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Hanna K, Calvelli H, Kashem MA, Zhao H, Cheng K, Leotta E, Yanagida R, Shigemura N, Toyoda Y. Donor and Recipient Age in Interstitial Lung Disease: Types of Lung Transplant Survival Outcomes. J Surg Res 2024; 293:136-143. [PMID: 37748382 DOI: 10.1016/j.jss.2023.07.012] [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: 03/01/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Lung transplantation is the last option for patients with end-stage interstitial lung disease (ILD), yet organ allocation remains a challenge. This single-center study investigated the correlation of procedure type and donor and recipient age with survival outcomes in patients with ILD. METHODS We performed a retrospective study of lung recipients diagnosed with ILD who were transplanted in our center. Survival was assessed using Kaplan-Meier curves and log-rank tests according to the following variables: double lung transplant (DLT) or single lung transplant (SLT), recipient age <65 and ≥65, recipient sex, donor sex, and donor age. Cox proportional hazards regression was performed using the same variables. P values < 0.05 were considered significant. RESULTS Of 969 lung recipients transplanted at our center, 648 (66.8%) were diagnosed with ILD. There was no significant difference in survival for patients <65 or ≥65 when compared by DLT versus SLT. There were no significant differences in survival based on donor age. Survival at 5 y was significantly higher for recipient age <65 versus ≥65 (P = 0.0014). For DLT patients <65 or ≥65, there was no significant survival difference. However, for SLT patients, survival at 5 y was significantly higher for patients <65 (P = 0.0109). CONCLUSIONS Our findings suggest that donor age did not have a significant association with survival of patients with ILD posttransplant. In older patients with ILD, there was no significant difference for DLT versus SLT. However, within the SLT group, younger patients with ILD showed better survival compared to older patients.
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Affiliation(s)
- Katherine Hanna
- Division of Cardiovascular Surgery, Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
| | - Hannah Calvelli
- Division of Cardiovascular Surgery, Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Mohammed Abul Kashem
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Division of Cardiovascular Surgery, Department of Surgery, Center for Biostatistics and Epidemiology at Temple University, Philadelphia, Pennsylvania
| | - Ke Cheng
- Division of Cardiovascular Surgery, Department of Surgery, Center for Biostatistics and Epidemiology at Temple University, Philadelphia, Pennsylvania
| | - Eros Leotta
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Roh Yanagida
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Norihisa Shigemura
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Yoshiya Toyoda
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania
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2
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Sim JPY, Nilsen K, Borg BM, Levvey B, Vazirani J, Ennis S, Plit M, Snell GI, Darley DR, Tonga KO. Oscillometry in Stable Single and Double Lung Allograft Recipients Transplanted for Interstitial Lung Disease: Results of a Multi-Center Australian Study. Transpl Int 2023; 36:11758. [PMID: 38116170 PMCID: PMC10728296 DOI: 10.3389/ti.2023.11758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023]
Abstract
Peak spirometry after single lung transplantation (SLTx) for interstitial lung disease (ILD) is lower than after double lung transplantation (DLTx), however the pathophysiologic mechanisms are unclear. We aim to assess respiratory mechanics in SLTx and DLTx for ILD using oscillometry. Spirometry and oscillometry (tremoflo® C-100) were performed in stable SLTx and DLTx recipients in a multi-center study. Resistance (R5, R5-19) and reactance (X5) were compared between LTx recipient groups, matched by age and gender. A model of respiratory impedance using ILD and DLTx data was performed. In total, 45 stable LTx recipients were recruited (SLTx n = 23, DLTx n = 22; males: 87.0% vs. 77.3%; median age 63.0 vs. 63.0 years). Spirometry was significantly lower after SLTx compared with DLTx: %-predicted mean (SD) FEV1 [70.0 (14.5) vs. 93.5 (26.0)%]; FVC [70.5 (16.8) vs. 90.7 (12.8)%], p < 0.01. R5 and R5-19 were similar between groups (p = 0.94 and p = 0.11, respectively) yet X5 was significantly worse after SLTx: median (IQR) X5 [-1.88 (-2.89 to -1.39) vs. -1.22 (-1.87 to -0.86)] cmH2O.s/L], p < 0.01. R5 and X5 measurements from the model were congruent with measurements in SLTx recipients. The similarities in resistance, yet differences in spirometry and reactance between both transplant groups suggest the important contribution of elastic properties to the pathophysiology. Oscillometry may provide further insight into the physiological changes occurring post-LTx.
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Affiliation(s)
- Joan P. Y. Sim
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Kristopher Nilsen
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Brigitte M. Borg
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bronwyn Levvey
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Jaideep Vazirani
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Samantha Ennis
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Marshall Plit
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Gregory I. Snell
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - David R. Darley
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Katrina O. Tonga
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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3
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Rama Esendagli D, Ntiamoah P, Kupeli E, Bhardwaj A, Ghosh S, Mukhopadhyay S, Mehta AC. Recurrence of primary disease following lung transplantation. ERJ Open Res 2022; 8:00038-2022. [PMID: 35651363 PMCID: PMC9149385 DOI: 10.1183/23120541.00038-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
Lung transplant has become definitive treatment for patients with several end-stage lung diseases. Since the first attempted lung transplantation in 1963, survival has significantly improved due to advancement in immunosuppression, organ procurement, ex vivo lung perfusion, surgical techniques, prevention of chronic lung allograft dysfunction and bridging to transplant using extracorporeal membrane oxygenation. Despite a steady increase in number of lung transplantations each year, there is still a huge gap between demand and supply of organs available, and work continues to select recipients with potential for best outcomes. According to review of the literature, there are some rare primary diseases that may recur following transplantation. As the number of lung transplants increase, we continue to identify disease processes at highest risk for recurrence, thus shaping our future approaches. While the aim of lung transplantation is improving survival and quality of life, choosing the best recipients is crucial due to a shortage of donated organs. Here we discuss the common disease processes that recur and highlight its impact on overall outcome following lung transplantation. This article reviews the underlying conditions leading to lung transplant with potential for recurrence and the impact of such recurrences on the overall outcome following transplanthttps://bit.ly/3v3gSvJ
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4
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Kapnadak SG, Raghu G. Lung transplantation for interstitial lung disease. Eur Respir Rev 2021; 30:30/161/210017. [PMID: 34348979 DOI: 10.1183/16000617.0017-2021] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/02/2021] [Indexed: 01/18/2023] Open
Abstract
Lung transplantation (LTx) can be a life-extending treatment option for patients with advanced and/or progressive fibrotic interstitial lung disease (ILD), especially idiopathic pulmonary fibrosis (IPF), fibrotic hypersensitivity pneumonitis, sarcoidosis and connective tissue disease-associated ILD. IPF is now the most common indication for LTx worldwide. Several unique features in patients with ILD can impact optimal timing of referral or listing for LTx, pre- or post-transplant risks, candidacy and post-transplant management. As the epidemiology of LTx and community practices have evolved, recent literature describes outcomes and approaches in higher-risk candidates. In this review, we discuss the unique and important clinical findings, course, monitoring and management of patients with IPF and other progressive fibrotic ILDs during pre-LTx evaluation and up to the day of transplantation; the need for co-management with clinical experts in ILD and LTx is emphasised. Some post-LTx complications are unique in these patient cohorts, which require prompt detection and appropriate management by experts in multiple disciplines familiar with telomere biology disorders and infectious, haematological, oncological and cardiac complications to enhance the likelihood of improved outcomes and survival of LTx recipients with IPF and other ILDs.
