751
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Hipertensión pulmonar y trasplante. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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752
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Venkataraman A, Blackwell JW, Funkhouser WK, Birchard KR, Beamer SE, Simmons WT, Randell SH, Egan TM. Beware Cold Agglutinins in Organ Donors! Ex Vivo Lung Perfusion From an Uncontrolled Donation After Circulatory-Determination-of-Death Donor With a Cold Agglutinin: A Case Report. Transplant Proc 2017; 49:1678-1681. [PMID: 28838463 PMCID: PMC6034983 DOI: 10.1016/j.transproceed.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/27/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND We began to recover lungs from uncontrolled donation after circulatory determination of death to assess for transplant suitability by means of ex vivo lung perfusion (EVLP) and computerized tomographic (CT) scan. Our first case had a cold agglutinin with an interesting outcome. CASE REPORT A 60-year-old man collapsed at home and was pronounced dead by Emergency Medical Services personnel. Next-of-kin consented to lung retrieval, and the decedent was ventilated and transported. Lungs were flushed with cold Perfadex, removed, and stored cold. The lungs did not flush well. Medical history revealed a recent hemolytic anemia and a known cold agglutinin. Warm nonventilated ischemia time was 51 minutes. O2-ventilated ischemia time was 141 minutes. Total cold ischemia time was 6.5 hours. At cannulation for EVLP, established clots were retrieved from both pulmonary arteries. At initiation of EVLP with Steen solution, tiny red aggregates were observed initially. With warming, the aggregates disappeared and the perfusate became red. After 1 hour, EVLP was stopped because of florid pulmonary edema. The lungs were cooled to 20°C; tiny red aggregates formed again in the perfusate. Ex vivo CT scan showed areas of pulmonary edema and a pyramidal right middle lobe opacity. Dissection showed multiple pulmonary emboli-the likely cause of death. However, histology showed agglutinated red blood cells in the microvasculature in pre- and post-EVLP biopsies, which may have contributed to inadequate parenchymal preservation. CONCLUSIONS Organ donors with cold agglutinins may not be suitable owing to the impact of hypothermic preservation.
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Affiliation(s)
- A Venkataraman
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - J W Blackwell
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - W K Funkhouser
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - K R Birchard
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - S E Beamer
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - W T Simmons
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - S H Randell
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina
| | - T M Egan
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, North Carolina.
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753
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Harnisch LO, Moerer O. Sequential use of extracorporeal devices to avoid mechanical ventilation in a patient with complicated pulmonary fibrosis. J Artif Organs 2017; 20:365-370. [PMID: 28864998 DOI: 10.1007/s10047-017-0983-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/24/2017] [Indexed: 11/25/2022]
Abstract
Extracorporeal lung assist devices are widely used these days for a growing number of indications. We report the case of a patient managed with three different flow-range devices sequentially, enabling us to avoid mechanical ventilation. Handling and ethics of this approach are discussed.
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Affiliation(s)
- L O Harnisch
- Department of Anaesthesiology, Georg-August University of Goettingen, Robert-Koch-Str. 40, 37099, Goettingen, Germany.
| | - O Moerer
- Department of Anaesthesiology, Georg-August University of Goettingen, Robert-Koch-Str. 40, 37099, Goettingen, Germany
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754
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Schertel A, Funke-Chambour M, Geiser T. [Not Available]. PRAXIS 2017; 106:999-1006. [PMID: 28875747 DOI: 10.1024/1661-8157/a002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Trotz der Verfügbarkeit neuer Antifibrotika, mit denen eine Verlangsamung der Krankheitsprogression erreicht werden kann, bleibt die idiopathische Lungenfibrose eine invalidisierende, progressive Erkrankung mit schlechter Prognose. Mit dem Ziel einer Verbesserung der Lebensqualität und der Vermeidung von Komplikationen werden deshalb neben der antifibrotischen Therapie auch die Behandlung von Komorbiditäten sowie nicht-medikamentöse Therapieansätze eingesetzt, welche im Folgenden vorgestellt werden.
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Affiliation(s)
- Anke Schertel
- 1 Universitätsklinik für Pneumologie, Universitätsspital Inselspital, Universität Bern
| | | | - Thomas Geiser
- 1 Universitätsklinik für Pneumologie, Universitätsspital Inselspital, Universität Bern
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755
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756
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Mizutani RF, Terra-Filho M, Lima E, Freitas CSG, Chate RC, Kairalla RA, Carvalho-Oliveira R, Santos UP. Hard metal lung disease: a case series. J Bras Pneumol 2017; 42:447-452. [PMID: 28117477 PMCID: PMC5344095 DOI: 10.1590/s1806-37562016000000260] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/31/2016] [Indexed: 01/08/2023] Open
Abstract
Objective: To describe diagnostic and treatment aspects of hard metal lung disease (HMLD) and to review the current literature on the topic. Methods: This was a retrospective study based on the medical records of patients treated at the Occupational Respiratory Diseases Clinic of the Instituto do Coração, in the city of São Paulo, Brazil, between 2010 and 2013. Results: Of 320 patients treated during the study period, 5 (1.56%) were diagnosed with HMLD. All of those 5 patients were male (mean age, 42.0 ± 13.6 years; mean duration of exposure to hard metals, 11.4 ± 8.0 years). Occupational histories were taken, after which the patients underwent clinical evaluation, chest HRCT, pulmonary function tests, bronchoscopy, BAL, and lung biopsy. Restrictive lung disease was found in all subjects. The most common chest HRCT finding was ground glass opacities (in 80%). In 4 patients, BALF revealed multinucleated giant cells. In 3 patients, lung biopsy revealed giant cell interstitial pneumonia. One patient was diagnosed with desquamative interstitial pneumonia associated with cellular bronchiolitis, and another was diagnosed with a hypersensitivity pneumonitis pattern. All patients were withdrawn from exposure and treated with corticosteroid. Clinical improvement occurred in 2 patients, whereas the disease progressed in 3. Conclusions: Although HMLD is a rare entity, it should always be included in the differential diagnosis of respiratory dysfunction in workers with a high occupational risk of exposure to hard metal particles. A relevant history (clinical and occupational) accompanied by chest HRCT and BAL findings suggestive of the disease might be sufficient for the diagnosis. Objetivo: Descrever aspectos relacionados ao diagnóstico e tratamento de pacientes com doença pulmonar por metal duro (DPMD) e realizar uma revisão da literatura. Métodos: Estudo retrospectivo dos prontuários médicos de pacientes atendidos no Serviço de Doenças Respiratórias Ocupacionais do Instituto do Coração, localizado na cidade de São Paulo, entre 2010 e 2013. Resultados: Entre 320 pacientes atendidos no período do estudo, 5 (1,56%) foram diagnosticados com DPMD. Todos os pacientes eram do sexo masculino, com média de idade de 42,0 ± 13,6 anos e média de tempo de exposição a metal duro de 11,4 ± 8,0 anos. Os pacientes foram submetidos a avaliação clinica, história ocupacional, TCAR de tórax, prova de função pulmonar, broncoscopia com LBA e biópsia pulmonar. Todos apresentaram distúrbio ventilatório restritivo. O achado de imagem à TCAR de tórax mais frequente foi de opacidades em vidro fosco (em 80%). Em 4 pacientes, o LBA revelou presença de células gigantes multinucleadas. Em 3, foi diagnosticada pneumonia intersticial por células gigantes na biópsia pulmonar. Houve o diagnóstico de pneumonia intersticial descamativa associada à bronquiolite celular em 1 paciente e de pneumonite de hipersensibilidade em 1. Todos foram afastados da exposição e tratados com corticoide. Houve melhora em 2 pacientes e progressão da doença em 3. Conclusões: Apesar de ser uma entidade rara, a DPMD deve ser sempre considerada em trabalhadores com risco ocupacional elevado de exposição a metais duros. A história clínica e ocupacional associada a achados em TCAR de tórax e LBA sugestivos da doença podem ser suficientes para o diagnóstico.
