Current opinion in organ transplantation
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Curr Opin Organ Transplant · Oct 2013
ReviewExtracorporeal membrane oxygenation post lung transplantation.
Extracorporeal membrane oxygenation (ECMO) has been employed as a management strategy to support the failing pulmonary allograft following lung transplantation. We review the indications, technical considerations, management strategies, and outcomes of using ECMO after lung transplantation. ⋯ Advances in technology and management strategies continue to increase the effectiveness of ECMO in supporting the failing pulmonary allograft.
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This article reviews recent developments in the selection of the lung donor that aim to increase donor organ use. The scarcity of suitable donor organs continues to limit lung transplantation resulting in long waiting times and significant mortality for those patients awaiting transplantation. ⋯ After considering the evolution of lung donor and recipient management practices, in 2013 the available evidence suggests that the traditional factors defining a lung as 'extended', do not actually compromise outcomes within the framework of current management strategies. Extended donor lungs are safe.
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Curr Opin Organ Transplant · Oct 2013
ReviewRole of innate immunity in primary graft dysfunction after lung transplantation.
Primary graft dysfunction (PGD), a form of acute lung injury after lung transplantation, has a significant impact on clinical outcomes after lung transplantation. This potentially reversible graft impairment occurs after ischemia-reperfusion injury. This review describes the expanding body of literature evaluating the central role of innate immune activation, nonadaptive responses and dysregulation in the development of PGD after lung transplant. ⋯ Innate immune pathways are involved in the development of PGD and may provide attractive targets for therapies. It may be possible to prevent or treat PGD, as well as to allow pre-transplant PGD risk stratification. To improve understanding of the mechanisms behind clinical risk factors for PGD will require further in-depth correlation of donor-specific and recipient-related triggers of nonadaptive immune responses.
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Curr Opin Organ Transplant · Oct 2013
ReviewStrategies for safe donor expansion: donor management, donations after cardiac death, ex-vivo lung perfusion.
The number of patients listed for lung transplantation largely exceeds the number of available transplantable organs because of both a shortage of organ donors and a low utilization rate of lungs from those donors. Two major innovations in recent years include the use of lungs from donations after cardiac death (DCD) and the use of ex-vivo lung perfusion (EVLP) to assess and improve injured donor lungs. ⋯ A significant increase on the number of available lungs for transplantation is expected in the coming years with the wider use of DCD lungs and with organ-specific ex-vivo treatment strategies.
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Curr Opin Organ Transplant · Jun 2013
ReviewResults of pretransplant treatment of hepatorenal syndrome with terlipressin.
Hepatorenal syndrome (HRS) is a dreaded complication of end-stage liver disease. The best treatment option for HRS is liver transplantation (LT) in suitable candidates. Pretransplant care of HRS is of utmost importance in order to secure a good posttransplant outcome. We review the advances during the last year in the diagnosis and management of HRS in candidates who are awaiting liver transplantation. ⋯ Ongoing advances in the management of patients with HRS before liver transplantation indicate that vasoconstrictors plus albumin should be offered to all suitable candidates. Liver transplantation remains the best treatment option for HRS.