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Functions of Inverted Grafts Are Satisfactory Compared with Non-Inverted Grafts in Living-Donor Lobar Lung Transplantation
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The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017
Medical School. This protocol comprises performing bilateral lung retransplantation via sternum-sparing anterolateral thoracotomies, off-pump surgery with meticulous hemostasis, more time between first and second side to allow low-pressure reperfusion as well as empiric administration of 2 g fibrinogen and 2 platelet concentrates. Patient charts were retrospectively reviewed starting with lung retransplantations performed between January 2005 and May 2016. Results: From 04/2010 through 03/2016, 774 total lung transplantations were performed, 49 were retransplantations. In the era 01/2005-03/2010, a total of 480 lung transplantations were performed, of those being 38 retransplantations. The leading indication for retransplantation was chronic lung allograft dysfunction (CLAD) in both eras (89.9%; n= 4 4 vs. 81.6%; n= 3 1). Other indications were acute graft failure (04/201005/2016: n= 2, 01/2005-03/2010: n= 5) or airway complications (n= 2 in each cohort). Mean operation time in the era 04/2010-05/2016 was significantly longer as compared to the era 01/2005-03/2010 (406.1±86.8 vs. 296.1±96.1, p< 0 .0001). Intraoperative need for transfusion of red packed cells was significantly lower in the era 04/2010-05/2016 (median 4(2-10) vs. 10(4.5-15) p= 0 .002). Median time until extubation was significantly shorter in the era 04/2010-05/2016 (1(1-2) days vs. 11.5(124) days, p= 0 .0009). Similarly, median intensive care unit (ICU) stay time was shorter in the era 04/2010-05/2016 (4 (2-5.5) days vs. 12.5(3-30.5) days, p= 0.003). Significantly less patients required dialysis for acute renal failure in the era 04/2010-05/2016 as compared to the earlier era (10.2% vs. 39.5%, p= 0 .005). Patient survival was significantly better in the era starting in April 2010 at 30 days (98% vs. 76.3%, p= 0 .002) as well as 1-year after retransplantation (80.6% vs. 63.2%, p= 0 .01). Conclusion: Re-transplantation of the lung can be performed safely using a protocol of less invasive techniques with lower associated morbidity and favourable mid-term survival.
2( 85) Functions of Inverted Grafts Are Satisfactory Compared with NonInverted Grafts in Living-Donor Lobar Lung Transplantation H. Kayawake , T.F. Chen-Yoshikawa, Y. Goda, H. Oda, S. Ueda, H. Motoyama, M. Hamaji, K. Hijiya, A. Aoyama, H. Date. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan. Purpose: To overcome a small-for-size graft in standard living-donor lobar lung transplantation (LDLLT), we developed an inverted LDLLT based on the notion that the right lower lobe is 125% larger than the left lower lobe. In this novel technique, a right lower lobe from one donor is implanted as a right graft and another right lower lobe from the other donor is implanted as a left graft (figure A). We retrospectively analyzed the functions of inverted grafts compared with those of non-inverted grafts. Methods: Between 2008 and 2015, 64 LDLLTs were performed in Kyoto University. In this study, included were 35 LDLLTs whose recipients were adults and were followed more than 6 months without developing chronic lung allograft dysfunction. In these 35 LDLLTs, 65 lobes were eligible for this analysis. Thirty-one right lower lobes were implanted as a right graft (R to R group), 7 right lower lobes were implanted as an inverted left graft (R to L group) and 27 left lower lobes were implanted as a left graft (L to L group). We analyzed graft volume and graft forced vital capacity (G-FVC) of 65 lobes before and 6 months after LDLLT and compared them among 3 groups. Graft volume was evaluated by using three-dimensional CT volumetry. G-FVC was estimated by the number of graft segments before LDLLT and by the ventilation distribution 6 months after LDLLT, respectively. Results: Of all 35 patients, median age was 51 years (range, 22-63). Preoperatively, G-FVC in R to L group (1050 mL) was comparable with R to R group (1177 mL), and it was better than L to L group (791 mL, p< 0.01). Six months after LDLLT, G-FVC in R to L group (1015 mL) was also comparable with R to R group (975 mL), and it was better than L to L group (713 mL, p= 0.047, figure B, C). The ratio of graft volume 6 months after LDLLT to that before LDLLT was comparable among 3 groups. Conclusion: We found that functions of inverted grafts in inverted LDLLTs were satisfactory compared with those of non-inverted grafts in standard LDLLTs.
