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Tian D, Zuo YJ, Yan HJ, Huang H, Liu MZ, Yang H, Zhao J, Shi LZ, Chen JY. Machine learning model predicts airway stenosis requiring clinical intervention in patients after lung transplantation: a retrospective case-controlled study. BMC Med Inform Decis Mak 2024; 24:229. [PMID: 39160522 PMCID: PMC11331769 DOI: 10.1186/s12911-024-02635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/14/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Patients with airway stenosis (AS) are associated with considerable morbidity and mortality after lung transplantation (LTx). This study aims to develop and validate machine learning (ML) models to predict AS requiring clinical intervention in patients after LTx. METHODS Patients who underwent LTx between January 2017 and December 2019 were reviewed. The conventional logistic regression (LR) model was fitted by the independent risk factors which were determined by multivariate LR. The optimal ML model was determined based on 7 feature selection methods and 8 ML algorithms. Model performance was assessed by the area under the curve (AUC) and brier score, which were internally validated by the bootstrap method. RESULTS A total of 381 LTx patients were included, and 40 (10.5%) patients developed AS. Multivariate analysis indicated that male, pulmonary arterial hypertension, and postoperative 6-min walking test were significantly associated with AS (all P < 0.001). The conventional LR model showed performance with an AUC of 0.689 and brier score of 0.091. In total, 56 ML models were developed and the optimal ML model was the model fitted using a random forest algorithm with a determination coefficient feature selection method. The optimal model exhibited the highest AUC and brier score values of 0.760 (95% confidence interval [CI], 0.666-0.864) and 0.085 (95% CI, 0.058-0.117) among all ML models, which was superior to the conventional LR model. CONCLUSIONS The optimal ML model, which was developed by clinical characteristics, allows for the satisfactory prediction of AS in patients after LTx.
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Affiliation(s)
- Dong Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, 214023, China.
| | - Yu-Jie Zuo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Hao-Ji Yan
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, 113-8431, Japan
| | - Heng Huang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ming-Zhao Liu
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, 214023, China
| | - Hang Yang
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, 214023, China
| | - Jin Zhao
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, 214023, China
| | - Ling-Zhi Shi
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, 214023, China.
| | - Jing-Yu Chen
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, 214023, China.
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Simonova MS, Rusakov MA, Parshin VD. [Airway complications after lung transplantation]. Khirurgiia (Mosk) 2021:77-83. [PMID: 34270198 DOI: 10.17116/hirurgia202107177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lung transplantations have been regularly performed in the Russian Federation since 2010. Therefore, the number of lung transplant recipients, as well as the number of patients with airway complications following lung transplantation has been increasing. Treatment of these patients takes place not only in transplantation centers, but also in other hospitals. This review is devoted to risk factors, clinical manifestations, treatment and prevention of airway complications after lung transplantation. We analyzed literature data over the last 15 years. It was confirmed that bronchoscopy is a «gold standard» for diagnosis of airway complications while bronchoscopic interventions are preferred for treatment. Balloon and rigid bronchodilation and endoscopic airway stenting are the most effective interventions. Silicone stents are the most optimal. Antimicrobial prophylaxis and timely use of antiproliferative immunosuppressive drugs are important factors in prevention and treatment of airway complications after lung transplantation.
