Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation

Author:

Hirdman Gabriel,Niroomand Anna,Olm Franziska,Lindstedt SandraORCID

Abstract

Abstract Purpose of Review This article reviews controversial questions within the field of lung transplantation, with a focus on data generated within the last 3 years. We aim to summarize differing opinions on a selection of topics, including bridge-to-transplantation, intraoperative machine circulatory support, bronchial anastomosis, size mismatch, delayed chest closure, and ex vivo lung perfusion. Recent Findings With the growing rate of lung transplantations worldwide and increasing numbers of patients placed on waiting lists, the importance of determining best practices has only increased in recent years. Factors which promote successful outcomes have been identified across all the topics, with certain approaches promoted, such as ambulation in bridge-to-transplant and widespread intraoperative ECMO as machine support. Summary While great strides have been made in the operative procedures involved in lung transplantation, there are still key questions to be answered. The consensus which can be reached will be instrumental in further improving outcomes in recipients.

Funder

Lund University

Publisher

Springer Science and Business Media LLC

Subject

Transplantation,Nephrology,Hepatology,Immunology,Surgery

Reference86 articles.

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2. Valapour M, Lehr CJ, Skeans MA, Smith JM, Miller E, Goff R, et al. OPTN/SRTR 2019 annual data report: lung. Am J Transplant. 2021;21(Suppl 2):441–520. https://doi.org/10.1111/ajt.16495.

3. Tipograf Y, Salna M, Minko E, Grogan EL, Agerstrand C, Sonett J, et al. Outcomes of extracorporeal membrane oxygenation as a bridge to lung transplantation. Ann Thorac Surg. 2019;107(5):1456–63. https://doi.org/10.1016/j.athoracsur.2019.01.032. This is a large singe center study showing no significant differences in survival between BTT and matched non-BTT patients.

4. Benazzo A, Schwarz S, Frommlet F, Schweiger T, Jaksch P, Schellongowski P, et al. Twenty-year experience with extracorporeal life support as bridge to lung transplantation. J Thorac Cardiovasc Surg. 2019;157(6):2515–25 e10. https://doi.org/10.1016/j.jtcvs.2019.02.048. This study, examining 20 years of BTT, found significant improvements in survival over time attributable to increased experience, standardisation of protocols and technical improvements.

5. Langer F, Aliyev P, Schafers HJ, Trudzinski FC, Seiler F, Bals R, et al. Improving outcomes in bridge-to-transplant: extended extracorporeal membrane oxygenation support to obtain optimal donor lungs for marginal recipients. ASAIO J. 2019;65(5):516–21. https://doi.org/10.1097/MAT.0000000000000843. This study found that a bridging time of less than 30 days was crucial for success in survival.

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