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Results of Lung Transplantations Among Cystic Fibrosis Patients: A Single-Center Study. Transplant Proc 2022; 54:1082-1085. [DOI: 10.1016/j.transproceed.2022.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
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Raskin J, Vanstapel A, Verbeken EK, Beeckmans H, Vanaudenaerde BM, Verleden SE, Neyrinck AP, Ceulemans LJ, Van Raemdonck DE, Verleden GM, Vos R, Godinas L, Yserbyt J, Dupont LJ, Van Herck A, Sacreas A, Kaes J, Heigl T, Ordies S, Schaevers V, De Leyn P, Coosemans W, Nafteux P, Decaluwé H, Van Veer H, Depypere L, Frick AE, Weynand B, Emonds M. Mortality after lung transplantation: a single‐centre cohort analysis. Transpl Int 2019; 33:130-141. [DOI: 10.1111/tri.13540] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/04/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Jo Raskin
- Department of Respiratory Diseases University Hospitals Leuven Leuven Belgium
| | - Arno Vanstapel
- Division of Respiratory Diseases Department of Chronic Diseases, Metabolism & Ageing (CHROMETA) KU Leuven Leuven Belgium
- Department of Histopathology KU Leuven Leuven Belgium
| | | | - Hanne Beeckmans
- Department of Respiratory Diseases University Hospitals Leuven Leuven Belgium
| | - Bart M. Vanaudenaerde
- Division of Respiratory Diseases Department of Chronic Diseases, Metabolism & Ageing (CHROMETA) KU Leuven Leuven Belgium
| | - Stijn E. Verleden
- Division of Respiratory Diseases Department of Chronic Diseases, Metabolism & Ageing (CHROMETA) KU Leuven Leuven Belgium
| | - Arne P. Neyrinck
- Department of Anesthesiology University Hospitals Leuven Leuven Belgium
| | - Laurens J. Ceulemans
- Division of Respiratory Diseases Department of Chronic Diseases, Metabolism & Ageing (CHROMETA) KU Leuven Leuven Belgium
- Department of Thoracic Surgery University Hospitals Leuven Leuven Belgium
| | - Dirk E. Van Raemdonck
- Division of Respiratory Diseases Department of Chronic Diseases, Metabolism & Ageing (CHROMETA) KU Leuven Leuven Belgium
- Department of Thoracic Surgery University Hospitals Leuven Leuven Belgium
| | - Geert M. Verleden
- Department of Respiratory Diseases University Hospitals Leuven Leuven Belgium
- Division of Respiratory Diseases Department of Chronic Diseases, Metabolism & Ageing (CHROMETA) KU Leuven Leuven Belgium
| | - Robin Vos
- Department of Respiratory Diseases University Hospitals Leuven Leuven Belgium
- Division of Respiratory Diseases Department of Chronic Diseases, Metabolism & Ageing (CHROMETA) KU Leuven Leuven Belgium
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Blitzer D, Copeland H, Roe D, Hage C, Wang IW, Duncan M, Manghelli J, Gooch D, Wozniak T. Long term survival after lung transplantation: A single center experience. J Card Surg 2019; 35:273-278. [PMID: 31389633 DOI: 10.1111/jocs.14163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are approximately 2000 lung transplants performed across the United States annually. There is limited data to identify factors predictive of long-term survival. OBJECTIVE We evaluated 10-year survivors after lung transplant to determine predictors of long-term survival. METHODS Data were collected from the United Network for Organ Sharing registry database from a single institution. Inclusion criteria were: patients who received a lung transplant between 1989 and 2005. Descriptive statistics were calculated, and survival outcomes were analyzed using the Kaplan-Meier method. RESULTS Three hundred sixty-one patients received a lung transplant between 1989 and 2005, and 77 patients survived at least 10 years (21%). Diagnoses at the time of transplant included: chronic obstructive pulmonary disease/emphysema 45 (58.4%), idiopathic pulmonary fibrosis 12 (15.6%), alpha 1 anti-trypsin deficiency 6 (7.8%), cystic fibrosis 4 (5.2%), primary pulmonary hypertension 2 (2.6%), and Eisenmenger's syndrome 1 (1.3%). Seventy-four recipients (96.10%) were Caucasian; 46 (59.74%) were female. Age at the time of transplant ranged from 19 to 67 years (mean 50.8; median 52). Forty-two patients (54.5%) were double lung recipients. Survival ranged from 10.0 to 21.9 years (mean 15.5y; median 15.48y). Forty-two (54.5%) subjects are currently alive; the most common causes of death included: chronic rejection (20%), and infection (17.14%). CONCLUSIONS Ten-year survivors were significantly younger, weighed less, and had significantly shorter lengths of hospitalization after transplantation. Bilateral lung transplantation was a significant factor in prolonged survival. Survival also improved with institutional experience.
