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Review article: Biomedical intelligence

Vol. 141 No. 4546 (2011)

Challenges in lung transplantation

  • T Krueger
  • C Berutto
DOI
https://doi.org/10.4414/smw.2011.13292
Cite this as:
Swiss Med Wkly. 2011;141:w13292
Published
07.11.2011

Summary

Lung transplantation is an established therapy for end-stage pulmonary disorders in selected patients without significant comorbidities. The particular constraints associated with organ transplantation from deceased donors involve specific allocation rules in order to optimise the medical efficacy of the procedure. Comparison of different policies adopted by national transplant agencies reveals that an optimal and unique allocation system is an elusive goal, and that practical, geographical and logistic parameters must be taken into account.

A solution to attenuate the imbalance between the number of lung transplant candidates and the limited availability of organs is to consider marginal donors. In particular, assessment and restoration of gas exchange capacity ex vivo in explanted lungs is a new and promising approach that some lung transplant programmes have started to apply in clinical practice.

Chronic lung allograft dysfunction, and especially bronchiolitis obliterans, remains the major medium- and long-term problem in lung transplantation with a major impact on survival. Although there is to date no cure for established bronchiolitis obliterans, new preventive strategies have the potential to limit the burden of this feared complication. Unfortunately, randomised prospective studies are infrequent in the field of lung transplantation, and data obtained from larger studies involving kidney or liver recipients are not always relevant for this purpose.