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Affiliation(s)
- Rafael Futoshi Mizutani
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Mário Terra-Filho
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,Disciplina de Pneumologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Evelise Lima
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Carolina Salim Gonçalves Freitas
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Rodrigo Caruso Chate
- Divisão de Diagnóstico por Imagem, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Ronaldo Adib Kairalla
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,Disciplina de Pneumologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Regiani Carvalho-Oliveira
- Laboratório Experimental de Poluição Atmosférica, Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Ubiratan Paula Santos
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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757
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Jo HE, Troy LK, Keir G, Chambers DC, Holland A, Goh N, Wilsher M, de Boer S, Moodley Y, Grainge C, Whitford H, Chapman S, Reynolds PN, Glaspole I, Beatson D, Jones L, Hopkins P, Corte TJ. Treatment of idiopathic pulmonary fibrosis in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand and the Lung Foundation Australia. Respirology 2017; 22:1436-1458. [DOI: 10.1111/resp.13146] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Helen E. Jo
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney NSW Australia
- Faculty of Medicine, University of Sydney; Sydney NSW Australia
| | - Lauren K. Troy
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney NSW Australia
- Faculty of Medicine, University of Sydney; Sydney NSW Australia
| | - Gregory Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital; Brisbane QLD Australia
| | - Daniel C. Chambers
- Department of Respiratory Medicine, The Prince Charles Hospital; Brisbane QLD Australia
| | - Anne Holland
- Department of Physiotherapy, The Alfred Hospital; Melbourne VIC Australia
| | - Nicole Goh
- Department of Respiratory Medicine, The Prince Charles Hospital; Brisbane QLD Australia
- Department of Respiratory Medicine; Austin Hospital; Melbourne VIC Australia
| | - Margaret Wilsher
- Department of Respiratory Medicine; Auckland District Health Board; Auckland New Zealand
| | - Sally de Boer
- Department of Respiratory Medicine; Auckland District Health Board; Auckland New Zealand
| | - Yuben Moodley
- Department of Respiratory Medicine; Fiona Stanley Hospital; Perth WA Australia
| | - Christopher Grainge
- Department of Respiratory Medicine; John Hunter Hospital; Newcastle NSW Australia
| | - Helen Whitford
- Department of Respiratory Medicine, The Alfred Hospital; Melbourne VIC Australia
| | - Sally Chapman
- Department of Respiratory Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Paul N. Reynolds
- Department of Respiratory Medicine; Royal Adelaide Hospital; Adelaide SA Australia
| | - Ian Glaspole
- Department of Respiratory Medicine, The Alfred Hospital; Melbourne VIC Australia
| | | | - Leonie Jones
- Department of Respiratory Medicine; John Hunter Hospital; Newcastle NSW Australia
| | - Peter Hopkins
- Department of Respiratory Medicine, The Prince Charles Hospital; Brisbane QLD Australia
| | - Tamera J. Corte
- Department of Respiratory Medicine; Royal Prince Alfred Hospital; Sydney NSW Australia
- Faculty of Medicine, University of Sydney; Sydney NSW Australia
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758
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Kotecha S, Buchan C, Parker K, Toghill J, Paul E, Miller B, Naughton M, Snell G, Dabscheck E. Domiciliary non-invasive ventilation post lung transplantation. Respirology 2017; 23:96-99. [PMID: 28840631 DOI: 10.1111/resp.13160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/19/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The benefits of domiciliary non-invasive ventilation (NIV) post lung transplantation (LTx) have not previously been described. This was a single-centre retrospective audit of patients requiring domiciliary NIV post-LTx. Our aim was to describe indications for NIV and outcomes in chronic lung allograft dysfunction (CLAD) and diaphragmatic palsy. METHODS All patients requiring domiciliary NIV post-LTx between 2010 and June 2016 were assessed. NIV indications, respiratory function and patient outcomes were collected. RESULTS Out of 488 LTx recipients, 20 patients were identified as requiring NIV over the 6.5-year study period. The most common indications for NIV were CLAD and diaphragmatic palsy. Hypercapnia improved significantly with NIV. Patient outcomes were poor with nine (45%) patients dying, four (20%) undergoing redo-LTx, four (20%) continuing domiciliary NIV and only three (15%) patients weaned off NIV. CONCLUSION This is the first case series to describe the use of domiciliary NIV post-LTx. Patients commenced on NIV post-LTx had severely impaired lung function and severe hypercapnia. Patients with diaphragmatic palsy often recovered. The mortality rate was high in chronic allograft dysfunction.
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Affiliation(s)
- Sakhee Kotecha
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Catherine Buchan
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Kerry Parker
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Jo Toghill
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Clinical Haematology, Alfred Hospital, Melbourne, VIC, Australia
| | - Belinda Miller
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Matthew Naughton
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Gregory Snell
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Eli Dabscheck
- Department of Lung Transplantation and General Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
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759
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Ikezoe K, Handa T, Tanizawa K, Chen-Yoshikawa TF, Kubo T, Aoyama A, Motoyama H, Hijiya K, Tokuda S, Nakatsuka Y, Yamamoto Y, Oshima A, Harashima SI, Nagai S, Hirai T, Date H, Chin K. Prognostic factors and outcomes in Japanese lung transplant candidates with interstitial lung disease. PLoS One 2017; 12:e0183171. [PMID: 28800589 PMCID: PMC5553985 DOI: 10.1371/journal.pone.0183171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/31/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Young patients with advanced interstitial lung disease (ILD) are potential candidates for cadaveric lung transplantation. This study aimed to examine clinical features, outcomes, and prognostic factors in Japanese ILD patients awaiting lung transplantation. METHODS We investigated the clinical features and outcomes of 77 consecutive candidates with ILD who were referred to Kyoto University Hospital and subsequently actively listed for lung transplant in the Japan Organ Transplant Network between 2010 and 2014. RESULTS Of the 77 candidates, 33 had idiopathic pulmonary fibrosis (IPF) and 15 had unclassifiable ILD. During the observational period, 23 patients (30%) received lung transplantations and 49 patients (64%) died before transplantation. Of the 33 patients with IPF, 13 (39%) had a family history of ILD and 13 (39%) had an "inconsistent with usual interstitial pneumonia pattern" on high-resolution computed tomography (HRCT). The median survival time from registration was 16.7 months, and mortality was similar among patients with IPF, unclassifiable ILD, and other ILDs. Using a multivariate stepwise Cox proportional hazards model, 6-min walking distance was shown to be an independent prognostic factor in candidates with ILD (per 10 m, hazard ratio (HR): 0.97; 95% confidence interval (CI): 0.95-0.99, p<0.01), while lower body mass index (HR: 0.83; 95% CI: 0.72-0.95, p < 0.01) independently contributed to mortality in patients with IPF. CONCLUSIONS Japanese patients with ILD awaiting transplantation had very poor outcomes regardless of their specific diagnosis. A substantial percentage of IPF patients had an atypical HRCT pattern. 6-min walking distance in ILD patients and body mass index in IPF patients were independent predictors of mortality.
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Affiliation(s)
- Kohei Ikezoe
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Aoyama
- Department of Thoracic surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideki Motoyama
- Department of Thoracic surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kyoko Hijiya
- Department of Thoracic surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinsaku Tokuda
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshinari Nakatsuka
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuko Yamamoto
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ayako Oshima
- Department of Metabolism and Clinical Nutrition, Kyoto University Hospital, Kyoto, Japan
| | - Shin-ichi Harashima
- Department of Diabetes, Endocrinology, and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sonoko Nagai
- Kyoto Central Clinic/Clinical Research Center, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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760
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Abstract
Pediatric lung transplantation has been undertaken since the 1980s, and it is today considered an accepted therapy option in carefully selected children with end-stage pulmonary diseases, providing carefully selected children a net survival benefit and improved health-related quality of life. Nowadays, >100 pediatric lung transplants are done worldwide every year. Here, specific pediatric aspects of lung transplantation are reviewed such as the surgical challenge, effects of immunosuppression on the developing pediatric immune system, and typical infections of childhood, as it is vital to comprehend that children undergoing lung transplants present a real challenge as children are not 'just small adults'. Further, an update on the management of the pediatric lung transplant patient is provided in this review, and future challenges outlined. Indications for lung transplantation in children are different compared to adults, the most common being cystic fibrosis (CF). However, the primary diagnoses leading to pediatric lung transplantation vary considerably by age group. Furthermore, there are regional differences regarding the primary indication for lung transplantation in children. Overall, early referral, careful patient selection and appropriate timing of listing are crucial to achieve real survival benefit. Although allograft function is to be preserved, immunosuppressant-related side effects are common in children post-transplantation. Strategies need to be put into practice to reduce drug-related side effects through careful therapeutic drug monitoring and lowering of target levels of immunosuppression, to avoid acute-reversible and chronic-irreversible renal damage. Instead of a "one fits all approach", tailored immunosuppression and a personalized therapy is to be advocated, particularly in children. Further, infectious complications are a common in children of all ages, accounting for almost 50% of death in the first year post-transplantation. However, chronic lung allograft dysfunction (CLAD) remains the major obstacle for improved long-term survival.