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Affiliation(s)
- David Blitzer
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Hannah Copeland
- Division of Cardiac Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - David Roe
- Department of Medicine Pulmonary, Critical Care, Transplant Medicine, Indiana University School of Medicine, Methodist Hospital, Indianapolis, Indiana
| | - Chadi Hage
- Department of Medicine Pulmonary, Critical Care, Transplant Medicine, Indiana University School of Medicine, Methodist Hospital, Indianapolis, Indiana
| | - I-Wen Wang
- Department of Cardiothoracic Transplant Surgery, Indiana University School of Medicine Methodist Hospital, Indianapolis, Indiana
| | - Michael Duncan
- Department of Medicine Pulmonary, Critical Care, Transplant Medicine, Indiana University School of Medicine, Methodist Hospital, Indianapolis, Indiana
| | - Joshua Manghelli
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Danyel Gooch
- Department of Transplant Medicine, Indiana University Methodist Hospital, Indianapolis, Indiana
| | - Thomas Wozniak
- Department of Cardiothoracic Transplant Surgery, Indiana University School of Medicine Methodist Hospital, Indianapolis, Indiana
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Castellani C, Duff AJA, Bell SC, Heijerman HGM, Munck A, Ratjen F, Sermet-Gaudelus I, Southern KW, Barben J, Flume PA, Hodková P, Kashirskaya N, Kirszenbaum MN, Madge S, Oxley H, Plant B, Schwarzenberg SJ, Smyth AR, Taccetti G, Wagner TOF, Wolfe SP, Drevinek P. ECFS best practice guidelines: the 2018 revision. J Cyst Fibros 2018; 17:153-178. [PMID: 29506920 DOI: 10.1016/j.jcf.2018.02.006] [Citation(s) in RCA: 446] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/26/2018] [Accepted: 02/08/2018] [Indexed: 12/12/2022]
Abstract
Developments in managing CF continue to drive dramatic improvements in survival. As newborn screening rolls-out across Europe, CF centres are increasingly caring for cohorts of patients who have minimal lung disease on diagnosis. With the introduction of mutation-specific therapies and the prospect of truly personalised medicine, patients have the potential to enjoy good quality of life in adulthood with ever-increasing life expectancy. The landmark Standards of Care published in 2005 set out what high quality CF care is and how it can be delivered throughout Europe. This underwent a fundamental re-write in 2014, resulting in three documents; center framework, quality management and best practice guidelines. This document is a revision of the latter, updating standards for best practice in key aspects of CF care, in the context of a fast-moving and dynamic field. In continuing to give a broad overview of the standards expected for newborn screening, diagnosis, preventative treatment of lung disease, nutrition, complications, transplant/end of life care and psychological support, this consensus on best practice is expected to prove useful to clinical teams both in countries where CF care is developing and those with established CF centres. The document is an ECFS product and endorsed by the CF Network in ERN LUNG and CF Europe.
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Affiliation(s)
- Carlo Castellani
- Cystic Fibrosis Centre, Azienda Ospedaliera Universitaria Integrata Verona, Italy; Cystic Fibrosis Centre, Gaslini Institute, Genoa, Italy
| | - Alistair J A Duff
- Regional Paediatric CF Unit, Leeds General Infirmary Leeds, UK; Department of Clinical & Health Psychology, St James' University Hospital, Leeds, UK.
