Field Of Lung Transplantation Research Articles

Donor-Specific Blood Transfusion in Lung Transplantation

Lung transplantation is still hindered by a high rate of chronic rejection necessitating profound immunosuppression with its associated complications. Donor-specific blood transfusion is a pre-transplant strategy aimed at improving graft acceptance. In contrast with standard stored blood or donor-specific regulatory T cells transfusions, this approach utilizes fresh whole blood from the donor prior to allograft transplantation, encompassing all cell types and plasma. The precise mechanisms underlying donor-specific blood transfusion-induced tolerance remain incompletely understood. Associations with regulatory/helper T cells, modulation of mononuclear phagocytic cells or microchimerism have been suggested. While numerous (pre-)clinical studies have explored its application in solid organ transplants like liver, kidney, and intestine, limited attention has been given to the setting of lung transplantation. This comprehensive review summarizes existing knowledge on the mechanisms and outcomes of donor-specific blood transfusion in solid organ transplants both in preclinical and clinical settings. We also address the potential benefits and risks associated with donor-specific blood transfusion in the field of lung transplantation, offering insights into future research directions.

Lung Transplantation in Patients with Previous or Unknown Oncological Disease: Evaluation of Short- and Long-Term Outcomes

The accurate selection of the recipient is a crucial aspect in the field of lung transplantation (LTX), especially if patients were previously affected by oncological disease. The aim of this bicentric retrospective study was to evaluate short- and long-term outcomes in patients with previous oncological disease or unknown neoplasia found on native lungs submitted to LTX, compared to a control group. A total of 433 patients were included in the analysis, 31 with malignancies (Group 1) and 402 without neoplastic disease (Group 2). The two groups were compared in terms of short- and long-term outcomes. Patients in Group 1 were older (median age 58 years vs. 50 years, p = 0.039) and mostly affected by idiopathic pulmonary fibrosis (55% vs. 40% p = 0.002). Even though in Group 1 a lower rate of late post-operative complications was found (23% vs. 45%, p = 0.018), the median overall survival (OS) was lower compared to the control group (10 months vs. 29 months, p = 0.015). LTX represents a viable therapeutic option for patients with end-stage lung disease and a history of neoplastic disease. However, every case should be carefully debated in a multidisciplinary setting, considering oncological (histology, stage, and proper disease free-interval) and clinical factors (patient’s age and comorbidities). A scrupulous post-transplant follow-up is especially mandatory in those cases.

Bibliometric Analysis of Scientific Output Growth in the Field of Lung Transplantation.

Lung transplantation (LT) has recently emerged as a scientifically validated curative therapeutic modality for patients afflicted with end-stage lung disease. This study aimed to conduct a global bibliometric analysis of research articles on LT between 1983 and 2021. Employing the Web of Science database, a bibliometric analysis was conducted to assess the expansion of scientific output within the field of LT. We searched specific bibliometric characteristics such as language, and year of publication, first author, institutional affiliation, main publishing journals, and highly cited articles. Additionally, we made comparisons of the most productive countries. The VOSviewer program and the open-source visualization software Biblioshiny (version 2.0) were used to perform the bibliometric analysis. We identified 10,467 articles on LT published between 1983 and 2021, of which 94.898% were published in the Science Citation Index Expanded. The articles were from 101 different research areas. The publications were from 81 different countries globally, and mostly from the United States (41.196%), Germany (7.118%), and Canada (6.372%). The Journal of Heart and Lung Transplantation was the most published journal. Four thousand seven hundred and ninety three of the publications were published in the last 10 years with a 78,781 citation number in total. The highest number of publications and citations was in 2021. The majority of cutting-edge research findings are focused on only a few developed nations, and exchanges with emerging nations are still in their infancy. The United States has a strong, commanding position among the active countries in LT.