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Affiliation(s)
- Christian Benden
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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761
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Current approaches to the management of idiopathic pulmonary fibrosis. Respir Med 2017; 129:24-30. [DOI: 10.1016/j.rmed.2017.05.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 12/15/2022]
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762
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Savale L, Le Pavec J, Mercier O, Mussot S, Jaïs X, Fabre D, O’Connell C, Montani D, Stephan F, Sitbon O, Simonneau G, Dartevelle P, Humbert M, Fadel E. Impact of High-Priority Allocation on Lung and Heart-Lung Transplantation for Pulmonary Hypertension. Ann Thorac Surg 2017; 104:404-411. [DOI: 10.1016/j.athoracsur.2017.02.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 12/20/2016] [Accepted: 02/08/2017] [Indexed: 11/26/2022]
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763
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Lung transplant outpatient clinic at Centro Hospitalar São João - 10 year review. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:294-295. [PMID: 28754529 DOI: 10.1016/j.rppnen.2017.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 06/11/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022] Open
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764
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Lung transplantation in the elderly: Influence of age, comorbidities, underlying disease, and extended criteria donor lungs. J Thorac Cardiovasc Surg 2017; 154:2135-2141. [PMID: 28823801 DOI: 10.1016/j.jtcvs.2017.07.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 06/15/2017] [Accepted: 07/21/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE As large registries show an increased risk for lung transplant recipients aged 60 years or more, few single centers report favorable outcomes for carefully selected older recipients without providing essential details. The purpose of our study was to determine variables that influence survival in the elderly. METHODS All adult bilateral first lung transplants between January 2000 and December 2014 were divided in 2 groups: those aged less than 60 years (N = 223) and those aged 60 years or more (N = 83). The Charlson-Deyo Index determined recipient comorbidities. The Oto Donor Score assessed donor lung quality. RESULTS Recipients aged 60 years or more had a significant lower median survival compared with their younger counterparts (48 vs 112 months, respectively, P < .001). Recipient age was as an exponentially increasing univariate risk factor for mortality. By adjusting for variables in multivariate analysis, this trend was nonsignificant. The displacing variables were idiopathic pulmonary fibrosis (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.0-2.2), Charlson-Deyo Index 2 or greater (HR, 1.3; 95% CI, 1.0-1.8), systemic hypertension (HR, 1.7; 95% CI, 1.2-2.6), gastroesophageal reflux (HR, 1.9; 95% CI, 1.1-3.1), diverticulosis (HR, 1.7; 95% CI, 1.0-2.7), and an Oto Donor Score 8 or greater (HR, 1.5; 95% CI, 1.1-2.0). All of these risk factors were significantly more likely to occur in recipients aged 60 years or more, except for a tendency for high Charlson-Deyo Index. CONCLUSIONS The comorbidity profile, underlying disease, and donor lung quality appear to be more important than age in reducing long-term survival. Older age serves as a marker for a complex constellation of factors that might be considered the relative or absolute contraindication to lung transplantation rather than age, per se.
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765
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Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev (Orlando) 2017; 32:36-57. [PMID: 28811074 DOI: 10.1016/j.trre.2017.07.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 12/17/2022]
Abstract
Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.
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766
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Khandhar SJ, Althouse AD, Mulukutla S, Kormos R, Toma C, Marroquin O, Volz E, Tefera L, Bermudez C. Postoperative outcomes and management strategies for coronary artery disease in patients in need of a lung transplantation. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Sameer J. Khandhar
- Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
| | | | | | - Robert Kormos
- University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Catalin Toma
- University of Pittsburgh Medical Center; Pittsburgh PA USA
| | | | - Elizabeth Volz
- University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Leben Tefera
- University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Christian Bermudez
- Perelman School of Medicine at the University of Pennsylvania; Philadelphia PA USA
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767
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Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agustí A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med 2017; 195:557-582. [PMID: 28128970 DOI: 10.1164/rccm.201701-0218pp] [Citation(s) in RCA: 2089] [Impact Index Per Article: 298.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.
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Affiliation(s)
- Claus F Vogelmeier
- 1 University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Gerard J Criner
- 2 Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Fernando J Martinez
- 3 New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Antonio Anzueto
- 4 University of Texas Health Science Center, San Antonio, Texas.,5 South Texas Veterans Health Care System, San Antonio, Texas
| | - Peter J Barnes
- 6 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jean Bourbeau
- 7 McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | - Rongchang Chen
- 9 State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Peter Frith
- 12 Faculty of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | | | | | | | - Nicolas Roche
- 16 Hôpital Cochin (Assistance Publique-Hôpitaux de Paris), University Paris Descartes, Paris, France
| | | | - Don D Sin
- 18 St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Singh
- 19 University of Manchester, Manchester, United Kingdom
| | | | - Jørgen Vestbo
- 19 University of Manchester, Manchester, United Kingdom
| | - Jadwiga A Wedzicha
- 6 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alvar Agustí
- 21 Hospital Clínic, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedade Respiratorias, Barcelona, Spain
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768
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Zamora-Legoff JA, Krause ML, Crowson CS, Ryu JH, Matteson EL. Progressive Decline of Lung Function in Rheumatoid Arthritis-Associated Interstitial Lung Disease. Arthritis Rheumatol 2017; 69:542-549. [PMID: 27788297 DOI: 10.1002/art.39971] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/25/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Interstitial lung disease (ILD) is associated with substantial morbidity in rheumatoid arthritis (RA), but very little is known about its long-term progression. This study was undertaken to investigate the progression of pulmonary disease using a large single-center cohort of patients with RA-associated ILD. METHODS Records of all patients with RA-associated ILD seen at Mayo Clinic between 1998 and 2014, with at least 4 weeks follow-up and at least 1 pulmonary function test, were identified and manually screened for study inclusion. Progression was defined as a diffusing capacity for carbon monoxide (DLco) <40% predicted (or patients whose illness was too advanced to undergo screening) or a forced vital capacity (FVC) <50% predicted. Time to progression was analyzed using the Kaplan-Meier method. RESULTS Of the 167 patients included in the study, 81 (49%) were female, with a mean ± SD age of 67 ± 10 years at diagnosis of ILD. Median follow-up time from diagnosis of ILD was 3.3 years (range 0.01-14.8). One-third of the patients required supplemental oxygen, 40% developed DLco <40% predicted, and 22% developed FVC <50% predicted within 5 years after ILD diagnosis. Usual interstitial pneumonia (UIP) versus nonspecific interstitial pneumonia (NSIP) was a risk factor for DLco progression (hazard ratio 3.29 [95% confidence interval 1.28-8.41]). Lower DLco and FVC at baseline increased the risk for progression to DLco <40% predicted and FVC <50% predicted, and higher rates of change in the first 6 months also increased the risk of progression. CONCLUSION Progressive loss of pulmonary function is common in RA-associated ILD and is worse in patients with UIP than in those with NSIP. Predictors of progression in patients with RA-associated ILD may aid clinicians in identifying patients at highest risk for progression of ILD.
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Affiliation(s)
| | | | | | - Jay H Ryu
- Mayo Clinic College of Medicine, Rochester, Minnesota
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769
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Leuschner G, Stocker F, Veit T, Kneidinger N, Winter H, Schramm R, Weig T, Matthes S, Ceelen F, Arnold P, Munker D, Klenner F, Hatz R, Frankenberger M, Behr J, Neurohr C. Outcome of lung transplantation in idiopathic pulmonary fibrosis with previous anti-fibrotic therapy. J Heart Lung Transplant 2017; 37:S1053-2498(17)31886-7. [PMID: 28734935 DOI: 10.1016/j.healun.2017.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/06/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anti-fibrotic drugs may interfere with wound-healing after major surgery, theoretically preventing sufficient bronchial anastomosis formation after lung transplantation (LTx). The aim of this study was to assess the impact of previous treatment with pirfenidone and nintedanib on outcomes after LTx in patients with idiopathic pulmonary fibrosis (IPF). METHODS All patients with IPF undergoing LTx at the University of Munich between January 2012 and November 2016 were retrospectively screened for previous use of anti-fibrotics. Post-transplant outcome and survival of patients with and without anti-fibrotic treatment were analyzed. RESULTS A total of 62 patients with IPF were transplanted (lung allocation score [mean ± SD] 53.1 ± 16.1). Of these, 23 (37.1%) received pirfenidone and 7 (11.3%) received nintedanib before LTx; the remaining 32 (51.6%) did not receive any anti-fibrotic drug (control group). Patients receiving anti-fibrotics were significantly older (p = 0.004) and their carbon monoxide diffusion capacity was significantly higher (p = 0.008) than in controls. Previous anti-fibrotic treatment did not increase blood product utilization, wound-healing or anastomotic complications after LTx. Post-transplant surgical revisions due to bleeding and/or impaired wound-healing were necessary in 18 (29.0%) patients (pirfenidone 30.4%, nintedanib 14.3%, control 31.3%; p = 0.66). Anastomosis insufficiency occurred in 2 (3.2%) patients, both in the control group. No patient died within the first 30 days post-LTx, and no significant differences regarding survival were seen during the follow-up (12-month survival: pirfenidone 77.0%, nintedanib 100%, control 90.6%; p = 0.29). CONCLUSION Our data show that previous use of anti-fibrotic therapy does not increase surgical complications or post-operative mortality after LTx.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany.
