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Rafiroiu S, Hassouna H, Ahmad U, Koval C, McCurry KR, Pettersson GB, Ibrahim M, Johnston DR, Budev M, Murthy SC, Toth AJ, Blackstone EH, Tong MZ. Consequences of Delayed Chest Closure During Lung Transplantation. Ann Thorac Surg 2020; 109:277-284. [DOI: 10.1016/j.athoracsur.2019.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
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Jonigk D, Rath B, Borchert P, Braubach P, Maegel L, Izykowski N, Warnecke G, Sommer W, Kreipe H, Blach R, Anklamm A, Haverich A, Eder M, Stadler M, Welte T, Gottlieb J, Kuehnel M, Laenger F. Comparative analysis of morphological and molecular motifs in bronchiolitis obliterans and alveolar fibroelastosis after lung and stem cell transplantation. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2016; 3:17-28. [PMID: 28138398 PMCID: PMC5259562 DOI: 10.1002/cjp2.60] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/22/2016] [Accepted: 09/25/2016] [Indexed: 12/14/2022]
Abstract
Chronic lung allograft dysfunction (CLAD) remains the major obstacle to long‐term survival following lung transplantation (LuTx). Morphologically CLAD is defined by obliterative remodelling of the small airways (bronchiolitis obliterans, BO) as well as a more recently described collagenous obliteration of alveoli with elastosis summarised as alveolar fibroelastosis (AFE). Both patterns are not restricted to pulmonary allografts, but have also been reported following haematopoietic stem cell transplantation (HSCT) and radio chemotherapy (RC). In this study we performed compartment‐specific morphological and molecular analysis of BO and AFE lesions in human CLAD (n = 22), HSCT (n = 29) and RC (n = 6) lung explants, utilising conventional histopathology, laser‐microdissection, PCR techniques and immunohistochemistry to assess fibrosis‐associated gene and protein expression. Three key results emerged from our analysis of fibrosis‐associated genes: (i) generally speaking, “BO is BO”. Despite the varying clinical backgrounds, the molecular characteristics of BO lesions were found to be alike in all groups. (ii) “AFE is AFE”. In all groups of patients suffering from restrictive changes to lung physiology due to AFE there were largely – but not absolutely ‐ identical gene expression patterns. iii) BO concomitant to AFE after LuTx is characterised by an AFE‐like molecular microenvironment, representing the only exception to (i). Additionally, we describe an evolutionary model for the AFE pattern: a non‐specific fibrin‐rich reaction to injury pattern triggers a misguided resolution attempt and eventual progression towards manifest AFE. Our data point towards an absence of classical fibrinolytic enzymes and an alternative fibrin degrading mechanism via macrophages, resulting in fibrous remodelling and restrictive functional changes. These data may serve as diagnostic adjuncts and help to predict the clinical course of respiratory dysfunction in LuTx and HSCT patients. Moreover, analysis of the mechanism of fibrinolysis and fibrogenesis may unveil potential therapeutic targets to alter the course of the eventually fatal lung remodelling.
