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Rifi R, Matar M, Ghazi M, Abboud C, El Masri J, Al Majdalany D, Salameh P. Current state of clinical trials regarding lung transplant rejection. Transpl Immunol 2022; 74:101668. [PMID: 35842078 DOI: 10.1016/j.trim.2022.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Over the last several decades, the field of lung transplantation has made significant advances. Despite these advancements, morbidity and mortality rates are still high when compared to other solid organ transplants. Clinical trials have a significant role bringing new medications with better effects than their predecessors. Our study is critical in evaluating and tracking clinical trials involving rejection of lung transplant, with a focus on interventional therapeutic trials. METHODS On November 3, 2021, we searched clinicaltrial.gov for interventional clinical trials related to lung transplant rejection. A total of 39 clinical trials are included in this study. Characteristics on each trial were gathered. Linked publications were searched using Medline/PubMed and Embase/Scopus, and their content reviewed and summarized. RESULTS The majority of trials were divided into completed (15 out of 39) and recruiting (12 out of 39). 17 trials had between 11 and 50 participants, and 8 had above 100. Only 1 trial lasted >10 years, and the average length of all trials was 3.6 years. The majority of trials were conducted in Europe/UK/Russia and the United States/Canada (17 and 18 trials, respectively). The results were provided in 3 trials, and also published in 3, showing a decrease in the rate of patients reaching an endpoint after chronic rejection with liposomal aerosol cyclosporine, a decrease in their cytokines level, and an increase in their 5-year-survival rate compared to the oral conventional immunosuppressant, the benefit of sirolimus in decreasing the acute rejection rate and severity in comparison to azathioprine, and its efficacy against cytomegalovirus infections. Other trials revealed the benefits of azithromycin in remarkably decreasing airways and systemic inflammation, with a concomitant decline in the risk of both BOS and CLAD; highlighting the deleterious effects of air pollution after transplantation surgery; and using the grading biopsy as a post-transplantation assessment tool. CONCLUSION This study is a descriptive analysis of clinical trials targeting lung transplant rejection. This study shows the low number of trials, lack of variety in location and low publishing rates. Although focus of published trials was mainly towards azithromycin, bronchiolitis obliterans syndrome, air pollution, and biopsy in grading, a remarkable progress was realized concerning therapies, leading to less complications with a delay of chronic rejection onset, and an increase in overall survival. This sheds the light on the need for managing research efforts to fulfill any lack in specific domain, leading to new, effective therapies, and providing thereby much more benefit.
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Affiliation(s)
- Rami Rifi
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Melissa Matar
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Maya Ghazi
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Chafic Abboud
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Jad El Masri
- Faculty of Medicine, Lebanese University, Beirut, Lebanon; Faculty of Medicine, Neuroscience Research Center, Lebanese University, Beirut, Lebanon.
| | | | - Pascale Salameh
- Faculty of Medicine, Lebanese University, Beirut, Lebanon; Lebanese American University, School of Medicine, Lebanon; iNSPECT-LB (Intitut National de Santé Publique, Epidémiologie Clinique et Toxicologie-Liban), Beirut, Lebanon; School of Medicine, University of Nicosia, Cyprus
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2
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Bonnet P, Le Gal S, Calderon E, Delhaes L, Quinio D, Robert-Gangneux F, Ramel S, Nevez G. Pneumocystis jirovecii in Patients With Cystic Fibrosis: A Review. Front Cell Infect Microbiol 2020; 10:571253. [PMID: 33117730 PMCID: PMC7553083 DOI: 10.3389/fcimb.2020.571253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
Pneumocystis pneumonia (PCP) remains the most frequent AIDS-defining illness in developed countries. This infection also occurs in non-AIDS immunosuppressed patients, e.g., those who have undergone an organ transplantation. Moreover, mild Pneumocystis jirovecii infections related to low pulmonary fungal burden, frequently designated as pulmonary colonization, occurs in patients with chronic pulmonary diseases, e.g., cystic fibrosis (CF). Indeed, this autosomal recessive disorder alters mucociliary clearance leading to bacterial and fungal colonization of the airways. This mini-review compiles and discusses available information on P. jirovecii and CF. It highlights significant differences in the prevalence of P. jirovecii pulmonary colonization in European and Brazilian CF patients. It also describes the microbiota associated with P. jirovecii in CF patients colonized by P. jirovecii. Furthermore, we have described P. jirovecii genomic diversity in colonized CF patients. In addition of pulmonary colonization, it appears that PCP can occur in CF patients specifically after lung transplantation, thus requiring preventive strategies. In other respects, Pneumocystis primary infection is a worldwide phenomenon occurring in non-immunosuppressed infants within their first months. The primary infection is mostly asymptomatic but it can also present as a benign self-limiting infection. It probably occurs in the same manner in CF infants. Nonetheless, two cases of severe Pneumocystis primary infection mimicking PCP in CF infants have been reported, the genetic disease appearing in these circumstances as a risk factor of PCP while the host-pathogen interaction in older children and adults with pulmonary colonization remains to be clarified.
