Citations 2
Dynamic associations between adverse events after lung transplantation and allograft ischaemic time
Zhang, Wenxi , Qiu, Tong, Metelmann, Isabella , Rucker, A. Justin , Du, Wenxing , Sef, Davorin , Jiao, Wenjie , Fritz, Ashley V, Sef, Davorin , Fritz, Ashley Virginia
European Journal of Cardio-Thoracic Surgery | December 3, 2024 | Volume: 66 | Issue: 6 | Pages: No page available
Abstract OBJECTIVES The effect of allograft ischaemic time (AIT) on postoperative events after lung transplantation remains unclear. This study aims to assess the feasibility of extending the duration of AIT. METHODS The United Network for Organ Sharing database was queried for adult lung transplantation from 4 May 2005 to 30 June 2020. Patients were divided as per AIT into standard ischaemic time (<6 h) and prolonged ischaemic time (≥6 h) groups using propensity score matching and evaluated on a continuous scale using restricted cubic splines. The primary outcome was overall 1-year and 5-year survival. RESULTS Among 11 438 propensity-matched recipients, standard ischaemic time and prolonged ischaemic time showed no differences in overall 1-year (P = 0.29) or 5-year (P = 0.29) survival. Prolonged ischaemic time independently predicted early postoperative ventilator support for >48 h (OR = 1.33, 95% CI 1.22–1.44), dialysis (OR = 1.55, 95% CI 1.30–1.84), primary graft dysfunction (PGD; OR = 1.28, 95% CI 1.09–1.50), acute rejection (OR = 1.42, 95% CI 1.24–1.62), and interestingly, decreased 5-year bronchiolitis obliterans syndrome (HR = 0.91, 95% CI 0.85–0.97). In relative risk curves, 1-year mortality, prolonged ventilation, dialysis and PGD steadily increased per hour as AIT extended. The risk of acute rejection and 5-year bronchiolitis obliterans syndrome also showed significant changes between 5 and 8 h of AIT. In contrast, 5-year mortality remained constant despite rising AIT. CONCLUSIONS Prolonged AIT worsened early outcomes such as PGD, but improved bronchiolitis obliterans syndrome freedom at later time points. Despite this, both short- and long-term survival were similar between prolonged ischaemic time and standard ischaemic time patients. Dynamic risk changes in post-transplant events should be noted for prolonged ischaemia lung use.
Pig-to-human lung xenotransplantation in a brain-dead human recipient
Liu, Xiaoyou , Peng, Guilin, Shi, Jiang , Ju, Chunrong, He, Ping , Liu, Xiaoqing , Zhang, Zuopen, Chen, Chuanbao, Pan, Dengke, Yang, Zifeng , Guan, Wenda, 陈, 中华克劳斯, Liu, Menyang, Liang, Hengrui , Zhao, Yi , Huang, Weiqing , Rucker, A. Justin , Xu, Xin , He, Jianxing , Yang, Chao , Liu, Hui, Liu, Xiaoqing, Zhang, Zuopeng , Pan, Dengke , Yang, Zifeng , Guang, Wenda, Li, Hongtao , Chen, Zhonghua, Liang, Hengrui , Jeon, Kyeongman , Chen-Yoshikawa, Toyofumi Fengshi , Lal, Amos, Zhang, Kang , Zhang, Kang , Liu, Xiaoyou , Xu, Xin
No container title available | November 10, 2024 | Volume: No volume available | Issue: No issue available | Pages: No page available
Abstract This study reports the first pig-to-human lung xenotransplantation using a six gene-edited pig lung. A left lung from a gene-edited Chinese Bama Xiang pig was transplanted into a 39-year-old brain-dead human recipient. The xenograft maintained viability and functionality for 216 hours without signs of hyperacute rejection. Postoperatively, severe edema resembling primary graft dysfunction (PGD) was observed, potentially due to ischemia-reperfusion injury. Antibody-mediated rejection appeared to contribute to xenograft damage on postoperative days 3 and 6, with partial recovery by day 9 under the current immunosuppressive regimen. This pioneering study suggests that genetically modified pig lungs could potentially be used for future clinical applications in xenotransplantation.