Thoracic Ultrasound in Lung Transplantation—Insights in the Field

The use of thoracic ultrasound (TUS) is a novel and dynamic diagnostic and monitoring modality that has shown remarkable advances within the last decade, with several published papers investigating its role within the field of lung transplantation. The aim of this current opinion review is to review the existing literature on the role of TUS in all stages of LTx, from in-donor lung evaluation to graft assessment on ex vivo lung perfusion and in the short- and long-term follow-up after LTx.

Diagnostic and Therapeutic Implications of Ex Vivo Lung Perfusion in Lung Transplantation: Potential Benefits and Inherent Limitations.

Ex vivo lung perfusion (EVLP), a technique in which isolated lungs are continually ventilated and perfused at normothermic temperature, is emerging as a promising platform to optimize donor lung quality and increase the lung graft pool. Over the past few decades, the EVLP technique has become recognized as a significant achievement and gained much attention in the field of lung transplantation. EVLP has been demonstrated to be an effective platform for various targeted therapies to optimize donor lung function before transplantation. Additionally, some physical parameters during EVLP and biological markers in the EVLP perfusate can be used to evaluate graft function before transplantation and predict posttransplant outcomes. However, despite its advantages, the clinical practice of EVLP continuously encounters multiple challenges associated with both intrinsic and extrinsic limitations. It is of utmost importance to address the advantages and disadvantages of EVLP for its broader clinical usage. Here, the pros and cons of EVLP are comprehensively discussed, with a focus on its benefits and potential approaches for overcoming the remaining limitations. Directions for future research to fully explore the clinical potential of EVLP in lung transplantation are also discussed.

THE PRESENT AND FUTURE OF EX-VIVO LUNG PERFUSION

A current limiting factor within the field of lung transplantation is the availability of viable donor lungs to meet the increasing recipient demand. Exvivo lung perfusion (EVLP) is a novel technology which involves the active ventilation of lungs in a physiologic-like environment outside of the body. During EVLP, high risk donor lungs can be assessed, treated and repaired prior to transplantation. Indeed, many transplant centers have now reported comparable outcomes of using these extended criteria lungs to conventional donors through the use of EVLP. Pre-clinical studies and case reports have demonstrated EVLP as an ideal intervention for targeted therapeutics to address donor-related complications such as infection, pulmonary emboli, and aspiration-injury. In addition, increasing evidence has been put forth demonstrating that EVLP usage can extend the total length of pulmonary preservation, which may serve a variety of clinical purposes.

Novel approaches for long-term lung transplant survival.

Allograft failure remains a major barrier in the field of lung transplantation and results primarily from acute and chronic rejection. To date, standard-of-care immunosuppressive regimens have proven unsuccessful in achieving acceptable long-term graft and patient survival. Recent insights into the unique immunologic properties of lung allografts provide an opportunity to develop more effective immunosuppressive strategies. Here we describe advances in our understanding of the mechanisms driving lung allograft rejection and highlight recent progress in the development of novel, lung-specific strategies aimed at promoting long-term allograft survival, including tolerance.

Extracorporeal membrane oxygenation support for lung transplantation: Initial experience in a single center in China and a literature review.

