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Bertolotti, A; Gomez , B; Absi, D; Osses, J; Caneva, J; Ahumada, R; Wagner, G; Favaloro, RR.

Brain Death Lung Donors Procurement And Prediction Of Primary Graft Dysfunction ISHLT Grade 3 After Lung Transplantation In Argentina. Bertolotti, A; Gomez , B; Absi, D; Osses, J; Caneva, J; Ahumada, R; Wagner, G; Favaloro, RR. Favaloro Foundation University Hospital, Buenos Aires, Argentina.

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Bertolotti, A; Gomez , B; Absi, D; Osses, J; Caneva, J; Ahumada, R; Wagner, G; Favaloro, RR.

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  1. Brain Death Lung Donors Procurement And Prediction Of Primary Graft Dysfunction ISHLT Grade 3 After Lung Transplantation In Argentina Bertolotti, A; Gomez , B; Absi, D; Osses, J; Caneva, J; Ahumada, R; Wagner, G; Favaloro, RR. Favaloro Foundation University Hospital, Buenos Aires, Argentina

  2. Report of the ISHLT Working Group on Primary Graft Dysfunction (2005)

  3. Grading of Severity for PGD Classification according to different time-points • T-zero (T0): Defined as within 6 hours of final lung reperfusion. • T24, T48 and T72:Times will be measured after T0±6 hours

  4. Clinical Markers • Biological Markers • Lung Preservation • Methods of Preservation • Temperature and Volume of Preservation Solution • Inflation or Ventilation • Storage Temperature • Oxygenation • Preservation Solution • Retrograde Flush • Ischemic Time J Heart Lung Transplant 2005;24:1460–67

  5. Objectives: • To analyze characteristics and maintenance of brain death lung donors (BDLD) and their relationship with the development of postoperative primary graft dysfunction ISHLT grade 3 (PGD3) at a single center in Argentina

  6. Methods • Since 2007 the ISHLT grading system was adopted and data were collected prospectively at a single institution in Argentina. • Retrospective / Single Institution: January 2007 to June 2011 • Lung Transplant Recipients: 81 lung transplants were performed in 77 recipients

  7. Methods • Incidence and Clasification of Primary Graft Disfunction: • Grade 0 to 3 (T0-72) • Univariate analysis to identify potential predictors of PGD 3 at T zero (t student; Wilcoxon Mann Whitney; Chi square or Pearson) • Pre-harvest BDLD maintenance and demographic variables were analysed • In-hospital mortality

  8. Indications for Transplantation 81 Transplants on 77 Recipients

  9. Population

  10. Population • Lung Donor Managment at Harvesting Procedure: • Bronchoscopy • Albumin iv 500 mg + Metilprednisolone bolus • Antegrade and retrograde flush of preservation solution (60 ml/kg) Implant Procedure:

  11. Results Brain Death Lung Donors: General Characteristics

  12. Results BDL Donors: Respiratory Parameters

  13. Results: BDL Donors: Hemodynamic Parameters During Maintenance

  14. Incidence of PGD T0 to T72 (ISHLT Grading System) (81 transplant/77 patients) Nº of transplants PGD Grade 18% 25% 17% 40% Results

  15. Results In-hospital Mortality: PGD 3 (T0)vs. PGD < 3 (T0) 53% p<0,005 17%

  16. Results: Prediction of PGD 3 T0: Univariate Analysis

  17. Discussion:Limits of the stydy • Retrospective analysis in a small population • There is a bias on donor selection ( most of them were “optimal donors”) • The findings in the univariate analysis of PGD prediction ( hypotension, cardiac arrest and CPR) failed in a multivariate analysis.

  18. Conclusions • BDLD characteristics and maintenance of cadaveric donors didn’t show a relationship with the development of PGD3 in this cohort of patients • PGD 3 T0 is related to a high early mortality and is mandatory to identified predictors to avoid or diminish its incidence.

  19. Thank you for your attention…

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