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A strategy for protecting the lungs in potential organ donors nearly doubled the number of lungs that were suitable for transplantation, according to a report in the Dec. 15 issue of JAMA.
The lung-protection strategy, which apparently forestalled much of the pulmonary damage associated with brain injury and mechanical ventilation, had no detrimental effects on other organs – hearts, livers, and kidneys – harvested from the same donors for transplantation, said Dr. Luciana Mascia of the departments of anesthesia and intensive care medicine at the University of Turin (Italy).
Potential organ donors who have relatively normal pulmonary function at the time of brain death often show marked declines in that function, so that only 15%-20% of these lungs are suitable for transplantation when organ harvesting commences.
Dr. Mascia and her colleagues studied 118 patients with brain death who were potential organ donors and were being treated at 12 intensive care units (ICUs) in Italy and Spain between 2004 and 2009. A total of 59 patients were randomly assigned to undergo conventional lung ventilation techniques, and the other 59 were assigned to a strategy of using lower tidal volumes, higher positive end-expiratory pressure (to prevent atelectasis), a closed system for any tracheal suctioning, alveolar recruitment maneuvers after any ventilator disconnections, and continuous positive airway pressure during apnea tests.
After a mandatory 6-hour interval before brain death could be officially declared, there were 49 potential donors in the conventional-care group and 51 in the lung-protection group. The number of patients who then were found to meet lung-donor eligibility criteria had decreased with the conventional ventilation strategy by 29% to only 32 patients. In contrast, the number in the lung-protection group had increased to 56 patients, a significant difference.
This means that of the original potential donors, only 54% in the conventional-care group met eligibility criteria, compared with 95% in the lung-protection group, Dr. Mascia and her associates said (JAMA 2010;304:2620-27).
The ultimate number of lungs that were successfully harvested was 27% of the conventional-care group (16 lungs), compared with 54% of the lung-protection group (32 lungs), also a significant difference.
For the lung recipients, the median ICU length of stay was 12 days for patients who received lungs from the conventional-care group and 8 days for those who received lungs from the lung-protection group. Six-month survival was 69% for patients who received lungs from the conventional-care group and 75% for those who received lungs from the lung-protection group, a nonsignificant difference.
The number of other organs harvested did not differ between the two study groups, and 6-month survival of those recipients also did not differ significantly.
The Protective Ventilatory Strategy in Potential Organ Donors Study (clinicaltrials.gov ID: NCT00260676) was stopped after 118 patients were enrolled, because of termination of funding.
This study was supported by the Ministero della Salute Programma Ricerca Finalizzata, the Regione Piemonte Programma Ricerca Finalizzata, and the Ministero dell’Universita Programma di Ricerca di Interesse Nazionale. No financial conflicts of interest were reported.
"This study breaks important new ground in providing a solid evidence base for the care of potential organ donors and testing techniques of organ preservation," said Dr. Mark S. Roberts.
The "profound" results showed that a relatively simple protection strategy nearly doubled the number of donor lungs and did double the number of patients from whom transplantable lungs could be harvested. Moreover, although the study sample was small, there were no detrimental effects on transplant outcomes, either with the lungs or with other donated organs.
"Doubling [the lung] donation rate could potentially meet steady-state demand as well as reduce waiting-list backlog, especially because each donor provides organs for more than 1 transplant," he noted.
"The study by Mascia et al. [also] provides sobering evidence that conventional lung preservation practices, which have been used for many years, are remarkably inefficient in their task," he added.
Mark S. Roberts, M.D., is in the department of health policy and management at the University of Pittsburgh School of Public Health. He reported no financial disclosures. These comments were taken from his editorial accompanying Dr. Mascia’s report (JAMA 2010;304:2643-4).
"This study breaks important new ground in providing a solid evidence base for the care of potential organ donors and testing techniques of organ preservation," said Dr. Mark S. Roberts.
The "profound" results showed that a relatively simple protection strategy nearly doubled the number of donor lungs and did double the number of patients from whom transplantable lungs could be harvested. Moreover, although the study sample was small, there were no detrimental effects on transplant outcomes, either with the lungs or with other donated organs.
"Doubling [the lung] donation rate could potentially meet steady-state demand as well as reduce waiting-list backlog, especially because each donor provides organs for more than 1 transplant," he noted.
"The study by Mascia et al. [also] provides sobering evidence that conventional lung preservation practices, which have been used for many years, are remarkably inefficient in their task," he added.
Mark S. Roberts, M.D., is in the department of health policy and management at the University of Pittsburgh School of Public Health. He reported no financial disclosures. These comments were taken from his editorial accompanying Dr. Mascia’s report (JAMA 2010;304:2643-4).
"This study breaks important new ground in providing a solid evidence base for the care of potential organ donors and testing techniques of organ preservation," said Dr. Mark S. Roberts.
The "profound" results showed that a relatively simple protection strategy nearly doubled the number of donor lungs and did double the number of patients from whom transplantable lungs could be harvested. Moreover, although the study sample was small, there were no detrimental effects on transplant outcomes, either with the lungs or with other donated organs.
"Doubling [the lung] donation rate could potentially meet steady-state demand as well as reduce waiting-list backlog, especially because each donor provides organs for more than 1 transplant," he noted.
"The study by Mascia et al. [also] provides sobering evidence that conventional lung preservation practices, which have been used for many years, are remarkably inefficient in their task," he added.
Mark S. Roberts, M.D., is in the department of health policy and management at the University of Pittsburgh School of Public Health. He reported no financial disclosures. These comments were taken from his editorial accompanying Dr. Mascia’s report (JAMA 2010;304:2643-4).
