Innovations in Lung Transplant Research and Practice: The Future is Now

Transplant International, Journal Year: 2025, Volume and Issue: 38

Published: Feb. 4, 2025

Recent advancements in transplantation research and practice have focused on expanding the donor pool, developing novel biomarkers diagnostic tools, exploring innovative treatment opportunities. These efforts aim to address persistent shortage of organs improve longterm outcomes for transplant recipients.With coming age artificial intelligence (AI) 21st Century, it is expected that next decade medical -and its clinical implications -will exponentially lead new discoveries, deepened insights, better management logistical processes disease mechanisms involved transplantation. However, surprisingly none papers included our special issue Transplant International "Lung 21 st Century: care improved outcomes" implemented use AI methodologies their research. It nevertheless 'old-school' approach performing scientific be replaced by practices incorporating tools analyze, visualize, summarize, present findings. Is this a bad evolution? Probably hopefully -not, as proper may help galvanize big data complex findings into more efficient flows, diagnostics, therapies, personalized options field transplantation.The authors current editorial therefore opted freely available tool (Perplexity AI, Inc., San Francisco, USA) synthesize information regarding sixteen which were International. The reporting demonstrates potential efficiently aggregate distill information, potentially accelerating dissemination knowledge rapidly evolving fields like medicine. crucial note AI-generated summaries should reviewed validated subject matter experts ensure accuracy contextual relevance. Post-generation, summary was manually checked edited authors.Considerable progress has been made organ preservation techniques, moving beyond traditional static cold storage. Hoetzenecker et al. introduced concept semi-elective lung using prolonged storage at 10°C, geographical range allocation. (1) highlight method allows ischemic times, up 24 hours, without compromising function or short-term outcomes. This technique through large animal experiments multi-center observational study. 10°C temperature shown cause less mitochondrial damage compared ice methods. development could transform logistics, enabling procedures improving sharing between distant regions.Cenik principles controlled hypothermic (CHS) (2) CHS temperatures higher than storage, typically around 10°C. Animal showed superior physiology after ≤4°C. Molecular analyses revealed protection health levels antioxidative metabolites with CHS. While initial are promising suggest need withdrawal from conventional ice-based method, further needed draw robust conclusions about safety efficacy transplantation.These studies techniques increase number viable soon. 3) Their split-lung EVLP model simultaneous perfusion ventilation two single lungs same donor. offers several advantages: i) provides cost-effective reliable platform testing therapeutic interventions human lungs, ii) one receive an intervention while other serves control, eliminating inter-donor variation, iii) facilitates continuous monitoring hemodynamic airway parameters, well blood gas, perfusate, tissue sampling, iv) pulmonary edema can assessed directly ultrasound indirectly wet:dry ratio measurements, v) enables researchers evaluate efficiently, increasing transplantable organs.This accelerate reconditioning strategies.of death (cDCD) abdominal normothermic regional (A-NRP). ( 4) update cDCD donation, highlighting alleviate lungs. They describe Maastricht classification DCD donors emphasize most accepted type donation. paper includes step-by-step protocol procurement A-NRP, critical achieving high retrieval rates. also discuss selection criteria importance adequate intensive unit.This study highlights increased A-NRP expand pool.Sandiumenge systemic inflammation brain dead (DBD) impact recipients. (5) measured plasma cytokines IL-6, IL-8, IL-10, TNF-α 40 DBD Results significantly IL-8 donors. Higher associated incidence primary graft dysfunction (PGD) recipients.The DCD, correlate PGD incidence, results allow tailored antiinflammatory treatments attenuate PGD, patient outcomes.Shudo evaluated revised United Network Organ Sharing heart allocation policy October 2018 en-bloc heart-lung (6) analyzed adult patients registered transplants before change. rates, shorter waitlist reduced mortality post-policy period. Despite higher-risk recipients post-period, survival rates remained similar change.The access allografts post-transplant outcome. digital droplet PCR-detected cfDNA biomarker predicting CLAD differentiating rejection infection low-grade acute cellular (ACR) not always correspond molecular TCMR, indicating diagnosis identify who would benefit anti-rejection therapy.and PECAM-1 ACR (10) observed significant PD-L1 expression within group, suggesting attempt suppress immune responses. elevated cases ACR. indicate both serve valuable markers diagnosing recipients.This contribute accurate identifying transplantation, outcomes.Vaiter investigated effects lower doses unfractionated heparin (UFH) intraoperative extracorporeal membrane oxygenation (ECMO) anticoagulation. (11) 109 underwent central VA ECMO support 2020 20223. found UFH led derivative consumption loss thrombotic complications. suggests decrease surgical revision hemothorax.The anticoagulation during might reduce complications mitigating risk factors, managing CSAI recipients.Palleschi relationship diaphragm transplantation.(13) how factors including underlying respiratory diseases comorbidities, diaphragmatic function. procedure itself trauma diaphragm, leading morphological functional alterations. Conversely, influences aspects graftto-chest cavity size matching long-term postoperative performance.The review emphasizes careful dissection avoid phrenic nerve but lack standard evaluating hinders assessment outcomes.Sempere absorption inhaled tobramycin (14) conducted retrospective analysis treated least 3 days. indications bronchial aspirate bacterial isolation (18 patients) tracheobronchitis (15 patients). Key include: 82% had detectable serum levels, 26% showing (>2 μg/mL), developed kidney injury treatment, invasively mechanically ventilated median trough non-ventilated individuals.The concludes administration recipients, especially those invasive mechanical ventilation, result substantial absorption, important consider early phase.Jin donor-specific transfusion (DSBT) strategy inducing immunological tolerance (15). DSBT involves infusing fresh whole recipient aiming acceptance induce tolerance. summarizes existing solid transplants, preclinical settings. explores associations regulatory T cells, mononuclear phagocytic cell modulation, microchimerism. benefits risks offering insights future directions.The approach, if successful, immunosuppression these offer perspectives facing challenging complication.While explicitly covered provided papers, stem regenerative medicine xenotransplant approaches represent avenues ways repair replace damaged organs.In conclusion, recent advances demonstrate multifaceted addressing challenges outcomes, developments preservation, discovery, immunomodulation strategies. Also, immense demonstrated herein. Moreover, incorporation methods radically shape Century (lung) medicine, already evidenced steep publications since 2020. (17) Hence, years truly turning (pre-)clinical patients. So, let begin!