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Affiliation(s)
- Pierre Bonnet
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France
| | - Solène Le Gal
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France.,Groupe d'Etude des Interactions Hôte-Pathogène (ER, GEIHP), Université d'Angers, Université de Brest, Brest, France
| | - Enrique Calderon
- CIBER de Epidemiologia y Salud Publica and Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
| | - Laurence Delhaes
- Laboratory of Parasitology and Mycology, Bordeaux University Hospital, Bordeaux, France Inserm U1045 - University of Bordeaux, Bordeaux, France
| | - Dorothée Quinio
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France
| | - Florence Robert-Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085, Rennes, France
| | - Sophie Ramel
- Centre de Ressources et de Compétences de la Mucoviscidose, Fondation Ildys, Roscoff, France
| | - Gilles Nevez
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France.,Groupe d'Etude des Interactions Hôte-Pathogène (ER, GEIHP), Université d'Angers, Université de Brest, Brest, France
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3
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Single Lung Transplantation With Concomitant Cardiac Surgery in a Patient With Cystic Fibrosis: A Case Report. Transplant Proc 2020; 52:2554-2557. [PMID: 32571702 DOI: 10.1016/j.transproceed.2020.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/04/2020] [Accepted: 03/19/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cystic fibrosis is a congenital, progressive disease affecting many organs. It frequently leads to severe respiratory failure, which can be treated by means of a double lung transplantation. Single lung transplantation is justified only in certain cases. CASE REPORT This is a case report describing a 20-year-old female patient who became the recipient of a single lung transplant as a result of cystic fibrosis. The transplant was performed during cardiothoracic surgery, which included an intervention in the right atrium. At the age of 14, the patient underwent left pneumonectomy. In addition, the patient had a percutaneous endoscopic gastrostomy placed and a vascular port implanted. During preoperative evaluation, she presented with clinical symptoms of chronic respiratory failure. The patient was approved for lung transplantation at the age of 16. After 2 years on the national lung transplant waiting list, in 2018, the patient underwent right lung transplantation and removal of numerous thrombi in the right atrium during 1 procedure. This surgery was accomplished with the use of extracorporeal circulation, which is an extracorporeal membrane oxygenator combined with cardiopulmonary bypass. The patient was discharged 3 weeks after the procedure in good general condition. Presently, her pulmonary function is excellent and she presents with normal respiratory capacity. CONCLUSIONS Patients with cystic fibrosis often require double lung transplantation. Under normal circumstances, performing only a single lung transplantation would be considered medical malpractice. However, in certain cases, a single lung transplant is a life-saving procedure.
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4
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Schwensen HF, Moser C, Perch M, Pressler T, Høiby N. Pseudomonas aeruginosa antibody response in cystic fibrosis decreases rapidly following lung transplantation. J Cyst Fibros 2020; 19:587-594. [PMID: 32044245 DOI: 10.1016/j.jcf.2020.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/04/2019] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Specific Pseudomonas aeruginosa (PA) precipitating immunoglobulin G antibodies in serum are correlated with PA biofilm infection and are used as diagnostic and prognostic markers in cystic fibrosis (CF). The aim of this study was to examine the change of PA antibody response in CF patients after bilateral sequential lung transplantation (LTx). METHODS PA antibodies and airway bacteriology were retrospectively evaluated in 20 chronically infected CF patients, who underwent LTx between 2001 and 2016 at Rigshospitalet, Copenhagen. Yearly precipitin counts from one year before LTx and up to five years after LTx were compared. Monthly airway cultures were examined in the five-year period after LTx. In addition, crossed immunoelectrophoresis (CIE) were analysed for each patient for antigenic similarities from time of infection, pre-LTx and post-LTx. RESULTS All patients experienced a significant drop in PA antibodies from one year pre-LTx to one year post-LTx (p < 0.0001). The PA antibody level did not differ between those, who became reinfected immediately after LTx, and those, who did not. No patients regained the high pre-LTx precipitin levels in the following five years. The antigenic specificities of the sera post-LTx were in each patient similar to the antigenic specificities at the beginning of infection indicating a decades long memory of their immune response like an "immunological fingerprint". CONCLUSIONS After LTx a significant and continuous reduction in PA antibodies was observed. The reduction was independent of immediate reinfection after LTx. A novel three-factor explanatory model is presented.
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Affiliation(s)
- Hanna Ferløv Schwensen
- Department of Clinical Microbiology, Rigshospitalet (Copenhagen University Hospital), Denmark.
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet (Copenhagen University Hospital), Denmark
| | - Michael Perch
- Department of Cardiology, Section for Lung transplantation, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tacjana Pressler
- Department of Infectious Diseases, Cystic Fibrosis Center Copenhagen, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Rigshospitalet (Copenhagen University Hospital), Denmark; Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, Panum Institute, University of Copenhagen, Denmark
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5
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Bonk M, Rey MM, Hadjiliadis D. New Comorbidities in the Changing Face of Cystic Fibrosis Care. J Cyst Fibros 2019; 16:647-648. [PMID: 29150009 DOI: 10.1016/j.jcf.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael Bonk
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael M Rey
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Denis Hadjiliadis
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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6
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Ryu JH, Choi S, Lee HJ, Kim YT, Kim YW, Yang J. Low early posttransplant serum tacrolimus levels are associated with poor patient survival in lung transplant patients. Ann Thorac Med 2019; 14:186-191. [PMID: 31333768 PMCID: PMC6611203 DOI: 10.4103/atm.atm_160_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND: Low-dose tacrolimus-based immunosuppression is a standard therapy in kidney and liver transplantation; however, the optimal therapeutic level of tacrolimus has not been established in lung transplantation. We aimed to identify the tacrolimus level associated with better outcomes in lung transplant patients. METHODS: This retrospective study included patients who underwent lung transplantation at Seoul National University Hospital between 2006 and 2016. Kaplan–Meier survival analysis and Cox regression were performed according to tacrolimus levels at several time-points within 1-year posttransplantation. RESULTS: A total of 43 patients received bilateral lung transplantation. The median age was 53 years and the median follow-up was 20.5 months. Overall and 1-year patient survival rates were 55.8% and 74.4%, respectively. Infection was the most common cause of death (78.9%). Chronic lung allograft dysfunction was observed in 16.3%. A tacrolimus level <9 ng/ml at 1 month was associated with lower rejection-free survival (P = 0.009). A time-averaged tacrolimus level <10 ng/ml within 1 month posttransplantation was an independent risk factor for poor patient survival (hazard ratio: 4.904; 95% confidence interval: 1.930–12.459; P= 0.001). Furthermore, higher tacrolimus levels did not increase infectious complications. CONCLUSIONS: These finding suggest that tacrolimus levels ≥10 ng/ml within 1 month after lung transplantation appear to be associated with better patient survival.