References

  1. Davis SQ, Garrity ER, Jr. Organ allocation in lung transplant. Chest. 2007;132(5):1646–51.
  2. Smits JM, Vanhaecke J, Haverich A, de VE, Roels L, Persijn G, et al. Waiting for a thoracic transplant in Eurotransplant. Transpl Int. 2006;19(1):54–66.
  3. Uehlinger NB, Beyeler F, Weiss J, Marti HP, Immer FF. Organ transplantation in Switzerland: impact of the new transplant law on cold ischaemia time and organ transports. Swiss Med Wkly. 2010;140(15-16):222–7.
  4. Smits JM, Nossent GD, de VE, Rahmel A, Meiser B, Strueber M, et al. Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant. J Heart Lung Transplant. 2011;30(1):22–8.
  5. Takahashi SM, Garrity ER. The impact of the lung allocation score. Semin Respir Crit Care Med. 2010;31(2):108–14.
  6. Egan TM, Murray S, Bustami RT, Shearon TH, McCullough KP, Edwards LB, et al. Development of the new lung allocation system in the United States. Am J Transplant. 2006;6(5 Pt 2):1212–27.
  7. Arnaoutakis GJ, Allen JG, Merlo CA, Sullivan BE, Baumgartner WA, Conte JV, et al. Impact of the lung allocation score on resource utilization after lung transplantation in the United States. J Heart Lung Transplant. 2011;30(1):14–21.
  8. Gries CJ, Rue TC, Heagerty PJ, Edelman JD, Mulligan MS, Goss CH. Development of a predictive model for long-term survival after lung transplantation and implications for the lung allocation score. J Heart Lung Transplant. 2010;29(7):731–8.
  9. Russo MJ, Iribarne A, Hong KN, Davies RR, Xydas S, Takayama H, et al. High lung allocation score is associated with increased morbidity and mortality following transplantation. Chest. 2010;137(3):651–7.
  10. Russo MJ, Davies RR, Hong KN, Iribarne A, Kawut S, Bacchetta M, et al. Who is the high-risk recipient? Predicting mortality after lung transplantation using pretransplant risk factors. J Thorac Cardiovasc Surg. 2009;138(5):1234–8.
  11. Meers C, Van RD, Verleden GM, Coosemans W, Decaluwe H, De LP, et al. The number of lung transplants can be safely doubled using extended criteria donors; a single-center review. Transpl Int. 2010;23(6):628–35.
  12. Steinbrook R. Organ donation after cardiac death. N Engl J Med. 2007;357(3):209–13.
  13. Orens JB, Boehler A, de PM, Estenne M, Glanville AR, Keshavjee S, et al. A review of lung transplant donor acceptability criteria. J Heart Lung Transplant. 2003;22(11):1183–200.
  14. Angel LF, Levine DJ, Restrepo MI, Johnson S, Sako E, Carpenter A, et al. Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes. Am J Respir Crit Care Med. 2006;174(6):710–6.
  15. Steen S, Ingemansson R, Eriksson L, Pierre L, Algotsson L, Wierup P, et al. First human transplantation of a nonacceptable donor lung after reconditioning ex vivo. Ann Thorac Surg. 2007;83(6):2191–4.
  16. Steen S, Liao Q, Wierup PN, Bolys R, Pierre L, Sjoberg T. Transplantation of lungs from non-heart-beating donors after functional assessment ex vivo. Ann Thorac Surg. 2003;76(1):244–52.
  17. Steen S, Sjoberg T, Pierre L, Liao Q, Eriksson L, Algotsson L. Transplantation of lungs from a non-heart-beating donor. Lancet. 2001;357(9259):825–9.
  18. Wierup P, Haraldsson A, Nilsson F, Pierre L, Schersten H, Silverborn M, et al. Ex vivo evaluation of nonacceptable donor lungs. Ann Thorac Surg. 2006;81(2):460–6.
  19. Cypel M, Rubacha M, Yeung J, Hirayama S, Torbicki K, Madonik M, et al. Normothermic ex vivo perfusion prevents lung injury compared to extended cold preservation for transplantation. Am J Transplant. 2009;9(10):2262–9. Epub 2009/08/12.
  20. Cypel M, Yeung JC, Hirayama S, Rubacha M, Fischer S, Anraku M, et al. Technique for prolonged normothermic ex vivo lung perfusion. J Heart Lung Transplant. 2008;27(12):1319–25. Epub 2008/12/09.
  21. Ingemansson R, Eyjolfsson A, Mared L, Pierre L, Algotsson L, Ekmehag B, et al. Clinical transplantation of initially rejected donor lungs after reconditioning ex vivo. Ann Thorac Surg. 2009;87(1):255–60.
  22. Takashima S, Koukoulis G, Inokawa H, Sevala M, Egan TM. Inhaled nitric oxide reduces ischemia-reperfusion injury in rat lungs from non-heart-beating donors. J Thorac Cardiovasc Surg. 2006;132(1):132–9.
  23. Inci I, Ampollini L, Arni S, Jungraithmayr W, Inci D, Hillinger S, et al. Ex vivo reconditioning of marginal donor lungs injured by acid aspiration. J Heart Lung Transplant. 2008;27(11):1229–36.
  24. Inci I, Zhai W, Arni S, Inci D, Hillinger S, Lardinois D, et al. Fibrinolytic treatment improves the quality of lungs retrieved from non-heart-beating donors. J Heart Lung Transplant. 2007;26(10):1054–60.
  25. Cypel M, Liu M, Rubacha M, Yeung JC, Hirayama S, Anraku M, et al. Functional repair of human donor lungs by IL-10 gene therapy. Sci Transl Med. 2009;1(4):4ra9. Epub 2010/04/07.
  26. Cypel M, Yeung JC, Liu M, Anraku M, Chen F, Karolak W, et al. Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med. 2011;364(15):1431–40. Epub 2011/04/15.
  27. Zych B, Marczin N, Carby M, McCurry M, Mullins C, Bashford A, et al. Ex vivo lung perfusion – a way to salvage lungs for transplantation? Initial experience at a single institution. Br J Transplant. 2010:410–6.
  28. Christie JD, Edwards LB, Kucheryavaya AY, Aurora P, Dobbels F, Kirk R, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult lung and heart-lung transplant report – 2010. J Heart Lung Transplant. 2010;29(10):1104–18.
  29. Estenne M, Maurer JR, Boehler A, Egan JJ, Frost A, Hertz M, et al. Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria. J Heart Lung Transplant. 2002;21(3):297–310.
  30. Bharat A, Kuo E, Steward N, Aloush A, Hachem R, Trulock EP, et al. Immunological link between primary graft dysfunction and chronic lung allograft rejection. Ann Thorac Surg. 2008;86(1):189–95.