| | - Florian Stocker
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany
| | - Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Hauke Winter
- Munich Lung Transplant Group, Munich, Germany; Department of Thoracic Surgery, University of Munich, Munich, Germany
| | - René Schramm
- Munich Lung Transplant Group, Munich, Germany; Clinic of Cardiac Surgery, University of Munich, Munich, Germany
| | - Thomas Weig
- Munich Lung Transplant Group, Munich, Germany; Department of Anesthesiology, University of Munich, Munich, Germany
| | - Sandhya Matthes
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Felix Ceelen
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Paola Arnold
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Friederike Klenner
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Rudolf Hatz
- Munich Lung Transplant Group, Munich, Germany; Department of Thoracic Surgery, University of Munich, Munich, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum München, Member of the German Center for Lung Research, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
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770
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Tseng HJ, Henry TS, Veeraraghavan S, Mittal PK, Little BP. Pulmonary Function Tests for the Radiologist. Radiographics 2017; 37:1037-1058. [DOI: 10.1148/rg.2017160174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hsiang-Jer Tseng
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Travis S. Henry
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Srihari Veeraraghavan
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Brent P. Little
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
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771
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Higo H, Kurosaki T, Ichihara E, Kubo T, Miyoshi K, Otani S, Sugimoto S, Yamane M, Miyahara N, Kiura K, Miyoshi S, Oto T. Clinical characteristics of Japanese candidates for lung transplant for interstitial lung disease and risk factors for early death while on the waiting list. Respir Investig 2017; 55:264-269. [PMID: 28705305 DOI: 10.1016/j.resinv.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/20/2017] [Accepted: 03/01/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Lung transplants have produced very favorable outcomes for patients with interstitial lung disease (ILD) in Japan. However, because of the severe donor lung shortage, patients must wait approximately 2.5 years before they can undergo transplantation and many candidates die before allocation. We reveal the clinical characteristics of Japanese patients with ILD who are candidates for lung transplants and the risk factors for early death while on the waiting list. METHODS We retrospectively reviewed the clinical data of patients registered in the Japan Organ Transplant Network from Okayama University Hospital who are candidates for cadaveric lung transplants for ILD between 1999 and 2015. RESULTS Fifty-three patients with ILD were included (24 patients with idiopathic pulmonary fibrosis and 29 others). They had severe pulmonary dysfunction and low exercise tolerability. The median waiting time for transplantation was 462 days, and 22 patients died before allocation. Patients who died before 462 days without undergoing transplantation had more severe dyspnea, shorter 6-minute walk distance (6MWD), and lower performance status than those who waited ≥462 days. CONCLUSIONS Japanese candidates for cadaveric lung transplants for ILD have severe pulmonary dysfunction. Severe dyspnea, short 6MWD, and low performance status are risk factors for early death while on the waiting list.
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Affiliation(s)
- Hisao Higo
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takeshi Kurosaki
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Eiki Ichihara
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshio Kubo
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Shinji Otani
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Masaomi Yamane
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Nobuaki Miyahara
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Katsuyuki Kiura
- Department of Respiratory and Allergy Medicine, Okayama University Hospital, Okayama, Japan
| | - Shinichiro Miyoshi
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Takahiro Oto
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan.
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772
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Hajari Case A, Johnson P. Clinical use of nintedanib in patients with idiopathic pulmonary fibrosis. BMJ Open Respir Res 2017; 4:e000192. [PMID: 28883926 PMCID: PMC5531305 DOI: 10.1136/bmjresp-2017-000192] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/26/2017] [Indexed: 01/08/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a rare lung disease characterised by progressive loss of lung function, dyspnoea and cough. IPF has a variable clinical course but a poor prognosis. Nintedanib, a tyrosine kinase inhibitor, is one of two drugs approved for the treatment of IPF. In clinical trials, nintedanib slowed disease progression by reducing the rate of decline in forced vital capacity (FVC) in patients with IPF and mild or moderate lung function impairment. The effect of nintedanib was consistent across patient subgroups defined by baseline characteristics including FVC % predicted, diffusion capacity of the lung for carbon monoxide % predicted and the presence of emphysema. Recently, it has been shown that the rate of decline in FVC and the treatment effect of nintedanib are the same in patients with preserved lung volume (FVC >90% predicted) as in patients with greater impairment in FVC, supporting the value of early treatment of IPF. The adverse events most commonly associated with nintedanib, both in clinical trials and real-world clinical practice, are mild gastrointestinal events, particularly diarrhoea. Side effects are manageable in a majority of patients through symptomatic treatment, dose reductions and treatment interruptions, enabling most patients to stay on treatment in the long term.
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Affiliation(s)
- Amy Hajari Case
- Division of Pulmonary, Critical Care, and Sleep Medicine, Piedmont Healthcare, Atlanta, Georgia, USA
| | - Peace Johnson
- Division of Pulmonary, Critical Care, and Sleep Medicine, Piedmont Healthcare, Atlanta, Georgia, USA
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773
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Suzuki A, Kondoh Y, Fischer A. Recent advances in connective tissue disease related interstitial lung disease. Expert Rev Respir Med 2017; 11:591-603. [PMID: 28544856 DOI: 10.1080/17476348.2017.1335600] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Interstitial lung disease (ILD) is a common manifestation of connective tissue disease (CTD). Although the majority of patients with CTD-ILD are stable or slowly progressive, a significant group exhibits a more severe and progressive decline. Interstitial pneumonia with autoimmune features (IPAF) describes the subset of patients with interstitial pneumonia who have features suggesting underlying autoimmunity, but whose features fall short of a clear diagnosis of CTD. Areas covered: In this focused review, we discuss recent advances in early detection, prognostic evaluation, and management of autoimmune forms of ILD. Expert commentary: Early detection of ILD and a better understanding of factors that impact prognostication may be helpful when making decisions regarding therapeutic interventions. The treatment of CTD-ILD should be comprehensive, is often fraught with challenges and can be complicated by comorbid conditions and extra-thoracic disease activities. Several large randomized studies have examined the impact of immunosuppressive therapy for CTD-ILD, however, additional studies are needed to determine the optimal treatment strategies. Future studies may provide additional information about the best treatments in patients with IPAF.
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Affiliation(s)
- Atsushi Suzuki
- a Department of Respiratory Medicine and Allergy , Tosei General Hospital , Seto , Japan
| | - Yasuhiro Kondoh
- a Department of Respiratory Medicine and Allergy , Tosei General Hospital , Seto , Japan
| | - Aryeh Fischer
- b Department of Medicine, Divisions of Rheumatology, Pulmonary Sciences and Critical Care Medicine , University of Colorado , Aurora , CO , USA
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774
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Ledroit M, Megne Wabo M, Berroneau A, Dromer C, Xuereb F, Breilh D. La greffe pulmonaire et ses traitements. ACTUALITES PHARMACEUTIQUES 2017. [DOI: 10.1016/j.actpha.2017.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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775
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Burgel PR, Fajac I. Cystic fibrosis: Current aspects and perspectives. Presse Med 2017. [DOI: 10.1016/j.lpm.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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776
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Briganti DF, D'Ovidio F. Long-term management of patients with end-stage lung diseases. Best Pract Res Clin Anaesthesiol 2017; 31:167-178. [DOI: 10.1016/j.bpa.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/12/2017] [Accepted: 07/19/2017] [Indexed: 01/08/2023]
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777
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Rozenberg D, Mathur S, Herridge M, Goldstein R, Schmidt H, Chowdhury NA, Mendes P, Singer LG. Thoracic muscle cross-sectional area is associated with hospital length of stay post lung transplantation: a retrospective cohort study. Transpl Int 2017; 30:713-724. [PMID: 28390073 DOI: 10.1111/tri.12961] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 02/20/2017] [Accepted: 03/31/2017] [Indexed: 12/30/2022]
Abstract
Low muscle mass is common in lung transplant (LTx) candidates; however, the clinical implications have not been well described. The study aims were to compare skeletal muscle mass in LTx candidates with controls using thoracic muscle cross-sectional area (CSA) from computed tomography and assess the association with pre- and post-transplant clinical outcomes. This was a retrospective, single-center cohort study of 527 LTx candidates [median age: 55 IQR (42-62) years; 54% male]. Thoracic muscle CSA was compared to an age- and sex-matched control group. Associations between muscle CSA and pre-transplant six-minute walk distance (6MWD), health-related quality of life (HRQL), delisting/mortality, and post-transplant hospital outcomes and one-year mortality were evaluated using multivariable regression analysis. Muscle CSA for LTx candidates was about 10% lower than controls (n = 38). Muscle CSA was associated with pre-transplant 6MWD, but not HRQL, delisting or pre- or post-transplant mortality. Muscle CSA (per 10 cm2 difference) was associated with shorter hospital stay [0.7 median days 95% CI (0.2-1.3)], independent of 6MWD. In conclusion, thoracic muscle CSA is a simple, readily available estimate of skeletal muscle mass predictive of hospital length of stay, but further study is needed to evaluate the relative contribution of muscle mass versus functional deficits in LTx candidates.