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Affiliation(s)
- Siddhartha G Kapnadak
- Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Medicine, University of Washington, Seattle, WA, USA
| | - Ganesh Raghu
- Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Medicine, University of Washington, Seattle, WA, USA .,Dept of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
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5
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Li D, Liu Y, Wang B. Single versus bilateral lung transplantation in idiopathic pulmonary fibrosis: A systematic review and meta-analysis. PLoS One 2020; 15:e0233732. [PMID: 32437437 PMCID: PMC7241801 DOI: 10.1371/journal.pone.0233732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/11/2020] [Indexed: 02/05/2023] Open
Abstract
Objective Lung transplantation remains the only curative treatment for end-stage lung disease, conferring a better survival for some IPF patients, but whether they should receive double lung transplantation (DLT) or single lung transplantation (SLT) is still controversial. The aim of this study was to determine which type of lung transplantation was more effective and relatively safe in IPF patients by meta-analysis. Methods Publications comparing overall survival (OS) or other perioperative characteristics between IPF patients undergoing SLT and DLT were selected from electronic databases. The hazard ratios (HRs) were abstracted or calculated to evaluate the survival outcome. Odds ratios (ORs) or mean differences (MDs) were used to compare the causes of death or perioperative parameters. A random-effect model was used to combine data. Heterogeneity was quantified by means of an I2 with 95% confidence interval (95% CI). The publication bias was estimated using the Eggers test with Begg’s funnel plots. Results 16 studies with 17,872 IPF cases who met the inclusion criteria were included in this meta-analysis. SLT was associated with declined post-transplant FEV1% (MD = -15.37, 95% CI:-22.28,-8.47; P<0.001), FVC % (MD = -12.52, 95% CI:-19.45,-5.59; P<0.001) and DLCO% (MD = -13.85, 95% CI:-20.42,-7.29; P<0.001), but no significant advantage of DLT over SLT was seen in the overall survival outcome (HR = 1.08, 95% CI: 0.91–1.29; P = 0.391). Subgroup analyses for studies of follow-up period ≥ 60 months also showed similar results (all P-values>0.05). Moreover, there was fewer deaths attributable to primary graft dysfunction in SLT recipients (OR = 0.31, 95% CI: 0.2–0.48; P<0.001), while more patients with SLT died of malignancy (OR = 3.44, 95% CI: 2.06–5.77; P<0.001). Conclusion Our findings suggest that DLT was associated with better postoperative pulmonary function, but there was no difference in long-term overall survival between patients undergoing DLT and SLT. However, further high-quality and large-scale studies are needed to confirm these findings.
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Affiliation(s)
- Diandian Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yi Liu
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Bo Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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6
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Procedure Preference and Intention-to-Treat Outcomes after Listing for Lung Transplantation among U.S. Adults. A Cohort Study. Ann Am Thorac Soc 2020; 16:231-239. [PMID: 30188172 DOI: 10.1513/annalsats.201804-258oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
RATIONALE Bilateral lung transplantation is widely used to treat chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), on the basis of an expectation of improved survival after transplantation. Yet, waiting list mortality is higher while awaiting bilateral transplantation. The net effect of procedure preference on overall survival is unknown. OBJECTIVES To determine whether an unrestricted procedure preference is associated with improved overall outcomes after listing for lung transplantation. METHODS We performed a retrospective cohort study of 12,155 adults with COPD or ILD listed for lung transplantation in the United States between May 4, 2005, and December 31, 2014. We defined a "restricted" procedure preference as listing for "bilateral transplantation only" and an "unrestricted" procedure preference as listing for any combination of bilateral or single lung transplantation. We used a composite "intention-to-treat" primary outcome that included events both before and after transplantation, defined as the number of days between listing and death, removal from the list for clinical deterioration, or retransplantation. RESULTS In adjusted analyses, an unrestricted procedure preference was associated with a 3% lower rate of the primary intention-to-treat outcome in COPD (adjusted hazard ratio [aHR], 0.97; 95% confidence interval [CI], 0.89-1.07) and a 1% higher rate in ILD (aHR, 1.01; 95% CI, 0.94-1.08). There was no convincing evidence that these associations varied by age, disease severity, or the use of mechanical support. Among those with ILD and concomitant severe pulmonary hypertension, an unrestricted preference was associated with a 17% increased rate of the primary outcome (aHR, 1.17; 95% CI, 0.99-1.39). An unrestricted preference was consistently associated with lower rates of death or removal from the list for clinical deterioration and with higher rates of transplantation. Graft failure rates were similar among those listed with restricted and unrestricted preferences. CONCLUSION When considering outcomes both before and after transplantation, we found no evidence that patients with COPD or ILD benefit from listing for bilateral lung transplantation compared with listing for a more liberal procedure preference. An unrestricted listing strategy for suitable candidates may increase the number of transplants performed without impacting overall survival.
