801
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Rajagopal K, Hoeper MM. State of the Art: Bridging to lung transplantation using artificial organ support technologies. J Heart Lung Transplant 2016; 35:1385-1398. [PMID: 27916175 DOI: 10.1016/j.healun.2016.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022] Open
Abstract
Lung transplantation increasingly is being performed in recipients of higher risk and acuity. A subset of these patients has severely abnormal gas exchange and/or right ventricular dysfunction, such that artificial organ support strategies are required to bridge patients to lung transplantation. We review the rationales and currently used and potential strategies for bridging to lung transplantation and characterize bridging outcomes. Based on physiologic reasoning and a study of the existing literature, we provide a working strategy for bridging to lung transplantation.
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Affiliation(s)
- Keshava Rajagopal
- Center for Advanced Heart Failure and Department of Cardiothoracic/Vascular Surgery, University of Texas-Houston and Memorial Hermann-Texas Medical Center, Houston, Texas.
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, and German Center for Lung Research (DZL), Hannover, Germany
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802
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How important is coronary artery disease when considering lung transplant candidates? J Heart Lung Transplant 2016; 35:1453-1461. [DOI: 10.1016/j.healun.2016.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 03/01/2016] [Accepted: 03/27/2016] [Indexed: 12/30/2022] Open
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803
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Liu YM, Nepali K, Liou JP. Idiopathic Pulmonary Fibrosis: Current Status, Recent Progress, and Emerging Targets. J Med Chem 2016; 60:527-553. [DOI: 10.1021/acs.jmedchem.6b00935] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Yi-Min Liu
- School of Pharmacy, College
of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
| | - Kunal Nepali
- School of Pharmacy, College
of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
| | - Jing-Ping Liou
- School of Pharmacy, College
of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
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804
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Blumenthal NP, Petty MG, McCorkle R. Missing Domains of Lung Transplant Patient Selection. Prog Transplant 2016; 27:90-97. [PMID: 27888278 DOI: 10.1177/1526924816679840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The goal of consistent, predictable, and improved outcomes has continued to elude the scientific community in the 30 years since lung transplantation became the procedure of choice for patients with terminal, nonmalignant lung disease. Background: Although there is consensus regarding disease-specific indications for lung transplant, ambiguity remains regarding how patient-specific attributes should influence lung transplant candidacy. This study had 3 aims (1) to establish the missing domains of the interdisciplinary assessment of the lung transplant candidate, (2) to have these domains validated by an international panel of lung transplant experts, and (3) to recommend the next step for inclusion of these domains into the lung transplant candidate selection process. Methods: Three levels of evidence were reviewed. A search for standards and guidelines, a comprehensive literature review, and a validation of domains by experts were conducted. Results: Seven domains of patient attributes were identified as relevant to lung transplant patient selection: cognitive performance, frailty, psychological factors, self-efficacy, social support, quality of life, and sociodemographic factors. Within each domain, several elements were identified to be incorporated in the process of patient assessment. Conclusion: Assessment of the missing domains and elements should be incorporated into the interdisciplinary lung transplant evaluation process. Standardized recognition and reporting of the patient-specific attributes will inform the work of individual transplant programs and the international transplant community. Further study is needed to associate these patient attributes with transplant outcomes. Improved understanding is needed regarding how nurses assess lung transplant candidates and how they communicate their findings within interdisciplinary settings.
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Affiliation(s)
- Nancy P. Blumenthal
- Lung Transplant Program, Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Doctorate of Nursing Practice Program, Yale University, West Haven, CT, USA
| | - Michael G. Petty
- Department of Nursing, University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Ruth McCorkle
- Division of Acute Care/Health Systems, Yale University School of Nursing, West Haven, CT, USA
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805
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Chaparro C, Keshavjee S. Lung transplantation for cystic fibrosis: an update. Expert Rev Respir Med 2016; 10:1269-1280. [DOI: 10.1080/17476348.2016.1261016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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806
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Dabak G, Dalar L, Taşçı E, Clark S. Lung transplantation in Turkey: lessons from surgeons and pulmonologists. Turk J Med Sci 2016; 46:1434-1442. [PMID: 27966310 DOI: 10.3906/sag-1506-51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 01/05/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM In order to actualize an efficient lung transplantation program, it is necessary to determine priorities and set up strategies. This study aimed to estimate the present situation in Turkey by determining the level of interest and knowledge of pulmonologists and thoracic surgeons regarding lung transplantation. MATERIALS AND METHODS A questionnaire was prepared to establish the level of interest and knowledge of physicians on lung transplantation. It was sent to 2131 pulmonologists and thoracic surgeons, and 130 physicians completed the questionnaire. RESULTS Of the 130 physicians who responded, 42 were thoracic surgeons and 88 were pulmonologists. There was no significant difference between the two groups regarding the availability of lung transplantation at their hospitals. The rates of correct answers to the questions and responses supporting the transplant initiative were higher in the thoracic surgeon group than in the pulmonologist group. CONCLUSION The establishment of a successful system for lung transplantation in Turkey requires an increase in interest, knowledge, and dedication of physicians, coupled with adequate and continuous training. There also needs to be sufficient equipment and financing in addition to disciplined multidisciplinary teams and cooperation. This survey shows there is still much work to be done to achieve success in lung transplantation in Turkey.
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Affiliation(s)
- Gül Dabak
- Department of Chest Diseases, İstanbul Occupational Diseases Hospital, İstanbul, Turkey
| | - Levent Dalar
- Department of Pulmonology, Faculty of Medicine, İstanbul Bilim University, İstanbul, Turkey
| | - Erdal Taşçı
- Department of Thoracic Surgery, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Stephen Clark
- Cardiopulmonary Transplant Unit, Freeman Hospital and University of Northumbria, Newcastle, United Kingdom
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807
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D'Ambrosio R, Aghemo A, Rossetti V, Carrinola R, Colombo M. Sofosbuvir-based regimens for the treatment of hepatitis C virus in patients who underwent lung transplant: case series and review of the literature. Liver Int 2016; 36:1585-1589. [PMID: 27429162 DOI: 10.1111/liv.13203] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic infection with HCV can rapidly progress to cirrhosis leading to increased mortality rates in immunosuppressed organ-transplanted patients. In liver-transplanted patients, the introduction of directly acting antivirals has modified HCV natural history by providing a safe and effective therapy for this group of patients. To date there are no data on safety and efficacy of IFN-free regimens in HCV patients who received lung transplant (LuT). METHODS We report three patients who have received anti-HCV treatment after LuT with Sofosbuvir-based regimens. RESULTS All patients achieved a SVR, no unexpected safety signals were observed and no modifications in immunosuppressants were required. CONCLUSIONS Our report is the first to show that HCV patients who underwent LuT can be safely treated with IFN-free regimens, thus opening the door for refined clinical management of this category of patients.