| | - Scott C Bell
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Harry G M Heijerman
- Dept of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne Munck
- Hopital Robert Debré Assistante publique-Hôpitaux de Paris, Université Paris 7, Pediatric CF Centre, Paris, France
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Canada
| | - Isabelle Sermet-Gaudelus
- Service de Pneumologie et Allergologie Pédiatriques, Centre de Ressources et de Compétence de la Mucoviscidose, Institut Necker Enfants Malades/INSERM U1151 Hôpital Necker Enfants Malades, P, France
| | - Kevin W Southern
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jurg Barben
- Ostschweizer Kinderspital Sankt Gallen, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Patrick A Flume
- Division of Pulmonary and Critical Care, Medical University of South Carolina, USA
| | - Pavla Hodková
- Department of Clinical Psychology, University Hospital, Prague, Czech Republic
| | - Nataliya Kashirskaya
- Department of Genetic Epidemiology (Cystic Fibrosis Group), Federal State Budgetary Institution, Research Centre for Medical Genetics, Moscow, Russia
| | - Maya N Kirszenbaum
- Department of Pediatric Pulmunology, CRCM, Hôpital Necker-Enfants Malades, Paris, France
| | - Sue Madge
- Cystic Fibrosis Centre, Royal Brompton Hospital, London, UK
| | - Helen Oxley
- Manchester Adult Cystic Fibrosis Centre, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Barry Plant
- Cork Adult CF Centre, Cork University Hospital, University College, Cork, Republic of Ireland
| | - Sarah Jane Schwarzenberg
- Divison of Pediatric Gastroenterology Hepatology and Nutrition, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Alan R Smyth
- Division of Child Health, Obstetrics & Gynaecology (COG), University of Nottingham, Nottingham, UK
| | - Giovanni Taccetti
- Cystic Fibrosis Centre, Department of Paediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Thomas O F Wagner
- Frankfurter Referenzzentrum für Seltene Erkrankungen (FRZSE), Universitätsklinikum Frankfurt am Main, Wolfgang von Goethe-Universität, Frankfurt am Main, Germany
| | - Susan P Wolfe
- Regional Paediatric CF Unit, The Leeds Children's Hospital, Leeds Teaching Hospitals, Belmont Grove, Leeds, UK
| | - Pavel Drevinek
- Department of Medical Microbiology, Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
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Indications for lung resection surgery and lung transplant in South American children with cystic fibrosis. Paediatr Respir Rev 2018; 25:37-42. [PMID: 28366682 DOI: 10.1016/j.prrv.2017.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/03/2017] [Indexed: 11/21/2022]
Abstract
The current available literature evaluating lung resection surgery and lung transplantation in children with cystic fibrosis (CF) was reviewed through a PubMed search and references from selected studies were additionally included. Pulmonary resections, i.e. lobectomy, segmentectomy, and pneumonectomy, are seldom performed in CF. The main indications, in patients with a forced expiratory volume in 1second (FEV1) that is greater than 30% predicted, are localized bronchiectasis/atelectasis, severe hemoptysis, and bronchopleural fistula refractory to medical management. The potential benefits are decreased symptoms and pulmonary exacerbations, and an improved quality of life. Pre and postoperative intensive care is mandatory for surgical candidates. The risk of death should be taken into account when the procedure is considered. Selection for lung transplantation (LTx) candidates in children with CF in South America follows the International Society for Heart and Lung Transplantation (ISHLT) criteria. When compared to adults with CF, a poorer survival rate after LTx in children with CF has been observed in the literature, as well as in our LTx center in Brazil, reasons for which are still unknown. The main complications after LTx in children are early and late acute rejection, and infections. LTx is a therapeutic option for eligible children with CF, fulfilling the lung transplant candidacy criteria, as post-transplant survival rates are increasingly improving due to better management of the transplanted patient.
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Lung transplantation in cystic fibrosis patients with difficult to treat lung infections. Curr Opin Pulm Med 2017; 23:574-579. [DOI: 10.1097/mcp.0000000000000431] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Gilljam M, Nyström U, Dellgren G, Skog I, Hansson L. Survival after lung transplantation for cystic fibrosis in Sweden. Eur J Cardiothorac Surg 2017; 51:571-576. [PMID: 28364441 DOI: 10.1093/ejcts/ezw328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/29/2016] [Indexed: 01/27/2023] Open
Abstract
Objectives In Sweden, lung transplantation has been performed in patients with end-stage lung disease since 1990. We assessed survival after lung transplantation for cystic fibrosis (CF) with focus on early mortality and outcome for patients infected with certain multiresistant bacteria, considered a relative contraindication for lung transplantation. Methods Review of CF and transplant databases and patient charts. The Kaplan-Meier method and log-rank test were used for survival analysis and group comparison. Results From November 1991 to December 2014, 115 transplantations were performed in 106 CF patients (9 retransplantations): 3 heart-lung, 106 double lung-, 1 double lobar- and 5 single lung transplantations, constituting 13% (115/909) of all lung-transplant procedures performed in Sweden. The mean age at surgery was 31 (SD 10, range 10-61) years and there were 48% females. Overall 1-year survival after lung transplantation for CF was 86.4%, 5-year survival was 73.7% and 10-year survival was 62.4%. The mean and median survival after transplantation were 13.1 (95% confidence interval (CI): 11-15.3) and 14.6 (95% CI: 9.3-19.8) years, respectively, and there was no significant difference for gender or transplant centre. Extracorporeal membrane oxygenation was used as a bridge to transplantation in 11 cases and five patients received reconditioned lungs. Vascular and infectious complications contributed to eight deaths within the first three postoperative months. The mean survival for 14 patients infected pretransplant with Mycobacterium abscessus or Burkholderia cepacia complex was 8.8 (95% CI: 6.1-11.6) years compared to 13.2 (95% CI: 10.9-15.8) years for patients negative for these bacteria. Nineteen patients (14% of all listed), of whom three were listed for retransplantation, died while waiting a median time of 94 days (range 4 days-2.5 years) after listing. Conclusions Survival after lung transplantation in Sweden is good, also for patients with pretransplant infection with M. abscessus or B. cepacia complex, and comparable to international data.