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7
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Jacob M, Damas C. Lung transplantation for Interstitial Lung disease, the experience of an outpatient clinic. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2020; 37:e2020007. [PMID: 33264376 PMCID: PMC7690055 DOI: 10.36141/svdld.v37i3.9346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/17/2020] [Indexed: 11/02/2022]
Affiliation(s)
- Maria Jacob
- Pulmonology department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Damas
- Pulmonology department, Centro Hospitalar Universitário de São João, Porto, Portugal
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8
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Wilson-Smith AR, Kim YS, Evans GE, Yan TD. Single versus double lung transplantation for fibrotic disease-systematic review. Ann Cardiothorac Surg 2020; 9:10-19. [PMID: 32175235 DOI: 10.21037/acs.2019.12.04] [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] [Indexed: 11/06/2022]
Abstract
Background Lung transplantation has long been the accepted therapy for end-stage pulmonary fibrotic disease. Presently, there is an ongoing debate over whether single or bilateral transplantation is the most appropriate treatment for end-stage disease, with a paucity of high-quality evidence comparing the two approaches head-to-head. Methods This review was performed in accordance with PRISMA recommendations and guidance. Searches were performed on PubMed Central, Scopus and Medline from dates of database inception to September 2019. For the assessed papers, data was extracted from the reviewed text, tables and figures, by two independent authors. Estimated survival was analyzed using the Kaplan-Meier method for studies where time-to-event data was provided. Results Overall, 4,212 unique records were identified from the literature search. Following initial screening and the addition of reference list findings, 83 full-text articles were assessed for eligibility, of which 17 were included in the final analysis, with a total of 5,601 patients. Kaplan-Meier survival analysis illustrated improved survival in patients receiving bilateral lung transplantation (BLTx) than in those receiving unilateral transplantation for idiopathic pulmonary fibrosis at all time intervals, with aggregated survival for BLTx at 57%, 35.3% and 24% at 5-, 10- and 15-year follow-up, respectively. Survival rates for SLTx were 50%, 27.8% and 13.9%, respectively. Conclusions Whilst a number of studies present conflicting results with respect to short-term transplantation outcomes, BLTx confers improved long-term survival over SLTx, with large-scale registries supporting findings from single- and multi-center studies. Through an aggregation of published survival data, this meta-analysis identified improved survival in patients receiving BLTx versus SLTx at all time intervals.
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Affiliation(s)
- Ashley R Wilson-Smith
- The University of New South Wales, Medicine, Sydney, Australia.,The Collaborative Research Group (CORE), Macquarie University, Sydney, Australia
| | - Yong Sul Kim
- The University of New South Wales, Medicine, Sydney, Australia
| | | | - Tristan D Yan
- The Collaborative Research Group (CORE), Macquarie University, Sydney, Australia.,The Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Adventist Hospital, University of Sydney, Sydney, Australia
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9
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Ranganath NK, Malas J, Phillips KG, Lesko MB, Smith DE, Angel LF, Lonze BE, Kon ZN. Single and Double Lung Transplantation Have Equivalent Survival for Idiopathic Pulmonary Fibrosis. Ann Thorac Surg 2019; 109:211-217. [PMID: 31445911 DOI: 10.1016/j.athoracsur.2019.06.090] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/20/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several studies have described improved survival with double lung transplant (DLT) compared with single lung transplant (SLT) in pulmonary fibrosis. To avoid the innate selection bias of including patients exclusively listed for SLT or DLT, this study analyzed those deemed appropriate for either procedure at time of listing. METHODS All consecutive adult lung transplants for idiopathic pulmonary fibrosis provided by the Scientific Registry of Transplant Recipients were retrospectively reviewed (2007-2017). Isolated lobar transplants (n = 11) or patients listed only for SLT (n = 1834) or DLT (n = 2372) were excluded. Group stratification was based on the ultimate procedure (SLT vs DLT). Group propensity matching was performed based on 24 recipient and donor characteristics. Recipient demographics, donor demographics, and outcomes were compared between groups. RESULTS During the study period 45% (974/2179) and 55% (1205/2179) of patients ultimately received SLT and DLT, respectively. After propensity matching 466 matched patients remained in each group. SLT patients were less likely to require prolonged (>48 hours) ventilator support than DLT patients. There was also a trend toward reduced rates of posttransplant renal failure and hospital length of stay in SLT recipients. Whether analyzed by time of listing or time of transplant, survival was similar between groups. CONCLUSIONS In recipients concurrently listed for SLT and DLT overall survival was similar regardless of the eventual procedure. These data suggest that the previously purported survival advantage for DLT may purely represent selection bias and should not preclude the use of SLT in appropriately selected idiopathic pulmonary fibrosis patients.
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Affiliation(s)
- Neel K Ranganath
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
| | - Jad Malas
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Katherine G Phillips
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Melissa B Lesko
- Department of Medicine, NYU Langone Health, New York, New York
| | - Deane E Smith
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Luis F Angel
- Department of Medicine, NYU Langone Health, New York, New York
| | - Bonnie E Lonze
- Department of Surgery, Transplant Institute, NYU Langone Health, New York, New York
| | - Zachary N Kon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
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10
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Bode H, Verleden SE, Wuyts WA, Yserbyt J, Verleden GM, Vos R. Outcome of lung transplantation in non-idiopathic pulmonary fibrosis interstitial lung disease. Clin Transplant 2019; 33:e13661. [PMID: 31286560 DOI: 10.1111/ctr.13661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 01/20/2023]
Abstract
Lung transplantation remains the only curative treatment option for selected patients with end-stage interstitial lung disease (ILD). Candidate selection is impeded by patient heterogeneity, particularly in the subgroup of non-idiopathic pulmonary fibrosis (non-IPF) interstitial lung diseases. We performed a descriptive analysis of all non-IPF ILD patients who underwent lung transplantation in our center between July 1991 and November 2016 (n = 129) and searched for pre-transplant variables correlating with graft loss and chronic lung allograft dysfunction (CLAD). Our study cohort was characterized by a significantly affected medical condition, an extensive pre-transplant corticosteroid use (73.8%), and a high prevalence of pulmonary hypertension (55.7%). Earlier year of transplantation (P = .004), higher bilirubin level (P < .0001), older recipient age (P = .04), and smaller recipient height (P = .02) were found to be associated with earlier graft loss in multivariate analysis. Moreover, pre-transplant corticosteroid treatment tended to be related to earlier graft loss (P = .06), while pulmonary hypertension did not significantly correlate. None of the pre-transplant variables were shown to be associated with CLAD development. Ongoing research is required to further explore this diverse patient population and the pre-transplant variables determining their post-transplant outcome.