BackgroundExtracorporeal membrane oxygenation (ECMO) is a versatile tool associated with favorable outcomes in the field of lung transplantation (LTx). Here, the clinical outcomes and complications of patients who underwent LTx with ECMO support, mainly prophylactically both intraoperatively and post-operatively, in a single center in China are reviewed.MethodsThe study cohort included all consecutive patients who underwent LTx between January 2020 and January 2022. Demographics and LTx data were retrospectively reviewed. Perioperative results, including complications and survival outcomes, were assessed.ResultsOf 86 patients included in the study, 32 received ECMO support, including 21 who received prophylactic intraoperative use of ECMO with or without prolonged post-operative use (pro-ECMO group), while the remaining 54 (62.8%) received no external support (non-ECMO group). There were no significant differences in the incidence of grade 3 primary graft dysfunction (PGD), short-term survival, or perioperative outcomes and complications between the non-ECMO and pro-ECMO groups. However, the estimated 1- and 2-year survival were superior in the pro-ECMO group, although this difference was not statistically significant (64.1% vs. 82.4%, log-rank P = 0.152; 46.5% vs. 72.1%, log-rank P = 0.182, respectively). After regrouping based on the reason for ECMO support, 30-day survival was satisfactory, while 90-day survival was poor in patients who received ECMO as a bridge to transplantation. However, prophylactic intraoperative use of ECMO and post-operative ECMO prolongation demonstrated promising survival and acceptable complication rates. In particular, patients who initially received venovenous (VV) ECMO intraoperatively with the same configuration post-operatively achieved excellent outcomes. The use of ECMO to salvage a graft affected by severe PGD also achieved acceptable survival in the rescue group.ConclusionsProphylactic intraoperative ECMO support and post-operative ECMO prolongation demonstrated promising survival outcomes and acceptable complications in LTx patients. Particularly, VV ECMO provided safe and effective support intraoperatively and prophylactic prolongation reduced the incidence of PGD in selected patients. However, since this study was conducted in a relatively low-volume transplant center, further studies are needed to validate the results.

Current state of clinical trials regarding lung transplant rejection

BackgroundOver the last several decades, the field of lung transplantation has made significant advances. Despite these advancements, morbidity and mortality rates are still high when compared to other solid organ transplants. Clinical trials have a significant role bringing new medications with better effects than their predecessors. Our study is critical in evaluating and tracking clinical trials involving rejection of lung transplant, with a focus on interventional therapeutic trials. MethodsOn November 3, 2021, we searched clinicaltrial.gov for interventional clinical trials related to lung transplant rejection. A total of 39 clinical trials are included in this study. Characteristics on each trial were gathered. Linked publications were searched using Medline/PubMed and Embase/Scopus, and their content reviewed and summarized. ResultsThe majority of trials were divided into completed (15 out of 39) and recruiting (12 out of 39). 17 trials had between 11 and 50 participants, and 8 had above 100. Only 1 trial lasted >10 years, and the average length of all trials was 3.6 years. The majority of trials were conducted in Europe/UK/Russia and the United States/Canada (17 and 18 trials, respectively). The results were provided in 3 trials, and also published in 3, showing a decrease in the rate of patients reaching an endpoint after chronic rejection with liposomal aerosol cyclosporine, a decrease in their cytokines level, and an increase in their 5-year-survival rate compared to the oral conventional immunosuppressant, the benefit of sirolimus in decreasing the acute rejection rate and severity in comparison to azathioprine, and its efficacy against cytomegalovirus infections. Other trials revealed the benefits of azithromycin in remarkably decreasing airways and systemic inflammation, with a concomitant decline in the risk of both BOS and CLAD; highlighting the deleterious effects of air pollution after transplantation surgery; and using the grading biopsy as a post-transplantation assessment tool. ConclusionThis study is a descriptive analysis of clinical trials targeting lung transplant rejection. This study shows the low number of trials, lack of variety in location and low publishing rates. Although focus of published trials was mainly towards azithromycin, bronchiolitis obliterans syndrome, air pollution, and biopsy in grading, a remarkable progress was realized concerning therapies, leading to less complications with a delay of chronic rejection onset, and an increase in overall survival. This sheds the light on the need for managing research efforts to fulfill any lack in specific domain, leading to new, effective therapies, and providing thereby much more benefit.

The potential of electronic nose technology in lung transplantation: a proof of principle.

