HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Takahiro Oto Marc Rabinov Donald S. Esmore Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Oto, T. Articles by Snell, G. I. Search for Related Content PubMed PubMed Citation Articles by Oto, T. Articles by Snell, G. I. Related Collections Lung - transplantation

J Thorac Cardiovasc Surg 2005;130:1446
© 2005 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Unexpected donor pulmonary embolism affects early outcomes after lung transplantation: A major mechanism of primary graft failure?

Heart and Lung Transplant Unit, The Alfred Hospital, Monash University, Melbourne, Australia.

Received for publication May 26, 2005; revisions received June 30, 2005; accepted for publication July 11, 2005.

^_* Address for reprints: Gregory I. Snell, FRACP, The Alfred Hospital, Heart & Lung Transplant Unit, Commercial Rd, Melbourne, Victoria 3004, Australia (Email: g.snell{at}alfred.org.au).

OBJECTIVE: Primary graft failure remains a significant cause of morbidity and mortality after lung transplantation, and its mechanism is not understood. Previously 2 case reports described fatal primary graft failure due to donor-related unexpected pulmonary embolism. This study investigated the incidence, early outcome, and risk factors of unexpected pulmonary embolism in lung transplantation.

METHODS: An exploratory retrograde donor lung flush before implantation to diagnose pulmonary embolism (emboli group) or no pulmonary embolism (no-emboli group) was performed in 74 of 122 consecutive lung transplantations.

RESULTS: The incidence of macroscopic unexpected pulmonary embolism was 38% (28% clot and 9% fat). In the emboli group, significantly decreased oxygenation (P < .05), increased pulmonary vascular resistance (P < .001), an increased proportion of opacity on chest radiograph (P = .03), prolonged intubation (P < .001) and intensive care unit stay (P < .01), and decreased 1-year survival (P = .03) were seen after transplantation. In multivariate analysis, pulmonary embolism was an independent risk factor for prolonged intubation (hazard ratio, 2.42; P < .01). In logistic regression, death due to trauma with fracture and a smoking history of more than 20 pack-years were significant donor risk factors for pulmonary embolism (adjusted odds ratio, 8.77 and 5.64; P = .02 and .04, respectively). No deleterious effects of the exploratory flush were seen.

CONCLUSIONS: Unexpected pulmonary embolism is relatively common, is potentially predicted by donor history (but not by arterial blood gas analysis or chest radiograph), and is associated with primary graft failure. Donor lungs with risk factors of pulmonary embolism should undergo an exploratory flush. When pulmonary embolism is diagnosed, further therapeutic strategies must be considered.

This article has been cited by other articles:

				M. Shihata, N. Ghorpade, D. Lien, and D. Modry Ex Vivo Bilateral Pulmonary Embolectomy for Donor Lungs Prior to Transplantation Ann. Thorac. Surg., June 1, 2008; 85(6): 2110 - 2112. [Abstract] [Full Text] [PDF]

				M. E. Prekker, C. S. Herrington, M. I. Hertz, D. M. Radosevich, and P. S. Dahlberg Early Trends in PaO2/Fraction of Inspired Oxygen Ratio Predict Outcome in Lung Transplant Recipients With Severe Primary Graft Dysfunction Chest, September 1, 2007; 132(3): 991 - 997. [Abstract] [Full Text] [PDF]

				J. Padilla, C. Jorda, J. C. Penalver, J. Ceron, J. Escriva, and F. Vera-Sempere Donor Fat Embolism and Primary Graft Dysfunction After Lung Transplantation Ann. Thorac. Surg., August 1, 2007; 84(2): e4 - e5. [Abstract] [Full Text] [PDF]

				T. Oto, B. J. Levvey, H. Whitford, A. P. Griffiths, T. Kotsimbos, T. J. Williams, and G. I. Snell Feasibility and Utility of a Lung Donor Score: Correlation With Early Post-Transplant Outcomes Ann. Thorac. Surg., January 1, 2007; 83(1): 257 - 263. [Abstract] [Full Text] [PDF]

				T. Oto, A. P. Griffiths, B. J. Levvey, T. J. Williams, and G. I. Snell Unilateral radiographic abnormalities after bilateral lung transplantation: Exclusion from the definition of primary graft dysfunction? J. Thorac. Cardiovasc. Surg., December 1, 2006; 132(6): 1441 - 1446. [Abstract] [Full Text] [PDF]

				T. Oto, A. P. Griffiths, F. Rosenfeldt, B. J. Levvey, T. J. Williams, and G. I. Snell Early Outcomes Comparing Perfadex, Euro-Collins, and Papworth Solutions in Lung Transplantation Ann. Thorac. Surg., November 1, 2006; 82(5): 1842 - 1848. [Abstract] [Full Text] [PDF]

				T. Oto, A. P. Griffiths, B. J. Levvey, D. V. Pilcher, T. J. Williams, and G. I. Snell Definitions of primary graft dysfunction after lung transplantation: Differences between bilateral and single lung transplantation J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 140 - 147. [Abstract] [Full Text] [PDF]

				O. Ashraf Unexpected pulmonary embolism in lung transplantation: Diagnosis and prospects J. Thorac. Cardiovasc. Surg., April 1, 2006; 131(4): 930 - 930. [Full Text] [PDF]

				T. Oto, M. Rabinov, J. Negri, S. Marasco, M. Rowland, A. Pick, G. Snell, F. Rosenfeldt, and D. Esmore Techniques of Reconstruction for Inadequate Donor Left Atrial Cuff in Lung Transplantation Ann. Thorac. Surg., April 1, 2006; 81(4): 1199 - 1204. [Abstract] [Full Text] [PDF]

				T. Oto and G. I. Snell Reply to the Editor J. Thorac. Cardiovasc. Surg., April 1, 2006; 131(4): 930 - 931. [Full Text] [PDF]