in mortality over time. Seven patients (3.8%) were re-transplanted. CONCLUSIONS Outcomes following cardiac transplantation in childhood are improving with increased experience. There has been a reduction in 30-day mortality over time.
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Affiliation(s)
- Claire A Irving
- Department of Paediatric Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
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De Soyza A, Meachery G, Hester KL, Nicholson A, Parry G, Tocewicz K, Pillay T, Clark S, Lordan JL, Schueler S, Fisher AJ, Dark JH, Gould FK, Corris PA. Lung transplantation for patients with cystic fibrosis and Burkholderia cepacia complex infection: A single-center experience. J Heart Lung Transplant 2010; 29:1395-404. [DOI: 10.1016/j.healun.2010.06.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 06/07/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022] Open
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Avlonitis VS, Wigfield CH, Kirby JA, Dark JH. Treatment of the brain-dead lung donor with aprotinin and nitric oxide. J Heart Lung Transplant 2010; 29:1177-84. [PMID: 20615728 DOI: 10.1016/j.healun.2010.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 05/11/2010] [Accepted: 05/26/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It has been previously shown that donor treatment with aprotinin or inhaled nitric oxide reduces reperfusion injury after lung transplantation in animals. These studies used living donors with normal lungs. However, the main source of lungs for transplantation is brain-dead donors. Brain death causes systemic inflammatory response and lung injury, rendering the organ susceptible to reperfusion injury after transplantation. We hypothesized that treatment with aprotinin or inhaled nitric oxide after brain death would improve the donor inflammatory response and reduce lung reperfusion injury after transplantation. METHODS Brain death was induced in 24 rats by intracranial balloon inflation. Subsequently, the animals received intravenous aprotinin (n = 8), inhaled nitric oxide (n = 7), or no treatment (n = 9) for 5 hours. The lungs were retrieved and reperfused for 2 hours using recipient rats. RESULTS After brain death, oxygenation deteriorated earlier and significantly more in rats that received treatment, especially with nitric oxide. Treatment did not reduce the donor systemic inflammatory response as assessed by serum levels of proinflammatory cytokines. Oxygenation, airway pressure, pulmonary vascular resistance, lung water index and bronchoalveolar lavage cytokine levels were similar after reperfusion of grafts from all three groups of donors. CONCLUSIONS Donor treatment with aprotinin or inhaled nitric oxide does not improve lungs that have been injured by brain death.
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Affiliation(s)
- Vassilios S Avlonitis
- Applied Immunology and Transplant Research Group, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Burdett CL, Critchley RJ, Black F, Barnard S, Clark SC, Corris PA, Gould KF, Butt T, Dark JH. Invasive biopsy is effective and useful after lung transplant. J Heart Lung Transplant 2010; 29:759-63. [DOI: 10.1016/j.healun.2010.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 02/04/2010] [Accepted: 03/02/2010] [Indexed: 11/25/2022] Open
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Brodlie M, McKean MC, Johnson GE, Perry JD, Nicholson A, Verdon B, Gray MA, Dark JH, Pearson JP, Fisher AJ, Corris PA, Lordan J, Ward C. Primary bronchial epithelial cell culture from explanted cystic fibrosis lungs. Exp Lung Res 2010; 36:101-10. [PMID: 20205595 DOI: 10.3109/01902140903165265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lung disease is responsible for more than 95% of morbidity and mortality in cystic fibrosis. The exact pathogenesis of cystic fibrosis lung disease remains poorly understood. Experimental models are therefore vital for use in research. Animal models and immortalized cell lines both have inherent limitations. Explanted lungs removed from people with cystic fibrosis at the time of transplantation represent a potentially valuable but technically and logistically challenging source of primary cystic fibrosis bronchial epithelial cells. In this study, pieces of segmental bronchus from explanted lungs were treated with patient-specific antimicrobials prior to isolation of bronchial epithelial cells. Cultured cells were characterized by their morphology under light microscopy, cytokeratin and hematoxylin-eosin staining, and electrophysiological profile. Primary bronchial epithelial cells were successfully cultured from 15 of 22 patients attempted. The cells exhibited typical epithelial morphology, staining for cytokeratin, lack of responsiveness to forskolin treatment, and remained viable after storage in liquid nitrogen. Seven unsuccessful cultures failed due to early infection with bacteria known to colonize the airways pretransplant. The results show that primary bronchial epithelial cell culture is possible from explanted cystic fibrosis lungs. This provides an important cellular model to elucidate the pathogenic mechanisms in cystic fibrosis lung disease and to investigate potential therapeutic targets.
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Affiliation(s)
- Malcolm Brodlie
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Robertson AGN, Ward C, Pearson JP, Corris PA, Dark JH, Griffin SM. Lung transplantation, gastroesophageal reflux, and fundoplication. Ann Thorac Surg 2010; 89:653-60. [PMID: 20103377 DOI: 10.1016/j.athoracsur.2009.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/06/2009] [Accepted: 09/01/2009] [Indexed: 02/06/2023]
Abstract
Lung transplantation is an accepted treatment strategy for end-stage lung disease; however, bronchiolitis obliterans syndrome is a major cause of morbidity and mortality. This review explores the role of gastroesophageal reflux disease in bronchiolitis obliterans syndrome and the evidence suggesting the benefits of anti-reflux surgery in improving lung function and survival. There is a high prevalence of gastroesophageal reflux in patients post lung transplantation. This may be due to a high preoperative incidence, vagal damage and immunosuppression. Reflux in these patients is associated with a worse outcome, which may be due to micro-aspiration. Anti-reflux surgery is safe in selected lung transplant recipients; however there has been one report of a postoperative mortality. Evidence is conflicting but may suggest a benefit for patients undergoing anti-reflux surgery in terms of lung function and survival; there are no controlled studies. The precise indications, timing, and choice of fundoplication are yet to be defined, and further studies are required.
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Affiliation(s)
- Andrew G N Robertson
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle, United Kingdom
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