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Affiliation(s)
- Roberta D'Ambrosio
- A.M. and A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
| | - Alessio Aghemo
- A.M. and A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Valeria Rossetti
- Respiratory Medicine Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Rosaria Carrinola
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Massimo Colombo
- A.M. and A. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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808
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Van Raemdonck D, Vos R, Yserbyt J, Decaluwe H, De Leyn P, Verleden GM. Lung cancer: a rare indication for, but frequent complication after lung transplantation. J Thorac Dis 2016; 8:S915-S924. [PMID: 27942415 DOI: 10.21037/jtd.2016.11.05] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Lung transplantation is an effective and safe therapy for carefully selected patients suffering from a variety of end-stage pulmonary diseases. Lung cancer negatively affects prognosis, particularly in patients who are no longer candidates for complete resection. Lung transplantation can be considered for carefully selected and well staged lung cancer patients with proven, lung-limited, multifocal, (minimally invasive) adenocarcinoma in situ (AIS) (previously called bronchioloalveolar cell carcinoma) causing respiratory failure. Despite a substantial risk of tumour recurrence (33-75%), lung transplantation may offer a survival benefit (50% at 5 years) with best palliation of their disease. Reports on lung transplantation for other low-grade malignancies are rare. Lung transplant candidates at higher risk for developing lung cancer [mainly previous smokers with chronic obstructive lung disease (COPD) and idiopathic pulmonary fibrosis (IPF) or older patients] should be thoroughly and repeatedly screened for lung cancer prior to listing, and preferably also during waiting list time if longer than 1 year, including the use of PET-CT scan and EBUS-assisted bronchoscopy in case of undefined, but suspicious pulmonary abnormalities. Double-lung transplantation should now replace single-lung transplantation in these high-risk patients because of a 6-9% prevalence of lung cancer developing in the remaining native lung. Patients with unexpected, early stage bronchial carcinoma in the explanted lung may have favourable survival without recurrence. Early PET-CT (at 3-6 months) following lung transplantation is advisable to detect early, subclinical disease progression. Donor lungs from (former) smokers should be well examined at retrieval. Suspicious nodules should be biopsied to avoid grafting cancer in the recipient. Close follow-up with regular visits and screening test in all recipients is needed because of the increased risk of developing a primary or secondary cancer in the allograft from either donor or recipient origin.
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Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
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809
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810
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Schmid FA, Inci I, Bürgi U, Hillinger S, Schneiter D, Opitz I, Huber LC, Isenring BD, Jungraithmayr W, Schuurmans MM, Weder W, Benden C. Favorable outcome of children and adolescents undergoing lung transplantation at a European adult center in the new era. Pediatr Pulmonol 2016; 51:1222-1228. [PMID: 26773327 DOI: 10.1002/ppul.23383] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/28/2015] [Accepted: 12/20/2015] [Indexed: 01/27/2023]
Abstract
Lung transplantation (LTx) is an accepted therapy in children with end-stage lung diseases. Pediatric-specific experience is considered important in pediatric LTx. We present our institutional experience and its outcome since the year 2000, asking whether different treatment strategies produce comparable outcomes in pediatric lung transplant recipients at our predominantly adult center. This is a retrospective analysis of children and adolescents aged ≤20 years, undergoing LTx between January 2001 and December 2013. Minimum follow-up was 12 months. Primary endpoints were re-transplantation or death. We performed 33 lung transplant procedures in 29 patients. Survival 1 month post-operatively was 96.6%, at 3 months 93.1% and at 12 months 82.8%, respectively. At the end of our follow up, 72.4% of our pediatric cohort was still alive - median post-transplant survival was 59 months (range 0-159). 72.4% of the children were transplanted with support of extracorporeal membrane oxygenation (ECMO), size-reduced donor grafts were used in 69.0%. The differences between post-transplant survival of the "non-ECMO-group" versus the "ECMO-group" (137 vs. 28 months, P=0.7) and "full size" versus "size-reduced bilateral transplants" (61 vs. 28 months, P = 0.7) were not significant, though. There were no anastomotic complications, also not in size-reduced lungs. Our results are well comparable to the international data and show excellent short- and mid-term outcomes. We advocate ECMO-bridge to be considered as a valuable treatment option to prolong time on the waiting list in highly selected patients, as well as size reduction and lobar transplants as a strong strategy to increase the donor pool and reduce donor-recipient size-mismatches. Pediatr Pulmonol. 2016;51:1222-1228. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Florian A Schmid
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Ilhan Inci
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Urs Bürgi
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland
| | - Sven Hillinger
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Didier Schneiter
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Lars C Huber
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland
| | - Bruno D Isenring
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, and University of Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonary Medicine, University Hospital Zurich, and University of Zurich, Switzerland.
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811
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Jo HE, Randhawa S, Corte TJ, Moodley Y. Idiopathic Pulmonary Fibrosis and the Elderly: Diagnosis and Management Considerations. Drugs Aging 2016; 33:321-34. [PMID: 27083934 DOI: 10.1007/s40266-016-0366-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe and progressive fibrosing interstitial lung disease, which ultimately results in respiratory failure and death. The median age at diagnosis is 66 years, and the incidence increases with age, making this a disease that predominantly affects the elderly population. IPF can often be difficult to diagnose, as its symptoms--cough, dyspnoea and fatigue--are non-specific and can often be attributed to co-morbidities such as heart failure and chronic obstructive pulmonary disease. Making an accurate diagnosis of IPF is imperative, as new treatments that appear to slow the progression of IPF have recently become available. Pirfenidone and nintedanib are two such treatments, which have shown efficacy in randomised controlled trials. As with all new treatments, caution must be advocated in the elderly, as these patients often lie outside the narrow clinical trial cohorts that are studied, and the benefits of therapy must be weighed against potential toxicities. Both medications, while relatively safe, have been associated with adverse effects, particularly gastrointestinal symptoms such as nausea, diarrhoea and anorexia. In this review, we highlight measures to improve recognition and accurate diagnosis of IPF, as well as co-morbidities that often affect the diagnosis and disease course. The gold standard for IPF diagnosis is a multidisciplinary meeting whereby clinicians, radiologists and histopathologists reach a consensus after interactive discussion. In many cases, a lung biopsy may not be available because of high risk or patient choice, particularly in the elderly. In these cases, there is debate as to whether a biopsy is required, given the high rates of IPF in patients over the age of 70 years with interstitial changes on computed tomography. We also discuss the management of IPF, drawing particular attention to specific issues affecting the elderly population, especially with regard to polypharmacy and end-of-life care. Through this article, we endeavour to improve awareness of this devastating disease and thus improve recognition of the disease and its outcomes in elderly patients.
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Affiliation(s)
- Helen E Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Sharan Randhawa
- Department of Respiratory Medicine, Fiona Stanely Hospital, Perth, WA, Australia.,University of Western Australia, Perth, WA, Australia
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Yuben Moodley
- Department of Respiratory Medicine, Fiona Stanely Hospital, Perth, WA, Australia. .,University of Western Australia, Perth, WA, Australia.