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Affiliation(s)
- Jung-Hwa Ryu
- Transplant Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sunmi Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Joo Lee
- Department of Thoracic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Thoracic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Whan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaeseok Yang
- Transplant Center, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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7
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Savi D, Mordenti M, Bonci E, Troiani P, Giordani B, D'Alù V, Bertasi S, Cimino G, Rossi P, Poggi C, Palange P, Quattrucci S. Survival After Lung Transplant for Cystic Fibrosis in Italy: A Single Center Experience With 20 Years of Follow-up. Transplant Proc 2018; 50:3732-3738. [PMID: 30577264 DOI: 10.1016/j.transproceed.2018.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/16/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Lung transplantation is currently the only treatment for end-stage respiratory failure in patients with cystic fibrosis (CF). In this study we retrospectively analyzed our experience since the start of the transplantation program in 1996 with focus on survival analysis. METHODS All patients with CF who underwent lung transplant at our center were included (1996-2016). Survival analysis after lung transplant was performed using the Kaplan-Meier estimate, comparing by sex and by 4 eras (1996-2000, 2001-2005, 2006-2010, and 2011-2016). RESULTS In a 20-year period, 243 patients with CF were listed for lung transplant; 123 patients (61 male, 62 female) underwent transplant, and 85 died while waiting for donor organs. The mean (SD) and median age at transplant was 27.7 (8.7) years and 26.9 years (range, 9.1 - 52.1 years), respectively. Mean (SD) forced expiratory volume in the first second was 27.6 (9.7)% predicted; 115 patients (92.0%) were pancreatic insufficient, and 43 patients (34.0%) had CF-related diabetes. Removing patients with CF who died within the first 3 postoperative months, the mean (SD) and median survival after transplant were 8.2 (5.7) years and 7.5 years (range, 3 months-20 years), respectively. Overall post-lung transplant 1-year survival was 93.6%, 5-year survival was 71.4%, 10-year survival was 53.6%, 15-year survival was 36.7%, and 20-year survival was 31.6%. We found no difference in survival between sex (P = .22) and among the 4 eras (P = .56). CONCLUSIONS Survival after lung transplant in our single center is similar to international data.
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Affiliation(s)
- D Savi
- Department of Public Health and Infectious Diseases, Adult Cystic Fibrosis Center, Sapienza University of Rome, Italy; Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, Rome, Italy.
| | - M Mordenti
- Department of Public Health and Infectious Diseases, Adult Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - E Bonci
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - P Troiani
- Department of Pediatrics, Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - B Giordani
- Lega Italiana Fibrosi Cistica ONLUS-LIFC, Rome, Italy
| | - V D'Alù
- Department of Public Health and Infectious Diseases, Adult Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - S Bertasi
- Department of Pediatrics, Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - G Cimino
- Department of Public Health and Infectious Diseases, Adult Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - P Rossi
- Department of Pediatrics, Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - C Poggi
- Department of General Surgery and Organ Transplant, Division of Thoracic Surgery, Sapienza University of Rome, Italy
| | - P Palange
- Department of Public Health and Infectious Diseases, Adult Cystic Fibrosis Center, Sapienza University of Rome, Italy
| | - S Quattrucci
- Department of Pediatrics, Cystic Fibrosis Center, Sapienza University of Rome, Italy
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8
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Birch J, Sunny SS, Hester KLM, Parry G, Kate Gould F, Dark JH, Clark SC, Meachery G, Lordan J, Fisher AJ, Corris PA, De Soyza A. Outcomes of lung transplantation in adults with bronchiectasis. BMC Pulm Med 2018; 18:82. [PMID: 29789006 PMCID: PMC5964693 DOI: 10.1186/s12890-018-0634-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 04/25/2018] [Indexed: 11/17/2022] Open
Abstract
Background Lung transplantation is a well-established treatment for end-stage non-cystic fibrosis bronchiectasis (BR), though information regarding outcomes of transplantation remains limited. Our results of lung transplantation for Br are reported here. Methods A retrospective review of case notes and transplantation databases was conducted for patients that had underwent lung transplantation for bronchiectasis at the Freeman Hospital between 1990 and 2013. Results Fourty two BR patients underwent lung transplantation, the majority (39) having bilateral sequential lung transplantation. Mean age at transplantation was 47.1 years. Pre-transplantation osteoporosis was a significant non-pulmonary morbidity (48%). Polymicrobial infection was common, with Pseudomonas aeruginosa infection frequently but not universally observed (67%). Forced expiratory volume in 1 second (% predicted) improved from a pre-transplantation mean of 0.71 L (22% predicted) to 2.56 L (79 % predicted) at 1-year post-transplantation. Our survival results were 74% at 1 year, 64% at 3 years, 61% at 5 years and 48% at 10 years. Sepsis was a common cause of early post-transplantation deaths. Conclusions Lung transplantation for end-stage BR is a useful therapeutic option, with good survival and lung function outcomes. Survival values were similar to other bilateral lung transplants at our centre. Pre-transplantation Pseudomonas infection is common.
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Affiliation(s)
- Jodie Birch
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Syba S Sunny
- Sir William Leech Centre for lung research, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Katy L M Hester
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Sir William Leech Centre for lung research, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Gareth Parry
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - F Kate Gould
- Department of Medical Microbiology, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - John H Dark
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Stephen C Clark
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Gerard Meachery
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - James Lordan
- Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Andrew J Fisher
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Paul A Corris
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Institute of Transplantation, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Anthony De Soyza
- Institute of Cellular Medicine, Newcastle University, M2060 Leech Building, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. .,Sir William Leech Centre for lung research, The Freeman Hospital, High Heaton, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK.