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Affiliation(s)
- M S Simonova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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A Single-Center Case Series Describing Tracheobronchial Bonastent Implantation. J Bronchology Interv Pulmonol 2019; 26:265-272. [DOI: 10.1097/lbr.0000000000000567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Wojarski J, Żegleń S, Ochman M, Karolak W. Early Sirolimus-Based Immunosuppression is Safe for Lung Transplantation Patients: Retrospective, Single Arm, Exploratory Study. Ann Transplant 2018; 23:598-607. [PMID: 30135417 PMCID: PMC6248054 DOI: 10.12659/aot.908471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Sirolimus, a mechanistic target of sirolimus inhibitor, is an immunosuppression medication for patients undergoing heart and abdominal transplantation. Sirolimus-based immunosuppression administered de novo post-lung transplantation is associated with bronchial anastomosis healing-related complications. We hypothesized that sirolimus administration within the first postoperative month in selected lung transplant recipients is safe and may be associated with favorable short-term and long-term outcomes due to its anti-proliferative properties and minimal adverse side effects. Material/Methods Thirteen patients (13.3%; mean age, 46.8±11.9 years) received early sirolimus-based immunosuppression along with cyclosporine and prednisone; 10 patients received single-lung transplantation, 3 received double-lung transplantation, and all received induction immunosuppressants. Patients received early sirolimus-based immunosuppression after an uncomplicated postoperative course and detailed bronchoscopic assessment. Results Sirolimus was begun on a mean of 20.6±4.7 days postoperatively (range, 14–32 days). The in-hospital and 30-day mortality rate was 0%. At long-term follow-up, 5 patients died (due to bacterial infection in 4 patients and pneumocystis jiroveci pneumonia in 1 patient). The mean overall survival was 4.4±2.53 (range, 0.8–10.0) years, 1-year survival was 92%, and 5-year survival was 62%. In 4 patients (30.8%), sirolimus was stopped due to infection in 3 patients and re-transplantation in 1 patient. Only one of the 13 patients developed bronchiolitis obliterans syndrome. In patients still taking sirolimus, renal function, systolic blood pressure, and lipid profile were within normal ranges; however, these patients required statin therapy. Conclusions In selected lung transplant recipients, early sirolimus-based immunosuppression is safe and associated with beneficial short-term and long-term outcomes.
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Affiliation(s)
- Jacek Wojarski
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Sławomir Żegleń
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Marek Ochman
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.,Department of Pharmacology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Wojtek Karolak
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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5
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Varela A, Hoyos L, Romero A, Campo-Cañaveral JL, Crowley S. Management of Bronchial Complications After Lung Transplantation and Sequelae. Thorac Surg Clin 2018; 28:365-375. [DOI: 10.1016/j.thorsurg.2018.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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6
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Transplanted fibroblasts proliferate in host bronchial tissue and enhance bronchial anastomotic healing in a rodent model. Int J Artif Organs 2017. [PMID: 28623643 DOI: 10.5301/ijao.5000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Healing of airway anastomoses after preoperative irradiation can be a significant clinical problem. The augmentation of bronchial anastomoses with a fibroblast-seeded human acellular dermis (hAD) was shown to be beneficial, although the underlying mechanism remained unclear. Therefore, in this study we investigated the fate of the fibroblasts transplanted to the scaffold covering the anastomosis. MATERIAL AND METHODS 32 Fisher rats underwent surgical anastomosis of the left main bronchus. In a 2 × 2 factorial design, they were randomized to receive preoperative irradiation of 20 Gy and augmentation of the anastomosis with a fibroblast-seeded transplant. Fibroblasts from subcutaneous fat of Fischer-344 rat were transduced retrovirally with tdTomato for cell tracking. After 7 and 14 days, animals were sacrificed and cell concentration of transplanted and nontransplanted fibroblasts in the hAD as well as in the bronchial tissue was measured using RT-PCR. RESULTS Migration of transplanted fibroblasts from dermis to bronchus were demonstrated in both groups, irradiated and nonirradiated. In the irradiated groups, there was a cell count of 7 × 104 ± 1 × 104 tomato+-fibroblasts in the bronchial tissue at day 7, rising to 1 × 105 ± 1 × 104 on day 14 (p <0.0001). Tomato+-cell concentration in hAD increased from 6 × 103 ± 1 × 103 at day 7 to 6 × 104 ± 1 × 104 at day 14 (p <0.0001). In the nonirradiated groups, tomato+-cell concentration in bronchus was 4 × 103 ± 1 × 103 on day 7 and 4 × 103 ± 1 × 103 at day 14. In the hAD tomato+ cell concentration rising from 1 × 104 ± 1 × 103 at day 7 to 2 × 104 ± 3 × 103 cells at day 14 (p = 0.0028). CONCLUSIONS Transplanted fibroblasts in the irradiated groups proliferate and migrate into the irradiated host bronchial tissue, but not in the nonirradiated groups.
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Abstract
Lung transplantation (LT) is the only viable option for a selected group of patients with end stage pulmonary diseases. During the recent years satisfactory results in terms of long-term survival and quality of life have been achieved with improvements in surgical technique, immunosuppression and perioperative management. Since the beginning, the airway anastomosis has been considered crucial and significant efforts have been made to understand the healing process. A number of experimental studies allowed improving the surgical technique by modifying the technique of suturing, the anastomotic protection and type and dose of immunosuppression, reducing the risk of airway complications. Furthermore, a huge progress has been made in the management of such complications. Early diagnosis of bronchial complications and their prompt and correct management are crucial to achieve long-term survival.
