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Abstract：
BACKGROUND: Lung donation after circulatory death (DCD) has proved to be an effective strategy for expanding the donor pool, but is still considered challenging. We report a successful case of lung procurement from an extended-criteria uncontrolled DCD.
METHODS: We evaluated the lungs of an uncontrolled DCD from a hospital without extracorporeal membrane oxygenation (ECMO) program. The donor was a non-smoker 20-year old male with a history of cardiomyopathy, cardiocirculatory arrests, and Lennox-Gastaut syndrome. Cardiac arrest occurred in a swimming pool, and bronchoscopy showed signs of inhalation. We employed our usual normothermic in-situ open-ventilated lung approach. After retrieval, lungs were stored on ice, then evaluated with ex-vivo lung perfusion (EVLP) and judged suitable for transplantation. The recipient was a 26-year old female with cystic fibrosis on long-term oxygen therapy, on the waitlist for up to 21 months due to her anthropomorphic characteristics. She required central VA-ECMO support during bilateral lung transplantation. Primary graft dysfunction (PGD) within the first 72 h reached grade 3; post-operative peripheral VV-ECMO support was discontinued two days after surgery. The patient was discharged 28 days after surgery; she is alive two years after transplantation with no signs of rejection nor anastomotic complications.
CONCLUSIONS: Despite the spreading use of lungs from controlled DCD, perplexities remain on uncontrolled DCD, namely: severe PDG, postoperative mortality, airway complications.
CONCLUSIONS: Our case report suggests that good results can be achieved with uncontrolled DCD despite the presence of relative contraindications: inhalation of water, prolonged ischemic times and recipient in poor conditions.
METHODS: We evaluated the lungs of an uncontrolled DCD from a hospital without extracorporeal membrane oxygenation (ECMO) program. The donor was a non-smoker 20-year old male with a history of cardiomyopathy, cardiocirculatory arrests, and Lennox-Gastaut syndrome. Cardiac arrest occurred in a swimming pool, and bronchoscopy showed signs of inhalation. We employed our usual normothermic in-situ open-ventilated lung approach. After retrieval, lungs were stored on ice, then evaluated with ex-vivo lung perfusion (EVLP) and judged suitable for transplantation. The recipient was a 26-year old female with cystic fibrosis on long-term oxygen therapy, on the waitlist for up to 21 months due to her anthropomorphic characteristics. She required central VA-ECMO support during bilateral lung transplantation. Primary graft dysfunction (PGD) within the first 72 h reached grade 3; post-operative peripheral VV-ECMO support was discontinued two days after surgery. The patient was discharged 28 days after surgery; she is alive two years after transplantation with no signs of rejection nor anastomotic complications.
CONCLUSIONS: Despite the spreading use of lungs from controlled DCD, perplexities remain on uncontrolled DCD, namely: severe PDG, postoperative mortality, airway complications.
CONCLUSIONS: Our case report suggests that good results can be achieved with uncontrolled DCD despite the presence of relative contraindications: inhalation of water, prolonged ischemic times and recipient in poor conditions.
摘要：
背景：循环性死亡（DCD）后的肺捐赠已被证明是扩大捐赠池的有效策略，但仍被认为具有挑战性。我们报告了一例从扩展标准的不受控制的DCD中进行肺部采购的成功案例。
方法：我们评估了来自没有体外膜氧合（ECMO）计划的医院的不受控制的DCD的肺部。捐赠者是一名20岁的非吸烟者，有心肌病史，心脏循环停止,和Lennox-Gastaut综合征.心脏骤停发生在游泳池,支气管镜检查显示有吸入迹象。我们采用了通常的常温原位开放通气肺方法。检索后,肺被储存在冰上，然后用离体肺灌注（EVLP）进行评估，并判断是否适合移植。接受者是一名26岁的女性，患有长期氧疗的囊性纤维化，由于她的拟人化特征，在等候名单上长达21个月。在双侧肺移植期间，她需要中央VA-ECMO支持。在最初的72小时内，原发性移植物功能障碍（PGD）达到3级；手术后两天停止了外周VV-ECMO支持。患者在手术后28天出院；她在移植后两年还活着，没有排斥反应或吻合并发症的迹象。
结论：尽管受控DCD的肺部使用广泛，不受控制的DCD仍然存在困惑，即:重度PDG,术后死亡率,气道并发症。
结论：我们的病例报告表明，尽管存在相对禁忌症，但不受控制的DCD可以取得良好的效果：吸入水，延长缺血时间和条件差的接受者。
方法：我们评估了来自没有体外膜氧合（ECMO）计划的医院的不受控制的DCD的肺部。捐赠者是一名20岁的非吸烟者，有心肌病史，心脏循环停止,和Lennox-Gastaut综合征.心脏骤停发生在游泳池,支气管镜检查显示有吸入迹象。我们采用了通常的常温原位开放通气肺方法。检索后,肺被储存在冰上，然后用离体肺灌注（EVLP）进行评估，并判断是否适合移植。接受者是一名26岁的女性，患有长期氧疗的囊性纤维化，由于她的拟人化特征，在等候名单上长达21个月。在双侧肺移植期间，她需要中央VA-ECMO支持。在最初的72小时内，原发性移植物功能障碍（PGD）达到3级；手术后两天停止了外周VV-ECMO支持。患者在手术后28天出院；她在移植后两年还活着，没有排斥反应或吻合并发症的迹象。
结论：尽管受控DCD的肺部使用广泛，不受控制的DCD仍然存在困惑，即:重度PDG,术后死亡率,气道并发症。
结论：我们的病例报告表明，尽管存在相对禁忌症，但不受控制的DCD可以取得良好的效果：吸入水，延长缺血时间和条件差的接受者。