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812
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Skolnik K, Kirkpatrick G, Quon BS. Nontuberculous Mycobacteria in Cystic Fibrosis. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016; 8:259-274. [PMID: 28035194 PMCID: PMC5155018 DOI: 10.1007/s40506-016-0092-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nontuberculous mycobacteria (NTM) are found in approximately 10 % of cystic fibrosis (CF) patients, but only a portion will develop NTM disease. The management of CF lung disease should be optimized, including antibiotic therapy targeted to the individual's usual airway bacteria, prior to considering treatment for NTM lung disease. Those who meet criteria for NTM lung disease may not necessarily require treatment and could be monitored expectantly if symptoms and radiographic findings are minimal. However, the presence of Mycobacterium abscessus complex (MABSC), severe lung disease, and/or anticipated lung transplant should prompt NTM therapy initiation. For CF patients with Mycobacterium avium complex (MAC), recommended treatment includes triple antibiotic therapy with a macrolide, rifampin, and ethambutol. Azithromycin is generally our preferred macrolide in CF as it is better tolerated and has fewer drug-drug interactions. MABSC treatment is more complex and requires an induction phase (oral macrolide and two IV agents including amikacin) as well as a maintenance phase (nebulized amikacin and two to three oral antibiotics including a macrolide). The induction phase may range from one to three months (depending on infection severity, treatment response, and medication tolerability). For both MAC and MABSC, treatment duration is extended 1-year post-culture conversion. However, in patients who do not achieve culture negative status but tolerate therapy, we consider ongoing treatment for mycobacterial suppression and prevention of disease progression.
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Affiliation(s)
- Kate Skolnik
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, Alberta Canada
- Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC Canada
- Rockyview General Hospital Respirology Offices, 7007 14th Street SW, Calgary, AB T2V 1P9 Canada
| | - Gordon Kirkpatrick
- Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC Canada
| | - Bradley S. Quon
- Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC Canada
- St. Paul’s Hospital, 8B Providence Wing, 1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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813
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Adegunsoye A, Strek ME, Garrity E, Guzy R, Bag R. Comprehensive Care of the Lung Transplant Patient. Chest 2016; 152:150-164. [PMID: 27729262 DOI: 10.1016/j.chest.2016.10.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 10/01/2016] [Indexed: 12/20/2022] Open
Abstract
Lung transplantation has evolved into a life-saving treatment with improved quality of life for patients with end-stage respiratory failure unresponsive to other medical or surgical interventions. With improving survival rates, the number of lung transplant recipients with preexisting and posttransplant comorbidities that require attention continues to increase. A partnership between transplant and nontransplant care providers is necessary to deliver comprehensive and optimal care for transplant candidates and recipients. The goals of this partnership include timely referral and assistance with transplant evaluation, optimization of comorbidities and preparation for transplantation, management of common posttransplant medical comorbidities, immunization, screening for malignancy, and counseling for a healthy lifestyle to maximize the likelihood of a good outcome. We aim to provide an outline of the main aspects of the care of candidates for and recipients of lung transplants for nontransplant physicians and other care providers.
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Affiliation(s)
- Ayodeji Adegunsoye
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Mary E Strek
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Edward Garrity
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL; Lung Transplant Program, University of Chicago, Chicago, IL
| | - Robert Guzy
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL; Lung Transplant Program, University of Chicago, Chicago, IL
| | - Remzi Bag
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL; Lung Transplant Program, University of Chicago, Chicago, IL.
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814
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A Review of Lung Transplantation and Its Implications for the Acute Inpatient Rehabilitation Team. PM R 2016; 9:294-305. [DOI: 10.1016/j.pmrj.2016.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 12/12/2022]
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815
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Hayes D, Joy BF, Reynolds SD, Tobias JD, Tumin D. Influence of graft ischemic time and geographic distance between donor and recipient on survival in children after lung transplantation. J Heart Lung Transplant 2016; 35:1220-1226. [DOI: 10.1016/j.healun.2016.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 02/02/2023] Open
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816
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Lewandowski AN, Skillings JL. Who gets a lung transplant? Assessing the psychosocial decision-making process for transplant listing. Glob Cardiol Sci Pract 2016; 2016:e201626. [PMID: 29043272 PMCID: PMC5642746 DOI: 10.21542/gcsp.2016.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/12/2016] [Indexed: 12/14/2022] Open
Abstract
In the United States, there is a significant shortage of available donor organs. This requires transplant professionals to hold simultaneous, yet divergent roles as (1) advocates for patients who are in need of a lifesaving transplant, and (2) responsible stewards in the allocation of scarce donor organs. In order to balance these roles, most transplant teams utilize a committee based decision-making process to select suitable candidates for the transplant waiting list. These committees use medical and psychosocial criteria to guide their decision to list a patient. Transplant regulatory bodies have established medical standards for identifying appropriate medical candidates for transplantation. However, transplant regulatory bodies have not developed policies to standardize psychosocial criteria for listing patients. This affords transplant centers the autonomy to develop their own psychosocial criteria for determining which patients will be placed on the transplant waiting list. This lack of a standardized policy has resulted in inconsistent psychosocial practices amongst transplant centers nationwide. Since there has been no formal review of the inconsistency in psychosocial policy and practice, this paper seeks to explore the non-standardized psychosocial approach to organ transplant listing. The authors review factors that are relevant to the standardization of the psychosocial decision-making process, including shared decision-making, clinician judgment, bias in decision-making and moral distress in transplant staff. We conclude with a discussion about the impact of these issues on psychosocial practices in solid organ transplantation.
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Affiliation(s)
- Amber N. Lewandowski
- Richard DeVos Heart and Lung Transplant Program, Spectrum Health, Grand Rapids, MI, USA
| | - Jared Lyon Skillings
- Richard DeVos Heart and Lung Transplant Program, Spectrum Health, Grand Rapids, MI, USA
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817
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Fuller LM, Button B, Tarrant B, Steward R, Bennett L, Snell G, Holland AE. Longer Versus Shorter Duration of Supervised Rehabilitation After Lung Transplantation: A Randomized Trial. Arch Phys Med Rehabil 2016; 98:220-226.e3. [PMID: 27697429 DOI: 10.1016/j.apmr.2016.09.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/01/2016] [Accepted: 09/01/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the effects of a supervised longer- (14wk) versus shorter-duration (7wk) rehabilitation program after lung transplantation (LTX). DESIGN Randomized controlled trial. SETTING Outpatient rehabilitation gym setting. PARTICIPANTS Post-LTX patients aged ≥18 years (N=66; 33 women; mean age, 51±13y) who had undergone either single LTX or bilateral LTX. INTERVENTION Outpatient rehabilitation program consisting of thrice-weekly sessions with cardiovascular training on bike ergometer and treadmill plus upper and lower limb strength training. MAIN OUTCOME MEASURES Measures were taken at baseline, 7 weeks, 14 weeks, and 6 months by assessors who were blinded to group allocation. Functional exercise capacity was measured by the 6-minute walk test (6MWT). Strength of quadriceps and hamstrings was measured on an isokinetic dynamometer and recorded as average peak torque of 6 repetitions for both muscles. Quality of life (QOL) was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS Of the participants, 86% had bilateral LTX and 41% had primary diagnosis of chronic obstructive pulmonary disease. The 6MWT increased in both groups with no significant difference between groups at any time point (mean 6mo 6MWD: short, 590±85m vs long, 568±127m; P=0.5). Similarly, at 6 months, there was no difference between groups in quadriceps average peak torque (mean, 115±38Nm vs 114±40Nm, respectively; P=.59), hamstring average peak torque (57±18Nm vs 52±19Nm, respectively; P=.36), or mental or physical health domains of quality of life. CONCLUSIONS Shorter duration (7wk) of rehabilitation achieves comparable outcomes with 14 weeks of supervised rehabilitation for functional exercise capacity, lower limb strength, and quality of life at 6 months after LTX.