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Affiliation(s)
- Marita Gilljam
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulla Nyström
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Dellgren
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingrid Skog
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
| | - Lennart Hansson
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
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Verleden GM, Dupont L, Yserbyt J, Schaevers V, Van Raemdonck D, Neyrinck A, Vos R. Recipient selection process and listing for lung transplantation. J Thorac Dis 2017; 9:3372-3384. [PMID: 29221322 DOI: 10.21037/jtd.2017.08.90] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Lung transplantation remains the ultimate treatment option for selected patients with end-stage (cardio) pulmonary disease. Given the current organ shortage, it is without any doubt that careful selection of potential transplant candidates is essential as this may greatly influence survival after the procedure. In this paper, we will review the current guidelines for referral and listing of lung transplant candidates in general, and in more depth for the specific underlying diseases. Needless to state that these are not absolute guidelines, and that decisions depend upon center's activity, waiting list, etc. Therefore, every patient should be discussed with the transplant center before any definite decision is made to accept or decline a patient for lung transplantation.
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Affiliation(s)
- Geert M Verleden
- Department of Respiratory Diseases, Lung Transplantation Unit, University Hospital Gasthuisberg KU Leuven, Leuven, Belgium
| | - Lieven Dupont
- Department of Respiratory Diseases, Lung Transplantation Unit, University Hospital Gasthuisberg KU Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Respiratory Diseases, Lung Transplantation Unit, University Hospital Gasthuisberg KU Leuven, Leuven, Belgium
| | - Veronique Schaevers
- Department of Respiratory Diseases, Lung Transplantation Unit, University Hospital Gasthuisberg KU Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, Lung Transplantation Unit, University Hospital Gasthuisberg KU Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Department of Amesthesiology, Lung Transplantation Unit, University Hospital Gasthuisberg KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, Lung Transplantation Unit, University Hospital Gasthuisberg KU Leuven, Leuven, Belgium
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Hohwieler M, Perkhofer L, Liebau S, Seufferlein T, Müller M, Illing A, Kleger A. Stem cell-derived organoids to model gastrointestinal facets of cystic fibrosis. United European Gastroenterol J 2017; 5:609-624. [PMID: 28815024 PMCID: PMC5548342 DOI: 10.1177/2050640616670565] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/25/2016] [Indexed: 12/16/2022] Open
Abstract
Cystic fibrosis (CF) is one of the most frequently occurring inherited human diseases caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) which lead to ample defects in anion transport and epithelial fluid secretion. Existing models lack both access to early stages of CF development and a coeval focus on the gastrointestinal CF phenotypes, which become increasingly important due increased life span of the affected individuals. Here, we provide a comprehensive overview of gastrointestinal facets of CF and the opportunity to model these in various systems in an attempt to understand and treat CF. A particular focus is given on forward-leading organoid cultures, which may circumvent current limitations of existing models and thereby provide a platform for drug testing and understanding of disease pathophysiology in gastrointestinal organs.
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Affiliation(s)
- Meike Hohwieler
- Department of Internal Medicine 1, University Medical Centre Ulm, Ulm, Germany
| | - Lukas Perkhofer
- Department of Internal Medicine 1, University Medical Centre Ulm, Ulm, Germany
| | - Stefan Liebau
- Institute of Neuroanatomy, Eberhard Karls University Tuebingen, Oesterbergstr. 3, 72074 Tuebingen, Germany
| | - Thomas Seufferlein
- Department of Internal Medicine 1, University Medical Centre Ulm, Ulm, Germany
| | - Martin Müller
- Department of Internal Medicine 1, University Medical Centre Ulm, Ulm, Germany
| | - Anett Illing
- Department of Internal Medicine 1, University Medical Centre Ulm, Ulm, Germany
| | - Alexander Kleger
- Department of Internal Medicine 1, University Medical Centre Ulm, Ulm, Germany
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