Extended-criteria uncontrolled DCD donor for a fragile recipient: A case report about a challenging yet successful lung transplantation. (2020)

• Record Type: Journal Article
• Authors: Musso, Valeria; Mendogni, Paolo; Scaravilli, Vittorio; Morlacchi, Letizia Corinna; Croci, Giorgio Alberto; Palleschi, Alessandro
• Is Part Of: International journal of surgery case reports. Volume 77(2020)Supplement
• Page Start: S67
• Page End: S71
• Publication Date: 2020
• Subjects: Lung transplantation -- Uncontrolled DCD -- EVLP -- Case report -- Extended-criteria -- Graft ischemia; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.09.051
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Lung donation after cardiac death is a valuable option to fight organ shortage. Grafts from an extended uncontrolled DCD donor were transplanted. The recipient was a high-risk fragile patient with cystic fibrosis. Ex-vivo lung perfusion has a pivotal role in graft function evaluation. Good results were achieved despite several relative contraindications. Abstract: Introduction: 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. Presentation of case: 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. Discussion: Despite the spreading use of lungs from controlled DCD, perplexities remain on uncontrolled DCD, namely: severe PDG, postoperative mortality, airway complications. Conclusion: 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.