2( 86) A Comparison of Propofol Based Total Intravenous Anesthesia and Sevoflurane Based Balanced Anesthesia on Renal Protection During Lung Transplantation Under Extracorporeal Membrane Oxygenation A Prospective, Randomized Trial N. Kim ,1 J.G. Lee,2 S. Lee,2 K.S. Nam,2 J.W. Shu,2 H.C. Paik,2 Y.C. Yoo.1 1Anesthesiology, Yonsei University, Seoul, Korea, Republic of; 2Thoracic and Cardiovascular Surgery, Yonsei University, Seoul, Korea, Republic of. Purpose: Postoperative renal dysfunction is known to increase morbidity and mortality after lung transplantation. Propofol has been shown to provide protection against acute kidney injury (AKI) in patients undergoing valvular heart surgery compared with sevoflurane. We aimed to investigate the effect of propofol anesthesia on the occurrence of AKI following lung transplantation surgery. Methods: Adult patients undergoing lung transplantation with extracorporeal membrane oxygenation (ECMO) support were randomized to receive either propofol (group P) or sevoflurane anesthesia (group S) both with sufentanil. The primary endpoint was incidence of postoperative 48 h AKI assessed by plasma levels of creatinine and neutrophil gelatinase-associated lipocaline (NGAL). Results: Sixty patients were included in analysis (n= 29 and 31 in group P and group S, respectively). Baseline kidney function determined by serum biomarkers was comparable between the groups. There was a trend toward lower incidence of AKI in group P than group S (14 % vs.36, P= 0.053). Plasma NGAL level was significantly lower in group P than group S immediately after surgery (91.5 [69.5-145.2] vs. 128.8 [85.0-179.0] ng/ml, P= 0.031) and postoperative 24 h (76.5 [57.0-107.2] vs. 131.8 [90.0-237.0] ng/ml, P= 0.002). There was a trend toward a shorter length of hospital stay and lower incidence of early mortality in group P compared to group S. Conclusion: Propofol anesthesia could reduce perioperative renal injury and might be helpful to facilitate recovery in patients undergoing lung transplantation with ECMO support compared with sevoflurane.
Table 1. Postoperative renal outcomes Variables Baseline serum Creatinine Incidence of AKI stratified by AKIN criteria Stage I Stage II Stage III Plasma NGAL, ng/ml Baseline Immediately after surgery Postoperative 24 h
Group S(n = 31) 0.6 [0.5-0.9]
Group P(n= 29) 0.6 [0.5-0.7]
P value 0.501
11 (36)
4 (14)
0.053
7 (23) 3 (10) 1 (3)
4 (14) 0 0
0.379 0.238 1.000
85.4 [60.0-128.7] 128.8 [85.0-179.0]
79.0 [53.0-122.6] 91.5 [69.5-145.2]
0.539 0.031
131.8 [90.0-237.0]
76.5 [57.0-107.2]
0.002
Data are expressed as median [IQR] or number of patients. AKI= acute kidney injury; AKIN= acute kidney injury network; NGAL= neutrophil gelatinaseassociated lipocalin
The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017
Medical School. This protocol comprises performing bilateral lung retransplantation via sternum-sparing anterolateral thoracotomies, off-pump surgery with meticulous hemostasis, more time between first and second side to allow low-pressure reperfusion as well as empiric administration of 2 g fibrinogen and 2 platelet concentrates. Patient charts were retrospectively reviewed starting with lung retransplantations performed between January 2005 and May 2016. Results: From 04/2010 through 03/2016, 774 total lung transplantations were performed, 49 were retransplantations. In the era 01/2005-03/2010, a total of 480 lung transplantations were performed, of those being 38 retransplantations. The leading indication for retransplantation was chronic lung allograft dysfunction (CLAD) in both eras (89.9%; n= 4 4 vs. 81.6%; n= 3 1). Other indications were acute graft failure (04/201005/2016: n= 2, 01/2005-03/2010: n= 5) or airway complications (n= 2 in each cohort). Mean operation time in the era 04/2010-05/2016 was significantly longer as compared to the era 01/2005-03/2010 (406.1±86.8 vs. 296.1±96.1, p< 0 .0001). Intraoperative need for transfusion of red packed cells was significantly lower in the era 04/2010-05/2016 (median 4(2-10) vs. 10(4.5-15) p= 0 .002). Median time until extubation was significantly shorter in the era 04/2010-05/2016 (1(1-2) days vs. 11.5(124) days, p= 0 .0009). Similarly, median intensive care unit (ICU) stay time was shorter in the era 04/2010-05/2016 (4 (2-5.5) days vs. 12.5(3-30.5) days, p= 0.003). Significantly less patients required dialysis for acute renal failure in the era 04/2010-05/2016 as compared to the earlier era (10.2% vs. 39.5%, p= 0 .005). Patient survival was significantly better in the era starting in April 2010 at 30 days (98% vs. 76.3%, p= 0 .002) as well as 1-year after retransplantation (80.6% vs. 63.2%, p= 0 .01). Conclusion: Re-transplantation of the lung can be performed safely using a protocol of less invasive techniques with lower associated morbidity and favourable mid-term survival.