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Affiliation(s)
- Marco Anile
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| | - Daniele Diso
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| | - Erino Angelo Rendina
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| | - Federico Venuta
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
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Abstract
Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.
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Affiliation(s)
- Michael Machuzak
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jose F Santacruz
- Pulmonary, Critical Care and Sleep Medicine Consultants, Houston Methodist, Houston, TX 77030, USA
| | - Thomas Gildea
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Barnes L, Reed RM, Parekh KR, Bhama JK, Pena T, Rajagopal S, Schmidt GA, Klesney-Tait JA, Eberlein M. MECHANICAL VENTILATION FOR THE LUNG TRANSPLANT RECIPIENT. CURRENT PULMONOLOGY REPORTS 2015; 4:88-96. [PMID: 26495241 DOI: 10.1007/s13665-015-0114-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mechanical ventilation (MV) is an important aspect in the intraoperative and early postoperative management of lung transplant (LTx)-recipients. There are no randomized-controlled trials of LTx-recipient MV strategies; however there are LTx center experiences and international survey studies reported. The main early complication of LTx is primary graft dysfunction (PGD), which is similar to the adult respiratory distress syndrome (ARDS). We aim to summarize information pertinent to LTx-MV, as well as PGD, ARDS, and intraoperative MV and to synthesize these available data into recommendations. Based on the available evidence, we recommend lung-protective MV with low-tidal-volumes (≤6 mL/kg predicted body weight [PBW]) and positive end-expiratory pressure for the LTx-recipient. In our opinion, the MV strategy should be based on donor characteristics (donor PBW as a parameter of actual allograft size), rather than based on recipient characteristics; however this donor-characteristics-based protective MV is based on indirect evidence and requires validation in prospective clinical studies.
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Affiliation(s)
- Lindsey Barnes
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics
| | - Robert M Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland
| | - Kalpaj R Parekh
- Department of Thoracic and Cardiovascular Surgery, University of Iowa Hospitals and Clinics
| | - Jay K Bhama
- Department of Thoracic and Cardiovascular Surgery, University of Iowa Hospitals and Clinics
| | - Tahuanty Pena
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Pennsylvania
| | | | - Gregory A Schmidt
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics
| | - Julia A Klesney-Tait
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics
| | - Michael Eberlein
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics
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10
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Practical guidelines: lung transplantation in patients with cystic fibrosis. Pulm Med 2014; 2014:621342. [PMID: 24800072 PMCID: PMC3988894 DOI: 10.1155/2014/621342] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 12/12/2022] Open
Abstract
There are no European recommendations on issues specifically related to lung transplantation (LTX) in cystic fibrosis (CF). The main goal of this paper is to provide CF care team members with clinically relevant CF-specific information on all aspects of LTX, highlighting areas of consensus and controversy throughout Europe. Bilateral lung transplantation has been shown to be an important therapeutic option for end-stage CF pulmonary disease. Transplant function and patient survival after transplantation are better than in most other indications for this procedure. Attention though has to be paid to pretransplant morbidity, time for referral, evaluation, indication, and contraindication in children and in adults. This review makes extensive use of specific evidence in the field of lung transplantation in CF patients and addresses all issues of practical importance. The requirements of pre-, peri-, and postoperative management are discussed in detail including bridging to transplant and postoperative complications, immune suppression, chronic allograft dysfunction, infection, and malignancies being the most important. Among the contributors to this guiding information are 19 members of the ECORN-CF project and other experts. The document is endorsed by the European Cystic Fibrosis Society and sponsored by the Christiane Herzog Foundation.
