Histopathologic and radiologic assessment of nontransplanted donor lungs
Histopathologic and radiologic assessment of nontransplanted donor lungs
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非移植供体肺的组织病理学和放射学评估
DOI：
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发表时间：
2020
影响因子：
8.8
通讯作者：
S. Verleden
中科院分区：
文献类型：
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作者：
A. Vanstapel;A. Dubbeldam;B. Weynand;E. Verbeken;R. Vos;A. Neyrinck;D. Vasilescu;L. Ceulemans;A. Frick;D. Van raemdonck;J. Verschakelen;B. Vanaudenaerde;G. Verleden;S. Verleden
捐赠器官短缺导致大量等待名单上的死亡。供体肺评估目前基于供体的病史、气体交换、胸部X线、支气管镜检查结果，最终是原位检查，但仍然是主观的。我们将非移植供体肺的组织病理学和放射学与拒绝提供器官的临床指征相关联。对62个未用于移植的供体肺（2010 - 2019年）进行了采购、充气、冷冻、计算机断层扫描、系统采样以及组织学和放射学评估。39个（63%）肺因同种异体移植相关原因而拒绝。在13/39（33%）个肺中，组织学无法证实下降的原因，在另外8/39（21%）个肺中，组织学异常仅被认为是轻度的。在16/39（41%）例肺部中，放射学无法确认下降的原因。23个（37%）供体肺由于肺外原因未移植，其中3个（13%）肺显示重度组织学异常（肺炎，n = 2;肺气肿，n = 1），9个（39%）肺显示轻度肺气肿，1个（4%）肺显示轻度支气管扩张。放射学检查显示，8/23（35%）例肺部存在磨玻璃样阴影，4/23（17%）例肺部存在肺气肿。非移植供体肺的组织学和放射学评估显示与临床下降原因存在实质性差异。优化供体肺评估对于提高当前器官接受率是必要的。
Donor organ shortage results in significant waiting list mortality. Donor lung assessment is currently based on donors’ history, gas exchange, chest X‐ray, bronchoscopy findings, and ultimately in situ inspection but remains subjective. We correlated histopathology and radiology in nontransplanted donor lungs with the clinical indications to decline the offered organ. Sixty‐two donor lungs, not used for transplantation (2010‐2019), were procured, air‐inflated, frozen, scanned with computed tomography, systematically sampled, and histologically and radiologically assessed. Thirty‐nine (63%) lungs were declined for allograft‐related reasons. In 13/39 (33%) lungs, histology could not confirm the reason for decline, in an additional 8/39 (21%) lungs, histologic abnormalities were only considered mild. In 16/39 (41%) lungs, radiology could not confirm the reason for decline. Twenty‐three (37%) donor lungs were not transplanted due to extrapulmonary causes, of which three (13%) lungs displayed severe histologic abnormalities (pneumonia, n = 2; emphysema, n = 1), in addition to mild emphysema in 9 (39%) lungs and minor bronchopneumonia in 1 (4%). Radiology revealed ground‐glass opacities in 8/23 (35%) and emphysema in 4/23 (17%) lungs. Histopathologic and radiologic assessment of nontransplanted donor lungs revealed substantial discrepancy with the clinical reason for decline. Optimization of donor lung assessment is necessary to improve current organ acceptance rates.