2( 85) Functions of Inverted Grafts Are Satisfactory Compared with NonInverted Grafts in Living-Donor Lobar Lung Transplantation H. Kayawake , T.F. Chen-Yoshikawa, Y. Goda, H. Oda, S. Ueda, H. Motoyama, M. Hamaji, K. Hijiya, A. Aoyama, H. Date. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan. Purpose: To overcome a small-for-size graft in standard living-donor lobar lung transplantation (LDLLT), we developed an inverted LDLLT based on the notion that the right lower lobe is 125% larger than the left lower lobe. In this novel technique, a right lower lobe from one donor is implanted as a right graft and another right lower lobe from the other donor is implanted as a left graft (figure A). We retrospectively analyzed the functions of inverted grafts compared with those of non-inverted grafts. Methods: Between 2008 and 2015, 64 LDLLTs were performed in Kyoto University. In this study, included were 35 LDLLTs whose recipients were adults and were followed more than 6 months without developing chronic lung allograft dysfunction. In these 35 LDLLTs, 65 lobes were eligible for this analysis. Thirty-one right lower lobes were implanted as a right graft (R to R group), 7 right lower lobes were implanted as an inverted left graft (R to L group) and 27 left lower lobes were implanted as a left graft (L to L group). We analyzed graft volume and graft forced vital capacity (G-FVC) of 65 lobes before and 6 months after LDLLT and compared them among 3 groups. Graft volume was evaluated by using three-dimensional CT volumetry. G-FVC was estimated by the number of graft segments before LDLLT and by the ventilation distribution 6 months after LDLLT, respectively. Results: Of all 35 patients, median age was 51 years (range, 22-63). Preoperatively, G-FVC in R to L group (1050 mL) was comparable with R to R group (1177 mL), and it was better than L to L group (791 mL, p< 0.01). Six months after LDLLT, G-FVC in R to L group (1015 mL) was also comparable with R to R group (975 mL), and it was better than L to L group (713 mL, p= 0.047, figure B, C). The ratio of graft volume 6 months after LDLLT to that before LDLLT was comparable among 3 groups. Conclusion: We found that functions of inverted grafts in inverted LDLLTs were satisfactory compared with those of non-inverted grafts in standard LDLLTs.
2( 86) A Comparison of Propofol Based Total Intravenous Anesthesia and Sevoflurane Based Balanced Anesthesia on Renal Protection During Lung Transplantation Under Extracorporeal Membrane Oxygenation A Prospective, Randomized Trial N. Kim ,1 J.G. Lee,2 S. Lee,2 K.S. Nam,2 J.W. Shu,2 H.C. Paik,2 Y.C. Yoo.1 1Anesthesiology, Yonsei University, Seoul, Korea, Republic of; 2Thoracic and Cardiovascular Surgery, Yonsei University, Seoul, Korea, Republic of. Purpose: Postoperative renal dysfunction is known to increase morbidity and mortality after lung transplantation. Propofol has been shown to provide protection against acute kidney injury (AKI) in patients undergoing valvular heart surgery compared with sevoflurane. We aimed to investigate the effect of propofol anesthesia on the occurrence of AKI following lung transplantation surgery. Methods: Adult patients undergoing lung transplantation with extracorporeal membrane oxygenation (ECMO) support were randomized to receive either propofol (group P) or sevoflurane anesthesia (group S) both with sufentanil. The primary endpoint was incidence of postoperative 48 h AKI assessed by plasma levels of creatinine and neutrophil gelatinase-associated lipocaline (NGAL). Results: Sixty patients were included in analysis (n= 29 and 31 in group P and group S, respectively). Baseline kidney function determined by serum biomarkers was comparable between the groups. There was a trend toward lower incidence of AKI in group P than group S (14 % vs.36, P= 0.053). Plasma NGAL level was significantly lower in group P than group S immediately after surgery (91.5 [69.5-145.2] vs. 128.8 [85.0-179.0] ng/ml, P= 0.031) and postoperative 24 h (76.5 [57.0-107.2] vs. 131.8 [90.0-237.0] ng/ml, P= 0.002). There was a trend toward a shorter length of hospital stay and lower incidence of early mortality in group P compared to group S. Conclusion: Propofol anesthesia could reduce perioperative renal injury and might be helpful to facilitate recovery in patients undergoing lung transplantation with ECMO support compared with sevoflurane.
Table 1. Postoperative renal outcomes Variables Baseline serum Creatinine Incidence of AKI stratified by AKIN criteria Stage I Stage II Stage III Plasma NGAL, ng/ml Baseline Immediately after surgery Postoperative 24 h
Group S(n = 31) 0.6 [0.5-0.9]
Group P(n= 29) 0.6 [0.5-0.7]
P value 0.501
11 (36)
4 (14)
0.053
7 (23) 3 (10) 1 (3)
4 (14) 0 0
0.379 0.238 1.000
85.4 [60.0-128.7] 128.8 [85.0-179.0]
79.0 [53.0-122.6] 91.5 [69.5-145.2]
0.539 0.031
131.8 [90.0-237.0]
76.5 [57.0-107.2]
0.002
Data are expressed as median [IQR] or number of patients. AKI= acute kidney injury; AKIN= acute kidney injury network; NGAL= neutrophil gelatinaseassociated lipocalin