Exhaled breath analysis using eNose technology holds promise as a point-of-care indicator of clinical status after lung transplantation. This case study invites further exploration of eNose technology in the field of lung transplantation. https://bit.ly/3wgQ3DE

Impact of Prognostic Nutrition Index on the Waitlist Mortality of Lung Transplantation

<h3>Purpose</h3> Preoperative nutritional status affects surgical complications and prognoses postoperatively. The prognostic nutrition index (PNI) is a nutritional and inflammatory index recently regarded as a new preoperative prognostic score in the field of lung transplantation (LTx). However, no studies have reported the correlation between PNI and waitlist mortality for LTx. Thus, this study aimed to investigate the impact of PNI as a prognostic parameter of mortality on the waiting list for LTx. <h3>Methods</h3> A retrospective review was conducted on the data of 132 patients who were registered for LTx in our department between January 2013 and June 2020. Patients who registered for re-transplantation and those with insufficient data at the time of registration were excluded. Patients who finally received LTx were analyzed as censored data. The overall survival was evaluated using the Kaplan-Meier method for preoperative factors including PNI. Discriminative abilities of continuous variable factors were evaluated using a receiver operating characteristic (ROC) curve for overall mortality. <h3>Results</h3> The median follow-up period and age of patients on the waiting list were 16.3 months and 46 (range, 19-60) years, respectively. Sixty-six (52%) patients were male, and 52 (41%) had a smoking history. The largest number of indications for LTx was idiopathic interstitial pneumonias (n = 44, 35%). The cut-off value, calculated by the ROC curve, of the PNI for the waitlist mortality was 45.8. The low PNI group had a significantly worse prognosis (<i>p</i> = 0.0005). Multivariate analysis demonstrated that idiopathic interstitial pneumonia as an indication for LTx (<i>p</i> = 0.00002), PNI (<i>p</i> = 0.0005), lung allocation score (LAS) (<i>p</i> = 0.0009), and age (<i>p</i> = 0.012) were independent prognostic factors for waitlist mortality. In addition, PNI was significantly correlated with LAS (r = -0.22, <i>p</i> = 0.014). <h3>Conclusion</h3> PNI can be an independent prognostic parameter in registered candidates for LTx.

Extracorporeal membrane oxygenation in lung transplantation: Indications, techniques and results.

The use of extracorporeal membrane oxygenation (ECMO) in the field of lung transplantation has rapidly expanded over the past 30 years. It has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative setting. ECMO is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the recipient. For example, patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous (VV) ECMO or peripheral veno-arterial (VA) ECMO in the case of hemodynamic instability. Moreover, in an intra-operative setting, VV ECMO can be maintained or switched to a VA ECMO. The routine use of intra-operative ECMO and its eventual prolongation in the post-operative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion injury. This review will assess the current evidence on the role of ECMO in the different phases of lung transplantation, while analyzing different studies on pre, intra- and post-operative utilization of this extracorporeal support.

The Year 2020 in Review: Noteworthy Literature for Thoracic Transplant Anesthesiologists.

The year 2020 was a monumental year in medicine, and this review focuses on selected articles for cardiothoracic anesthesiologists and perioperative physicians involved in the care of heart and lung transplant patients. In the field of lung transplantation, significant strides were made in our knowledge of risk stratification during the preoperative assessment of potential recipients, perioperative transfusion medicine, and the administration of coagulation factor concentrates. In addition, variations in perioperative management and outcomes between institutions were studied across an assortment of metrics regarding lung transplantation, including case volumes and anesthetic practices. Transitioning to topics in the field of heart transplantation, consideration was given to recipients with adult congenital heart disease, and separately, approaches to expanding the donor pool through donation after circulatory death. With regard to preoperative support, outcomes for the total artificial heart as well as the MitraClip as bridges to transplantation were published.

Combined low-dose everolimus and low-dose tacrolimus after Alemtuzumab induction therapy: a randomized prospective trial in lung transplantation

