Int J Angiol
DOI: 10.1055/s-0044-1782536
Review Article

Pulmonary Embolism in Donor Lungs—Incidence and Management

1   Department of Surgery, The University of Texas Medical Branch, Galveston, Texas
,
2   Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations

Abstract

In efforts to decrease the mortality on the waiting list for lung transplantation, alternatives to increase the donor pool have been explored. Caution must be used when accepting donor lungs with pulmonary embolism (PE), as prior evidence has shown mixed results after transplantation of donor lungs with PE. However, the mere diagnosis of PE on imaging should not be the sole reason for the exclusion of these donors for transplant, and they should be reviewed as any other donor. A comprehensive evaluation should be performed for every donor, with a special focus on abnormalities of gas exchange and gross pathologic characteristics during procurement.



Publication History

Article published online:
15 March 2024

© 2024. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 McCurry KR. Brief overview of lung, heart, and heart-lung transplantation. Crit Care Clin 2019; 35 (01) 1-9
  • 2 Valapour M, Lehr CJ, Skeans MA. et al. OPTN/SRTR 2016 Annual Data Report: lung. Am J Transplant 2018; 18 (Suppl. 01) 363-433
  • 3 Egan TM, Murray S, Bustami RT. et al. Development of the new lung allocation system in the United States. Am J Transplant 2006; 6 (5 Pt 2): 1212-1227
  • 4 Valapour M, Lehr CJ, Wey A, Skeans MA, Miller J, Lease ED. Expected effect of the lung composite allocation score system on US lung transplantation. Am J Transplant 2022; 22 (12) 2971-2980
  • 5 Kahan ES, Petersen G, Gaughan JP, Criner GJ. High incidence of venous thromboembolic events in lung transplant recipients. J Heart Lung Transplant 2007; 26 (04) 339-344
  • 6 Ribeiro Neto ML, Budev M, Culver DA. et al. Venous thromboembolism after adult lung transplantation: a frequent event associated with lower survival. Transplantation 2018; 102 (04) 681-687
  • 7 Zheng M, Yousef I, Mamary AJ. et al. Venous thromboembolism in lung transplant recipients real world experience from a high volume center. J Heart Lung Transplant 2021; 40 (10) 1145-1152
  • 8 Lisman T, Leuvenink HGD, Porte RJ, Ploeg RJ. Activation of hemostasis in brain dead organ donors: an observational study. J Thromb Haemost 2011; 9 (10) 1959-1965
  • 9 Steen S, Sjöberg T, Pierre L, Liao Q, Eriksson L, Algotsson L. Transplantation of lungs from a non-heart-beating donor. Lancet 2001; 357 (9259): 825-829
  • 10 Barr ML, Baker CJ, Schenkel FA. et al. Living donor lung transplantation: selection, technique, and outcome. Transplant Proc 2001; 33 (7-8): 3527-3532
  • 11 Waller DA, Bennett MK, Corris PA, Dark JH. Donor-acquired fat embolism causing primary organ failure after lung transplantation. Ann Thorac Surg 1995; 59 (06) 1565-1566
  • 12 Glorion M, Sarsam M, de Wolf J, Sage E. Successful management of donor-acquired fat embolism after lung transplantation. Interact Cardiovasc Thorac Surg 2021; 33 (01) 158-160
  • 13 Jacob S, Courtwright A, El-Chemaly S. et al. Donor-acquired fat embolism syndrome after lung transplantation. Eur J Cardiothorac Surg 2016; 49 (05) 1344-1347
  • 14 López-Sánchez M, Alvarez-Antoñán C, Arce-Mateos FP, Gómez-Román J, Quesada-Suescun A, Zurbano-Goñi F. Single lung transplantation and fatal fat embolism acquired from the donor: management and literature review. Clin Transplant 2010; 24 (01) 133-138
  • 15 Fischer S, Gohrbandt B, Meyer A, Simon AR, Haverich A, Strüber M. Should lungs from donors with severe acute pulmonary embolism be accepted for transplantation? The Hannover experience. J Thorac Cardiovasc Surg 2003; 126 (05) 1641-1643
  • 16 Shihata M, Ghorpade N, Lien D, Modry D. Ex vivo bilateral pulmonary embolectomy for donor lungs prior to transplantation. Ann Thorac Surg 2008; 85 (06) 2110-2112
  • 17 Sareyyupoglu B, Shigemura N, Toyoda Y. Utilizing donor lungs after thrombolytic therapy and thrombectomy for acute massive pulmonary embolus. J Heart Lung Transplant 2011; 30 (03) 358