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Affiliation(s)
- Hannelore Bode
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Stijn E Verleden
- Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Wim A Wuyts
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Geert M Verleden
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
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11
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Rudasill SE, Iyengar A, Sanaiha Y, Khoury H, Mardock AL, Xing H, Kwon MH, Hunter C, Benharash P. Pretransplant malignancy among lung transplant recipients in the modern era. Surgery 2019; 165:1228-1233. [DOI: 10.1016/j.surg.2019.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/29/2018] [Accepted: 01/19/2019] [Indexed: 02/07/2023]
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12
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Martin AK, Renew JR, Jayaraman AL, Murray AW, Fritz AV, Ramakrishna H. Analysis of Outcomes in Lung Transplantation. J Cardiothorac Vasc Anesth 2019; 33:1455-1466. [DOI: 10.1053/j.jvca.2018.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Indexed: 01/04/2023]
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13
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Wei D, Gao F, Wu B, Zhou M, Zhang J, Yang H, Liu D, Fan L, Chen J. Single versus bilateral lung transplantation for idiopathic pulmonary fibrosis. CLINICAL RESPIRATORY JOURNAL 2019; 13:376-383. [PMID: 30916868 DOI: 10.1111/crj.13020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 02/18/2019] [Accepted: 03/05/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Lung transplantation, either single or bilateral, serves as the only effective treatment for end-stage idiopathic pulmonary fibrosis (IPF), but their superiority is still being debated, and its application in Chinese patients has not been data analysed. METHODS We reviewed 109 IPF patients who received lung transplantation at our centre between January 1, 2015 and December 31, 2017. The patients were divided into single lung transplantation (SLT) group and bilateral lung transplantation (BLT) group. We compared the two groups' demographic characteristics and clinical indexes (intraoperative conditions, postoperative complications, follow-ups and life qualities). RESULTS Patients in BLT group were significantly younger than those in SLT group (P < 0.001), and had more pretransplant infections (P = 0.007). The total ischemic time (P < 0.001) was shorter and intraoperative blood loss was less (P = 0.001) in SLT group. No significant difference was found in the proportion of patients in using anti-fibrosis drugs, pulmonary artery pressure, extracorporeal membrane oxygenation during the surgery; the length of intensive care unit stay; the incidence of complication; and the overall survival rate between two groups. However, the hierarchical analysis found that patients aged > 60 years showed a better survival in SLT group (P = 0.008). Both groups got normal MOS 36-item Short Form (SF-36) scores, and the scores of BLT were higher than those of SLT. The BLT group had better lung function than SLT group 1 year post-lung transplantation. CONCLUSIONS Both SLT and BLT are effective and SLT is more favourable for the patients of > 60 years.
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Affiliation(s)
- Dong Wei
- Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Fei Gao
- Department of Emergency, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Bo Wu
- Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Min Zhou
- Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Ji Zhang
- Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Hang Yang
- Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Dong Liu
- Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Li Fan
- Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Jingyu Chen
- Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu, China
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Villavicencio MA, Axtell AL, Osho A, Astor T, Roy N, Melnitchouk S, D'Alessandro D, Tolis G, Raz Y, Neuringer I, Sundt TM. Single- Versus Double-Lung Transplantation in Pulmonary Fibrosis: Impact of Age and Pulmonary Hypertension. Ann Thorac Surg 2018; 106:856-863. [PMID: 29803692 DOI: 10.1016/j.athoracsur.2018.04.060] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/25/2018] [Accepted: 04/02/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Double-lung transplantation (DLT) has better long-term outcomes compared with single-lung transplantation (SLT) in pulmonary fibrosis. However, controversy persists about whether older patients or patients with high lung allocation scores would benefit from DLT. Moreover, the degree of pulmonary hypertension in which SLT should be avoided is unknown. METHODS A retrospective analysis using the United Network for Organ Sharing database was performed in all recipients of lung transplants for pulmonary fibrosis. Kaplan-Meier survival for SLT versus DLT was compared and stratified by age, allocation score, and mean pulmonary artery pressure. Cox regression and propensity-matching analyses were performed. RESULTS Between 1987 and 2015; 9,191 of 29,779 lung transplants were performed in pulmonary fibrosis. Ten-year survival rates were 55% for DLT and 32% for SLT (p < 0.001). When stratified by age, DLT recipients had improved survival at all age cutoffs, except age ≥70 years. In addition, DLT recipients had improved survival across all lung allocation scores (<45, ≥45, ≥60, ≥75) and all pulmonary artery pressure categories (<25, ≥25, ≥30, ≥40 mm Hg). Among DLT recipients, pulmonary artery pressure and allocation score did not affect survival. Among SLT recipients, a pressure ≥25 mm Hg did not influence survival. Conversely, patients with a pressure ≥30 mm Hg and an allocation score ≥45 had decreased survival. On Cox regression and on propensity matching, DLT had improved survival compared with SLT. CONCLUSIONS In pulmonary fibrosis, DLT has improved survival compared with SLT and should be considered the procedure of choice in patients younger than 70 years of age. SLT in patients with mean pulmonary artery pressure ≥30 mm Hg and an allocation score ≥45 should be discouraged.