BackgroundLong-term outcomes of lung transplantation are severely affected by comorbidities and development of chronic rejection. Among the comorbidities, kidney insufficiency is one of the most frequent and it is mainly caused by the cumulative effect of calcineurin inhibitors (CNIs). Currently, the most used immunosuppression protocols worldwide include induction therapy and a triple-drug maintenance immunosuppression, with one calcineurin inhibitor, one anti-proliferative drug, and steroids. Our center has pioneered the use of alemtuzumab as induction therapy, showing promising results in terms of short- and long-term outcomes. The use of alemtuzumab followed by a low-dose double drug maintenance immunosuppression, in fact, led to better kidney function along with excellent results in terms of acute rejection, chronic lung allograft dysfunction, and survival (Benazzo et al., PLoS One 14(1):e0210443, 2019). The hypothesis driving the proposed clinical trial is that de novo introduction of low-dose everolimus early after transplantation could further improve kidney function via a further reduction of tacrolimus. Based on evidences from kidney transplantation, moreover, alemtuzumab induction therapy followed by a low-dose everolimus and low-dose tacrolimus may have a permissive action on regulatory immune cells thus stimulating allograft acceptance.MethodsA randomized prospective clinical trial has been set up to answer the research hypothesis. One hundred ten patients will be randomized in two groups. Treatment group will receive the new maintenance immunosuppression protocol based on low-dose tacrolimus and low-dose everolimus and the control group will receive our standard immunosuppression protocol. Both groups will receive alemtuzumab induction therapy. The primary endpoint of the study is to analyze the effect of the new low-dose immunosuppression protocol on kidney function in terms of eGFR change. The study will have a duration of 24 months from the time of randomization. Immunomodulatory status of the patients will be assessed with flow cytometry and gene expression analysis.DiscussionFor the first time in the field of lung transplantation, this trial proposes the combined use of significantly reduced tacrolimus and everolimus after alemtuzumab induction. The new protocol may have a twofold advantage: (1) further reduction of nephrotoxic tacrolimus and (2) permissive influence on regulatory cells development with further reduction of rejection episodes.Trial registrationEUDRACT Nr 2018-001680-24. Registered on 15 May 2018

Development and prospect of clinical research on lung transplantation in post-COVID-19 era.

Lung transplantation has been advanced for nearly half a century around the globe, and it has been developed rapidly for over 20 years in China. The field of lung transplantation in China has been gradually integrated into the international community. The outbreak of novel coronavirus pneumonia (COVID-19) in 2020 brought big challenges, as well as diverted the worldwide attention to the development of lung transplantation in China, accelerating international communication and cooperation. With the steadily deepening of clinical and basic research on lung transplantation for severe cases of COVID-19, organ transplant physicians have deepened the understanding and thinking of the maintenance of donors, selection of elderly and pediatric candidates, and perioperative management of recipients, as the future perspective of lung transplantation in China. For interdisciplinary research related to lung transplantation, it is necessary to carry out multi-center clinical trials with qualified study design and constantly promote the theoretic and practical innovation. (English) [ABSTRACT FROM AUTHOR] 肺移植技术在全球经历了近半个世纪的发展，在中国也高速发展了二十余年，中国肺移植逐渐融 入国际肺移植大家庭。2020 年新型冠状病毒肺炎（新冠肺炎）疫情暴发，既是对中国肺移植发展的挑战，也使 得全球同行关注中国肺移植发展，加速了国际间的交流与合作。随着对新冠肺炎重症患者肺移植的临床和基础 研究逐步深入，移植科医师对于未来中国肺移植在供者的维护、高龄和儿童受者的选择、围手术期管理等方面 有了更多的认知和思考。对于肺移植相关学科交叉领域的研究，需要开展设计优良、多方协作的临床试验，不 断推进学科理论和实践的创新。 (Chinese) [ABSTRACT FROM AUTHOR] Copyright of Organ Transplantation / Qi Guan Yi Zhi is the property of Organ Transplantation Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Developments in lung transplantation over the past decade.