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11
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Castleberry AW, Worni M, Kuchibhatla M, Lin SS, Snyder LD, Shofer SL, Palmer SM, Pietrobon R, Davis RD, Hartwig MG. A comparative analysis of bronchial stricture after lung transplantation in recipients with and without early acute rejection. Ann Thorac Surg 2013; 96:1008-17; discussion 1017-8. [PMID: 23870829 DOI: 10.1016/j.athoracsur.2013.01.104] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/29/2012] [Accepted: 01/07/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Risk factors and outcomes of bronchial stricture after lung transplantation are not well defined. An association between acute rejection and development of stricture has been suggested in small case series. We evaluated this relationship using a large national registry. METHODS All lung transplantations between April 1994 and December 2008 per the United Network for Organ Sharing (UNOS) database were analyzed. Generalized linear models were used to determine the association between early rejection and development of stricture after adjusting for potential confounders. The association of stricture with postoperative lung function and overall survival was also evaluated. RESULTS Nine thousand three hundred thirty-five patients were included for analysis. The incidence of stricture was 11.5% (1,077/9,335), with no significant change in incidence during the study period (P=0.13). Early rejection was associated with a significantly greater incidence of stricture (adjusted odds ratio [AOR], 1.40; 95% confidence interval [CI], 1.22-1.61; p<0.0001). Male sex, restrictive lung disease, and pretransplantation requirement for hospitalization were also associated with stricture. Those who experienced stricture had a lower postoperative peak percent predicted forced expiratory volume at 1 second (FEV1) (median 74% versus 86% for bilateral transplants only; p<0.0001), shorter unadjusted survival (median 6.09 versus 6.82 years; p<0.001) and increased risk of death after adjusting for potential confounders (adjusted hazard ratio 1.13; 95% CI, 1.03-1.23; p=0.007). CONCLUSIONS Early rejection is associated with an increased incidence of stricture. Recipients with stricture demonstrate worse postoperative lung function and survival. Prospective studies may be warranted to further assess causality and the potential for coordinated rejection and stricture surveillance strategies to improve postoperative outcomes.
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Affiliation(s)
- Anthony W Castleberry
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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12
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Postoperative complications in the intensive care unit following lung transplantation in adults: results in University Hospital Reina Sofia. Transplant Proc 2013; 44:2663-5. [PMID: 23146487 DOI: 10.1016/j.transproceed.2012.09.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The postoperative period following lung transplantation remains critical because of several complications. Infection, primary graft failure, acute rejection, and surgical complications are risk factors for mortality and morbidity. The recognition and early treatment of these complications is important to optimize outcomes. This article provides an overview of postoperative complications observed in our center during the last year. We were particularly interested in the influence of variables, such as inotrope usage and Acute Physiology and Chronic Health Evaluation (APACHE II) score, a well-known, and validated mortality prediction model for general intensive care unit (ICU) patients only infrequently reported in the transplantation literature. High APACHE II scores were significantly associated with prolonged mechanical ventilation (P = 0.041) and a tracheostomy requirement (P = .035). The factors significantly associated with an early postoperative death were older donor age (P = .005), prolonged donor ICU period (P = .004), need for cardiopulmonary bypass (CB; P = .005), and high inotrope requirements in the ICU (P = .034). CB data were biased because we selected the worst case patients. Donor age and high inotrope requirements in the ICU have been reported previously to be prognostic factors for poor graft function. We believe that control of these variables may improve outcomes.