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Affiliation(s)
- Dmitry Rozenberg
- Department of Medicine, Respirology, University of Toronto, Toronto, ON, Canada.,Lung Transplant Program, University Health Network, Toronto, ON, Canada
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Margaret Herridge
- Department of Medicine, Respirology, University of Toronto, Toronto, ON, Canada.,Critical Care, University Health Network, Toronto, ON, Canada
| | - Roger Goldstein
- Department of Medicine, Respirology, University of Toronto, Toronto, ON, Canada.,Respirology, West Park Healthcare Center, Toronto, ON, Canada
| | - Heidi Schmidt
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Noori A Chowdhury
- Lung Transplant Program, University Health Network, Toronto, ON, Canada
| | - Polyana Mendes
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Lianne G Singer
- Department of Medicine, Respirology, University of Toronto, Toronto, ON, Canada.,Lung Transplant Program, University Health Network, Toronto, ON, Canada
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778
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Somayaji R, Ramos KJ, Kapnadak SG, Aitken ML, Goss CH. Common clinical features of CF (respiratory disease and exocrine pancreatic insufficiency). Presse Med 2017; 46:e109-e124. [PMID: 28554722 DOI: 10.1016/j.lpm.2017.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/06/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022] Open
Abstract
First described as a disease of the pancreas, cystic fibrosis is a genetically inherited progressive disease affecting multiple organ systems. Pulmonary and pancreatic involvement is common in individuals with cystic fibrosis, and the former is attributable to most of the mortality that occurs with the condition. This chapter provides an overview of a clinical approach to the pulmonary and pancreatic manifestations of cystic fibrosis.
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Affiliation(s)
- Ranjani Somayaji
- University of Calgary, Department of Medicine, Calgary, AB, Canada
| | - Kathleen J Ramos
- University of Washington, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Seattle, WA, USA
| | - Siddhartha G Kapnadak
- University of Washington, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Seattle, WA, USA
| | - Moira L Aitken
- University of Washington, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Seattle, WA, USA
| | - Christopher H Goss
- University of Washington, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Seattle, WA, USA; University of Washington, Department of Pediatrics, Division of Pediatric Pulmonology, Seattle, WA, USA; Seattle Children's Research Institute, Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle, WA, USA.
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779
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Physical activity level significantly affects the survival of patients with end-stage lung disease on a waiting list for lung transplantation. Surg Today 2017; 47:1526-1532. [PMID: 28540430 DOI: 10.1007/s00595-017-1542-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/08/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE Our objective was to investigate the factors predicting the survival of patients on the waiting list for lung transplantation (LT) during the waiting period, with a special emphasis on the physical activity level. METHODS The study included 70 patients with end-stage pulmonary disease who were on the waiting list for LT at Kyoto University Hospital. We examined the association between the baseline characteristics, including the body mass index and body composition, serum albumin, serum C-reactive protein (CRP), steroid administration, physical activity level (calculated by the food frequency questionnaire) and survival during the waiting period using Kaplan-Meier curves and Cox proportional hazard regression models. RESULTS A physical activity level of ≤1.2 was correlated with significantly decreased survival (1-year survival: 68 vs. 90.9%, p = 0.0089), with a hazard ratio (HR) of 2.24 (95% confidence interval (CI) 1.22-4.19, p = 0.0001). Hypo-albumin (HR 2.024, 95% CI 1.339-6.009, p = 0.004), a high level of CRP (HR 2.551, CI 1.229-4.892, p = 0.02), and the administration of steroids (HR 2.258, CI 1.907-5.032, p = 0.024) were also significant predictors of survival. CONCLUSIONS Low levels of physical activity during the waiting period for LT led to decreased survival times among LT candidates.
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780
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Town JA, Monroe EJ, Aitken ML. Deaths Related to Bronchial Arterial Embolization in Patients With Cystic Fibrosis: Three Cases and an Institutional Review. Chest 2017; 150:e93-e98. [PMID: 27719829 DOI: 10.1016/j.chest.2016.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/27/2016] [Accepted: 03/02/2016] [Indexed: 10/20/2022] Open
Abstract
Cystic fibrosis (CF) patients are at risk for life-threatening hemoptysis, sometimes necessitating bronchial arterial embolization (BAE). Spinal artery embolization and pulmonary infarction are commonly cited procedural risks, yet respiratory failure and death are underappreciated. We conducted a retrospective institutional review of our outcomes after BAE for hemoptysis in CF and present three cases highlighting this complication. From 2007 to 2015, 12 patients underwent 17 BAE procedures for hemoptysis at our institution. Three patients experienced respiratory failure and died within 3 months of BAE. Nonsurvivors had significantly lower baseline FEV1 values than survivors (21.8% vs 52.6%, P < .05). BAE as a treatment for life-threatening hemoptysis may precipitate respiratory failure in end-stage CF and should accelerate the evaluation for lung transplantation. Institutions should reevaluate their BAE practices to ensure preservation of the bronchial circulation, which contributes to gas exchange in these patients.
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Affiliation(s)
- James A Town
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA.
| | - Eric J Monroe
- Department of Radiology, Seattle Childrens, Seattle, WA
| | - Moira L Aitken
- Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA
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781
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Mooney JJ, Raimundo K, Chang E, Broder MS. Mechanical ventilation in idiopathic pulmonary fibrosis: a nationwide analysis of ventilator use, outcomes, and resource burden. BMC Pulm Med 2017; 17:84. [PMID: 28532459 PMCID: PMC5441011 DOI: 10.1186/s12890-017-0426-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/11/2017] [Indexed: 12/01/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is associated with increased risk of respiratory-related hospitalizations. Studies suggest mechanical ventilation (MV) use in IPF does not improve outcomes and guidelines recommend against its general use. Our objective was to investigate MV use and association with cost and mortality in IPF. Methods This retrospective study, using a nationwide sample, included claims with IPF (ICD-9-CM: 516.3) in 2009–2011 and principal respiratory disease diagnosis (ICD-9-CM: 460–519); excluding lung transplant. Regression models were used to determine predictors of MV and association with cost, LOS, and mortality. Domain analysis was used to account for use of subpopulation. Costs were adjusted to 2011. Data on patient severity not available. Results Twenty two thousand three hundred fifty non-transplant IPF patients were admitted with principal respiratory disease diagnosis: Mean age 70.0 (SD 13.9), 49.1% female, mean LOS 7.4 (SD 8.2). MV was used in 11.4% of patients with a non-significant decline over time. In regression models, MV was associated with an increased stay of 9.78 days (95% CI 8.38–11.18) and increased cost of $36,583 (95% CI $32,021–41,147). MV users had significantly increased mortality (OR 15.55, 95% CI 12.13–19.95) versus nonusers. Conclusions Mechanical ventilation use has not significantly changed over time and is mostly used in younger patients and those admitted for non-IPF respiratory conditions. MV was associated with a 4-fold admission cost increase ($49,924 versus $11,742) and a 7-fold mortality increase (56% versus 7.5%), although patients who receive MV may differ from those who do not. Advances in treatment and decision aids are needed to improve outcomes in IPF.
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Affiliation(s)
| | | | - Eunice Chang
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
| | - Michael S Broder
- Partnership for Health Analytic Research, LLC, Beverly Hills, CA, USA
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782
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783
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Abstract
OBJECTIVE To provide a detailed picture of the economic impact of hospitalization in idiopathic pulmonary fibrosis (IPF) and to identify factors associated with cost and length of stay (LOS). METHODS In this retrospective cross-sectional study using the Nationwide Inpatient Sample (NIS), this study included hospitalizations for IPF (ICD-9-CM 516.3) with a principal diagnosis of respiratory disease (ICD-9-CM 460-519) from 2009-2011; lung transplant admissions were excluded. Total inpatient cost, LOS, in-hospital death, and discharge disposition were reported. Linear regression models were used to determine variables predictive of LOS and cost. RESULTS From 2009-2011, 22,350 non-transplant IPF patients with a principal diagnosis of respiratory disease were admitted: mean (±SE) age was 70.0 (0.32), and 49.1% were female. While in hospital, 11.4% of patients received mechanical ventilation and 8.9% received non-invasive ventilation. Mean (±SE) LOS was 7.4 (0.15) days overall (p < .001). The mean (±SD) admission cost was $16,042 (±631). Of hospitalized patients, 14.1% died, 20.6% transferred facilities, and 46.4% were routinely discharged. The adjusted LOS (95% CI) for patients with and without mechanical ventilation was 16.1 days (15-17.5) vs. 6.3 (6-6.5); adjusted costs were $48,772 (43,979-53,565) vs. $11,861 (11,292-12,431). LIMITATIONS The positive predictive value of the algorithm used to identify IPF is not optimal. The NIS database does not follow patients longitudinally, and claims after admission are not available. Claims do not indicate whether listed diagnoses were present on admission or developed during hospitalization. The exclusion of transplant-related expenditures lead to under-estimation of cost. CONCLUSION Using a nationally-representative database, we found IPF respiratory-related hospitalizations represent a significant economic burden with ∼7,000 non-transplant IPF admissions per year, at a mean cost of $16,000 per admission. Mechanical ventilation is associated with statistically significant increases in LOS and cost. Therapeutic advances that reduce rates and costs of IPF hospitalizations are needed.
