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Kuklinski CA, Blatter JA. Interstitial lung disease as an indication for pediatric lung transplant. Pediatr Pulmonol 2024; 59:2313-2320. [PMID: 38131509 DOI: 10.1002/ppul.26812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 11/09/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
Interstitial lung disease can be an indication for lung transplant at any age, but it is a particularly common indication for lung transplant in infants. Nevertheless, not all interstitial lung diseases will lead to lung transplant in childhood. Genetic testing has aided the identification of these diseases in children. In severely affected patients, however, definitive diagnosis is not always necessary to consider referral to a transplant center. At experienced transplant centers, a multidisciplinary team educates patient families and aids in the transplant evaluation of children with interstitial lung disease. Children who have undergone transplant require lifetime immunosuppression and close surveillance, but can enjoy good quality of life for years following surgery.
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Affiliation(s)
- Cadence A Kuklinski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joshua A Blatter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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McLafferty FS, Gray AL. Lung transplant referral considerations for individuals with cystic fibrosis. Curr Opin Pulm Med 2024:00063198-990000000-00192. [PMID: 39132757 DOI: 10.1097/mcp.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
PURPOSE OF REVIEW The cystic fibrosis (CF) Foundation issued guidelines to promote timely lung transplant referral for people with cystic fibrosis (pwCF) in 2019. Since then more has been published to help refine this complex decision. The goal of this review is to summarize the recent literature informing disease severity in CF, barriers to referral for pwCF and guide timely and appropriate lung transplant referrals. RECENT FINDINGS Existing guidelines utilize the degree of airflow limitation as the primary criteria to refer for lung transplant, yet this variable has some prognostic uncertainty. Novel prognostic tools may provide more reliable metrics for predicting who with CF is at greatest risk of dying from their lung disease and could be used as an indicator for when to refer. In addition, updated analyses of national registry data have highlighted the significance of hemoptysis, low body mass index, and extra-pulmonary organ failure, as important prognostic markers. PwCF with these complications have historically been under-referred for lung transplant despite data suggesting lung transplant can be safe for some in these populations. Early referral should be considered in the presence of these complications. SUMMARY This review builds on existing guidelines by incorporating novel data to better determine when lung transplant referral is most appropriate. Improved prognostic tools are still needed to decrease the chances of pwCF dying without consideration of lung transplant. It is still unclear how novel therapies for CF may change the need and timing for lung transplant referral.
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Affiliation(s)
- Fred S McLafferty
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado - Anschutz Medical Campus Aurora, Colorado, USA
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Salvatore D, Cimino G, Troiani P, Bignamini E, Esposito I, Leonetti G, Zanda M, Manunza D, Pepe A. Elexacaftor/tezacaftor/ivacaftor in children aged 6-11 years with cystic fibrosis, at least one F508DEL allele, and advanced lung disease: A 24-week observational study. Pediatr Pulmonol 2022; 57:2253-2256. [PMID: 35577767 DOI: 10.1002/ppul.25980] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/26/2022] [Accepted: 05/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | - Giuseppe Cimino
- Lazio Reference Centre for Cystic Fibrosis, Policlinico Umberto I University Hospital, Rome, Italy
| | - Patrizia Troiani
- Lazio Reference Centre for Cystic Fibrosis, Policlinico Umberto I University Hospital, Rome, Italy
| | - Elisabetta Bignamini
- Pediatric Pulmonology Unit, Città della Salute e della Scienza, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Irene Esposito
- Pediatric Pulmonology Unit, Città della Salute e della Scienza, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Giuseppina Leonetti
- Pediatric Cystic Fibrosis Centre, Azienda Universitaria Ospedaliera Consorziale Policlinico, Bari, Italy
| | - Maurizio Zanda
- Cystic Fibrosis Center, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Daniela Manunza
- Cystic Fibrosis Center, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Angela Pepe
- Cystic Fibrosis Centre, Hospital San Carlo, Potenza, Italy.,Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Postgraduate School of Pediatrics, University of Salerno, Baronissi, Italy
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Greaney C, Bohan K, Tecklenborg S, Casserly B, Green J, Van de Ven P, Robinson K, Tierney A. Diet quality in cystic fibrosis - associations with patient reported outcome measures and enablers and barriers to eating a healthy diet: A protocol paper for a mixed methods study. HRB Open Res 2022; 5:33. [PMID: 36091185 PMCID: PMC9428499 DOI: 10.12688/hrbopenres.13533.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background: People with cystic fibrosis (PWCF) have increased energy requirements. However, in recent years concerns have emerged regarding the 'cystic fibrosis (CF) diet' in terms of reliance on energy-dense, nutrient poor foods, which tend to be higher in saturated fat, sugar, and salt. These foods lack essential nutrients and are aetiologically linked with diet-related chronic diseases. The aim is to explore habitual dietary intakes in PWCF and (i) assess adherence to CF dietary guidelines and population specific healthy eating guidelines; (ii) derive a diet quality score and the inflammatory potential for the average diet consumed by PWCF and assess associations with patient reported outcome measures; (iii) assess drivers for current consumption patterns and enablers and barriers to eating a healthy diet. Methods: The aim is to recruit between 100-180 PWCF. A mixed methods study will be performed. Using three-day food diaries and food frequency questionnaires, aims (i) and (ii) will be addressed. The Dietary Approaches to Stop Hypertension (DASH) score and Healthy Eating Index-International (HEI-I) will derive diet quality scores. The Dietary Inflammatory Index (DII®) will ascertain inflammatory potential of the diet. Validated questionnaires will be used to report health related quality of life measures. Online focus groups and semi-structured interview with PWCF will address aim (iii). Conclusions: It is timely to revise dietary priorities and targets for CF. However, a greater understanding of what adults with CF currently consume and what they require in terms of nutrition and dietary guidance into the future is needed. In doing so, this research will help to clarify nutrition priorities and simplify the dietary aspects of CF treatment, thereby supporting adherence.
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Affiliation(s)
- Cian Greaney
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie Bohan
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Sarah Tecklenborg
- Cystic Fibrosis Ireland, 24 Lower Rathmines Rd, Rathmines, Dublin, Ireland
| | - Brian Casserly
- Department of Respiratory Medicine, University Hospital Limerick, Dooradoyle, Limerick, V94 F858, Ireland
| | - James Green
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Pepijn Van de Ven
- Department of Electronic and Computer Engineering, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Audrey Tierney
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
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Antos NJ, Savant AP. Cystic fibrosis year in review 2020: Section 2 pulmonary disease, infections, and inflammation. Pediatr Pulmonol 2022; 57:347-360. [PMID: 34033706 DOI: 10.1002/ppul.25459] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
The outlook for those with cystic fibrosis (CF) has never been brighter with ever increasing life expectancy and the approval of the highly effective CFTR modulators, such as elexacaftor/tezacaftor/ivacaftor. With that being said, the progressive pulmonary decline and importance of lung health, infection, and inflammation in CF remains. This review is the second part in a three-part CF Year in Review 2020. Part one focused on the literature related to CFTR modulators while part three will feature the multisystem effects related to CF. This review focuses on articles from Pediatric Pulmonology, including articles from other journals that are of particular interest to clinicians. Herein, we highlight studies published during 2020 related to CF pulmonary disease, infection, treatment, and diagnostics.
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Affiliation(s)
- Nicholas J Antos
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Pediatric Pulmonology, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Adrienne P Savant
- Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, Louisiana, USA.,Department of Pediatrics, Tulane University, New Orleans, Louisiana, USA
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