The Journal of Thoracic and Cardiovascular Surgery

Transcription

1 Accepted Manuscript A First Start for Lung Transplantation? Jonathan D Cunha, MD, PhD PII: S (18) DOI: /j.jtcvs Reference: YMTC To appear in: The Journal of Thoracic and Cardiovascular Surgery Received Date: 26 August 2018 Accepted Date: 27 August 2018 Please cite this article as: D Cunha J, A First Start for Lung Transplantation?, The Journal of Thoracic and Cardiovascular Surgery (2018), doi: /j.jtcvs This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

2 A First Start for Lung Transplantation? Jonathan D Cunha, MD, PhD Division of Lung Transplantation and Lung Failure, Department of Cardiothoracic Surgery; University of Pittsburgh Medical Center; Pittsburgh, PA The author has no conflicts of interest to disclose. Corresponding Author: Jonathan D'Cunha, MD, PhD Department of Cardiothoracic Surgery University of Pittsburgh Medical Center UPMC Presbyterian Suite C Lothrop St. Pittsburgh, PA Tel: (412) FAX: (412) dcunhaj@upmc.edu

3 They told me there wasn t enough blood available. You cannot be serious. I said calmly. A donor was available for a recipient with a 20 year old inpatient with pulmonary fibrosis and short telomere syndrome who had associated dyskeratosis congenita and myelodysplastic syndrome. He was a re-operative chest due to previous right middle lobectomy. He was listed for lung/bone marrow transplant through a clinical protocol where we do the lung transplant first and 3 months later the bone marrow transplant occurs. With his bone marrow dysfunction a known substantial co-morbidity, platelet counts were in the range of 10,000 and his white blood cell count was supported with Filgrastim. The patient had waited for a long time for this bone marrow match and so we could not pass this opportunity up as he was on 25 L oxygen via nasal cannula and progressively declining. We needed time to coordinate. The donor OR was ready and they tried to accommodate as much as possible, but we were not ready in Pittsburgh. This recipient also needed a bone marrow match and this was literally his one chance as he had entertained many offers to date that had no good HLA matches in donors with good lungs. We went out to get the lungs, harvested them, and brought them back to Pittsburgh. They were placed on EVLP at a point where we were ready to move forward with the recipient and his blood products were now available. We also now had our daytime team for a what was anticipated to be a significantly complex transplant with a first start. We were able to request one of our best anesthesiologists. The blood bank director was ready to help in the operating room. Lung transplantation is a life-saving procedure for those afflicted by end-stage lung disease. The field has enjoyed tremendous growth and excitement in the past several

4 years. The implementation of ex vivo lung transplantation (EVLP) has opened the door to a new era in lung transplantation. In the editorial by Cypel, Yeung, and Keshavjee, they introduce the concept of the semi-elective lung transplantation using ex vivo (1). This is a timely article highlighting important preclinical and clinical developments in how we manage the practice of lung transplantation from day to day. In addition to highlighting important areas of investigation into ischemic times, the authors define nomenclature of the various phases of the transplant such that all can use universal definitions when comparing data and outcomes between centers. EVLP can help prolong donor lung preservation times without adverse effects to recipients and the doors have opened to considering additional therapies to improve quality and function. Originally developed with the vision of increasing the number of organs available for transplant, the evolution of its potential has brought forth numerous downstream enlightenments to the field. Managing logistics from donor evaluation to recipient transplant is just one of these potentially very important multifaceted areas of impact. Our patient got his transplant successfully and now is in the bone marrow transplant phase of his care. A first start for his case with the right team and resources was absolutely critical to success. As Cypel and colleagues point out, we are clearly entering an era where EVLP is a tool to make semi-elective lung transplantation a reality for patients. When applied thoughtfully, the downstream advantages suggest more lungs for more recipients while affording a more advantageous situation for lung transplant programs. As the cost and expertise of such technology is investigated deeper, it is

5 further believed that centralized EVLP centers will help drive all lung transplant centers to serve their patients in a positive way.

6 REFERENCES 1) Cypel et al. Introducing the concept of semi-elective lung transplantation. Journal of Thoracic and Cardiovascular Surgery, 2018; in press.

7