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Affiliation(s)
- Mauricio A Villavicencio
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Andrea L Axtell
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Asishana Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Todd Astor
- Harvard Medical School, Boston, Massachusetts; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Nathalie Roy
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - David D'Alessandro
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - George Tolis
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Yuval Raz
- Harvard Medical School, Boston, Massachusetts; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Isabel Neuringer
- Harvard Medical School, Boston, Massachusetts; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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15
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Kumar A, Kapnadak SG, Girgis RE, Raghu G. Lung transplantation in idiopathic pulmonary fibrosis. Expert Rev Respir Med 2018; 12:375-385. [DOI: 10.1080/17476348.2018.1462704] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Anupam Kumar
- Division of Pulmonary & Critical Care Medicine, Richard DeVos Heart & Lung Transplant Program, Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Siddhartha G. Kapnadak
- Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Reda E. Girgis
- Medical Director, Lung Transplantation and Pulmonary Hypertension, Richard DeVos Heart & Lung Transplant Program, Spectrum Health- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary & Critical Care Medicine, University of Washington Medical Center, Seattle, WA, USA
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16
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Murillo DA, Cerezo F, Gauman HD, Gonzalez FJ, Muñoz A, Moreno PM, Ceballos MJ, Salvatierra A. Left Single Lung Transplantation Through Left Anterolateral Thoracotomy With Longitudinal Partial Sternotomy (Hemiclamshell): An Innovative Surgical Resource. Transplant Proc 2018; 50:661-663. [PMID: 29579882 DOI: 10.1016/j.transproceed.2017.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/21/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Pulmonary fibrosis (PF) is one of the main indications for lung transplantation among end-stage respiratory diseases. PF represents a surgical challenge due to the pulmonary retraction, reduction of pleural space, and limitation for access of the lung hilum by elevation, specifically on the left lung. Unilateral sternothoracotomy, or hemiclamshell (HCS) approach, is the anterolateral thoracotomy with longitudinal partial sternotomy with possibility of cervical extension. This was initially described as a surgical approach for resection of lung apex tumors and of the cervicothoracic region, excision of mediastinal and thoracic wall tumors, and as an urgent incision for the repair of mediastinal and cervicothoracic vascular lesions. HCS is not usually described for liver transplantation. CASE A 62-year-old man who was a nonsmoker was diagnosed with idiopathic PF. After 3 years of medical management and follow-up, the patient was referred to us for a pretransplantation study. He presented with dyspnea grade III according to the Medical Research Council. In the radiograph of the chest and computed tomography of the thorax showed signs of pulmonary fibrosis predominantly left-lung associated with loss of volume and alteration of respiratory function tests. We performed left single lung transplantation through a left HCS approach. During implantation we converted the superior pulmonary vein into "neo-atrium" for the atrial anastomosis. The patient presented excellent evolution and was discharged from the hospital at 26 days. CONCLUSION We present a case of left single lung transplantation by PF through an HCS approach as novel and effective resource for this type of procedure.
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Affiliation(s)
- D A Murillo
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain.
| | - F Cerezo
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain
| | - H D Gauman
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain
| | - F J Gonzalez
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain
| | - A Muñoz
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain
| | - P M Moreno
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain
| | - M J Ceballos
- Pneumology and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain
| | - A Salvatierra
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain
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17
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Report of the ISHLT Working Group on primary lung graft dysfunction Part IV: Prevention and treatment: A 2016 Consensus Group statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2017; 36:1121-1136. [DOI: 10.1016/j.healun.2017.07.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/16/2017] [Indexed: 12/14/2022] Open
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Abstract
INTRODUCTION While many pharmacologic therapies for the treatment of idiopathic pulmonary fibrosis (IPF) have been evaluated via randomized, placebo-controlled clinical trials (RCTs) conducted over the past two decades, most therapies have been shown to be ineffective or even potentially harmful. However, a number of recently completed RCTs have shown significant efficacy for pirfenidone and nintedanib for the treatment of IPF. Areas covered: This manuscript reviews recent advances in the management of IPF and other forms of fibrosing interstitial lung disease (ILD) with an emphasis on IPF. The material upon which this discussion is based was obtained from various published texts and manuscripts identified via literature searching (e.g. PubMed). Expert commentary: Anti-fibrotic drugs are now available for clinical use and perceived as standard-of-care therapies that have the potential to blunt disease progression for many patients with IPF. However, these agents do not necessarily stop disease progression or have a significant impact on mortality, and more effective pharmacologic therapies are needed for patients with IPF. Additionally, whether anti-fibrotic agents can be effective therapies for other forms of pulmonary fibrosis, which often have radiologic and histopathologic manifestations that mimic IPF, is being evaluated in a number of RCTs.
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Affiliation(s)
- Keith C Meyer
- a Department of Medicine , University of Wisconsin School of Medicine and Public Health - Medicine , K4/910 Clinical Science Center 600 Highland Avenue Madison, Madison , WI , 53792-9988 , USA
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19
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Banga A, Mohanka M, Mullins J, Bollineni S, Kaza V, Ring S, Bajona P, Peltz M, Wait M, Torres F. Hospital length of stay after lung transplantation: Independent predictors and association with early and late survival. J Heart Lung Transplant 2016; 36:289-296. [PMID: 27642060 DOI: 10.1016/j.healun.2016.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/26/2016] [Accepted: 07/31/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Duration of index hospitalization after lung transplantation (LTx) is an important variable that has not received much attention. We sought to determine independent predictors of prolonged hospital length of stay (LOS) and its association with early and late outcomes. METHODS The United Network of Organ Sharing database was queried for adult patients undergoing LTx between 2006 and 2014 (N = 14,320). Patients with dual organ or previous transplantation and patients who died during the first 25 days after LTx were excluded (n = 12,647, mean age 55.2 years ± 13.1). Primary outcome was prolonged LOS (>25 days) (3,251/12,647; 25.7%). Donor, recipient, and procedure-related variables were analyzed as potential predictors of prolonged LOS. Association of prolonged LOS with 1-year and 5-year survival was evaluated using Cox proportional hazards analysis. RESULTS Independent predictors of prolonged LOS included serum albumin, lung allocation score, functional status, and need of extracorporeal membrane oxygenation or ventilator support at the time of transplant; donor age >40 years; gender mismatch (female donor to male recipient); donor body mass index; African American ethnicity; ischemic time >6 hours; and double LTx. Prolonged LOS was independently associated with increased mortality at 1 year (hazard ratio, 3.96; 95% confidence interval, 3.48-4.50; p < 0.001) and 5 years (hazard ratio, 2.00; 95% confidence interval, 1.79-2.25; p < 0.001). CONCLUSIONS A significant proportion of patients have a prolonged LOS after LTx, and several recipient, donor, and procedure-related variables are independent predictors of this outcome. Patients with prolonged LOS after LTx have significantly increased risk of death at 1 year and 5 years.