Language: Английский

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Lung rehabilitation using xenogeneic cross-circulation does not lead to hyperacute rejection in a human lung transplantation model

The Journal of Heart and Lung Transplantation, Journal Year: 2025, Volume and Issue: unknown

Published: March 1, 2025

Access to life-saving lung transplantation remains limited by a shortage of donor organs. We have previously described rehabilitation discarded human lungs quality suitable for using cross-circulation whole blood between xeno-support swine and lungs. However, the immunologic implications transplanting rehabilitated remain unknown. Human declined clinical (N=5) underwent xenogeneic up 12 hours. To model subsequent transplantation, were re-exposed autologous via normothermic ex vivo machine perfusion six Upon re-exposure, evaluated evidence hyperacute rejection through physiologic assessments tissue analyses including histology, immunostaining, flow cytometry. showed no significant change in function relative end (PaO2/FiO2: P=0.41; vascular resistance: P=0.27; dynamic compliance: P=0.24) histologic features absent all Despite pulmonary deposition porcine IgG during cross-circulation, re-exposure resulted decreased complement (P=0.019) with membrane attack complex formation (P=0.65) or apoptotic signaling (P=0.93). Endothelial integrity was maintained after preservation microvascular tight junctions, decreasing endothelial injury marker P-selectin (P=0.34), intact response alpha adrenergic stimulation. Our findings indicate that transient exposure does not result upon simulated representing an important step towards translation this organ platform.

Language: Английский

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New Techniques for the Optimization of Donor Lungs/Hearts

Anesthesiology Clinics, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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International Experience of Donation After Circulatory Death for Lung Transplantation. A Special Report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation

The Journal of Heart and Lung Transplantation, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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