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Affiliation(s)
- Joshua J Mooney
- a Department of Medicine , Stanford University , Stanford , CA , USA
| | | | - Eunice Chang
- c Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
| | - Michael S Broder
- c Partnership for Health Analytic Research, LLC , Beverly Hills , CA , USA
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784
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Carraro R, Nascimento E, Szachnowicz S, Camargo P, Campos S, Afonso J, Samano M, Pêgo-Fernandes P, Dolhnikoff M, Teixeiraa R, Costa A. Histopathological Findings Associated With Gastroesophageal Reflux Disease and Aspiration After Lung Transplantation: Initial Brazilian Single-Center Experience. Transplant Proc 2017; 49:886-889. [DOI: 10.1016/j.transproceed.2017.01.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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785
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Quezada Loaiza CA, Velázquez Martín MT, Jiménez López-Guarch C, Ruiz Cano MJ, Navas Tejedor P, Carreira PE, Flox Camacho Á, de Pablo Gafas A, Delgado Jiménez JF, Gómez Sánchez MÁ, Escribano Subías P. Trends in Pulmonary Hypertension Over a Period of 30 Years: Experience From a Single Referral Centre. ACTA ACUST UNITED AC 2017; 70:915-923. [PMID: 28454887 DOI: 10.1016/j.rec.2016.12.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Pulmonary arterial hypertension (PAH) is characterized by increased pulmonary vascular resistance, right ventricular dysfunction and death. Despite scientific advances, is still associated with high morbidity and mortality. The aim is to describe the clinical approach and determine the prognostic factors of patients with PAH treated in a national reference center over 30 years. METHODS Three hundred and seventy nine consecutive patients with PAH (January 1984 to December 2014) were studied. Were divided into 3 periods of time: before 2004, 2004-2009 and 2010-2014. Prognostic factors (multivariate analysis) were analyzed for clinical deterioration. RESULTS Median age was 44 years (68.6% women), functional class III-IV: 72%. An increase was observed in more complex etiologies in the last period of time: Pulmonary venooclusive disease and portopulmonary hypertension. Upfront combination therapy significantly increased (5% before 2004 vs 27% after 2010; P < .05). Multivariate analysis showed prognostic significance in age, sex, etiology and combined clinical variables as they are independent predictors of clinical deterioration (P < .05). Survival free from death or transplantation for the 1st, 3rd and 5th year was 92.2%, 80.6% and 68.5% respectively. The median survival was 9 years (95% confidence interval, 7.532-11.959) CONCLUSIONS: The PAH is a heterogeneous and complex disease, the median survival free from death or transplantation in our series is 9 years after diagnosis. The structure of a multidisciplinary unit PAH must adapt quickly to changes that occur over time incorporating new diagnostic and therapeutic techniques.
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Affiliation(s)
- Carlos Andrés Quezada Loaiza
- Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - María Teresa Velázquez Martín
- Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Jiménez López-Guarch
- Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Paula Navas Tejedor
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Esmeralda Carreira
- Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ángela Flox Camacho
- Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alicia de Pablo Gafas
- Unidad de Trasplante Pulmonar, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan Francisco Delgado Jiménez
- Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Ángel Gómez Sánchez
- Servicio de Cardiología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar Escribano Subías
- Unidad Multidisciplinar de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.
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786
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Balcı MK, Arı E, Vayvada M, Salturk C, Aşıcıoğlu E, Kahveci G, Akbal ÖY, Kutlu CA. Assessment of Pulmonary Hypertension in Lung Transplantation Candidates: Correlation of Doppler Echocardiography With Right Heart Catheterization. Transplant Proc 2017; 48:2797-2802. [PMID: 27788820 DOI: 10.1016/j.transproceed.2016.06.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/02/2016] [Accepted: 06/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Right heart catheterization (RHC) remains the gold standard to diagnosis of pulmonary hypertension among lung transplantation candidates. Doppler echocardiography (DE) may be as accurate as RHC, without risks of an invasive test. The aim of the study was to assess the feasibility of DE for the measurement of pulmonary artery pressure in lung transplantation candidates and the correlation between pulmonary artery pressures estimated by DE versus measured by RHC. METHODS A total of 103 lung transplantation candidates undergoing DE who were scheduled to undergo RHC within 72 hours were analyzed. The performance characteristics of DE were compared with RHC, and correlation analysis was performed to determine the correlation of pulmonary pressures obtained by DE versus measured by RHC. RESULTS The prevalence of pulmonary hypertension was 57% in lung transplantation candidates. Of the 103 candidates, evaluation of pulmonary artery systolic pressure (PASP) by DE was possible in 92 (89%). Median PASP by RHC was 45 (12-145) mm Hg and by DE 45 (20-144) mm Hg. There was a positive correlation between PASP estimated by DE and measured by RHC (r = 0.585, P < .0001). Sensitivity, specificity, and positive and negative predictive values of PASP estimation for diagnosis of pulmonary hypertension were 85%, 67%, 87%, and 61%, respectively. CONCLUSIONS There is a strong positive correlation between PASP estimated by DE compared with measured by RHC with an acceptable sensitivity and specificity in detecting pulmonary hypertension. Echocardiography can be recommended for measuring pulmonary pressures in lung transplantation candidates.
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Affiliation(s)
- M K Balcı
- Kartal Kosuyolu Yuksek Ihtisas Training Hospital, Lung Transplantation Clinic, Istanbul, Turkey.
| | - E Arı
- Kartal Training Hospital, Department of Nephrology, Istanbul, Turkey
| | - M Vayvada
- Kartal Kosuyolu Yuksek Ihtisas Training Hospital, Lung Transplantation Clinic, Istanbul, Turkey
| | - C Salturk
- Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Intensive Care Unit, Istanbul, Turkey
| | - E Aşıcıoğlu
- Marmara University School of Medicine, Department of Nephrology, Pendik, Turkey
| | - G Kahveci
- Koşuyolu Kartal Heart Training Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ö Y Akbal
- Koşuyolu Kartal Heart Training Hospital, Department of Cardiology, Istanbul, Turkey
| | - C A Kutlu
- Kartal Kosuyolu Yuksek Ihtisas Training Hospital, Lung Transplantation Clinic, Istanbul, Turkey
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787
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Abstract
INTRODUCTION While many pharmacologic therapies for the treatment of idiopathic pulmonary fibrosis (IPF) have been evaluated via randomized, placebo-controlled clinical trials (RCTs) conducted over the past two decades, most therapies have been shown to be ineffective or even potentially harmful. However, a number of recently completed RCTs have shown significant efficacy for pirfenidone and nintedanib for the treatment of IPF. Areas covered: This manuscript reviews recent advances in the management of IPF and other forms of fibrosing interstitial lung disease (ILD) with an emphasis on IPF. The material upon which this discussion is based was obtained from various published texts and manuscripts identified via literature searching (e.g. PubMed). Expert commentary: Anti-fibrotic drugs are now available for clinical use and perceived as standard-of-care therapies that have the potential to blunt disease progression for many patients with IPF. However, these agents do not necessarily stop disease progression or have a significant impact on mortality, and more effective pharmacologic therapies are needed for patients with IPF. Additionally, whether anti-fibrotic agents can be effective therapies for other forms of pulmonary fibrosis, which often have radiologic and histopathologic manifestations that mimic IPF, is being evaluated in a number of RCTs.
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Affiliation(s)
- Keith C Meyer
- a Department of Medicine , University of Wisconsin School of Medicine and Public Health - Medicine , K4/910 Clinical Science Center 600 Highland Avenue Madison, Madison , WI , 53792-9988 , USA
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788
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Abstract
Pulmonary fibrosis is associated with a number of specific forms of interstitial lung disease (ILD) and can lead to progressive decline in lung function, poor quality of life, and, ultimately, early death. Idiopathic pulmonary fibrosis (IPF), the most common fibrotic ILD, affects up to 1 in 200 elderly individuals and has a median survival that ranges from 3 to 5 years following initial diagnosis. IPF has not been shown to respond to immunomodulatory therapies, but recent trials with novel antifibrotic agents have demonstrated lessening of lung function decline over time. Pirfenidone has been shown to significantly slow decline in forced vital capacity (FVC) over time and prolong progression-free survival, which led to its licensing by the United States Food and Drug Administration (FDA) in 2014 for the treatment of patients with IPF. However, pirfenidone has been associated with significant side effects, and patients treated with pirfenidone must be carefully monitored. We review recent and ongoing clinical research and experience with pirfenidone as a pharmacologic therapy for patients with IPF, provide a suggested approach to incorporate pirfenidone into a treatment algorithm for patients with IPF, and examine the potential of pirfenidone as a treatment for non-IPF forms of ILD accompanied by progressive pulmonary fibrosis.