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Affiliation(s)
- Louise M Fuller
- Physiotherapy Department, The Alfred, Melbourne, Australia; Allergy, Immunology and Respiratory Department, The Alfred, Melbourne, Australia; Institute of Breathing and Sleep, La Trobe University, Bundoora, Australia.
| | - Brenda Button
- Physiotherapy Department, The Alfred, Melbourne, Australia; Monash University, Clayton, Australia
| | - Ben Tarrant
- Physiotherapy Department, The Alfred, Melbourne, Australia
| | | | - Lisa Bennett
- Physiotherapy Department, The Alfred, Melbourne, Australia
| | - Greg Snell
- Allergy, Immunology and Respiratory Department, The Alfred, Melbourne, Australia
| | - Anne E Holland
- Physiotherapy Department, The Alfred, Melbourne, Australia; Institute of Breathing and Sleep, La Trobe University, Bundoora, Australia
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818
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Søyseth TS, Lund MB, Bjørtuft Ø, Heldal A, Søyseth V, Dew MA, Haugstad GK, Malt UF. Psychiatric disorders and psychological distress in patients undergoing evaluation for lung transplantation: a national cohort study. Gen Hosp Psychiatry 2016; 42:67-73. [PMID: 27638975 DOI: 10.1016/j.genhosppsych.2016.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We sought to investigate type and prevalence of psychiatric disorders and psychological distress in patients being evaluated for lung transplantation. METHODS One hundred eighteen patients were assessed [74% with chronic obstructive pulmonary disease (COPD)] with the MINI Neuropsychiatric Interview, the General Health Questionnaire (GHQ), and Hospital Anxiety Depression Scale (HADS). Spirometry and the 6-min walk test (6MWT) assessed lung function with data subject to multivariate regression analyses. RESULTS Current and lifetime prevalence for mental disorders were 41.5% and 61.0% respectively, with anxiety (39.8% of patients), mood disorders (11.8%), and subsyndromal disorders (8.7%) identified. 15% of patients reported feelings of panic during the last week, 9% reported hopelessness, and 3% felt that life was not worth living. Statistically significant correlates were derived for HADS-depression with lung function (P=.0012) and 6MWT (P=.030) for the entire group (P=.012), and with lung function (P=.030) for COPD patients (P=.045), for whom higher chronic GHQ-scores correlated with poorer lung function (P=.009). In multivariate regression analysis, history of mental disorder was strongest predictor of current distress. CONCLUSIONS Our findings underline the importance of assessing past, current, and sub-syndromal psychiatric disorders in addition to levels of distress in transplant candidates, with prospective studies needed to investigate impact on long-term outcome after transplantation.
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Affiliation(s)
- Torunn S Søyseth
- Department of Clinical Service, Oslo University Hospital, Oslo, Norway
| | - May-Brit Lund
- Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Øystein Bjørtuft
- Department of Respiratory Medicine, Oslo University Hospital, Oslo, Norway
| | - Aasta Heldal
- Department of Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway
| | - Vidar Søyseth
- Department of Pulmonary Medicine, Akershus University Hospital, Nordbyhagen, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, USA
| | - Gro Killi Haugstad
- Oslo Akershus University College of Applied Sciences, Faculty of Health Sciences, Oslo, Norway
| | - Ulrik Fredrik Malt
- Department of Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway; Department of Research and Education (clinical neuroscience) Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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819
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Hayes D, Glanville AR, McGiffin D, Tobias JD, Tumin D. Age-related survival disparity associated with lung transplantation in cystic fibrosis: An analysis of the registry of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2016; 35:1108-15. [DOI: 10.1016/j.healun.2016.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 01/26/2023] Open
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820
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821
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Posttransplant solid organ malignancies in lung transplant recipients: a single-center experience and review of the literature. TUMORI JOURNAL 2016; 102:574-581. [PMID: 27647228 DOI: 10.5301/tj.5000557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Solid-organ tumor incidences are higher in solid organ transplant patients than in the general population. The aim of this study was to analyze solid-organ tumor frequency and characteristics in a population of lung transplant patients and provide a brief review of the literature. METHODS A retrospective analysis was conducted of all patients who underwent a lung transplant in the Lung Transplant Program at the University Hospital of Siena, Italy, from 2001 to 2014 (n = 119). Patients' demographics, pretransplant characteristics, immunosuppressive therapy, and infectious factors were recorded. RESULTS Nine patients with a median age of 59.0 years (range 50-63) of our cohort developed a solid-organ tumor (7.5%). Most of the patients experienced nonmelanoma skin cancer (44.4%); the others were diagnosed with lung cancer (22.2%), breast cancer (22.2%), and colon-rectal cancer (11.2%). The median time from transplantation to tumor diagnosis was 895.0 days (range 321-2046). No differences in pretransplant characteristics, immunosuppressive therapy, or infectious factors were found between patients who developed solid organ tumors and those who did not. CONCLUSIONS The present study confirmed that de novo malignancies are a major issue in lung transplant patients; in particular, skin and lung cancers demonstrated a higher incidence rate. Oncologic treatment of these patients is complex, requiring close collaboration between the transplant team and oncologist. Strict screening programs are key factors for an early diagnosis and to allow for prompt treatment resulting in a better outcome.
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822
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Lam DL, Kapnadak SG, Godwin JD, Kicska GA, Aitken ML, Pipavath SN. Radiologic computed tomography features of Mycobacterium abscessus in cystic fibrosis. CLINICAL RESPIRATORY JOURNAL 2016; 12:459-466. [PMID: 27460837 DOI: 10.1111/crj.12536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/08/2016] [Accepted: 07/17/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Mycobacterium abscessus infection in cystic fibrosis (CF) patients can lead to poor outcomes. Early diagnosis is important, but there are no studies outlining specific imaging features of M. abscessus in CF. OBJECTIVES To describe the computed tomography (CT) findings of early M. abscessus infection in our CF population. METHODS Thirteen CF patients with sputum cultures positive for M. abscessus from 2006 to 2013 were identified at our institution. Clinical characteristics including culture dates and lung function were reviewed. Positive cultures were classified as "disease" versus "colonization" based on published criteria. Chest CT scans were reviewed at times closest to initial infection, and features including bronchiectasis, mucous plugging, consolidation, ground glass opacities, nodules, and cavitation were evaluated. Brody scores were calculated to evaluate extent of CF lung disease. RESULTS All patients had bronchiectasis and mucous plugging, with 10 of 13 (76.9%) in an upper lobe distribution. Consolidation was seen in 12 of 13 (92.3%) patients, 8 (61.5%) patients had nodules, and 5 (38.5%) with cavitation. The average Brody score was 59.5, which was no different than previously described CF cohorts without M. abscessus. There were no significant differences between subjects with disease versus colonization. CONCLUSION The most common CT features of early M. abscessus in our CF population include bronchiectasis, mucus plugging, and consolidation, but the findings did not reveal a unique radiologic signature. CT at this initial time point may not distinguish early M. abscessus infection from background lung disease or mycobacterial colonization in CF patients.