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Abstract
INTRODUCTION Lung disease is the major cause of death among cystic fibrosis (CF) patients, affecting 80% of the population. The impact of extracorporeal circulation (ECC) during transplantation has not been fully clarified. This study aimed to evaluate the outcomes of lung transplantation for CF in a single center, and to assess the impact of ECC on survival. METHODS We performed a retrospective observational study of all trasplanted CF patients in a single center between 1992 and 2011. During this period, 64 lung transplantations for CF were performed. RESULTS Five- and 10-year survival of trasplanted patients was 56.7% and 41.3%, respectively. Pre-transplantation supplemental oxygen requirements and non-invasive mechanical ventilation (NIMV) do not seem to affect survival (P=.44 and P=.63, respectively). Five- and 10-year survival among patients who did not undergo ECC during transplantation was 75.69% and 49.06%, respectively, while in those did undergo ECC during the procedure, 5- and 10-year survival was 34.14% and 29.87%, respectively (P=.001). PaCO2 is an independent risk factor for the need for ECC. CONCLUSIONS The survival rates of CF patients undergoing lung transplantation in our hospital are similar to those described in international registries. Survival is lower among patients receiving ECC during the procedure. PaCO2 is a risk factor for the need for ECC during lung transplantation.
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10
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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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11
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Wang XX, Liu W, Zheng T, Park JM, Smith DE, Feng MR. Population pharmacokinetics of mycophenolic acid and its glucuronide metabolite in lung transplant recipients with and without cystic fibrosis. Xenobiotica 2016; 47:697-704. [DOI: 10.1080/00498254.2016.1214885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Tian Zheng
- Department of Pharmaceutical Sciences and
| | - Jeong M. Park
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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12
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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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13
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Venuta F, Diso D, Anile M, Rendina EA. Techniques of protection and revascularization of the bronchial anastomosis. J Thorac Dis 2016; 8:S181-5. [PMID: 26981269 DOI: 10.3978/j.issn.2072-1439.2016.01.68] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Airway anastomosis has been traditionally considered at risk for the onset of complications, particularly dehiscence with consequent infection and erosion in the adjacent vessels. Although the modifications and improvements of the surgical technique has contributed to reduce the incidence of complications, the protection and revascularization of the anastomotic site is still considered mandatory at many centers Many techniques have been proposed for encircling the bronchial anastomosis.
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Affiliation(s)
- Federico Venuta
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Daniele Diso
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Marco Anile
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
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14
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Walterspacher S, Fuhrmann C, Germann M, Ratka-Krüger P, Windisch W. Dental care before lung transplantation: are we being too rigorous? CLINICAL RESPIRATORY JOURNAL 2016; 7:220-5. [PMID: 22788979 DOI: 10.1111/j.1752-699x.2012.00308.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Poor dental status is known to cause infections in severely sick and in elderly patients. In patients awaiting lung transplantation, rigorous dental treatment is a common prerequisite, although evidence-based data are lacking with regard to extent, necessity and effect on post-transplantation infectious status. MATERIALS AND METHODS In the present retrospective study, dental status [dental history (missing teeth, caries, tooth restorations and extractions, prevalence of periodontitis) and dental treatment prior transplantation] was assessed in 85 lung transplant candidates at the University Hospital of Freiburg, Germany and evaluated for infectious foci in the first 3 years following transplantation. RESULTS Forty-nine patients got transplanted in the observed timespan. Total tooth count differed significantly between chronic obstructive pulmonary disease (16 ± 9), pulmonary fibrosis (22 ± 7) or cystic fibrosis (30 ± 3) patients prior transplantation (P > 0.001). Periodontitis prevalence yielded no difference and was mainly not treated prior transplantation. No dental-related infectious focus could be diagnosed post-transplantation. However, 15% of post-transplantation infections were of unknown focus, and infection rate was increased in year 2 post-transplantation in patients without periodontitis. CONCLUSION No clearly defined dental foci were registered following transplantation. This raises the question of whether current dental treatment in these highly compromised patients is too rigorous with regard to tooth extractions. However, no focus could be detected in 15% of the registered infections. Therefore, controversially, post-transplantation dental care could also be insufficient with regard to undertreated periodontitis.
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Affiliation(s)
- Stephan Walterspacher
- Department of Respiratory Medicine, University Hospital Freiburg, Freiburg, Germany.
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Pretransplant HRCT Characteristics Are Associated with Worse Outcome of Lung Transplantation for Cystic Fibrosis Patients. PLoS One 2015; 10:e0145597. [PMID: 26698308 PMCID: PMC4689402 DOI: 10.1371/journal.pone.0145597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 12/07/2015] [Indexed: 01/06/2023] Open
Abstract
Objectives Peri- and postoperative complications diminish the outcome of lung transplantation (LTx) in patients with cystic fibrosis (CF). We hypothesized that the degree of pathological findings on pre-LTx high resolution computed tomography (HRCT) is associated with higher morbidity and mortality in CF. Methods All our CF patients undergoing LTx between 2001 and 2011 were included. HRCT examinations were evaluated according to a scoring system for pulmonary disease in CF patients, the Severe Advanced Lung Disease (SALD) score and for pleural involvement. Results Fifty-three patients were included. Dominant infectious/inflammatory disease according to the SALD score was observed in 10 patients (19%). Five (50%) of those patients died within one week after LTx, compared to 2 (5%) patients without dominant infectious/inflammatory disease (p<0.001). This difference in survival percentage remained also significant in multivariate analysis. Patients with infectious/inflammatory disease received more packed red blood cells; 26 versus 8 in the first week (p<0.001). Pleural thickening was associated with higher requirement (10 units) for blood transfusion during LTx, compared to patients with normal pleura (4 units). Conclusions The analysis of HRCT in CF patients according to the SALD score showed that dominant infectious/inflammatory disease is associated with a higher mortality after LTx. If confirmed in other studies, HRCT might aid estimation of surgical risk in some adult CF patients.