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Affiliation(s)
- Keith C Meyer
- University of Wisconsin Lung Transplant and Advanced Lung Diseas Program.,Department of Medicine, Section of Allergy, Pulmonary and Critical Care Medicine, Clinical Sciences Center, University of Wisconsin School of Medicine and Public Health
| | - Catherine A Decker
- Department of Pharmacy.,Department of Pulmonary Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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789
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Simon C, Allou N, Schlossmacher P, Gendry T, Delay L, Gazaille V. [Lung transplantation in Reunion Island, current situation from January 2005 till May 2015]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:75-80. [PMID: 27993493 DOI: 10.1016/j.pneumo.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 06/06/2023]
Abstract
Lung transplantation (LT) is a therapeutic option for patients with terminal respiratory failure and high risk of mortality in two years. Until now, this activity is not performed in Reunion Island. The candidate potential are thus directed to the metropolitan reference centres causing logistics and financials constraints. This work presents a current situation of the pulmonary transplantation in Reunion Island. This retrospective study includes patients from Reunion Island with respiratory insufficiency who have been transferred to metropolitan centres to apply to LT. The selection was made from January, 2005 till May, 2015. Twenty-nine patients included, aged from 14 to 64 years, were transferred to metropolitan France: 13 patients with cystic fibrosis, 13 patients with pulmonary fibrosis, 1 patients with bronchiectasis, 1 patient with chronic obstructive pulmonary disease (COPD) and 1 patient with pulmonary arterial hypertension. Fifteen patients underwent LT (4 live in Reunion Island, 5 live in metropolitan France and 6 are dead), 1 patient is alive on waiting list, 3 died on the waiting list, 7 patients were refused for transplantation and 3 patients are lost to follow-up. The number of patients transferred for LT increases over 10 years with a maximal incidence in 2013 of 7 repatriated patients including 3 transplanted patients. LT could be performed in half of our patients with possible come back and follow-up on Reunion Island. Indications follow the current trends except an under representation of COPD.
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Affiliation(s)
- C Simon
- Centre hospitalier Félix-Guyon, CHU de la Réunion, allée des Topazes, 97400 Saint-Denis, Réunion.
| | - N Allou
- Centre hospitalier Félix-Guyon, CHU de la Réunion, allée des Topazes, 97400 Saint-Denis, Réunion.
| | - P Schlossmacher
- Centre hospitalier Félix-Guyon, CHU de la Réunion, allée des Topazes, 97400 Saint-Denis, Réunion.
| | - T Gendry
- Groupe hospitalier sud Réunion, CHU de la Réunion, avenue du président Miterrand, 97410 Saint-Pierre, Réunion.
| | - L Delay
- Centre hospitalier Louis-Pradel, 28, avenue du Doyen-Jean-Lépine, 69500 Lyon, France.
| | - V Gazaille
- Centre hospitalier Félix-Guyon, CHU de la Réunion, allée des Topazes, 97400 Saint-Denis, Réunion.
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790
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Fisher JH, Al-Hejaili F, Kandel S, Hirji A, Shapera S, Mura M. Multi-dimensional scores to predict mortality in patients with idiopathic pulmonary fibrosis undergoing lung transplantation assessment. Respir Med 2017; 125:65-71. [DOI: 10.1016/j.rmed.2017.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 02/16/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
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791
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Layton AM, Armstrong HF, Kim HP, Meza KS, D'Ovidio F, Arcasoy SM. Cardiopulmonary exercise factors predict survival in patients with advanced interstitial lung disease referred for lung transplantation. Respir Med 2017; 126:59-67. [PMID: 28427551 DOI: 10.1016/j.rmed.2017.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/06/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The purpose of this work was to determine if parameters assessed during Cardiopulmonary Exercise Testing (CPET) while using supplemental oxygen can independently predict one-year transplant-free survival in patients with Interstitial Lung Disease (ILD) referred for lung transplant evaluation. METHODS We performed a chart review of patients with ILD who completed CPET with 30% FiO2 and gathered spirometry, pulmonary hemodynamic, six-minute walk, and CPET data. The primary end-point was death or lung transplantation within one-year of CPET. RESULTS The final data set included 192 patients. 79 patients died/underwent transplant, 113 survived transplant-free. Multivariable Cox regression revealed peak workload % predicted, nadir CPET SpO2, and FVC% predicted as independent predictors of one-year transplant-free survival. Of the independent predictors of survival, receiver operating characteristics analysis revealed peak workload %predicted cutoff of 35% to be highly discriminatory, more so than nadir CPET SpO2 or FVC % predicted in identifying patients at risk for one-year mortality or transplant (peak workload % predicted < 35% HR = 4.71, 95% CI = 2.64-8.38 and area under the curve (AUC) = 0.740, nadir CPET SpO2 < 86% HR = 2.27, 95%CI = 1.41-3.68, AUC = 0.645, FVC %predicted <45% HR = 1.82, 95% CI = 1.15-2.87, AUC = 0.624). CONCLUSION Peak workload % predicted, nadir CPET SpO2, and FVC% predicted in ILD patients referred for lung transplant evaluation are independently predictive of one-year mortality or need for transplant.
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Affiliation(s)
- Aimee M Layton
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
| | - Hilary F Armstrong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Frank D'Ovidio
- Columbia Lung Transplant Program, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA; Columbia Lung Transplant Program, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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792
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Severe underweight decreases the survival rate in adult lung transplantation. Surg Today 2017; 47:1243-1248. [DOI: 10.1007/s00595-017-1508-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/12/2017] [Indexed: 11/25/2022]
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793
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Flint KM, Spertus JA, Tang F, Jones P, Fendler TJ, Allen LA. Association of global and disease-specific health status with outcomes following continuous-flow left ventricular assist device implantation. BMC Cardiovasc Disord 2017; 17:78. [PMID: 28288574 PMCID: PMC5348898 DOI: 10.1186/s12872-017-0510-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prognostic value of heart failure specific and global health status before and after left ventricular assist device (LVAD) implantation in the usual care setting is not well studied. METHODS We included 3,836 continuous-flow LVAD patients in the INTERMACS registry. Health status was measured pre-operatively and 3 months post-LVAD using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQol visual analog scale (VAS). Primary outcomes were mortality/rehospitalization. Inverse propensity weighting was used to minimize bias from missing data. RESULTS Pre-operative global and heart failure-specific health status were very poor: KCCQ median 34.6 (IQR 21.4-50.5); VAS median 43 (interquartile range (IQR) 25-65). Health status measures improved 3 months after LVAD placement: KCCQ median 69.3 (IQR 54.2-82.3); VAS median 75 (IQR 60-85). Pre-operative health status was not associated with death (unadjusted HR for lowest vs. highest score quartiles: 1.09 (0.85-1.41) KCCQ; 1.12 (0.85-1.49) VAS) or rehospitalization (unadjusted HR 0.83 (0.72-0.96) KCCQ; 0.99 (0.85-1.16) VAS). Three-month KCCQ was associated with mortality (unadjusted HR 2.17 (1.47-3.21); VAS was not (1.43 (0.94-2.17). Three-month KCCQ added incremental discriminatory value to the HeartMate II Risk Score for death (c-stat 0.60 to 0.66); VAS did not (c-stat 0.59 to 0.60). Three-month health status was associated with rehospitalization (unadjusted HR 1.31 (1.15-1.57) KCCQ; 1.24 (1.05-1.46) VAS), but did not add incremental discriminatory value (c-stat 0.52 to 0.55 and 0.54, respectively). CONCLUSIONS These real-world data suggest that pre-operative health status has limited association with outcomes after LVAD. However, persistently low health status after surgery may independently signal higher risk for subsequent death. Further study is needed to determine the clinical utility of routinely collected health status data after LVAD implantation.
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Affiliation(s)
- Kelsey M. Flint
- Division of Cardiology, University of Colorado Denver School of Medicine, Aurora, Colorado; Center for Cardiovascular Outcomes Research, 12631 East 17th Ave,, B130, Aurora, CO 80045 Denver, USA
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute and University of Missouri - Kansas City, Kansas City, MO USA
| | - Fengming Tang
- Saint Luke’s Mid America Heart Institute and University of Missouri - Kansas City, Kansas City, MO USA
| | - Philip Jones
- Saint Luke’s Mid America Heart Institute and University of Missouri - Kansas City, Kansas City, MO USA
| | - Timothy J. Fendler
- Saint Luke’s Mid America Heart Institute and University of Missouri - Kansas City, Kansas City, MO USA
| | - Larry A. Allen
- Division of Cardiology, Section of Advanced Heart Failure and Transplantation, University of Colorado Denver School of Medicine, Aurora, Colorado; Center for Cardiovascular Outcomes Research, Denver, CO USA
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794
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Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Respirology 2017; 22:575-601. [PMID: 28150362 DOI: 10.1111/resp.13012] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: (i) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; (iv)non-pharmacological therapies are comprehensively presented and (v) the importance of co-morbid conditions in managing COPD is reviewed.
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Affiliation(s)
- Claus F Vogelmeier
- University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Gerard J Criner
- Lewis Katz School of Medicine at, Temple University, Philadelphia, Pennsylvania
| | - Fernando J Martinez
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Antonio Anzueto
- University of Texas Health Science Center, San Antonio, Texas.,South Texas Veterans Health Care System, San Antonio, Texas
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | - Rongchang Chen
- State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Peter Frith
- Faculty of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | | | | | | | - Nicolas Roche
- Hôpital Cochin (Assistance Publique-Hôpitaux de Paris), University Paris Descartes, Paris, France
| | | | - Don D Sin
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dave Singh
- University of Manchester, Manchester, United Kingdom
| | | | - Jørgen Vestbo
- University of Manchester, Manchester, United Kingdom
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Alvar Agusti
- Hospital Clínic, Universitat de Barcelona, Centro de Investigación Biomé dica en Red de Enfermedade Respiratorias, Barcelona, Spain
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795
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Vogelmeier CF, Criner GJ, Martínez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodríguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agustí A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Arch Bronconeumol 2017; 53:128-149. [PMID: 28274597 DOI: 10.1016/j.arbres.2017.02.001] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/19/2022]
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
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Affiliation(s)
- Claus F Vogelmeier
- Universidad de Marburg, Marburg, Alemania, Miembro del Centro Alemán para Investigación Pulmonar (DZL).
