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The shortage of organs remains one of the biggest challenges in transplantation. To address this, we are increasingly turning to donation after circulatory death (DCD) donors and now in some countries to uncontrolled DCD donors. We consolidate the knowledge on uncontrolled DCD in Europe and provide recommendations and guidance for the development and optimization of effective uncontrolled DCD programmes., (© 2015 Steunstichting ESOT.)

Objectives: Competing requirements for organ perfusion may call for antagonistic strategies such as fluid replacement or high positive end-expiratory pressure. We recently proposed an intensive lung donor treatment protocol that nearly tripled lung procurement rates and validated it in a multicentre study. The next step was to evaluate the impact of our proposal on the other organ grafts recovered from lung donors and on the recipients' outcome after transplantation of those grafts., Methods: A quasi-experimental study was conducted in six Spanish hospitals during 2013 (2010-12 was historical control). Organ donor management was led by a trained and experienced intensive care staff., Results: A total of 618 actual donors after brain death (DBDs) were included, 453 DBDs in the control period (annual average 151) and 165 in the protocol period. No baseline differences were found between the periods. Heart, liver, kidney and pancreas retrieval rates were similar in both periods, and heart, liver, kidney and pancreas recipients' survival at 3 months showed no differences between both periods., Conclusions: Our lung donor treatment protocol is safe for other grafts obtained from donors undergoing these procedures with the aim of increasing lungs available for transplantation. It has no negative impact on the recovery rates of other grafts or on early survival of heart, liver, pancreas or kidney recipients., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: The shortage of lung donors for transplantation is the main limitation among patients awaiting this type of surgery. We previously demonstrated that an intensive lung donor-treatment protocol succeeded in increasing the lung procurement rate. We aimed to validate our protocol for centers with or without lung transplant programs., Methods: A quasi-experimental study was performed to compare lung donor rate before (historical group, 2010 to 2012) and after (prospective group, 2013) the application of a lung management protocol for donors after brain death (DBDs) in six Spanish hospitals. Lung donor selection criteria remained unchanged in both periods. Outcome measures for lung recipients were early survival and primary graft dysfunction (PGD) rates., Results: A total of 618 DBDs were included: 453 in the control period and 165 in the protocol period. Donor baseline characteristics were similar in both periods. Lung donation rate in the prospective group was 27.3%, more than twice that of the historical group (13%; p < 0.001). The number of lungs retrieved, grafts transplanted, and transplants performed more than doubled over the study period. No differences in early recipients' survival between groups were observed (87.6% vs. 84.5%; p = 0.733) nor in the rate of PGD., Conclusion: Implementing our intensive lung donor-treatment protocol increases lung procurement rates. This allows more lung transplants to be performed without detriment to either early survival or PGD rate., (Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

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

The Spanish Lung Transplant Registry (SLTR) began its activities in 2006 with the participation of all the lung transplantation (LT) groups with active programs in Spain. This report presents for the first time an overall description and results of the patients who received lung transplants in Spain from 2006 to 2010. LT activity has grown progressively, and in this time period 951 adults and 31 children underwent lung transplantation. The mean age of the recipients was 48.2, while the mean age among the lung donors was 41.7. In adult LT, the most frequent cause for lung transplantation was emphysema/COPD, followed by idiopathic pulmonary fibrosis, both representing more than 60% the total number of indications. The probability for survival after adult LT to one and three years was 72% and 60%, respectively, although in patients who survived until the third month post-transplantation, these survival rates reached 89.7% and 75.2%. The factors that most clearly influenced patient survival were the age of the recipient and the diagnosis that indicated the transplantation. Among the pediatric transplantations, cystic fibrosis was the main cause for transplantation (68%), with a one-year survival of 80% and a three-year survival of 70%. In adult as well as pediatric transplantations, the most frequent cause of death was infection. These data confirm the consolidated situation of LT in Spain as a therapeutic option for advanced chronic respiratory disease, both in children as well as in adults., (Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.)

