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Purpose Since the Food and Drug Administration's approval in 2014 of the XVIVO Perfusion System (XPS) and STEEN Solution as a Humanitarian Device Exemption (HDE), for the purpose of procuring marginal lungs to be transplantable, the University of Texas Southwestern (UTSW) Medical Center in Dallas, Texas, has solely utilized Cardiovascular Intensive Care Unit (CVICU) Registered Nurses (RNs) as lung perfusionists in the development of our unique Ex-Vivo Lung perfusion (EVLP) program model. Of the twenty-six XVIVO sites in the United States, we are the only RN-led team. Methods Our EVLP program centers on RNs with specializations in extracorporeal membrane oxygenation (ECMO). We have a set criteria for selection of specialist EVLP RNs. Once a RN meets criteria, training commences and involves runs utilizing the EVLP machine. Continuing education is required by all team members, including wet labs and monthly quality meetings. The EVLP team developed standardized step-by-step flashcards detailing each step of the EVLP process in order to decrease variations. Following extensive training, nursing personnel are credentialed and continue to work on both EVLP perfusion for lung transplantation and for research studies, like the XVIVO NOVEL Lung Trial and the current Mallinckrodt Study involving gNO via EVLP. Results Our team has worked on six cases with the intention for lung transplant. Four lungs showed progressive improvement in key parameters during EVLP perfusion. Of the four lungs that showed improvement, three were successfully transplanted and one withdrew consent. The two that did not move toward transplantation showed worsening in key parameters observed during perfusion. Since inclusion into the Mallinckrodt Study, our team has perfused research lungs. Along with our successes, our team has encountered challenges as well. Some of the challenges include establishing evidence-based practices and protocols, ensuring adequate supplies, on-boarding and training new staff. Conclusion We successfully established a novel EVLP model utilizing nurse specialists. Our EVLP nurse specialist team model has consistently produced successful outcomes. Much like the transition from perfusion led ECMO models to nurse specialist ECMO models throughout the country, we feel our novel model for EVLP is sustainable and will set a new standard in this arena. [ABSTRACT FROM AUTHOR]

Background: The current study describes the spectrum of community-acquired respiratory infections (CARV) during the first year after lung transplantation (LT). Additionally, we elucidate variables associated with CARV, management strategies utilized, and impact on early and late outcomes., Methods: This was a retrospective study among patients transplanted between 2012 and 2015 (n = 255, mean age 55.6 ± 13.5 years, M: F 152:103). The diagnosis of CARV was based on the multiplex PCR on nasopharyngeal swab samples. Baseline characteristics, post-transplant variables, and outcomes were compared among patients with and without CARV., Results: Eighty CARV infections developed among a quarter of the study group (n = 62, 24.3%). Rhinovirus/enterovirus was the most commonly isolated CARV (n = 24) followed by coronavirus (n = 17) and RSV (n = 9). A significant proportion of episodes (43.8%) required hospitalization. The use of nasal corticosteroids and left single LT was independently associated with an increased risk of CARV. CARV infections did not impact the lung functions during the first year or the CLAD-free survival at 3 years., Conclusions: There is a significant burden of CARV infections during the first year after LT. The use of nasal corticosteroids may increase the risk of CARV infection. CARV infections did not impact outcomes., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: With the introduction of the lung allocation score (LAS), sicker patients are prioritized for lung transplantation (LT). There is a lack of data regarding variables independently associated with 30-day mortality after LT., Methods: We queried the UNOS database for adult patients undergoing LT between 1989 and 2014. Patients with dual organ or previous transplantation and those with missing survival data were excluded. Mortality during the first 30 days after LT was the primary outcome variable., Results: The yearly trends indicate a statistically significant reduction in the 30-day mortality during the study period (P < 0.001, overall mortality: 5.5%) which has continued in the post-LAS era (P = 0. 014, overall mortality: 3.6%). Among patients with 30-day mortality, "primary non-function" (n = 118, 72.8%) was reported as the most common etiology. Transplant indication of vascular diseases, history of non-transplant cardiac or lung surgery, mean pulmonary pressures >35 mm Hg, disabled functional status, ECMO support, high LAS, ischemic time >6 hours, and blunt injury as the mechanism of donor death are independently associated with 30-day mortality., Conclusion: The incidence of early mortality after LT continues to decline in the post-LAS era. Apart from the mechanism of donor death and ischemic time, early mortality appears to be primarily driven by the recipient characteristics., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)