  31. Nawrot TS, Vos R, Jacobs L, Verleden SE, Wauters S, Mertens V, et al. The impact of traffic air pollution on bronchiolitis obliterans syndrome and mortality after lung transplantation. Thorax. 2011;66(9):748–54. Epub 2011/03/25.
  32. Kastelijn EA, Rijkers GT, Van Moorsel CH, Zanen P, Kwakkel-van Erp JM, Van De Graaf EA, et al. Systemic and exhaled cytokine and chemokine profiles are associated with the development of bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2010;29(9):997–1008.
  33. Fan Y, Xiao YB, Weng YG. Tacrolimus versus cyclosporine for adult lung transplant recipients: a meta-analysis. Transplant Proc. 2009;41(5):1821–4.
  34. Speich R, Schneider S, Hofer M, Irani S, Vogt P, Weder W, et al. Mycophenolate mofetil reduces alveolar inflammation, acute rejection and graft loss due to bronchiolitis obliterans syndrome after lung transplantation. Pulm Pharmacol Ther. 2010;23(5):445–9.
  35. McNeil K, Glanville AR, Wahlers T, Knoop C, Speich R, Mamelok RD, et al. Comparison of mycophenolate mofetil and azathioprine for prevention of bronchiolitis obliterans syndrome in de novo lung transplant recipients. Transplantation. 2006;81(7):998–1003.
  36. Hernandez RL, Gil PU, Gallo CG, de Pablo GA, Hernandez MC, Alvarez MJ. Rapamycin in lung transplantation. Transplant Proc. 2005;37(9):3999–4000.
  37. Bhorade S, Ahya VN, Baz MA, Valentine VG, Arcasoy SM, Love RB, et al. Comparison of sirolimus with azathioprine in a tacrolimus-based immunosuppressive regimen in lung transplantation. Am J Respir Crit Care Med. 2011;183(3):379–87. Epub 2010/09/14.
  38. Vos R, Vanaudenaerde BM, Verleden SE, De Vleeschauwer SI, Willems-Widyastuti A, Van Raemdonck DE, et al. A randomised controlled trial of azithromycin to prevent chronic rejection after lung transplantation. Eur Respir J. 2011;37(1):164–72.
  39. Canovas R, Cypel M, Farah ME, Belfort R, Jr. [Macular pigments]. Arquivos brasileiros de oftalmologia. 2009;72(6):839–44. Epub 2010/01/26. Pigmentos maculares.
  40. Cairn J, Yek T, Banner NR, Khaghani A, Hodson ME, Yacoub M. Time-related changes in pulmonary function after conversion to tacrolimus in bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2003;22(1):50–7.
  41. Sarahrudi K, Estenne M, Corris P, Niedermayer J, Knoop C, Glanville A, et al. International experience with conversion from cyclosporine to tacrolimus for acute and chronic lung allograft rejection. J Thorac Cardiovasc Surg. 2004;127(4):1126–32.
  42. Dusmet M, Maurer J, Winton T, Kesten S. Methotrexate can halt the progression of bronchiolitis obliterans syndrome in lung transplant recipients. J Heart Lung Transplant. 1996;15(9):948–54.
  43. Gerhardt SG, McDyer JF, Girgis RE, Conte JV, Yang SC, Orens JB. Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study. Am J Respir Crit Care Med. 2003;168(1):121–5.
  44. Jain R, Hachem RR, Morrell MR, Trulock EP, Chakinala MM, Yusen RD, et al. Azithromycin is associated with increased survival in lung transplant recipients with bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2010;29(5):531–7.
  45. Vanaudenaerde BM, Meyts I, Vos R, Geudens N, De WW, Verbeken EK, et al. A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy. Eur Respir J. 2008;32(4):832–43.
  46. Verleden GM, Verleden SE, Vos R, De Vleeschauwer SI, Dupont LJ, Van Raemdonck DE, et al. Montelukast for bronchiolitis obliterans syndrome after lung transplantation: a pilot study. Transpl Int. 2011.
  47. Hachem RR, Yusen RD, Meyers BF, Aloush AA, Mohanakumar T, Patterson GA, et al. Anti-human leukocyte antigen antibodies and preemptive antibody-directed therapy after lung transplantation. J Heart Lung Transplant. 2010;29(9):973–80.
  48. Iacono AT, Johnson BA, Grgurich WF, Youssef JG, Corcoran TE, Seiler DA, et al. A randomized trial of inhaled cyclosporine in lung-transplant recipients. N Engl J Med. 2006;354(2):141–50.
  49. Fisher AJ, Rutherford RM, Bozzino J, Parry G, Dark JH, Corris PA. The safety and efficacy of total lymphoid irradiation in progressive bronchiolitis obliterans syndrome after lung transplantation. Am J Transplant. 2005;5(3):537–43.
  50. Morrell MR, Despotis GJ, Lublin DM, Patterson GA, Trulock EP, Hachem RR. The efficacy of photopheresis for bronchiolitis obliterans syndrome after lung transplantation. J Heart Lung Transplant. 2010;29(4):424–31.
  51. Benden C, Speich R, Hofbauer GF, Irani S, Eich-Wanger C, Russi EW, et al. Extracorporeal photopheresis after lung transplantation: a 10-year single-center experience. Transplantation. 2008;86(11):1625–7.
  52. Dorent R, Lamy FX, Cantrelle C. The role of the French Agence de la biomedecine in lung transplantation. Rev Pneumol Clin. 2010;67(1):57–63.
  53. Palmer SM, Baz MA, Sanders L, Miralles AP, Lawrence CM, Rea JB, et al. Results of a randomized, prospective, multicenter trial of mycophenolate mofetil versus azathioprine in the prevention of acute lung allograft rejection. Transplantation. 2001;71(12):1772–6. Epub 2001/07/17.
  54. Hachem RR, Yusen RD, Chakinala MM, Meyers BF, Lynch JP, Aloush AA, et al. A randomized controlled trial of tacrolimus versus cyclosporine after lung transplantation. J Heart Lung Transplant. 2007;26(10):1012–8.
  55. Zuckermann A, Reichenspurner H, Birsan T, Treede H, Deviatko E, Reichart B, et al. Cyclosporine A versus tacrolimus in combination with mycophenolate mofetil and steroids as primary immunosuppression after lung transplantation: one-year results of a 2-center prospective randomized trial. J Thorac Cardiovasc Surg. 2003;125(4):891–900.
  56. Snell GI, Valentine VG, Vitulo P, Glanville AR, McGiffin DC, Loyd JE, et al. Everolimus versus azathioprine in maintenance lung transplant recipients: an international, randomized, double-blind clinical trial. Am J Transplant. 2006;6(1):169–77. Epub 2006/01/26.