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Affiliation(s)
- Amit Banga
- Division of Pulmonary and Critical Care Medicine.
| | | | | | | | - Vaidehi Kaza
- Division of Pulmonary and Critical Care Medicine
| | - Steve Ring
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Pietro Bajona
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Wait
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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20
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Sokai A, Handa T, Chen F, Tanizawa K, Aoyama A, Kubo T, Ikezoe K, Nakatsuka Y, Oguma T, Hirai T, Nagai S, Chin K, Date H, Mishima M. Serial perfusion in native lungs in patients with idiopathic pulmonary fibrosis and other interstitial lung diseases after single lung transplantation. Clin Transplant 2016; 30:407-14. [DOI: 10.1111/ctr.12701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Akihiko Sokai
- Department of Respiratory Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Fengshi Chen
- Department of Thoracic Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Care and Sleep Control Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Kohei Ikezoe
- Department of Respiratory Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Yoshinari Nakatsuka
- Department of Respiratory Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tsuyoshi Oguma
- Department of Respiratory Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Sonoko Nagai
- Kyoto Central Clinic/Clinical Research Center; Kyoto Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Hiroshi Date
- Department of Thoracic Surgery; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine; Graduate School of Medicine; Kyoto University; Kyoto Japan
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21
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Loveman E, Copley VR, Colquitt J, Scott DA, Clegg A, Jones J, O'Reilly KMA, Singh S, Bausewein C, Wells A. The clinical effectiveness and cost-effectiveness of treatments for idiopathic pulmonary fibrosis: a systematic review and economic evaluation. Health Technol Assess 2016; 19:i-xxiv, 1-336. [PMID: 25760991 DOI: 10.3310/hta19200] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a life-limiting lung disease that generally affects people over 60 years old. The main symptoms are shortness of breath and cough, and as the disease progresses there is a considerable impact on day-to-day life. Few treatments are currently available. OBJECTIVES To conduct a systematic review of clinical effectiveness and an analysis of cost-effectiveness of treatments for IPF based on an economic model informed by systematic reviews of cost-effectiveness and quality of life. DATA SOURCES Eleven electronic bibliographic databases, including MEDLINE, EMBASE, Web of Science, and The Cochrane Library and the Centre for Reviews and Dissemination databases, were searched from database inception to July 2013. Reference lists of relevant publications were also checked and experts consulted. METHODS Two reviewers independently screened references for the systematic reviews, extracted and checked data from the included studies and appraised their risk of bias. An advisory group was consulted about the choice of interventions until consensus was reached about eligibility. A narrative review with meta-analysis was undertaken, and a network meta-analysis (NMA) was performed. A decision-analytic Markov model was developed to estimate cost-effectiveness of pharmacological treatments for IPF. Parameter values were obtained from NMA and systematic reviews. Univariate and probabilistic sensitivity analyses were undertaken. The model perspective is NHS and Personal Social Services, and discount rate is 3.5% for costs and health benefits. RESULTS Fourteen studies were included in the review of clinical effectiveness, of which one evaluated azathioprine, three N-acetylcysteine (NAC) (alone or in combination), four pirfenidone, one BIBF 1120, one sildenafil, one thalidomide, two pulmonary rehabilitation, and one a disease management programme. Study quality was generally good, with a low risk of bias. The current evidence suggests that some treatments appear to be clinically effective. The model base-case results show increased survival for five pharmacological treatments, compared with best supportive care, at increased cost. General recommendations cannot be made of their cost-effectiveness owing to limitations in the evidence base. LIMITATIONS Few direct comparisons of treatments were identified. An indirect comparison through a NMA was performed; however, caution is recommended in the interpretation of these results. In relation to the economic model, there is an assumption that pharmacological treatments have a constant effect on the relative rate of per cent predicted forced vital capacity decline. CONCLUSIONS Few interventions have any statistically significant effect on IPF and a lack of studies on palliative care approaches was identified. Research is required into the effects of symptom control interventions, in particular pulmonary rehabilitation and thalidomide. Other research priorities include a well-conducted randomised controlled trial on inhaled NAC therapy and an updated evidence synthesis once the results of ongoing studies are reported. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002116. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Emma Loveman
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Vicky R Copley
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Jill Colquitt
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | | | - Andy Clegg
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Jeremy Jones
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Katherine M A O'Reilly
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sally Singh
- Cardiac and Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital of Munich, Munich, Germany
| | - Athol Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Trust, London, UK
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22
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Brown AW, Kaya H, Nathan SD. Lung transplantation in IIP: A review. Respirology 2015; 21:1173-84. [PMID: 26635297 DOI: 10.1111/resp.12691] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 08/10/2015] [Accepted: 10/24/2015] [Indexed: 12/15/2022]
Abstract
The idiopathic interstitial pneumonias (IIP) encompass a large and diverse subtype of interstitial lung disease (ILD) with idiopathic pulmonary fibrosis (IPF) and non-specific interstitial pneumonia (NSIP) being the most common types. Although pharmacologic treatments are available for most types of IIP, many patients progress to advanced lung disease and require lung transplantation. Close monitoring with serial functional and radiographic tests for disease progression coupled with early referral for lung transplantation are of great importance in the management of patients with IIP. Both single and bilateral lung transplantation are acceptable procedures for IIP. Procedure selection is a complex decision influenced by multiple factors related to patient, donor and transplant centre. While single lung transplant may reduce waitlist time and mortality, the long-term outcomes after bilateral lung transplantation may be slightly superior. There are numerous complications following lung transplantation including primary graft dysfunction, chronic lung allograft dysfunction (CLAD), infections, gastroesophageal reflux disease (GERD) and airway disease that limit post-transplant longevity. The median survival after lung transplantation is 4.7 years in patients with ILD, which is less than in patients with other underlying lung diseases. Although long-term survival is limited, this intervention still conveys a survival benefit and improved quality of life in suitable IIP patients with advanced lung disease and chronic hypoxemic respiratory failure.
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Affiliation(s)
- A Whitney Brown
- Advanced Lung Disease and Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Hatice Kaya
- Pulmonary Critical Care and Sleep Division, George Washington University, Washington, District of Columbia, USA
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USA.