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Filadelfia, Pensilvania, EE. UU
| | - Fernando J Martínez
- New York-Presbyterian Hospital, Weil Cornell Medical Center, Nueva York, Nueva York, EE. UU
| | - Antonio Anzueto
- University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, Texas, EE. UU
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, Londres, Reino Unido
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canadá
| | | | - Rongchang Chen
- Laboratorio Central Estatal para Enfermedades Respiratorias, Instituto de Enfermedades Respiratorias de Guangzhou, Primer Hospital Afiliado de la Universidad de Medicina de Guangzhou, Guangzhou, República Popular de China
| | | | | | - Peter Frith
- Flinders University Faculty of Medicine, Bedford Park, South Australia Australia
| | | | | | | | - Nicolás Roche
- Hôpital Cochin (APHP), Universidad Paris Descartes, París, Francia
| | | | - Don D Sin
- St. Paul's Hospital, University of British Columbia, Vancouver, Canadá
| | - Dave Singh
- University of Manchester, Manchester, Reino Unido
| | | | | | | | - Alvar Agustí
- Hospital Clínic, Universitat de Barcelona, Ciberes, Barcelona, España
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796
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Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.arbr.2017.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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797
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Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Chen R, Decramer M, Fabbri LM, Frith P, Halpin DMG, López Varela MV, Nishimura M, Roche N, Rodriguez-Roisin R, Sin DD, Singh D, Stockley R, Vestbo J, Wedzicha JA, Agusti A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Eur Respir J 2017; 49:1700214. [PMID: 28182564 DOI: 10.1183/13993003.00214-2017] [Citation(s) in RCA: 480] [Impact Index Per Article: 68.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 11/05/2022]
Abstract
This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
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Affiliation(s)
- Claus F Vogelmeier
- University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
- These authors contributed equally to the manuscript
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
- These authors contributed equally to the manuscript
| | - Fernando J Martinez
- New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
- These authors contributed equally to the manuscript
| | - Antonio Anzueto
- University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Rongchang Chen
- State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | - Peter Frith
- Flinders University Faculty of Medicine, Bedford Park, Australia
| | | | | | | | - Nicolas Roche
- Hôpital Cochin (APHP), University Paris Descartes, Paris, France
| | | | - Don D Sin
- St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Alvar Agusti
- Hospital Clínic, Universitat de Barcelona, Ciberes, Barcelona, Spain
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798
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Sköld CM, Bendstrup E, Myllärniemi M, Gudmundsson G, Sjåheim T, Hilberg O, Altraja A, Kaarteenaho R, Ferrara G. Treatment of idiopathic pulmonary fibrosis: a position paper from a Nordic expert group. J Intern Med 2017; 281:149-166. [PMID: 27862475 DOI: 10.1111/joim.12571] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a fatal progressive lung disease occurring in adults. In the last decade, the results of a number of clinical trials based on the updated disease classification have been published. The registration of pirfenidone and nintedanib, the first two pharmacological treatment options approved for IPF, marks a new chapter in the management of patients with this disease. Other nonpharmacological treatments such as lung transplantation, rehabilitation and palliation have also been shown to be beneficial for these patients. In this review, past and present management is discussed based on a comprehensive literature search. A treatment algorithm is presented based on available evidence and our overall clinical experience. In addition, unmet needs with regard to treatment are highlighted and discussed. We describe the development of various treatment options for IPF from the first consensus to recent guidelines based on evidence from large-scale, multinational, randomized clinical trials, which have led to registration of the first drugs for IPF.
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Affiliation(s)
- C M Sköld
- Respiratory Medicine Unit, Center for Molecular Medicine, Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden.,Lung-Allergy Clinic Karolinska University Hospital Solna, Stockholm, Sweden
| | - E Bendstrup
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - M Myllärniemi
- Transplantation laboratory and Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - G Gudmundsson
- Department of Respiratory Medicine and Sleep, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - T Sjåheim
- Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - O Hilberg
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - A Altraja
- Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia.,Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - R Kaarteenaho
- Unit of Medicine and Clinical Research, Pulmonary Division, Division of Respiratory Medicine, University of Eastern Finland and Center of Medicine and Clinical Research, Kuopio, Finland.,Respiratory research, Research Unit of Internal Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.,Kuopio University Hospital, Kuopio, Finland
| | - G Ferrara
- Respiratory Medicine Unit, Center for Molecular Medicine, Department of Medicine, Solna Karolinska Institutet, Stockholm, Sweden.,Lung-Allergy Clinic Karolinska University Hospital Solna, Stockholm, Sweden
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799
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Hoang V, Li GW, Kao CC, Dronavalli G, Parulekar AD. Determinants of pre-transplantation pectoralis muscle area (PMA) and post-transplantation change in PMA in lung transplant recipients. Clin Transplant 2017; 31. [PMID: 28008651 DOI: 10.1111/ctr.12897] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aimed to determine predictors of pectoralis muscle area (PMA) and assess change in PMA following lung transplantation and its relationship to outcomes. METHODS A retrospective review of 88 lung transplant recipients at a single center was performed. PMA was determined on a single axial slice from chest computerized tomography. Pectoralis muscle index (PMI) was calculated from the PMA divided by the height squared. RESULTS PMI decreased post-transplantation (8.1±2.8 cm2 /m2 pre-transplantation, 7.5±2.9 cm2 /m2 at 6 months, and 7.6±2.7 cm2 /m2 at 12 months, P<.05). Chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) were predictors of pre-transplant PMI (β=-2.3, P=.001 for COPD; β=2.1, P<.001 for ILD) and percent change in PMI at 12 months post-transplantation relative to baseline (β=19.2, P=.04 for COPD; β=-20.1, P=.01 for ILD). Patients in the highest quartile for PMI change at 12 months had fewer ventilator days compared with patients in the other quartiles (P=.03). CONCLUSIONS Underlying diagnosis was a significant predictor of both pre-transplantation PMI and change in PMI post-transplantation. Further studies of PMI are needed to determine its clinical utility in predicting outcomes following lung transplantation.
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Affiliation(s)
- Van Hoang
- Section of Pulmonary, Critical Care and Sleep, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Gloria W Li
- Section of Pulmonary, Critical Care and Sleep, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christina C Kao
- Section of Pulmonary, Critical Care and Sleep, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Goutham Dronavalli
- Section of Pulmonary, Critical Care and Sleep, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amit D Parulekar
- Section of Pulmonary, Critical Care and Sleep, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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800
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Heterogeneity in Survival in Adult Patients With Cystic Fibrosis With FEV 1 < 30% of Predicted in the United States. Chest 2017; 151:1320-1328. [PMID: 28115168 DOI: 10.1016/j.chest.2017.01.019] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/11/2016] [Accepted: 01/06/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Lung transplantation (LTx) is frequently considered for patients with cystic fibrosis (CF) when the FEV1 reaches < 30%. This study estimated transplant-free survival for patients with CF and an FEV1 < 30% and identified predictors of death without LTx. METHODS We conducted a retrospective cohort study using the CF Foundation Patient Registry from January 1, 2003 to December 31, 2013. Adult patients (≥ 18 years) with FEV1 < 30% prior to LTx were included. We performed Kaplan-Meier survival estimates censored at LTx. Multivariable Cox proportional hazard regression identified predictors of mortality. RESULTS There were 3,340 patients with an FEV1 < 30%. Death without LTx occurred in 1,250 patients (37.4%); 951 patients (28.5%) underwent LTx; 918 patients (27.5%) remained alive without LTx at the end of follow-up; and 221 patients (6.6%) were lost to follow-up. Median transplant-free survival after FEV1 < 30% was 6.6 years (95% CI, 5.9-7.0). Adjusted predictors of death without LTx included supplemental oxygen use (hazard ratio [HR], 2.1; 95% CI, 1.7-2.6), Burkholderia cepacia infection (HR, 1.8; 95% CI, 1.3-2.6), BMI ≤ 18 (HR, 1.6; 95% CI, 1.3-1.9), female sex (HR, 1.6; 95% CI, 1.2-2.0), CF-related diabetes in patients receiving insulin (HR, 1.4; 95% CI, 1.2-1.8), and ≥ one exacerbation per year (HR, 1.7; 95% CI, 1.3-2.2 vs. 0 exacerbations). CONCLUSIONS Median survival was > 6.5 years for patients with CF and an FEV1 < 30%, exceeding prior survival estimates. There was substantial heterogeneity in survival, with some patients with CF dying soon after reaching this lung function threshold and others living for many years. For this reason, we conclude that FEV1 < 30% remains an important marker of disease severity for patients with CF. Patients with a supplemental oxygen requirement or frequent exacerbations should have prompt referral because of their increased risk of death.
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