Purpose Primary graft dysfunction (PGD) is the main cause of mortality during the first month and the second one within the first year after lung transplantation (LT). Statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, have been proposed as an effective class of drugs to reduce serum cholesterol levels due to their immunomodulatory and anti-inflammatory effects unrelated to their cholesterol-lowering function. We hypothesized that preoperative statin therapy is associated with decreased incidence of PGD after LT. Methods Retrospective analysis of all consecutive adult LTs performed in a university transplant center between 2010 and 2017. Comparison between groups according to the recipient previous use of statins was carried out. Factors associated with the development of PGD and PGD grade 3 were analyzed using Chi square and U-Mann Whitney Test. Logistic regression model was built including those variables with p≤0.1 in the univariate analysis. Significance level p<0.05 Results A total of 474 adult LT recipients were followed, 54 of them (11%) under statins treatment. Statins group (SG) were older (59 vs 55;p=0.003), with higher prevalence of hypertension (HT)(37% vs 16%; p<0.001) and lower walking 6min test (W6T) results (211 vs 246 meters; p=0.019) than non-statin group (NSG). Cardiopulmonary bypass (CPB) was used in 29% of SG recipients and 17% of NSG (p=0.07). The rest of recipient and donor characteristics were similar between groups. Global and grade 3 incidence of PGD was 38% and 31.4%, respectively, with higher incidence in NSG (40% vs 24%; p =0.027; 33% vs 20%; p =0.063). After adjustment for recipient age, body mass index (BMI), HT, W6T, CPB and ischemia times, NSG showed an increased risk of PGD (OR=2.08; p=0.035), and PGD grade 3 (OR=1.87; p=0.086) compared with SG. Conclusion Recipient´s preoperative use of statins is associated with a decreased risk to develop PGD in our series. Prospective and multicentric studies are needed to confirm such results. [ABSTRACT FROM AUTHOR]

Primary graft dysfunction (PGD) is the main cause of mortality during the first month and the second one within the first year after lung transplant (LT) Statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, have shown to have immunomodulatory and antiinflamatory effects unrelated to their cholesterol-lowering function. We hypothesized that recipient's preoperative statin therapy is associated with decreased incidence of PGD after LT. Multicenter retrospective analysis of all consecutive adult LTs performed in 5 university transplant centers between 2015 and 2017. Combined multiple organ transplantation and lung retransplant recipients were excluded from the analysis. Comparison between groups according to recipient previous use of statins(E+/E-)) was performed. Factors associated with the development of PGD and its severity were analyzed using Chisquare and U-Mann Whitney Test. Logistic regression model was built including those variables with p≤0.1 in the univariate analysis. Significance level p<0.05. A total of 474 adult LT recipients were reviewed, 110 of them (E+=23%) were on statins treatment (SG). LT recipients in the statin group were older (60±7 vs 53±12; p<0.05) and had higher Body Mass Index (BMI) (26.3±3.8 vs 24.8±4.2;p<0.05) than those in not taking statins. The rest of recipient and donor characteristics were similar between groups. A total of 161 patients developed PGD (34%), without significative differences between groups (32.2% vs 39%). However PGD in E+ group was significantly less severe as stated by the percentage of patients with grade 3 PGD at 72h (55.9% vs 37.2%,p<0.036). After propensity score adjustments, only the need for hemoderivates transfusion during the implant (OR 4.50 IC 1.51 - 13.38 p<0.007) remained significant. Recipient statin use was not identified as a protective factor (OR 0.38 CI 0.12 - 1.206, p=0.10). Statin use may contribute to lessen the severity of PGD. Prospective and multicentric studies with larger samples are needed to confirm such results. [ABSTRACT FROM AUTHOR]

Our objective is to compare the inflammatory response pattern of lungs transplanted from DBD and cDCD donors. Eighty adult lung recipients, 40 from DBD and 40 from cDCD donors (paired by LT indication and age) were prospectively enrolled in 4 Spanish transplant centres from Jul-18 to Jul-19. Data from donors and recipients as well as transplant procedure were analyzed. Blood samples were collected from the donor before (E0) and during the retrieval process (E1), and from the recipient before implant (R-1), after graft reperfusion (R0) and 24(R24)/ 48(R48) and 72(R72) hours after LT. Inflammatory response (IL-6, IL-8, IL-10, TNF-α) was compared between groups. Demographics of donors and recipients as well as transplant surgical procedure characteristics were similar between groups except for a higher rate of corticoid treatment and vaso-active support in DBD donor group and higher blood transfusion requirements in cDCD donor group (Table 1). DBD donors presented higher IL6 and IL10 plasma levels (p<0.001), and recipients from DBD donors showed higher plasma levels of IL10 and TNFa at 72h after transplantation (p<0.05) (Figure 1). Controlled DCD triggers a lower inflammatory response than DBD that may also influence the inflammatory pattern in the recipient. cDCD is a safe alternative to DBD in lung transplantation. [ABSTRACT FROM AUTHOR]