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Affiliation(s)
- Diana L Lam
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Siddhartha G Kapnadak
- Department of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - J David Godwin
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Gregory A Kicska
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Moira L Aitken
- Department of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Sudhakar N Pipavath
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, 98195, USA
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823
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Liu Y, Vela M, Rudakevych T, Wigfield C, Garrity E, Saunders MR. Patient factors associated with lung transplant referral and waitlist for patients with cystic fibrosis and pulmonary fibrosis. J Heart Lung Transplant 2016; 36:264-271. [PMID: 27773453 DOI: 10.1016/j.healun.2016.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/19/2016] [Accepted: 08/17/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Since 2005, the Lung Allocation Score (LAS) has prioritized patient benefit and post-transplant survival, reducing waitlist to transplant time to <200 days and decreasing mortality on the waitlist. A current challenge is the wait for the waitlist-the time between the patient's transplant-eligible diagnosis and waitlist registration. METHODS We investigated whether sociodemographic (age, sex, race, insurance, marital status, median household income) and clinical (forced expiratory volume in 1 second [FEV1] percent of predicted, body mass index, depression/anxiety, alcohol/substance misuse, absolute/relative contraindications) factors influenced referral and waitlist registration. We conducted a retrospective cohort study through chart review of hospitalized patients on the University of Chicago general medicine service from 2006 to 2014 who met transplant-eligible criteria and ICD-9 billing codes for cystic fibrosis (CF) and pulmonary fibrosis (PF). We analyzed the times from transplant eligibility to referral, work-up and waitlisting using Kaplan-Meier curves and log-rank tests. RESULTS Overall, the referral rate for transplant-eligible patients was 64%. Of those referred, approximately 36% reach the lung transplant waitlist. Referred CF patients were significantly more likely to reach the transplant waitlist than PF patients (CF 60% vs PF 22%, p < 0.05). In addition, CF patients had a shorter wait from transplant eligibility to waitlist than PF patients (329 vs 2,369 days, respectively [25th percentile], p < 0.05). Patients with PF and CF both faced delays from eligibility to referral and waitlist. CONCLUSIONS Quality improvement efforts are needed to better identify and refer appropriate patients for lung transplant evaluation. Targeted interventions may facilitate more efficient evaluation completion and waitlist appearance.
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Affiliation(s)
- Yuan Liu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Monica Vela
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA; Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, Illinois, USA
| | - Tanya Rudakevych
- Department of Statistics, University of Chicago, Chicago, Illinois, USA; Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Edward Garrity
- Lung Transplant Program, University of Chicago, Chicago, Illinois, USA
| | - Milda R Saunders
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA.
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824
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Lung transplantation after prior cardiothoracic surgery: To transplant or not to transplant. J Heart Lung Transplant 2016; 35:1284-1285. [PMID: 27771205 DOI: 10.1016/j.healun.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/17/2016] [Indexed: 11/22/2022] Open
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825
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Wigfield CH, Buie V, Onsager D. "Age" in lung transplantation: factors related to outcomes and other considerations. CURRENT PULMONOLOGY REPORTS 2016; 5:152-158. [PMID: 27610336 PMCID: PMC4992499 DOI: 10.1007/s13665-016-0151-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The age of lung transplant recipients is steadily increasing. Older donors are more frequently considered. The risk factors associated with advanced age in lung transplantation warrant discussion to ensure optimal outcomes in this complex endeavor. This report provides a summary of the pertinent topics and available evidence.
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826
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Increased Mortality in Adult Cystic Fibrosis Patients with Medicaid Insurance Awaiting Lung Transplantation. Lung 2016; 194:799-806. [DOI: 10.1007/s00408-016-9927-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 08/02/2016] [Indexed: 01/20/2023]
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827
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Fuehner T, Kuehn C, Welte T, Gottlieb J. ICU Care Before and After Lung Transplantation. Chest 2016; 150:442-50. [DOI: 10.1016/j.chest.2016.02.656] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 02/09/2016] [Accepted: 02/22/2016] [Indexed: 12/27/2022] Open
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828
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829
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Abstract
Despite improvement in median life expectancy and overall health, some children with cystic fibrosis (CF) progress to end-stage lung or liver disease and become candidates for transplant. Transplants for children with CF hold the promise to extend and improve the quality of life, but barriers to successful long-term outcomes include shortage of suitable donor organs; potential complications from the surgical procedure and immunosuppressants; risk of rejection and infection; and the need for lifelong, strict adherence to a complex medical regimen. This article reviews the indications and complications of lung and liver transplantation in children with CF.
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Affiliation(s)
- Albert Faro
- Department of Pediatrics, Washington University in St. Louis, Campus Box 8116, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| | - Alexander Weymann
- Department of Pediatrics, Washington University in St. Louis, Campus Box 8116, 660 South Euclid Avenue, St Louis, MO 63110, USA
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830
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Koenig A, Stepanova M, Saab S, Ahmed A, Wong R, Younossi ZM. Long-term outcomes of lung transplant recipients with hepatitis C infection: a retrospective study of the U.S. transplant registry. Aliment Pharmacol Ther 2016; 44:271-8. [PMID: 27279496 DOI: 10.1111/apt.13693] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/02/2016] [Accepted: 05/21/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic hepatitis C patients in need of a lung transplant are often considered ineligible due to their infection. AIM To assess the association of hepatitis C virus (HCV) infection with long-term outcomes of lung transplants. METHODS From the Scientific Registry of Transplant Recipients (1995-2011), we selected all adults with and without HCV infection who underwent lung transplantation. RESULTS A total of 17 762 lung transplant recipients were included (55.5% bilateral). Of those, 319 (1.83%) had positive HCV serology. The HCV-positive recipients were 1.6 years younger, less Caucasian and more African-American, and had a significantly higher rate of co-infection with hepatitis B virus (all P < 0.001). Post-transplant patients were discharged alive at similar rates regardless of HCV status: 88.4% in HCV+ vs. 90.3% in HCV- (P = 0.25). The mortality rates were also similar at 1 and 2 years after transplantation (20.7% in HCV+ vs. 19.2% in HCV- and 31.6% in HCV+ vs. 28.9% in HCV-, respectively; both P > 0.05), but at post-transplant year 3 year, mortality rate in HCV+ became significantly higher (42.5% vs. 36.4%, P = 0.04) and remained higher for the duration of the follow-up (mean 9.1 years, max 18.4 years). In multivariate survival analysis, after adjustment for confounders, being HCV+ was associated with higher mortality: adjusted hazard ratio 1.24 (1.04-1.46), P = 0.01. No association of HCV infection with time to graft loss was found (P = 0.92). CONCLUSIONS Chronic HCV infection is associated with a moderate increase in post-lung transplant mortality. Treatment of HCV in lung transplant recipients may, therefore, result in improvement of post-transplant outcomes.
