Abstract
A total of 180 lung transplantations (LTx) were performed at a single center in Saudi Arabia. 92% of our donors were marginal. The criteria of deceased brain dead donors represent unique differences that bring unique challenges. This report highlights the challenges, management strategies and outcomes.
The LTx Program at King Faisal specialist hospital was established in 2000. Over the last 9 years the program has witnessed rapid growth. Retrospective review of 180 patients and their donors that underwent LTx at our center between January 2010 and September 2019.
The most common indication for LTx was pulmonary fibrosis (40%), followed by cystic fibrosis (CF)-related bronchiectasis (24%), non-CF-related bronchiectasis (21%), chronic obstructive pulmonary disease (4%), sarcoidosis (3%), Microtithiasis (3%).Regarding Lung donors (LDs) 92% of our lungs were marginal. 10% age >55 years, 16% PO2 <300 mmhg, 32% abnormal CXR, 22% Purulent secretions on bronchoscopy, 83% Prolonged ventilation more than 5 days with a mean duration of mechanical ventilation (MV) of 9+/-7 (days). Bacterial colonization was noted in 74% of LDs, including multidrug-resistant bacteria such as acinetobacter (31%), klibsiellae (24%) and pseudomonas (12%). Over the last 5 years extracorporeal membrane oxygenation (ECMO), was used in 21.5% of our LTx as a rescue strategy for grade 3 primary graft dysfunction with 30 days survival of 92% and 1 year survival 88%. Ex vivo lung perfusion was used to expand our pool of LDs, 9 successful cases from 20 attempts were performed over the last 5 years. In spite of the liberal utilization of marginal donors and prolonged post lung transplantation mechanical ventilation {Median (range)} 11 (1-145 days), length of ICU stay 14 (3-145) and length of hospital stay 36 (12-168), our 30 days, 90 days, 1 year, 3 years and 5 years survival rates were 94.3%, 89%, 87.5%, 76% and 62.5% respectively which is comparable to the international standards.
Shortage of good donors forced us to use extended criteria to transplant moderate and high risk patients. The selective use of Ex vivo and ECMO helped to achieve comparable results. Marginal donors even with bacterial colonization can be successfully utilized for LTx.