  • 18 Shah IK, Merfeld JM, Chun J, Tak T. Pathophysiology and management of pulmonary embolism. Int J Angiol 2022; 31 (03) 143-149
  • 19 Raskob GE, Angchaisuksiri P, Blanco AN. et al; ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Semin Thromb Hemost 2014; 40 (07) 724-735
  • 20 Alotaibi GS, Wu C, Senthilselvan A, McMurtry MS. Secular trends in incidence and mortality of acute venous thromboembolism: the AB-VTE population-based study. Am J Med 2016; 129 (08) 879.e19-879.e25
  • 21 Nagahiro I, Andou A, Aoe M, Sano Y, Date H, Shimizu N. Intermittent pneumatic compression is effective in preventing symptomatic pulmonary embolism after thoracic surgery. Surg Today 2004; 34 (01) 6-10
  • 22 Kroshus TJ, Kshettry VR, Hertz MI, Bolman III RM. Deep venous thrombosis and pulmonary embolism after lung transplantation. J Thorac Cardiovasc Surg 1995; 110 (02) 540-544
  • 23 Kristensen AW, Mortensen J, Berg RMG. Pulmonary thromboembolism as a complication of lung transplantation. Clin Transplant 2017; 31 (04) e12922
  • 24 Burns KEA, Iacono AT. Pulmonary embolism on postmortem examination: an under-recognized complication in lung-transplant recipients?. Transplantation 2004; 77 (05) 692-698
  • 25 Ware LB, Fang X, Wang Y, Babcock WD, Jones K, Matthay MA. High prevalence of pulmonary arterial thrombi in donor lungs rejected for transplantation. J Heart Lung Transplant 2005; 24 (10) 1650-1656
  • 26 van Belle A, Büller HR, Huisman MV. et al; Christopher Study Investigators. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA 2006; 295 (02) 172-179
  • 27 Kruip MJHA, Leclercq MGL, van der Heul C, Prins MH, Büller HR. Diagnostic strategies for excluding pulmonary embolism in clinical outcome studies. A systematic review. Ann Intern Med 2003; 138 (12) 941-951
  • 28 Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med 2002; 136 (09) 691-700
  • 29 Oto T, Rabinov M, Griffiths AP. 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 (05) 1446
  • 30 Oto T, Excell L, Griffiths AP, Levvey BJ, Snell GI. The implications of pulmonary embolism in a multiorgan donor for subsequent pulmonary, renal, and cardiac transplantation. J Heart Lung Transplant 2008; 27 (01) 78-85
  • 31 Sommer W, Kirschner H, Ius F. et al. Transplantation of donor lungs with pulmonary embolism - a retrospective study. Transpl Int 2019; 32 (06) 658-667
  • 32 Shigemura N, Tane S, Noda K. The bronchial arterial circulation in lung transplantation: bedside to bench to bedside, and beyond. Transplantation 2018; 102 (08) 1240-1249
  • 33 Terada Y, Gauthier JM, Pasque MK. et al. Clinical outcomes of lung transplants from donors with unexpected pulmonary embolism. Ann Thorac Surg 2021; 112 (02) 387-394
  • 34 Pan X, Yang J, Fu S, Zhao H. Application of ex vivo lung perfusion (EVLP) in lung transplantation. J Thorac Dis 2018; 10 (07) 4637-4642
  • 35 Russell C, Keshavamurthy S. Acute massive and submassive pulmonary embolism: historical considerations/surgical techniques of pulmonary embolectomy/novel applications in donor lungs with pulmonary emboli. Int J Angiol 2022; 31 (03) 188-193
  • 36 Brown CR, Brozzi NA, Vakil N, Shafii AE, Murthy SC, Pettersson GB, Mason DP. Donor lungs with pulmonary embolism evaluated with ex vivo lung perfusion. ASAIO J 2012; 58 (04) 432-434
  • 37 Jacob S, Garg P, Ahmed MES, Makey IA. Extending donor criteria: successful lung transplantation post ex vivo back table donor pulmonary artery thrombolysis. J Surg Case Rep 2023; 2023 (06) rjad367
  • 38 Machuca TN, Hsin MK, Ott HC. et al. Injury-specific ex vivo treatment of the donor lung: pulmonary thrombolysis followed by successful lung transplantation. Am J Respir Crit Care Med 2013; 188 (07) 878-880
  • 39 Ayyat KS, Okamoto T, Sakanoue I. et al. Ex-vivo pulmonary artery angioscopy: a novel technique for management of donor lung pulmonary embolism. J Heart Lung Transplant 2022; 41 (04) S255