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Affiliation(s)
- A Koenig
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - M Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | - S Saab
- Departments of Medicine and Surgery, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA, USA
| | - A Ahmed
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - R Wong
- Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, Oakland, CA, USA
| | - Z M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
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831
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Jung HS, Lee JG, Yu WS, Lee CY, Haam SJ, Paik HC. Early outcomes of lung transplantation for bronchiolitis obliterans syndrome after allogeneic haematopoietic stem cell transplantation: a single-centre experience. Interact Cardiovasc Thorac Surg 2016; 23:914-918. [DOI: 10.1093/icvts/ivw231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/20/2016] [Accepted: 04/28/2016] [Indexed: 11/12/2022] Open
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832
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Low levels of physical activity predict worse survival to lung transplantation and poor early post-operative outcomes. J Heart Lung Transplant 2016; 35:1041-3. [DOI: 10.1016/j.healun.2016.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/11/2016] [Accepted: 05/12/2016] [Indexed: 11/24/2022] Open
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833
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Abstract
Pneumothorax is a serious but common complication in patients with cystic fibrosis (CF). It has adverse prognostic implications as well as associations with subsequent reduction in lung function and significant risk of recurrence. Management dilemmas frequently occur that are beyond current guidelines. We review the evidence and highlight management difficulties in pneumothoraces in CF.
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Affiliation(s)
- Robert W Lord
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, United Kingdom; Institute of Inflammation and Repair, University of Manchester, United Kingdom
| | - Andrew M Jones
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, United Kingdom; Institute of Inflammation and Repair, University of Manchester, United Kingdom
| | - A Kevin Webb
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, United Kingdom; Institute of Inflammation and Repair, University of Manchester, United Kingdom
| | - Peter J Barry
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, M23 9LT, United Kingdom; Institute of Inflammation and Repair, University of Manchester, United Kingdom.
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834
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Michaud GC, Channick CL, Law AC, McCannon JB, Antkowiak M, Garrison G, Sayah D, Huynh RH, Brady AK, Adamson R, DuBrock H, Akuthota P, Marion C, Dela Cruz C, Town JA, Çoruh B, Thomson CC. ATS Core Curriculum 2016. Part IV. Adult Pulmonary Medicine Core Curriculum. Ann Am Thorac Soc 2016; 13:1160-9. [PMID: 27388404 PMCID: PMC6138058 DOI: 10.1513/annalsats.201601-060cme] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/28/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- Gaëtane C Michaud
- 1 Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, New York
| | - Colleen L Channick
- 2 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anica C Law
- 2 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica B McCannon
- 2 Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - MaryEllen Antkowiak
- 3 Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Garth Garrison
- 3 Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - David Sayah
- 4 Pulmonary and Critical Care Medicine, University of California, Los Angeles, Los Angeles, California
| | - Richard H Huynh
- 4 Pulmonary and Critical Care Medicine, University of California, Los Angeles, Los Angeles, California
| | - Anna K Brady
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Rosemary Adamson
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Hilary DuBrock
- 6 Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Praveen Akuthota
- 6 Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Chad Marion
- 7 Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Charles Dela Cruz
- 7 Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - James A Town
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Başak Çoruh
- 5 Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Carey C Thomson
- 8 Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
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835
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Courtwright AM, Salomon S, Lehmann LS, Brettler T, Divo M, Camp P, Goldberg HJ, Wolfe DJ. The association between mood, anxiety and adjustment disorders and hospitalization following lung transplantation. Gen Hosp Psychiatry 2016; 41:1-5. [PMID: 27302717 DOI: 10.1016/j.genhosppsych.2016.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Psychiatric comorbidities such as mood, anxiety and adjustment disorders are common among individuals seeking lung transplantation. The objective of this study is to describe the association between these disorders and length of initial hospitalization and number of hospitalizations in the first year following transplantation. METHODS This was a retrospective cohort study of all lung transplantation patients between January 1, 2008 and July 1, 2014 at a large academic center. We evaluated whether pretransplantation mood, anxiety or adjustment disorders were associated with length and number of hospitalizations after transplant, adjusting for age, sex, native disease, forced expiratory volume in 1 s prior to transplantation, wait list time and lung allocation score. RESULTS There were 185 patients who underwent transplantation during the 7.5-year study period of whom 125 (67.6%) had a mood, anxiety or adjustment disorder. Patients with an adjustment disorder had decreased length of initial hospitalization [B coefficient=-5.76; 95% confidence interval (CI)=-11.40 to -0.13; P=.04]. Patients with anxiety disorders had an increased number of hospitalizations in the first year following transplantation (rate ratio=1.41; 95% CI=1.06-1.88; P=.02). There was no association between mood disorders and length or number of hospitalizations. Mood, adjustment and anxiety disorders were not associated with time to initial rehospitalization. CONCLUSIONS Among the three most common pretransplantation psychiatric disorders, only anxiety disorders are associated with increased hospitalization in the first year following lung transplant. Interventions designed to better control pretransplantation and posttransplantation anxiety may be associated with less frequent hospitalization.
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Affiliation(s)
- Andrew M Courtwright
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Stacey Salomon
- Social Work, Care Coordination, Brigham and Women's Hospital, Boston, MA, USA
| | - Lisa Soleymani Lehmann
- Department of Medicine, Brigham and Women's Hospital; Department of Health Policy and Management, Harvard T. H. Chan School of Public Health; and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Talya Brettler
- Department of Pediatrics, Kaiser Permanente, Northern California, CA, USA
| | - Miguel Divo
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Phillip Camp
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Hilary J Goldberg
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - David J Wolfe
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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836
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Baddini-Martinez J, Baldi BG, Costa CHD, Jezler S, Lima MS, Rufino R. Update on diagnosis and treatment of idiopathic pulmonary fibrosis. J Bras Pneumol 2016; 41:454-66. [PMID: 26578138 PMCID: PMC4635093 DOI: 10.1590/s1806-37132015000000152] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/06/2015] [Indexed: 11/24/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation.