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Moreno P, Alvarez A, Carrasco G, Redel J, Guaman HD, Baamonde C, Algar FJ, Cerezo F, Salvatierra A. Lung transplantation for cystic fibrosis: differential characteristics and outcomes between children and adults. Eur J Cardiothorac Surg 2015; 49:1334-43. [DOI: 10.1093/ejcts/ezv377] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/10/2015] [Indexed: 12/19/2022] Open
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Abbott J, Morton AM, Hurley MA, Conway SP. Longitudinal impact of demographic and clinical variables on health-related quality of life in cystic fibrosis. BMJ Open 2015; 5:e007418. [PMID: 25991453 PMCID: PMC4442198 DOI: 10.1136/bmjopen-2014-007418] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The insights that people with cystic fibrosis have concerning their health are important given that aspects of health-related quality of life (HRQoL) are independent predictors of survival and a decrease in lung function is associated with a decrease in HRQoL over time. Cross-sectional data suggest that key variables, other than lung function, are also associated with HRQoL--although study results are equivocal. This work evaluates the relationship between these key demographic and clinical variables and HRQoL longitudinally. DESIGN Longitudinal observational study. Observations were obtained at seven time points: approximately every 2 years over a 12-year period. SETTING Large adult cystic fibrosis centre in the UK. PARTICIPANTS 234 participants aged 14-48 years at recruitment. OUTCOME MEASURE Nine domains of HRQoL (Cystic Fibrosis Quality of Life Questionnaire) in relation to demographic (age, gender) and clinical measures (forced expiratory volume in 1 s, (FEV1)% predicted, body mass index (BMI), cystic fibrosis-related diabetes, Burkholderia cepacia complex, totally implantable vascular access device, nutritional and transplant status). RESULTS A total of 770 patient assessments were obtained for 234 patients. The results of random coefficients modelling indicated that demographic and clinical variables were identified as being significant for HRQoL over time. In addition to lung function, transplant status, age, having a totally implantable vascular access device, cystic fibrosis-related diabetes, BMI and B. cepacia complex impacted on many HRQoL domains longitudinally. Gender was important for the domain of body image. CONCLUSIONS Demographic and changes in clinical variables were independently associated with a change in HRQoL over time. Compared with these longitudinal data, cross-sectional data are inadequate when evaluating the relationships between HRQoL domains and key demographic and clinical variables, as they fail to recognise the full impact of the CF disease trajectory and its treatments on quality of life.
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Affiliation(s)
- Janice Abbott
- School of Psychology, University of Central Lancashire, Preston, UK
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Peled O, Kalamaro V, Kerem E, Shoseyov D, Blau H, Efrati O, Block C. Contamination of hypertonic saline solutions in use by cystic fibrosis patients in Israel. J Cyst Fibros 2014; 13:550-6. [PMID: 24484849 DOI: 10.1016/j.jcf.2014.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/09/2014] [Accepted: 01/10/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment of cystic fibrosis (CF) patients with inhaled hypertonic saline (HS) solutions is safe, beneficial and reduces exacerbation rates. We studied contamination of solutions used by Israeli CF patients for prolonged periods. METHODS The study addressed whether daily opening of previously unopened solutions caused contamination, survival of 6 CF-associated bacteria in artificially inoculated solutions, in-use contamination of solutions and patterns of their use by patients. RESULTS Repeated opening did not contaminate solutions and survival of indicator bacteria was variable. Mycobacterium abscessus survived in 3% HS solution for 6 weeks and Burkholderia cenocepacia and Pseudomonas aeruginosa were longer. In 30/76 (39.5%) of used solutions 49 contaminants were found, none being common CF-associated pathogens. CONCLUSIONS Most CF-related bacteria survived to some degree in HS. Approximately 40% of solutions used by patients were contaminated by organisms of uncertain significance. Our findings highlight the potential risk posed by contamination of HS solutions and support recommendations to use sterile unit-dose formulations.
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Affiliation(s)
- Orit Peled
- Department of Pharmacy, Schneider Children's Medical Center, 14 Kaplan St., PO Box 559, Petah Tikva 49202, Israel
| | - Vardit Kalamaro
- Cystic Fibrosis Foundation of Israel, 79 Krinitzy St., Ramat-Gan 52423, Israel; Graub Cystic Fibrosis Center, Pulmonary Unit, Schneider Children's Medical Center, 14 Kaplan St., PO Box 559, Petah Tikva 49202, Israel; Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Eitan Kerem
- Department of Pediatrics and Cystic Fibrosis Center, Hadassah Hebrew University Hospital, PO Box 24035, Mount Scopus, Jerusalem 91240, Israel
| | - David Shoseyov
- Department of Pediatrics and Cystic Fibrosis Center, Hadassah Hebrew University Hospital, PO Box 24035, Mount Scopus, Jerusalem 91240, Israel
| | - Hannah Blau
- Graub Cystic Fibrosis Center, Pulmonary Unit, Schneider Children's Medical Center, 14 Kaplan St., PO Box 559, Petah Tikva 49202, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel
| | - Ori Efrati
- Edmond and Lili Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Colin Block
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, PO Box 12000, Ein Kerem, Jerusalem 91120, Israel.
