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J Thorac Cardiovasc Surg 2006;131:930
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Unexpected pulmonary embolism in lung transplantation: Diagnosis and prospects

Aga Khan University, Punjab, Pakistan

To the Editor:

I read with interest the article by Oto and colleagues, wherein they study and reflect upon the role of unexpected pulmonary embolism in lung transplantation. ¹ The authors have employed exploratory flush as a diagnostic tool for identification of emboli and quote it as the only diagnostic tool capable for identification of emboli in the subsegmental pulmonary vasculature. ¹ The procedure is invasive and can only be undertaken after the lungs have been procured from a donor. In other words, there has already been a certain consumption of time and resources before exploratory flush is carried out to indicate whether the donor lungs are suitable for the recipient. In contrast, multirow helical computed tomography is now widely accepted as a safe, noninvasive, and accurate tool for identification of emboli to the subsegmental pulmonary vasculature. ² The procedure can identify donors before they are selected for prospective donation of their lungs and thus save considerable amount of time and resources. This is of particular relevance, considering that exploratory flush showed no therapeutic benefit and was only indicated as a diagnostic tool. ¹

The authors propose that donors with risk factors for unexpected pulmonary embolism should be demarcated as marginal donors. ¹ However, trials have established that liberalization of donor criteria (with incorporation of donors having risk factors including those mentioned in this report) has no adverse outcomes of significance and leads merely to expansion of the donor pool and overcoming of shortage of donor lungs. ^3-5

	References

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1. Oto T, Rabinov M, Griffiths AP, Whitford H, Levvey BJ, Esmore DS, et al. Unexpected donor pulmonary embolism affects early outcomes after lung transplantation. a major mechanism of primary graft failure?. J Thorac Cardiovasc Surg. 2005;130:1446.[Abstract/Free Full Text]
   
2. Patel S, Kazerooni EA. Helical CT for the evaluation of acute pulmonary embolism. AJR Am J Roentgenol. 2005;85:135-149.
   
3. Bhorade SM, Vigneswaran W, McCabe MA, Garrity ER. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transplant. 2000;19:1199-1204.[Medline]
   
4. Lardinois D, Banysch M, Korom S, Hillinger S, Rousson V, Boehler A, et al. Extended donor lungs. eleven years experience in a consecutive series. Eur J Cardiothorac Surg. 2005;27:762-767.[Abstract/Free Full Text]
   
5. Sundaresan S, Semenkovich J, Ochoa L, Richardson G, Trulock EP, Cooper JD, et al. Successful outcome of lung transplantation is not compromised by the use of marginal donor lungs. J Thorac Cardiovasc Surg. 1995;109:1075-1079; discussion 1079-80.[Abstract/Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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): Omer Ashraf Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ashraf, O. Search for Related Content PubMed PubMed Citation Articles by Ashraf, O. Related Collections Lung - transplantation Related Article