A strategy for protecting the lungs in potential organ donors nearly doubled the number of lungs that were suitable for transplantation, according to a report in the Dec. 15 issue of JAMA.
The lung-protection strategy, which apparently forestalled much of the pulmonary damage associated with brain injury and mechanical ventilation, had no detrimental effects on other organs – hearts, livers, and kidneys – harvested from the same donors for transplantation, said Dr. Luciana Mascia of the departments of anesthesia and intensive care medicine at the University of Turin (Italy).
Potential organ donors who have relatively normal pulmonary function at the time of brain death often show marked declines in that function, so that only 15%-20% of these lungs are suitable for transplantation when organ harvesting commences.
Dr. Mascia and her colleagues studied 118 patients with brain death who were potential organ donors and were being treated at 12 intensive care units (ICUs) in Italy and Spain between 2004 and 2009. A total of 59 patients were randomly assigned to undergo conventional lung ventilation techniques, and the other 59 were assigned to a strategy of using lower tidal volumes, higher positive end-expiratory pressure (to prevent atelectasis), a closed system for any tracheal suctioning, alveolar recruitment maneuvers after any ventilator disconnections, and continuous positive airway pressure during apnea tests.
After a mandatory 6-hour interval before brain death could be officially declared, there were 49 potential donors in the conventional-care group and 51 in the lung-protection group. The number of patients who then were found to meet lung-donor eligibility criteria had decreased with the conventional ventilation strategy by 29% to only 32 patients. In contrast, the number in the lung-protection group had increased to 56 patients, a significant difference.
This means that of the original potential donors, only 54% in the conventional-care group met eligibility criteria, compared with 95% in the lung-protection group, Dr. Mascia and her associates said (JAMA 2010;304:2620-27).
The ultimate number of lungs that were successfully harvested was 27% of the conventional-care group (16 lungs), compared with 54% of the lung-protection group (32 lungs), also a significant difference.
For the lung recipients, the median ICU length of stay was 12 days for patients who received lungs from the conventional-care group and 8 days for those who received lungs from the lung-protection group. Six-month survival was 69% for patients who received lungs from the conventional-care group and 75% for those who received lungs from the lung-protection group, a nonsignificant difference.
The number of other organs harvested did not differ between the two study groups, and 6-month survival of those recipients also did not differ significantly.
The Protective Ventilatory Strategy in Potential Organ Donors Study (clinicaltrials.gov ID: NCT00260676) was stopped after 118 patients were enrolled, because of termination of funding.
This study was supported by the Ministero della Salute Programma Ricerca Finalizzata, the Regione Piemonte Programma Ricerca Finalizzata, and the Ministero dell’Universita Programma di Ricerca di Interesse Nazionale. No financial conflicts of interest were reported.
A strategy for protecting the lungs in potential organ donors nearly doubled the number of lungs that were suitable for transplantation, according to a report in the Dec. 15 issue of JAMA.
The lung-protection strategy, which apparently forestalled much of the pulmonary damage associated with brain injury and mechanical ventilation, had no detrimental effects on other organs – hearts, livers, and kidneys – harvested from the same donors for transplantation, said Dr. Luciana Mascia of the departments of anesthesia and intensive care medicine at the University of Turin (Italy).
Potential organ donors who have relatively normal pulmonary function at the time of brain death often show marked declines in that function, so that only 15%-20% of these lungs are suitable for transplantation when organ harvesting commences.
Dr. Mascia and her colleagues studied 118 patients with brain death who were potential organ donors and were being treated at 12 intensive care units (ICUs) in Italy and Spain between 2004 and 2009. A total of 59 patients were randomly assigned to undergo conventional lung ventilation techniques, and the other 59 were assigned to a strategy of using lower tidal volumes, higher positive end-expiratory pressure (to prevent atelectasis), a closed system for any tracheal suctioning, alveolar recruitment maneuvers after any ventilator disconnections, and continuous positive airway pressure during apnea tests.
After a mandatory 6-hour interval before brain death could be officially declared, there were 49 potential donors in the conventional-care group and 51 in the lung-protection group. The number of patients who then were found to meet lung-donor eligibility criteria had decreased with the conventional ventilation strategy by 29% to only 32 patients. In contrast, the number in the lung-protection group had increased to 56 patients, a significant difference.
This means that of the original potential donors, only 54% in the conventional-care group met eligibility criteria, compared with 95% in the lung-protection group, Dr. Mascia and her associates said (JAMA 2010;304:2620-27).
The ultimate number of lungs that were successfully harvested was 27% of the conventional-care group (16 lungs), compared with 54% of the lung-protection group (32 lungs), also a significant difference.
For the lung recipients, the median ICU length of stay was 12 days for patients who received lungs from the conventional-care group and 8 days for those who received lungs from the lung-protection group. Six-month survival was 69% for patients who received lungs from the conventional-care group and 75% for those who received lungs from the lung-protection group, a nonsignificant difference.
The number of other organs harvested did not differ between the two study groups, and 6-month survival of those recipients also did not differ significantly.
The Protective Ventilatory Strategy in Potential Organ Donors Study (clinicaltrials.gov ID: NCT00260676) was stopped after 118 patients were enrolled, because of termination of funding.
This study was supported by the Ministero della Salute Programma Ricerca Finalizzata, the Regione Piemonte Programma Ricerca Finalizzata, and the Ministero dell’Universita Programma di Ricerca di Interesse Nazionale. No financial conflicts of interest were reported.
FROM JAMA