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23
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Gulack BC, Ganapathi AM, Speicher PJ, Meza JM, Hirji SA, Snyder LD, Davis RD, Hartwig MG. What Is the Optimal Transplant for Older Patients With Idiopathic Pulmonary Fibrosis? Ann Thorac Surg 2015. [PMID: 26210946 DOI: 10.1016/j.athoracsur.2015.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is controversy regarding the optimal type of lung transplant--single orthotopic lung transplantation (SOLT) versus bilateral orthotopic lung transplantation (BOLT)--for patients with idiopathic pulmonary fibrosis. We performed this study to determine which type of transplant is more appropriate for older patients with this condition. METHODS We conducted a review of the United Network for Organ Sharing database from 2005 to 2013 for patients aged 65 years or more with idiopathic pulmonary fibrosis. A 1:1 nearest-neighbor propensity match was utilized to determine differences in survival by transplant procedure type (SOLT versus BOLT). Logistic regression modeling taking into account interaction terms between prespecified variables and the type of transplant was utilized to determine variables that altered the survival outcomes associated with SOLT versus BOLT. RESULTS Of 1,564 patients who met study criteria, 521 (33.3%) received BOLT. After propensity matching 498 BOLT recipients to 498 SOLT recipients, BOLT was associated with a significantly improved 5-year survival (48.7% versus 35.2%, p < 0.01). However, the mortality hazard associated with BOLT varied from a nonsignificant reduction in survival within 3 months after transplant (hazard ratio 1.24, 95% confidence interval: 0.80 to 1.93) to a significant survival benefit for patients who survived beyond 1 year (hazard ratio 0.64, 95% confidence interval: 0.47 to 0.86). Functional status was also found to be a significant predictor of the survival benefit associated with BOLT. CONCLUSIONS Bilateral orthotopic lung transplantation is associated with significantly improved survival over SOLT for older patients with idiopathic pulmonary fibrosis, driven by a late survival benefit from bilateral transplantation. However, patients with a reduced preoperative functional status do not appear to derive a similar benefit from bilateral transplantation.
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Affiliation(s)
- Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Asvin M Ganapathi
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Paul J Speicher
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - James M Meza
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sameer A Hirji
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Laurie D Snyder
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - R Duane Davis
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matthew G Hartwig
- Department of Surgery, Duke University Medical Center, Durham, North Carolina.
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24
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Raghu G, Rochwerg B, Zhang Y, Garcia CAC, Azuma A, Behr J, Brozek JL, Collard HR, Cunningham W, Homma S, Johkoh T, Martinez FJ, Myers J, Protzko SL, Richeldi L, Rind D, Selman M, Theodore A, Wells AU, Hoogsteden H, Schünemann HJ. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline: Treatment of Idiopathic Pulmonary Fibrosis. An Update of the 2011 Clinical Practice Guideline. Am J Respir Crit Care Med 2015; 192:e3-19. [DOI: 10.1164/rccm.201506-1063st] [Citation(s) in RCA: 1242] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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25
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Kistler KD, Nalysnyk L, Rotella P, Esser D. Lung transplantation in idiopathic pulmonary fibrosis: a systematic review of the literature. BMC Pulm Med 2014; 14:139. [PMID: 25127540 PMCID: PMC4151866 DOI: 10.1186/1471-2466-14-139] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/29/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a distinct form of interstitial pneumonia with unknown origin and poor prognosis. Current pharmacologic treatments are limited and lung transplantation is a viable option for appropriate patients. The aim of this review was to summarize lung transplantation survival in IPF patients overall, between single (SLT) vs. bilateral lung transplantation (BLT), pre- and post Lung Allocation Score (LAS), and summarize wait-list survival. METHODS A systematic review of English-language studies published in Medline or Embase between 1990 and 2013 was performed. Eligible studies were those of observational design reporting survival post-lung transplantation or while on the wait list among IPF patients. RESULTS Median survival post-transplantation among IPF patients is estimated at 4.5 years. From ISHLT and OPTN data, one year survival ranged from 75% - 81%; 3-year: 59% - 64%; and 5-year: 47% - 53%. Post-transplant survival is lower for IPF vs. other underlying pre-transplant diagnoses. The proportion of IPF patients receiving BLT has steadily increased over the last decade and a half. Unadjusted analyses suggest improved long-term survival for BLT vs. SLT; after adjustment for patient characteristics, the differences tend to disappear. IPF patients account for the largest proportion of patients on the wait list and while wait list time has decreased, the number of transplants for IPF patients has increased over time. OPTN data show that wait list mortality is higher for IPF patients vs. other diagnoses. The proportion of IPF patients who died while awaiting transplantation ranged from 14% to 67%. While later transplant year was associated with increased survival, no significant differences were noted pre vs. post LAS implementation; however a high LAS vs low LAS was associated with decreased one-year survival. CONCLUSIONS IPF accounts for the largest proportion of patients awaiting lung transplants, and IPF is associated with higher wait-list and post-transplant mortality vs. other diagnoses. Improved BLT vs. SLT survival may be the result of selection bias. Survival pre- vs. post LAS appears to be similar except for IPF patients with high LAS, who have lower survival compared to pre-LAS. Data on post-transplant morbidity outcomes are sparse.
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26
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Hosseini Baharanchi FS, Hajizadeh E, Najafizadeh K, Baghestani AR, Shafaghi S. Risk factors associated with survival after lung transplant in iran. EXP CLIN TRANSPLANT 2014; 13:290-4. [PMID: 24844528 DOI: 10.6002/ect.2014.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Limited information is available about risk factors associated with survival after lung transplant in Iranian recipients. This study evaluated the effect of recipient and donor characteristics on survival after lung transplant. MATERIALS AND METHODS This retrospective study included 69 lung transplants (single, 31 patients [45%]; bilateral, 38 patients [55%]), from 2000 to 2013, at the National Research Institute of Tuberculosis and Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The Kaplan-Meier method was used to calculate survival, and variables were evaluated with multivariate analysis. RESULTS There were 54 male recipients (78%), and the most frequent indications for transplant included pulmonary fibrosis in 31 patients (45%) and bronchiectasis in 23 patients (33%). Recipient mean age was 36 ± 13 years and body mass index was 20 ± 4 kg/m2. Mean half-life (all recipients) was 2 ± 1 years and survival was 73% at 1 month, 67% at 1 year, and 40% at 5 years after transplant. For recipients who survived > 2 weeks after transplant half-life and survival were similar to previously international reported results. Recipient age, sex, type of transplant, body mass index, and pulmonary artery pressure were not associated with survival. Survival was significantly higher with recipient bronchiectasis, younger donors, and female donors. CONCLUSIONS Survival after lung transplant was better with recipients who had bronchiectasis and donors that were younger or female. Patient selection, invasive monitoring, and supportive techniques such as extracorporeal membrane oxygenation for unstable patients during surgery may be helpful.