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Affiliation(s)
- José Baddini-Martinez
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | - Bruno Guedes Baldi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | | | | | | | - Rogério Rufino
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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837
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838
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McKellar SH, Bowen ME, Baird BC, Raman S, Cahill BC, Selzman CH. Lung transplantation following coronary artery bypass surgery-improved outcomes following single-lung transplant. J Heart Lung Transplant 2016; 35:1289-1294. [PMID: 27381675 DOI: 10.1016/j.healun.2016.05.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 04/18/2016] [Accepted: 05/30/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prior coronary artery bypass grafting (CABG) has been a contraindication to lung transplantation (LTx) because of disease severity and technical considerations. Although patients increasingly are being referred for and receiving LTx, whether it should remain a contraindication is unknown. We sought to define the prevalence of LTx after CABG and determine the effect on outcomes. METHODS The United Network for Organ Sharing Standard Transplant Analysis and Research data set was queried during the period 2004-2013 for adult LTx patients, as prior CABG became a mandatory reporting field in 2004. The primary end-points were 30-day and 1-, 3-, and 5-year survivals. RESULTS The study cohort included 14,791 patients, of whom 292 patients had previously undergone CABG (single left, n = 68; single right, n = 181; bilateral, n = 43), representing 2% of all transplants. For the entire cohort, 30-day survival was 97%, and survival at 1, 3, and 5 years was 88%, 79%, and 74%. CABG was a predictor of mortality at all time points, with hazard ratios ranging from 1.97 (confidence interval, 1.23-3.16; p < 0.01) at 30 days to 1.38 (confidence interval, 1.12-1.69; p < 0.01) at 5 years. When stratified by type of transplant, CABG strongly predicted mortality at all time points for patients receiving bilateral, but not single, transplants. CONCLUSIONS Although LTx after CABG is uncommon, it is increasingly performed in the current era. Single right LTx is the most common procedure performed in patients with prior CABG. CABG before LTx is an independent predictor of mortality at all time points and is driven by increased mortality in patients receiving bilateral LTx.
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Affiliation(s)
- Stephen H McKellar
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Megan E Bowen
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Bradley C Baird
- Division of Business/Computer Information Systems, Arizona Western College, Yuma, Arizona
| | - Sanjeev Raman
- Division of Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, Utah
| | - Barbara C Cahill
- Division of Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, Utah
| | - Craig H Selzman
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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839
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Anton A, Ratarasarn K. Pulmonary Function Testing and Role of Pulmonary Rehabilitation in the Elderly Population with Pulmonary Diseases. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0164-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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840
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Vos R, Verleden GM, Dupont LJ. Long-term survival after lung transplantation among cystic fibrosis patients: Moving away from mere palliation. J Heart Lung Transplant 2016; 35:837-40. [DOI: 10.1016/j.healun.2016.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/10/2016] [Indexed: 01/07/2023] Open
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841
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Doucette K, Sumner S, Weinkauf J. Treatment of hepatitis C in a lung transplant recipient with sofosbuvir and daclatasvir. J Heart Lung Transplant 2016; 35:840-1. [DOI: 10.1016/j.healun.2016.01.1219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022] Open
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842
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Patient-reported symptoms and functioning as indicators of mortality in advanced cystic fibrosis: A new tool for referral and selection for lung transplantation. J Heart Lung Transplant 2016; 35:789-94. [DOI: 10.1016/j.healun.2016.01.1233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/02/2016] [Accepted: 01/26/2016] [Indexed: 11/24/2022] Open
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843
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Patti MG, Vela MF, Odell DD, Richter JE, Fisichella PM, Vaezi MF. The Intersection of GERD, Aspiration, and Lung Transplantation. J Laparoendosc Adv Surg Tech A 2016; 26:501-5. [PMID: 27218671 DOI: 10.1089/lap.2016.0170] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lung transplantation is a radical but life-saving treatment option for patients with end-stage lung diseases, such as idiopathic pulmonary fibrosis (IPF) and scleroderma. In light of the proposed association and controversy linking gastroesophageal reflux disease (GERD) to IPF and lung transplant outcome, the American Gastroenterological Association convened during the DDW in Washington in May 2015 a multidisciplinary group of experts in the field of GERD and lung transplantation to make considerations about the care of these patients based on available data and subsequent expert panel discussion at this symposium. The following topics were discussed: (1) pathophysiology of GERD-induced pulmonary symptoms, (2) GERD evaluation before and after lung transplantation, (3) outcome of lung transplantation for IPF and scleroderma, and (4) role of laparoscopic fundoplication before or after lung transplantation.
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Affiliation(s)
- Marco G Patti
- 1 Pritzker School of Medicine, University of Chicago , Chicago, Illinois
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844
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Sildenafil in severe pulmonary hypertension associated with chronic obstructive pulmonary disease: A randomized controlled multicenter clinical trial. J Heart Lung Transplant 2016; 36:166-174. [PMID: 27329400 DOI: 10.1016/j.healun.2016.04.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/24/2016] [Accepted: 04/13/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a well-known independent prognostic factor in chronic obstructive pulmonary disease (COPD) and a sufficient criterion for lung transplant candidacy. Limited data are currently available on the hemodynamic and clinical effect of phosphodiesterase 5 inhibitors in patients with severe PH associated with COPD. This study assessed the effect of sildenafil on pulmonary hemodynamics and gas exchange in severe PH associated with COPD. METHODS After screening, this multicenter, randomized, placebo-controlled double-blind trial randomized patients to receive 20 mg sildenafil or placebo 3 times a day (ratio 2:1) for 16 weeks. The primary end point was the reduction in pulmonary vascular resistance. Secondary end points included BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index, 6-minute walk test, and quality of life questionnaire. Changes in the partial pressure of arterial oxygen were evaluated as a safety parameter. RESULTS The final population included 28 patients, 18 in the sildenafil group and 10 in the placebo group. At 16 week, patients treated with sildenafil had a decrease in pulmonary vascular resistance (mean difference with placebo -1.4 WU; 95% confidence interval, ≤ -0.05; p = 0.04). Sildenafil also improved the BODE index, diffusion capacity of the lung for carbon monoxide percentage, and quality of life. Change from baseline in the partial pressure of arterial oxygen was not significantly different between the sildenafil and placebo groups. CONCLUSIONS This pilot study found that treatment with sildenafil reduced pulmonary vascular resistance and improved the BODE index and quality of life, without a significant effect on gas exchange.
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845
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Rademacher J, Ringshausen FC, Suhling H, Fuge J, Marsch G, Warnecke G, Haverich A, Welte T, Gottlieb J. Lung transplantation for non-cystic fibrosis bronchiectasis. Respir Med 2016; 115:60-5. [PMID: 27215505 DOI: 10.1016/j.rmed.2016.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/04/2016] [Accepted: 04/17/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Lung transplantation (LTx) is a well-established treatment for end-stage pulmonary disease. However, data regarding microbiology and outcome of patients with non-cystic fibrosis bronchiectasis (NCFB) after lung transplantation are limited. METHODS A retrospective analysis between August 1992 and September 2014 of all patients undergoing lung transplantation at our program of all recipients with a primary diagnosis of bronchiectasis was performed. Microbiology of sputum and bronchoalveolar lavage specimens, lung function and clinical parameters pre- and post-LTx were assessed retrospectively. Overall survival was compared to the total cohort of lung transplant recipients at institution. The survival and development of chronic lung allograft dysfunction (CLAD) was compared in patients with and without chronic Pseudomonas aeruginosa (PSA) infection after LTx. RESULTS 34 patients were transplanted. Median age at transplantation was 40 (IQR 33-52) years. The most common etiologies of bronchiectasis were idiopathic (41%), chronic obstructive pulmonary disease (COPD) (21%) and post-infectious (15%). The most common organism of pre- and posttransplant chronic airway infection was PSA. One-year Kaplan-Meier survival for patients with bronchiectasis was 85% and 5-year survival was 73% and similar to the entire cohort. All three patients with an associated diagnosis of immunodeficiency died due to infection and sepsis within the first year. Patients with persistent colonization with Pseudomonas aeruginosa after transplantation had worse long-term survival by trend and developed chronic lung allograft dysfunction more frequently. CONCLUSIONS Overall survival of patients with bronchiectasis after LTx is comparable to other underlying diseases. A reduced survival was observed in patients with the underlying diagnosis of immunodeficiency.