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Lobo LJ, Noone PG. Respiratory infections in patients with cystic fibrosis undergoing lung transplantation. THE LANCET RESPIRATORY MEDICINE 2013; 2:73-82. [PMID: 24461904 DOI: 10.1016/s2213-2600(13)70162-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cystic fibrosis is an inherited disease characterised by chronic respiratory infections associated with bronchiectasis. Lung transplantation has helped to extend the lives of patients with cystic fibrosis who have advanced lung disease. However, persistent, recurrent, and newly acquired infections can be problematic. Classic cystic fibrosis-associated organisms, such as Staphylococcus aureus and Pseudomonas aeruginosa, are generally manageable post-transplantation, and are associated with favourable outcomes. Burkholderia cenocepacia poses particular challenges, although other Burkholderia species are less problematic. Despite concerns about non-tuberculous mycobacteria, especially Mycobacterium abscessus, post-transplantation survival has not been definitively shown to be less than average in patients with these infections. Fungal species can be prevalent before and after transplantation and are associated with high morbidity, so should be treated aggressively. Appropriate viral screening and antiviral prophylaxis are necessary to prevent infection with and reactivation of Epstein-Barr virus and cytomegalovirus and their associated complications. Awareness of drug pharmacokinetics and interactions in cystic fibrosis is crucial to prevent toxic effects and subtherapeutic or supratherapeutic drug dosing. With the large range of potential infectious organisms in patients with cystic fibrosis, infection control in hospital and outpatient settings is important. Despite its complexity, lung transplantation in the cystic fibrosis population is safe, with good outcomes if the clinician is aware of all the potential pathogens and remains vigilant by means of surveillance and proactive treatment.
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Affiliation(s)
- Leonard J Lobo
- Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Peadar G Noone
- Pulmonary Division, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
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Eaden J, Peckham D. Myocardial infarction in an adult with cystic fibrosis and heart and lung transplant. Multidiscip Respir Med 2013; 8:37. [PMID: 23759073 PMCID: PMC3679814 DOI: 10.1186/2049-6958-8-37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/19/2013] [Indexed: 12/04/2022] Open
Abstract
We present a case of myocardial infarction in a 19 year old female with cystic fibrosis who had a heart and lung transplant performed at the age of four years old. She presented atypically with a one day history of severe, intermittent, central, sharp chest pain, radiating to her back and down her left arm. A coronary angiogram showed proximal stenosis of the left anterior descending artery and right coronary artery. She was treated with percutaneous coronary intervention, involving drug eluting stents to the left anterior descending artery (LAD) and the right coronary artery (RCA). In this study we discuss the pathophysiology, investigations and treatment of cardiac transplant vasculopathy. Although complete reversal of LAD and RCA stenosis was achieved, routine follow-up with coronary angiography and careful control of cardiac risk factors will be important to identify and reduce future restenosis and adverse cardiac events.
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Affiliation(s)
- James Eaden
- Leeds Cystic Fibrosis Unit, St James's University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK.
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Prospective multicenter study of Pneumocystis jirovecii colonization among cystic fibrosis patients in France. J Clin Microbiol 2012; 50:4107-10. [PMID: 23015669 DOI: 10.1128/jcm.01974-12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pneumocystis carriage was detected in 12.5% of 104 cystic fibrosis (CF) patients during a prospective multicenter French study, with a prevalence of genotype 85C/248C and geographic variations. It was significantly associated with the absence of Pseudomonas aeruginosa colonization and a greater forced expiratory volume in 1 s. Results are discussed considering the natural history of CF.
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Management issues for adolescents with cystic fibrosis. Pulm Med 2012; 2012:134132. [PMID: 22991662 PMCID: PMC3444048 DOI: 10.1155/2012/134132] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 08/15/2012] [Indexed: 11/17/2022] Open
Abstract
The healthy adolescent will encounter major changes in biological and psychosocial domains. The adolescent period can be greatly affected by a chronic illness. Cystic fibrosis is a terminal illness that can significantly affect an adolescent's biological, mental and psychosocial health. This paper discusses general issues to consider when managing an adolescent with a chronic medical condition, and specifically how cystic fibrosis may impact upon puberty, body image, risk-taking behaviours, mental health, independence, nonadherence, reproductive health, transition, lung transplantation, and end of life care.
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23
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Inci I, Stanimirov O, Benden C, Kestenholz P, Hofer M, Boehler A, Weder W. Lung transplantation for cystic fibrosis: a single center experience of 100 consecutive cases. Eur J Cardiothorac Surg 2011; 41:435-40. [DOI: 10.1016/j.ejcts.2011.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ostroumov A, Simonetti M, Nistri A. Cystic fibrosis transmembrane conductance regulator modulates synaptic chloride homeostasis in motoneurons of the rat spinal cord during neonatal development. Dev Neurobiol 2011; 71:253-68. [DOI: 10.1002/dneu.20855] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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25
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Hauser AR, Jain M, Bar-Meir M, McColley SA. Clinical significance of microbial infection and adaptation in cystic fibrosis. Clin Microbiol Rev 2011; 24:29-70. [PMID: 21233507 PMCID: PMC3021203 DOI: 10.1128/cmr.00036-10] [Citation(s) in RCA: 287] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A select group of microorganisms inhabit the airways of individuals with cystic fibrosis. Once established within the pulmonary environment in these patients, many of these microbes adapt by altering aspects of their structure and physiology. Some of these microbes and adaptations are associated with more rapid deterioration in lung function and overall clinical status, whereas others appear to have little effect. Here we review current evidence supporting or refuting a role for the different microbes and their adaptations in contributing to poor clinical outcomes in cystic fibrosis.
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Affiliation(s)
- Alan R Hauser
- Department of Microbiology/Immunology, Northwestern University, 303 E. Chicago Ave., Searle 6-495, Chicago, IL 60611, USA.
