Brain death triggers a systemic inflammatory response. Whether systemic inflammation is different in lung donors after brain- (DBD) or circulatory-death (DCD) is unknown, but this may potentially increase the incidence of primary graft dysfunction (PGD) after lung transplantation. We compared the plasma levels of interleukin (IL)-6, IL-8, IL-10 and TNF-α in BDB and DCD and their respective recipients, as well as their relationship with PGD and mortality after LT. A prospective, observational, multicenter, comparative, cohort-nested study that included 40 DBD and 40 DCD lung donors matched and their respective recipients. Relevant clinical information and blood samples were collected before/during lung retrieval in donors and before/during/after (24, 48 and 72 h) LT in recipients. Incidence of PGD and short-term mortality after LT was recorded. Plasma levels of all determined cytokines were numerically higher in DBD than in DCD donors and reached statistical significance for IL-6, IL-10 and IL-8. In recipients with PGD the donor’s plasma levels of TNF-α were higher. The post-operative mortality rate was very low and similar in both groups. DBD is associated with higher systemic inflammation than DCD donors, and higher TNF-α plasma levels in donors are associated with a higher incidence of PGD.

Introduction: The robotic-assisted (RATS) lobectomy learning curve is usually measured compared to an established videothoracoscopic (VATS) surgery program. The objective of our study is to compare the learning curves of both techniques. Methods: We performed an intention-to-treat analysis comparing the RATS vs. VATS lobectomies. Surgical time, conversions, complications, number of lymph nodes (LNs) and lymph node stations harvested, chest drainage duration, length of stay, readmissions, and 90-day mortality were compared between both groups. The learning curve was assessed using the CUSUM method. Results: RATS cases (30) and VATS cases (35) displayed no significant differences. The RATS learning curve was completed after 23 procedures while the VATS curve required 28 interventions. Complications appeared in four RATS procedures and in eight VATS patients. No differences in the number of LNs and harvested LN stations were reported. Four patients were readmitted in the RATS group, and eight in the VATS group. No 90-day postoperative mortality was observed in either group. The RATS group reported fewer chest tube days (3 (2–5) vs. 5 (4–5.8), p = 0.005) and hospital days (4 (3–6) vs. 5 (4–6), p = 0.023). Conclusions: The RATS curve appears shorter than the VATS curve. RATS lobectomies resulted in reduced chest tube duration and length of stay during the learning time period.

Uncontrolled donation after circulatory death (uDCD) represents a promising yet underutilized approach to expanding the lung donor pool amid persistent organ shortages. Since the first successful lung transplantation from a uDCD donor in 2001, increasing clinical experience and advancements in organ preservation have demonstrated its feasibility. This review critically explores historical evolution, physiological basis, preservation techniques, ethical and legal considerations, and clinical outcomes of uDCD lung transplantation. The lung's unique ability to maintain viability through passive oxygen diffusion in the absence of perfusion supports its potential in the uDCD context. Compared to donors after brain death (DBD), uDCD donors may avoid systemic inflammatory response, potentially preserving graft quality. However, concerns persist regarding ischemia-reperfusion injury and mitochondrial dysfunction, highlighting the need for mitigation strategies such as ex vivo lung perfusion and normothermic ventilation. Ethical and legal challenges—particularly those related to the determination of death and consent—remain key obstacles. Organizational demands, including rapid coordination between prehospital, hospital teams and transplant teams, further limit broader implementation. Despite these barriers, reported outcomes are encouraging: to date, over 70 transplants from uDCD donors have been documented, with 1-year survival rates ranging from 71% to 87.5% and long-term outcomes comparable to DBD transplants. Integration of uDCD into routine clinical practice will require standardized protocols, robust public engagement, and institutional commitment. When appropriately implemented, uDCD lung transplantation offers a viable opportunity to increase donor availability and improve access to life-saving treatment.

The pulmonary microbiome has emerged as a significant factor in respiratory health and diseases. Despite the sterile conditions maintained during ex vivo lung perfusion (EVLP), the use of antibiotics in the perfuse liquid can lead to dynamic changes in the lung microbiome. Here, we present the design of a study that aims to investigate the hypothesis that EVLP alters the lung microbiome and induces tissue inflammation. This pilot, prospective, controlled study will be conducted in two Spanish donor centers and will include seven organ donors after brain death or after controlled cardiac death. After standardized retrieval, the left lung will be preserved in cold storage and the right lung will be perfused with EVLP. Samples from bronchoalveolar lavage, perfusion and preservation solutions, and lung biopsies will be collected from both lungs and changes in lung microbiome and inflammatory response will be compared.

This clinical case shows the repercussions of acute exposure to cement dust in the respiratory tract and other mucous membranes. Following a cement dust pipe explosion, the patient endured a severe inhalation of dust. A combination of rigid bronchoscopy and a mechanical insufflation–exsufflation system was employed to remove cement debris from the airways. Respiratory physiotherapy sessions were implemented for effective secretion clearance, contributing to a successful short-term recovery. While this remains an isolated case, the unconventional techniques employed provide valuable insights for potential similar scenarios in the future.

Background: Hematological indices such as the neutrophil-lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and systemic immune inflammation index (SII) have been proposed as markers of inflammatory disease and prognostic indicators in some tumors, but their role remains controversial. This study aims to evaluate the relationship between these indices and postoperative complications in patients undergoing robotic-assisted anatomic lung resection for oncological purposes. Methods: This retrospective, single-center study included patients who underwent anatomical lung resection from January 2022 to June 2023 using robotic-assisted surgery. The data collected included hematological variables, demographic information, body mass index (BMI) data, information about pulmonary function, medical history, postoperative outcomes, and survival data. Results: A total of 96 patients were included, with a median BMI of 26.10. The data distribution across demographic and clinical variables was homogeneous. Univariate and multivariate analyses revealed no significant association between preoperative or postoperative inflammatory indices and postoperative complications, persistent air leak (PAL), or 1-year mortality. Conclusions: This small, retrospective study with short-term follow-up found no significant relationship between inflammatory indices and postoperative outcomes. These findings suggest that SII and similar indices are not reliable predictors of complications, PAL, or mortality in patients undergoing robotic-assisted anatomic lung resection.