With an improved median survival of 6.2 years, lung transplantation has become an increasingly acceptable treatment option for end-stage lung disease. Besides survival benefit, improvement of quality of life is achieved in the vast majority of patients. Many developments have taken place in the field of lung transplantation over the past decade. Broadened indication criteria and bridging techniques for patients awaiting lung transplantation have led to increased waiting lists and changes in allocation schemes worldwide. Moreover, the use of previously unacceptable donor lungs for lung transplantation has increased, with donations from donors after cardiac death, donors with increasing age and donors with positive smoking status extending the donor pool substantially. Use of ex vivo lung perfusion further increased the number of lungs suitable for lung transplantation. Nonetheless, the use of these previously unacceptable lungs did not have detrimental effects on survival and long-term graft outcomes, and has decreased waiting list mortality. To further improve long-term outcomes, strategies have been proposed to modify chronic lung allograft dysfunction progression and minimise toxic immunosuppressive effects. This review summarises the developments in clinical lung transplantation over the past decade.

Effect of Donor Death by Drug Intoxication Combined with Chronic Drug Abuse on Lung Transplantation: A Single Center Study

In the field of lung transplantation, there is a high wait list mortality. Broader use of extended criteria donors would provide additional organs for transplantation. An increasing number of organ donors are dying from drug overdose. These donors are often considered "high risk" because of their exposure to infectious diseases such as HIV and Hepatitis B and C. However, these organ donors are often younger and healthier than those that die from stroke or cardiac arrest. Successful use of lung donors who have a history of drug abuse may serve to provide additional organs for those patients on the wait list. This study reviews the results of lung grafts transplanted from donors with a history of drug abuse. This study is a retrospective analysis of 266 lung transplants done at a single center from 2014 to 2018. Extracted data included both donor and recipient characteristics, as well as clinical transplant outcomes. Donor history of illicit drug use was taken from the medical/social history derived by the onsite transplant coordinator. This history included both a review of the medical record, as well as an interview with family and friends of the donor. Clinical outcomes for this study included early and 1-year survival, need for ECMO, post-transplant ventilator time, hospital length of stay and 90-day readmission rates. Donors in this cohort died primarily from trauma (49%), stroke (21%), and anoxic brain injury (∼30%). Specifically, there were 37 donors who died from a drug overdose (15%). Drug use among all donors (lifetime) included use of THC (37%), cocaine (14%), amphetamines (15%), and opioids (18%). Additionally, a large percentage of donors had a history of active alcohol abuse (22%). Comparing patients who received a lung graft from a donor who died of drug overdose to all other patients, there was no difference in early death (p=0.69), survival at 1-year (p=0.21), need for perioperative ECMO (p=0.31), and hours post op on the ventilator (p=0.13). The drug overdose donor group had a shorter length of hospital stay (21 vs 25 days, p=0.06). These results demonstrate that drug use and abuse among lung donors is common. Donor lung grafts taken from a patient who dies of a drug overdose have similar outcomes compared to all other donors. More aggressive use of these donors may provide additional organs for transplantation.

A New BOS: Burnout Syndrome in Lung Transplant Physicians

Burnout is common in all types of physicians, but little is known about burnout in lung transplant physicians. The purpose of this study was to explore burnout and its relationship to job factors and depression in lung transplant physicians. We conducted a cross-sectional study in September 2019 of lung transplant pulmonologists and surgeons worldwide. The survey included demographic and job characteristics, the Maslach Burnout Inventory (MBI), and the Patient Health Questionnaire-2 (PHQ-2), a screening tool for depression. The MBI included assessment of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Ninety lung transplantation pulmonologists and surgeons completed the survey. Physicians completing the survey were predominantly male (80%), pulmonologists (84.4%), and from the United States (73.3%). High emotional exhaustion is present in 42.2% of physicians, while high depersonalization was present in 15.6% and low personal accomplishment in 21.1%. Depression was present in 15.6% of responders. There was significant association between emotional exhaustion score and total score on the PHQ-2 (ρ=0.72, p<0.001). Gender, transplant volume, type of job, age, and call hours were not associated with differences in burnout. There was significantly greater emotional exhaustion in physicians with more years of experience (p=0.013). Greater time spent in the clinical care of lung transplantation patients was associated with a higher EE score (ρ=0.28, p=0.008), while greater time spent in teaching/education was associated with a lower EE score (ρ=-0.32, p=0.006). Those responders with high emotional exhaustion were more likely to find their job had a negative impact on their lives (p<0.001). Emotional exhaustion is common in lung transplant physicians and is associated with depression and a negative impact on life. More experienced transplant physicians have higher emotional exhaustion than less experienced physicians. More information is needed to determine if certain characteristics such as resilience allow retention in the field of lung transplantation despite high burnout levels.