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Affiliation(s)
- Danny Jonigk
- Institute of Pathology, Hannover Medical School (MHH)HanoverGermany; The German Center for Lung Research (Deutsches Zentrum für Lungenforschung DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH)HanoverGermany
| | - Berenice Rath
- Institute of Pathology, Hannover Medical School (MHH) Hanover Germany
| | - Paul Borchert
- Institute of Pathology, Hannover Medical School (MHH) Hanover Germany
| | - Peter Braubach
- Institute of Pathology, Hannover Medical School (MHH) Hanover Germany
| | - Lavinia Maegel
- Institute of Pathology, Hannover Medical School (MHH) Hanover Germany
| | - Nicole Izykowski
- Institute of Pathology, Hannover Medical School (MHH) Hanover Germany
| | - Gregor Warnecke
- The German Center for Lung Research (Deutsches Zentrum für Lungenforschung DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH)HanoverGermany; Division of Cardiac, Thoracic, Transplantation and Vascular SurgeryMedical School HanoverHanoverGermany
| | - Wiebke Sommer
- The German Center for Lung Research (Deutsches Zentrum für Lungenforschung DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH)HanoverGermany; Division of Cardiac, Thoracic, Transplantation and Vascular SurgeryMedical School HanoverHanoverGermany
| | - Hans Kreipe
- Institute of Pathology, Hannover Medical School (MHH) Hanover Germany
| | - Robert Blach
- Institute of Pathology, Hannover Medical School (MHH) Hanover Germany
| | - Adrian Anklamm
- Institute of Pathology, Hannover Medical School (MHH) Hanover Germany
| | - Axel Haverich
- The German Center for Lung Research (Deutsches Zentrum für Lungenforschung DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH)HanoverGermany; Division of Cardiac, Thoracic, Transplantation and Vascular SurgeryMedical School HanoverHanoverGermany
| | - Matthias Eder
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation Medical School Hanover Hanover Germany
| | - Michael Stadler
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation Medical School Hanover Hanover Germany
| | - Tobias Welte
- The German Center for Lung Research (Deutsches Zentrum für Lungenforschung DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH)HanoverGermany; Department of Respiratory Medicine, Medical School Hanover, Hanover, Germany
| | - Jens Gottlieb
- The German Center for Lung Research (Deutsches Zentrum für Lungenforschung DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH)HanoverGermany; Department of Respiratory Medicine, Medical School Hanover, Hanover, Germany
| | - Mark Kuehnel
- Institute of Pathology, Hannover Medical School (MHH)HanoverGermany; The German Center for Lung Research (Deutsches Zentrum für Lungenforschung DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH)HanoverGermany
| | - Florian Laenger
- Institute of Pathology, Hannover Medical School (MHH)HanoverGermany; The German Center for Lung Research (Deutsches Zentrum für Lungenforschung DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH)HanoverGermany
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Abstract
PURPOSE OF REVIEW Pulmonary antibody-mediated rejection (AMR) while contributing to acute and chronic allograft dysfunction remains a diagnostic and therapeutic challenge. The diagnostic tenets upon which AMR is defined will be reviewed in the light of recent studies. RECENT FINDINGS The introduction of solid phase assays such as the Luminex platform has provided a wealth of quantitative data on the presence of anti-human leukocyte antigen (HLA) donor-specific antibodies (DSA). Further studies are required to better define the relationship of circulating DSA and activation of proinflammatory immune pathways that result in allograft dysfunction. The limitations of C4d staining in defining AMR are highlighted from recent studies in lung transplantation and from the 2013 Banff meeting on renal transplantation. SUMMARY The current challenge to the lung transplant community is to agree on a working definition of pulmonary AMR. Only then can we better appreciate the epidemiology, clinical phenotypes, and treatment of AMR.
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Irvin CG, Hall GL. An epilogue to lung function and lung disease: state-of-the-art 2015. Respirology 2015; 20:1008-9. [PMID: 26239495 DOI: 10.1111/resp.12601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Charles G Irvin
- Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Graham L Hall
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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Verleden GM, Vos R, Vanaudenaerde B, Dupont L, Yserbyt J, Van Raemdonck D, Verleden S. Current views on chronic rejection after lung transplantation. Transpl Int 2015; 28:1131-9. [PMID: 25857869 DOI: 10.1111/tri.12579] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 02/28/2015] [Accepted: 04/07/2015] [Indexed: 01/01/2023]
Abstract
Chronic lung allograft dysfunction (CLAD) was recently introduced as an overarching term mainly to classify patients with chronic rejection after lung transplantation, although other conditions may also qualify for CLAD. Initially, only the development of a persistent and obstructive pulmonary function defect, clinically identified as bronchiolitis obliterans syndrome (BOS), was considered as chronic rejection, if no other cause could be identified. It became clear in recent years that some patients do not qualify for this definition, although they developed a chronic and persistent decrease in FEV1 , without another identifiable cause. As the pulmonary function decline in these patients was rather restrictive, this was called restrictive allograft syndrome (RAS). In the present review, we will further elaborate on these two CLAD phenotypes, with specific attention to the diagnostic criteria, the role of pathology and imaging, the risk factors, outcome, and the possible treatment options.
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Affiliation(s)
- Geert M Verleden
- Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Bart Vanaudenaerde
- Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium
| | - Lieven Dupont
- Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Stijn Verleden
- Department of Clinical and Experimental Medicine, Laboratory for Respiratory Diseases, Lung Transplantation Unit, KU Leuven - University of Leuven, Leuven, Belgium
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