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HDR brachytherapy: an option for preventing nonmalignant obstruction in patients after lung transplantation. Strahlenther Onkol 2012; 188:1085-90. [DOI: 10.1007/s00066-012-0215-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 07/16/2012] [Indexed: 10/27/2022]
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14
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Eberlein M, Arnaoutakis GJ, Yarmus L, Feller-Kopman D, Dezube R, Chahla MF, Bolukbas S, Reed RM, Klesney-Tait J, Parekh KR, Merlo CA, Shah AS, Orens JB, Brower RG. The effect of lung size mismatch on complications and resource utilization after bilateral lung transplantation. J Heart Lung Transplant 2012; 31:492-500. [DOI: 10.1016/j.healun.2011.12.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/15/2011] [Accepted: 12/14/2011] [Indexed: 12/27/2022] Open
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Transplantation pulmonaire : suites postopératoires précoces et réadmissions en réanimation. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-011-0440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Jungebluth P, Alici E, Baiguera S, Blomberg P, Bozóky B, Crowley C, Einarsson O, Gudbjartsson T, Le Guyader S, Henriksson G, Hermanson O, Juto JE, Leidner B, Lilja T, Liska J, Luedde T, Lundin V, Moll G, Roderburg C, Strömblad S, Sutlu T, Watz E, Seifalian A, Macchiarini P. Tracheobronchial transplantation with a stem-cell-seeded bioartificial nanocomposite: a proof-of-concept study. Lancet 2011; 378:1997-2004. [PMID: 22119609 DOI: 10.1016/s0140-6736(11)61715-7] [Citation(s) in RCA: 289] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tracheal tumours can be surgically resected but most are an inoperable size at the time of diagnosis; therefore, new therapeutic options are needed. We report the clinical transplantation of the tracheobronchial airway with a stem-cell-seeded bioartificial nanocomposite. METHODS A 36-year-old male patient, previously treated with debulking surgery and radiation therapy, presented with recurrent primary cancer of the distal trachea and main bronchi. After complete tumour resection, the airway was replaced with a tailored bioartificial nanocomposite previously seeded with autologous bone-marrow mononuclear cells via a bioreactor for 36 h. Postoperative granulocyte colony-stimulating factor filgrastim (10 μg/kg) and epoetin beta (40,000 UI) were given over 14 days. We undertook flow cytometry, scanning electron microscopy, confocal microscopy epigenetics, multiplex, miRNA, and gene expression analyses. FINDINGS We noted an extracellular matrix-like coating and proliferating cells including a CD105+ subpopulation in the scaffold after the reseeding and bioreactor process. There were no major complications, and the patient was asymptomatic and tumour free 5 months after transplantation. The bioartificial nanocomposite has patent anastomoses, lined with a vascularised neomucosa, and was partly covered by nearly healthy epithelium. Postoperatively, we detected a mobilisation of peripheral cells displaying increased mesenchymal stromal cell phenotype, and upregulation of epoetin receptors, antiapoptotic genes, and miR-34 and miR-449 biomarkers. These findings, together with increased levels of regenerative-associated plasma factors, strongly suggest stem-cell homing and cell-mediated wound repair, extracellular matrix remodelling, and neovascularisation of the graft. INTERPRETATION Tailor-made bioartificial scaffolds can be used to replace complex airway defects. The bioreactor reseeding process and pharmacological-induced site-specific and graft-specific regeneration and tissue protection are key factors for successful clinical outcome. FUNDING European Commission, Knut and Alice Wallenberg Foundation, Swedish Research Council, StratRegen, Vinnova Foundation, Radiumhemmet, Clinigene EU Network of Excellence, Swedish Cancer Society, Centre for Biosciences (The Live Cell imaging Unit), and UCL Business.
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Affiliation(s)
- Philipp Jungebluth
- Advanced Center for Translational Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Ear, Nose and Throat, Karolinska University Hospital, Stockholm, Sweden
| | - Evren Alici
- Cell and Gene Therapy Centre, Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Silvia Baiguera
- Advanced Center for Translational Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Pontus Blomberg
- Vecura, Clinical Research Center, Karolinska University Hospital, Stockholm, Sweden
| | - Béla Bozóky
- Division of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Claire Crowley
- Centre for Nanotechnology and Regenerative Medicine, University College London, London, UK
| | - Oskar Einarsson
- Department of Pulmonology, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sylvie Le Guyader
- Center for Biosciences, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Gert Henriksson
- Division of Ear, Nose and Throat, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Hermanson
- Linnaeus Center in Developmental Biology for Regenerative Medicine, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Erik Juto
- Division of Ear, Nose and Throat, Karolinska University Hospital, Stockholm, Sweden
| | - Bertil Leidner
- Department for Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology (Huddinge), Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Lilja
- Linnaeus Center in Developmental Biology for Regenerative Medicine, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Liska
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tom Luedde
- Department of Medicine 3, University Hospital RWTH Aachen, Aachen, Germany
| | - Vanessa Lundin
- Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden
| | - Guido Moll
- Departments of Medicine and Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Staffan Strömblad
- Center for Biosciences, Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Tolga Sutlu
- Cell and Gene Therapy Centre, Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Emma Watz
- Departments of Medicine and Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Seifalian
- Centre for Nanotechnology and Regenerative Medicine, University College London, London, UK
| | - Paolo Macchiarini
- Advanced Center for Translational Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden; European Airway Institute, Karolinska Institutet, Stockholm, Sweden; Division of Ear, Nose and Throat, Karolinska University Hospital, Stockholm, Sweden.
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