Use of Donors Who Died by Traumatic Asphyxiation in Lung Transplantation: A Single Center Study

Lung transplant wait list mortality remains high and poses a serious risk to those with end-stage lung disease awaiting transplantation. All available organ donors must be fully evaluated to assure that each patient receives the chance for a life-saving transplant. There is concern in the field of lung transplantation that use of donors who died by traumatic asphyxiation (TA) will have inferior post transplant outcomes. This study is designed to review the outcomes for these donors at a single center. Clinical outcomes include early and late graft function and survival, and post transplant complications. Successful use of these donors may increase the available donor pool. This study is a retrospective analysis of all lung transplants at a single center over a 4-year time period (2014-2018). The original medical records as recorded by the onsite coordinator were reviewed to determine the patient cause of death and any evidence of early lung injury. Recipient hospital records were extracted to review early and late clinical outcomes and complications. There were 266 patients in this cohort, 15 of whom died from traumatic asphyxiation (generally by hanging as a means of suicide). In the donor, TA patients' chest radiographs and computed tomography scans had no increased risk of an abnormal finding, except that the radiograph was more likely to show lung opacities in TA patients (57% vs 28%, p=0.02). Partial pressure of oxygen (PaO2) was equivalent for the highest level and the peak level, though TA patients did have a higher "lowest" PaO2 (100 vs 81, p=0.05). Donor bronchoscopy did not demonstrate different findings for TA donors. Clinical outcomes were equivalent post-transplant, with no differences in early graft function or 1-year survival, need for ECMO, need for tracheostomy, length of hospital stay, or hospital readmission rate. Lung donors who die from TA appear to have equivalent clinical outcomes when compared to other lung donors. These results suggest that lung grafts from these donors can be used routinely and may provide a source of additional donor organs.

The value of high-resolution HLA in the perioperative period of non-sensitized lung transplant recipients.

The importance of HLA antigen matching is widely recognized and accepted worldwide. With the improvement of diagnostic methods, recent studies have shown that eplet mismatched for organ transplantation is essential. In the field of lung transplantation, eplet mismatch (MM) is closely related to chronic rejection after lung transplantation. To further investigate the relationship between early graft failure and acute rejection, we performed high-resolution HLA analysis on 59 patients in our center. We conduct high-resolution HLA matching and Donor specific antibody (DSA) monitoring on 59 lung transplantation donors and recipients from April 1, 2018, to June 30, 2019. Baseline data were collected composed of both recipient characteristics and transplant-related features. Clinical outcomes were primary graft dysfunction (PGD) and acute rejection (AR). Overall, for these 59 patients, HLA antigen mismatch is 7.19±1.61, eplet mismatch is 8.31±1.75 (P=0.0005). As the number of mismatch sites increases, the severity of PGD increased significantly, especially when presented both eplet mismatch and HLA-DQ mismatch. In this group of patients, 2 cases of antibody-mediated rejection (AMR) occurred after transplantation, eplet MM 9 (HLA-DQ MM 2) and eplet MM 5 (HLA-DQ MM1). Both patients developed DSA after operation, and they are DQB1 06:01 and C07:02, respectively. There were 9 cases of death during the perioperative period. Five of them died of severe PGD, and 4 died of severe infection. All these 9 patients were with high-level eplet MM and HLA-DQ MM. Perioperative PGD and AR closely related to HLA mismatches, especially eplet and HLA-DQ MM. It might be noteworthy to do complementary detection of eplet matching and DSA in lung transplant donors and recipients, to predict the risk of early PGD and acute rejection after lung transplantation.