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Affiliation(s)
- Jessica Rademacher
- Dept. of Respiratory Medicine, Hannover Medical School, Carl- Neuberg Str. 1, Hannover, Germany.
| | - Felix C Ringshausen
- Dept. of Respiratory Medicine, Hannover Medical School, Carl- Neuberg Str. 1, Hannover, Germany; BREATH, Biomedical Research in End-stage and Obstructive Lung Disease, Hannover Medical School, Member of the German Center for Lung Research (DZL), Carl- Neuberg Str. 1, Germany
| | - Hendrik Suhling
- Dept. of Respiratory Medicine, Hannover Medical School, Carl- Neuberg Str. 1, Hannover, Germany
| | - Jan Fuge
- BREATH, Biomedical Research in End-stage and Obstructive Lung Disease, Hannover Medical School, Member of the German Center for Lung Research (DZL), Carl- Neuberg Str. 1, Germany
| | - Georg Marsch
- Dept. of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl- Neuberg Str. 1, Hannover, Germany
| | - Gregor Warnecke
- BREATH, Biomedical Research in End-stage and Obstructive Lung Disease, Hannover Medical School, Member of the German Center for Lung Research (DZL), Carl- Neuberg Str. 1, Germany; Dept. of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl- Neuberg Str. 1, Hannover, Germany
| | - Axel Haverich
- BREATH, Biomedical Research in End-stage and Obstructive Lung Disease, Hannover Medical School, Member of the German Center for Lung Research (DZL), Carl- Neuberg Str. 1, Germany; Dept. of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl- Neuberg Str. 1, Hannover, Germany
| | - Tobias Welte
- Dept. of Respiratory Medicine, Hannover Medical School, Carl- Neuberg Str. 1, Hannover, Germany; BREATH, Biomedical Research in End-stage and Obstructive Lung Disease, Hannover Medical School, Member of the German Center for Lung Research (DZL), Carl- Neuberg Str. 1, Germany
| | - Jens Gottlieb
- Dept. of Respiratory Medicine, Hannover Medical School, Carl- Neuberg Str. 1, Hannover, Germany; BREATH, Biomedical Research in End-stage and Obstructive Lung Disease, Hannover Medical School, Member of the German Center for Lung Research (DZL), Carl- Neuberg Str. 1, Germany
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846
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Borie R, Justet A, Beltramo G, Manali ED, Pradère P, Spagnolo P, Crestani B. Pharmacological management of IPF. Respirology 2016; 21:615-25. [PMID: 27072575 DOI: 10.1111/resp.12778] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 12/23/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a deadly disease with a median survival of approximately three years in historical cohorts. Despite increased knowledge of disease pathophysiology and selection of more targeted therapy, main clinical trials yielded negative results. However, two agents, pirfenidone and nintedanib, were recently shown to be effective in IPF and received marketing authorization worldwide. Both drugs significantly reduce functional decline and disease progression with an acceptable safety profile. Yet, none of these drugs actually improves or even stabilizes the disease or the symptoms perceived by the patient. Several other treatments and combinations are currently tested, and many more are ready for clinical trials. Their completion is critical for achieving the ultimate goal of curing patients with IPF.
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Affiliation(s)
- Raphael Borie
- APHP, Bichat Hospital, Department of Pneumology A, Centre de competence des maladies pulmonaires rares, DHU Fire, Paris, France.,INSERM, Paris, France.,Paris Diderot University, Paris, France
| | - Aurelien Justet
- APHP, Bichat Hospital, Department of Pneumology A, Centre de competence des maladies pulmonaires rares, DHU Fire, Paris, France.,INSERM, Paris, France.,Paris Diderot University, Paris, France
| | - Guillaume Beltramo
- APHP, Bichat Hospital, Department of Pneumology A, Centre de competence des maladies pulmonaires rares, DHU Fire, Paris, France.,INSERM, Paris, France.,Paris Diderot University, Paris, France
| | - Effrosyni D Manali
- 2nd Respiratory Medicine Department, 'Attikon' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pauline Pradère
- APHP, Bichat Hospital, Department of Pneumology A, Centre de competence des maladies pulmonaires rares, DHU Fire, Paris, France.,INSERM, Paris, France.,Paris Diderot University, Paris, France
| | - Paolo Spagnolo
- Clinica di Malattie dell'Apparato Respiratorio, Università degli Studi di Padova, Padova, Italy
| | - Bruno Crestani
- APHP, Bichat Hospital, Department of Pneumology A, Centre de competence des maladies pulmonaires rares, DHU Fire, Paris, France.,INSERM, Paris, France.,Paris Diderot University, Paris, France
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847
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Schmid FA, Benden C. Special considerations for the use of lung transplantation in pediatrics. Expert Rev Respir Med 2016; 10:655-62. [PMID: 26998955 DOI: 10.1586/17476348.2016.1168298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lung transplantation has become an accepted therapy in infants, children and adolescents suffering from end-stage lung diseases, an impaired quality of life as well as a reduced life expectancy. Within Europe, pediatric lung transplantation is largely performed in predominantly adult centers due to a relatively low overall case volume. Children do represent a specific and challenging cohort facing a transplant procedure, where the selection of potential candidates becomes a crucial step to maximize net survival benefit. Therefore, interdisciplinary evaluation and early listing in view of current indications and contraindications, adequate preoperative education of the child and family members, discussion of possibly required bridging procedures in case of deterioration, appropriate technical planning of the operation, adherence to postoperative medical treatment and follow-up are all crucial steps in this demanding puzzle. In this article, the authors review recent advances in the field of pediatric lung transplantation and outline challenges in the future.
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Affiliation(s)
- Florian A Schmid
- a Department of Surgery , University Hospital Zurich , Zurich , Switzerland
| | - Christian Benden
- b Division of Pulmonary Medicine , University Hospital Zurich , Zurich , Switzerland
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848
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Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant 2016; 35:433-9. [DOI: 10.1016/j.healun.2016.01.010] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/04/2015] [Accepted: 01/11/2016] [Indexed: 11/17/2022] Open
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849
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Hoeper MM, McLaughlin VV, Dalaan AMA, Satoh T, Galiè N. Treatment of pulmonary hypertension. THE LANCET RESPIRATORY MEDICINE 2016; 4:323-36. [DOI: 10.1016/s2213-2600(15)00542-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 01/15/2023]
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850
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Perrin JT, Kennedy CC. 48-Year-Old Man With Dyspnea on Exertion. Mayo Clin Proc 2016; 91:509-13. [PMID: 26803352 DOI: 10.1016/j.mayocp.2015.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/13/2015] [Accepted: 08/21/2015] [Indexed: 11/23/2022]
Affiliation(s)
- Jared T Perrin
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Cassie C Kennedy
- Advisor to resident and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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