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Gore AP, Kwon SH, Stenbit AE. A roadmap to the brittle bones of cystic fibrosis. J Osteoporos 2010; 2011:926045. [PMID: 21209785 PMCID: PMC3010683 DOI: 10.4061/2011/926045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 11/05/2010] [Indexed: 12/17/2022] Open
Abstract
Cystic fibrosis (CF) is an autosomal recessive disorder which despite advances in medical care continues to be a life-limiting and often fatal disease. With increase in life expectancy of the CF population, bone disease has emerged as a common complication. Unlike the osteoporosis seen in postmenopausal population, bone disease in CF begins at a young age and is associated with significant morbidity due to fractures, kyphosis, increased pain, and decreased lung function. The maintenance of bone health is essential for the CF population during their lives to prevent pain and fractures but also as they approach lung transplantation since severe bone disease can lead to exclusion from lung transplantation. Early recognition, prevention, and treatment are key to maintaining optimal bone health in CF patients and often require a multidisciplinary approach. This article will review the pathophysiology, current clinical practice guidelines, and potential future therapies for treating CF-related bone disease.
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Affiliation(s)
- Ashwini P. Gore
- Division of Endocrinology, Diabetes & Medical Genetics, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425-6300, USA
| | - Soon Ho Kwon
- Division of Endocrinology, Diabetes & Medical Genetics, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425-6300, USA
| | - Antine E. Stenbit
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425-6300, USA,*Antine E. Stenbit:
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Bartáková L, Fila L, Adámek S, Pozniak J, Malý M, Burkert J, S̆imonek J, Lischke R. Lung Transplantation in Cystic Fibrosis Patients in the Czech Republic: Initial Single-Center Experience. Transplant Proc 2010; 42:3711-3. [DOI: 10.1016/j.transproceed.2010.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 09/07/2010] [Indexed: 10/18/2022]
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Cystic fibrosis and the thoracic surgeon. Eur J Cardiothorac Surg 2010; 39:716-25. [PMID: 20822917 DOI: 10.1016/j.ejcts.2010.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/19/2010] [Accepted: 07/21/2010] [Indexed: 11/21/2022] Open
Abstract
Indications for thoracic surgery in patients with cystic fibrosis (CF) are principally represented by pleural diseases including pneumothorax, pleural effusion, and empyema and by parenchymal lung diseases including bronchiectasis, hemoptysis, and pulmonary abscess. Moreover, lung transplantation has proved a viable therapeutic option for progressive respiratory failure due to end-stage CF. Main surgical experiences in this setting are reviewed and discussed.
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Andrieux A, Harambat J, Bui S, Nacka F, Iron A, Llanas B, Fayon M. Renal impairment in children with cystic fibrosis. J Cyst Fibros 2010; 9:263-8. [PMID: 20413352 DOI: 10.1016/j.jcf.2010.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 03/06/2010] [Accepted: 03/11/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Due to the improvement in life expectancy in cystic fibrosis (CF), co-morbidities such as renal function impairment may be more frequent. AIM To determine the prevalence of renal disease in children with CF and to identify associated risk factors. METHODS A single-center retrospective study analyzing the genetic, clinical and therapeutic characteristics of 112 children. The estimated glomerular filtration rate (GFR), microalbuminuria and lithiasic risk factors were assessed. RESULTS The median calculated GFR (Schwartz) was 123, 161 and 155ml/min/1.73m(2) in children aged 1, 6 and 15years, respectively. The cumulative dose of aminoglycosides was not correlated to GFR. Microalbuminuria was present in 22/38 patients. Hyperoxaluria was observed in 58/83 patients and was associated with a severe genotype, pancreas insufficiency and liver disease. Hypercalciuria, hyperuricuria and hypocitraturia were identified in 16/87, 15/83 and 57/76 patients, respectively. CONCLUSION Renal impairment in CF has various presentations. There appears to be low levels of renal impairment in children with CF. However, the risk of oxalocalcic urolithiasis is enhanced, and GFR may be underestimated by the Schwartz formula. Further studies using measured GFR techniques are thus warranted.
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Affiliation(s)
- Annick Andrieux
- CHU de Bordeaux, Centre de Ressources et de Compétences de la Mucoviscidose pédiatrique, Hôpital Pellegrin Enfants, Bordeaux, France
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Knoop C, Dumonceaux M, Rondelet B, Estenne M. Complications de la transplantation pulmonaire : complications médicales. Rev Mal Respir 2010; 27:365-82. [DOI: 10.1016/j.rmr.2010.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 12/16/2009] [Indexed: 02/06/2023]
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Knoop C, Rondelet B, Dumonceaux M, Estenne M. [Medical complications of lung transplantation]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 67:28-49. [PMID: 21353971 DOI: 10.1016/j.pneumo.2010.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/15/2010] [Indexed: 05/30/2023]
Abstract
In 2010, lung transplantation is a valuable therapeutic option for a number of patients suffering from of end-stage non-neoplastic pulmonary diseases. The patients frequently regain a very good quality of life, however, long-term survival is often hampered by the development of complications such as the bronchiolitis obliterans syndrome, metabolic and infectious complications. As the bronchiolitis obliterans syndrome is the first cause of death in the medium and long term, an intense immunosuppressive treatment is maintained for life in order to prevent or stabilize this complication. The immunosuppression on the other hand induces a number of potentially severe complications including metabolic complications, infections and malignancies. The most frequent metabolic complications are arterial hypertension, chronic renal insufficiency, diabetes, hyperlipidemia and osteoporosis. Bacterial, viral and fungal infections are the second cause of mortality. They are to be considered as medical emergencies and require urgent assessment and targeted therapy after microbiologic specimens have been obtained. They should not, under any circumstances, be treated empirically and it has also to be kept in mind that the lung transplant recipient may present several concomitant infections. The most frequent malignancies are skin cancers, the post-transplant lymphoproliferative disorders, Kaposi's sarcoma and some types of bronchogenic carcinomas, head/neck and digestive cancers. Lung transplantation is no longer an exceptional procedure; thus, the pulmonologist will be confronted with such patients and should be able to recognize the symptoms and signs of the principal non-surgical complications. The goal of this review is to give a general overview of the most frequently encountered complications. Their assessment and treatment, though, will most often require the input of other specialists and a multidisciplinary and transversal approach.
