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J Thorac Cardiovasc Surg 2006;131:930-931
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

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

Thank you for the invitation to respond to Dr Ashraf's letter to the editor. The aims of our study were to describe the incidence of unexpected pulmonary embolism (PE) in donor lungs that were accepted for transplantation, to investigate the effect of unexpected PE on early posttransplant outcomes, and to investigate the risk factors for unexpected PE. ¹

Ashraf states that the multidetector row helical computed tomography (MDCT) rather than the exploratory flush should be used to detect PE in donor lungs. In the past several years, computed tomography (CT) technology has evolved, and MDCT specificity to detect PE in small pulmonary arteries has improved. ² However, MDCT is not available in many donor hospitals, and the sensitivity and specificity of CT pulmonary angiography, a possible alternative to MDCT, varies between 53% and 100%, and 78% and 100%, respectively. ² In reality, application of routine use of CT examination, including MDCT, for brain-dead donor evaluation remains too complicated due to logistical and cost issues. In contrast, an exploratory flush to detect PE is simple, safe, and cost-effective. ¹

Donors with risk factors of unexpected PE, including donor death due to trauma with fracture and a smoking history of more than 20 pack-years, could be considered as marginal (extended) donors because a significantly higher incidence of primary graft dysfunction is seen in the recipient after transplant. ^1,3 To distinguish a patient group likely to manifest primary graft dysfunction allows for consideration of further therapeutic strategies (ie, nitric oxide, surfactant therapy, etc). However, for the donors who have risk factors of unexpected PE, the combined use of MDCT with exploratory flush may be useful to increase the accuracy of detection of unexpected PE.

	References

Top References

 

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;130:1446-1452.[Abstract/Free Full Text]
   
2. Patel S, Kazerooni EA. Helical CT for the evaluation of acute pulmonary embolism. AJR Am J Roentgenol. 2005;185:135-149.[Abstract/Free Full Text]
   
3. Oto T, Griffiths AP, Levvey B, Pilcher DV, Whitford H, Kotsimbos TC, et al. A donor history of smoking affects early but not late outcome from lung transplantation. Transplantation. 2004;78:599-606.[Medline]
   

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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Oto, T. Articles by Snell, G. I. Search for Related Content PubMed Articles by Oto, T. Articles by Snell, G. I. Related Collections Lung - transplantation Related Article