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Affiliation(s)
- C Knoop
- Unité de transplantation cardiaque et pulmonaire (UTCP), service de pneumologie, hôpital universitaire Érasme, Bruxelles, Belgique.
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Soulsby N, Greville H, Coulthard K, Doecke C. Renal dysfunction in cystic fibrosis: is there cause for concern? Pediatr Pulmonol 2009; 44:947-53. [PMID: 19728391 DOI: 10.1002/ppul.21086] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Most people associate cystic fibrosis (CF) with lung disease. Although this is the major cause of morbidity and mortality, CF is in fact a multi-organ disease. Patients with CF are living longer. Accompanying their increased life expectancy are complications not previously encountered. One of the less obvious concerns is that of renal dysfunction associated with long-term exposure to aminoglycosides as well as renally toxic immunosuppressants in lung transplant recipients. This article reviews what is known about the extent of the problem, summarizes what the current practices of measuring and monitoring renal function in patients with CF, and makes suggestions for alternative approaches. In particular, the potential role of cystatin C will be discussed.
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Affiliation(s)
- Natalie Soulsby
- Sansom Institute, University of South Australia, South Australia, Australia.
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Abbott J. Health-related quality of life measurement in cystic fibrosis: advances and limitations. Chron Respir Dis 2009; 6:31-41. [PMID: 19176710 DOI: 10.1177/1479972308098159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Health-related quality of life (HRQoL) measurement in cystic fibrosis (CF) allows the inclusion of the patient's perspective in research and clinical practice. HRQoL scales have been used for many purposes and this review focuses on how HRQoL measurement has been implemented in CF research and care. Specifically, the review considers 1) the instruments used to measure HRQoL, 2) the factors that influence how people report HRQoL, 3) the monitoring of HRQoL in clinical practice, 4) HRQoL as an outcome measure in interventions and clinical trials and 5) whether HRQoL can predict survival. The challenge for the future is to use the available information to develop and evaluate psychological interventions that would be expected to improve HRQoL in children and adults with CF.
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Affiliation(s)
- J Abbott
- Faculty of Health, University of Central Lancashire, Preston, Lancashire, UK.
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Sato Y, Takayanagi Y, Onaka T, Kobayashi E. Impact of cyclosporine upon emotional and social behavior in mice. Transplantation 2007; 83:1365-70. [PMID: 17519788 DOI: 10.1097/01.tp.0000263332.65519.1f] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cyclosporine induces psychological side effects but its mechanisms of action remain to be elucidated. METHODS Mice were injected with cyclosporine (0, 10, 60 mg/kg intraperitoneal) and indexes of both anxiety-related and social behaviors were examined. Release of serotonin and dopamine in the prefrontal cortex was also investigated by microdialysis. RESULTS Intraperitoneal administration of cyclosporine increased cyclosporine concentrations in the blood and brains in mice. Cyclosporine administration at a higher-dose reduced motor activity, increased indexes of anxiety-related behavior, and decreased an index of social interaction. The administration reduced release of serotonin and dopamine in the prefrontal cortex. Clozapine administration abolished the reduced release of dopamine and partially restored the index of social behavior in cyclosporine-injected mice. CONCLUSIONS This in vivo model suggests that cyclosporine at a high dose induced hypo-function of the prefrontal cortex as a result of reduced release of serotonin and dopamine, increased anxiety-related behavior, and disturbed social behavior. Clozapine partially restored an index of social behavior. The present findings are pathologically relevant in patients who take cyclosporine.
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Affiliation(s)
- Yuki Sato
- Department of Anesthesiology, Jichi Medical University, Tochigi-ken, Japan
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Navas de Solís MS, Merino Torres JF, Mascarell Martínez I, Piñón Sellés F. Importancia del trasplante pulmonar en la aparición de diabetes mellitus en pacientes adultos con fibrosis quística. Arch Bronconeumol 2007. [DOI: 10.1157/13098419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Navas de Solís MS, Merino Torres JF, Martínez IM, Sellés FP. Lung Transplantation and the Development of Diabetes Mellitus in Adult Patients With Cystic Fibrosis. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1579-2129(07)60029-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Solís MSN, Torres JFM, Martínez IM, Sellés FP. Lung Transplantation and the Development of Diabetes Mellitus in Adult Patients With Cystic Fibrosis. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1579-2129(07)60035-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
PURPOSE OF REVIEW To examine recent publications on lung transplantation for cystic fibrosis for changes in surgical techniques, selection criteria of patients, and impact on quality of life. RECENT FINDINGS Recent evidence focuses on cystic fibrosis patient subsets enabling better decisions about listing for lung transplantation as a therapeutic option. There is information about Burkholderia cepacia infection, ventilator dependence, young age, and arthropathy. In the US, the United Network for Organ Sharing has addressed perceived inequities in organ distribution by allocating organs by illness severity rather than time on the waiting list. A Lung Allocation Score ranks severity for patients 12 years of age and older for transplantation based on variables including lung function, oxygen and ventilatory needs, diabetes, weight and physical performance. Some recently studied important variables that influence survival in cystic fibrosis and after lung transplantation, including airway infections, pancreatic exocrine function and acute exacerbations, are not included in the Lung Allocation Score. Few publications have examined quality of life after transplantation, and a definitive work has yet to appear. SUMMARY New information has refined decision-making about lung transplantation for patients with cystic fibrosis. We examine recent findings and make recommendations for patients, families and medical providers.
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Affiliation(s)
- Theodore G Liou
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah 84132, USA.
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Historical review and perspectives in pediatric transplantation. Curr Opin Organ Transplant 2006. [DOI: 10.1097/01.mot.0000244647.15965.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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