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27
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Oldham JM, Noth I. Idiopathic pulmonary fibrosis: early detection and referral. Respir Med 2014; 108:819-29. [PMID: 24746629 DOI: 10.1016/j.rmed.2014.03.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 01/20/2014] [Accepted: 03/17/2014] [Indexed: 01/13/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF), a devastating progressive interstitial lung disease (ILD) with no known cause or cure, is the most common and deadly of the idiopathic interstitial pneumonias. With a median survival of 3-5 years following diagnosis, IPF is characterized by a progressive decline in lung function and quality of life in most patients. Vigilance among clinicians in recognizing IPF early in the disease course remains critical to properly caring for these patients, as this provides the widest range of management options. When IPF is suspected, a multidisciplinary evaluation (MDE) by a clinician, radiologist and pathologist with ILD expertise should occur, as this improves diagnostic agreement in both community and academic settings. When community MDE is not possible, or diagnostic doubt exists, referral to an ILD center should be considered. ILD center referral may also provide access specialized care, including clinical trials and lung transplantation, and should be considered for any patient with an established diagnosis of IPF.
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Affiliation(s)
- Justin M Oldham
- The University of Chicago, Section of Pulmonary and Critical Care Medicine, 5841 S. Maryland Ave, MC 6076, Chicago, IL 60637, USA.
| | - Imre Noth
- The University of Chicago, Section of Pulmonary and Critical Care Medicine, 5841 S. Maryland Ave, MC 6076, Chicago, IL 60637, USA
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Meyer KC. Diagnosis and management of interstitial lung disease. TRANSLATIONAL RESPIRATORY MEDICINE 2014; 2:4. [PMID: 25505696 PMCID: PMC4215823 DOI: 10.1186/2213-0802-2-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/17/2013] [Indexed: 12/24/2022]
Abstract
The complex tasks of making a confident diagnosis of a specific form of interstitial lung disease (ILD) and formulating a patient-centered, personalized management plan in an attempt to achieve remission or stabilization of the disease process can pose formidable challenges to clinicians. When patients are evaluated for suspected ILD, an accurate diagnosis of the specific form of ILD that a patient has developed must be made to provide the patient with useful prognostic information and to formulate an appropriate management plan that can relieve symptoms and restore or significantly improve quality of life. A well-performed patient history and physical examination provides invaluable information that can be combined with appropriate laboratory testing, imaging, and, if needed, tissue biopsy to reach a confident ILD diagnosis, and high-resolution computed tomography (HRCT) of the thorax is usually a key component of the diagnostic evaluation. If treatment is indicated, many forms of ILD can respond significantly to immunosuppressive anti-inflammatory therapies. However, ILD accompanied by extensive fibrosis may be difficult to treat, and the identification of an effective pharmacologic therapy for idiopathic pulmonary fibrosis (IPF) has remained elusive despite the completion of many phase 3 clinical trials over the past decade. Nonetheless, patients with IPF or advanced forms of non-IPF ILD can benefit significantly from detection and treatment of various co-morbid conditions that are often found in patients (especially the elderly patient), and supportive care (oxygen therapy, pulmonary rehabilitation) can have a beneficial impact on quality of life and symptom palliation. Finally, lung transplantation is an option for patients with progressive, advanced disease that does not respond to other therapies, but only a relatively small subset of patients with end-stage ILD are able to meet wait listing requirements and eventually undergo successful lung transplantation.
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Affiliation(s)
- Keith C Meyer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin USA
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Abstract
Primary graft dysfunction (PGD) is a syndrome encompassing a spectrum of mild to severe lung injury that occurs within the first 72 hours after lung transplantation. PGD is characterized by pulmonary edema with diffuse alveolar damage that manifests clinically as progressive hypoxemia with radiographic pulmonary infiltrates. In recent years, new knowledge has been generated on risks and mechanisms of PGD. Following ischemia and reperfusion, inflammatory and immunological injury-repair responses appear to be key controlling mechanisms. In addition, PGD has a significant impact on short- and long-term outcomes; therefore, the choice of donor organ is impacted by this potential adverse consequence. Improved methods of reducing PGD risk and efforts to safely expand the pool are being developed. Ex vivo lung perfusion is a strategy that may improve risk assessment and become a promising platform to implement treatment interventions to prevent PGD. This review details recent updates in the epidemiology, pathophysiology, molecular and genetic biomarkers, and state-of-the-art technical developments affecting PGD.
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Affiliation(s)
- Yoshikazu Suzuki
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Edward Cantu
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jason D Christie
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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30
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Diamond JM, Lee JC, Kawut SM, Shah RJ, Localio AR, Bellamy SL, Lederer DJ, Cantu E, Kohl BA, Lama VN, Bhorade SM, Crespo M, Demissie E, Sonett J, Wille K, Orens J, Shah AS, Weinacker A, Arcasoy S, Shah PD, Wilkes DS, Ware LB, Palmer SM, Christie JD. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med 2013; 187:527-34. [PMID: 23306540 DOI: 10.1164/rccm.201210-1865oc] [Citation(s) in RCA: 478] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. OBJECTIVES We sought to identify donor, recipient, and perioperative risk factors for PGD. METHODS We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. MEASUREMENTS AND MAIN RESULTS A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FiO2 during allograft reperfusion (OR, 1.1 per 10% increase in FiO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95% CI, 1.2-3.3; P = 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1-1.5; P < 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality. CONCLUSIONS We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357).
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Affiliation(s)
- Joshua M Diamond
- Pulmonary, Allergy and Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Lee JC, Diamond JM, Christie JD. Critical care management of the lung transplant recipient. CURRENT RESPIRATORY CARE REPORTS 2012; 1:168-176. [PMID: 32288970 PMCID: PMC7102351 DOI: 10.1007/s13665-012-0018-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lung transplantation provides the prospect of improved survival and quality of life for patients with end stage lung and pulmonary vascular diseases. Given the severity of illness of such patients at the time of surgery, lung transplant recipients require particular attention in the immediate post-operative period to ensure optimal short-term and long-term outcomes. The management of such patients involves active involvement of a multidisciplinary team versed in common post-operative complications. This review provides an overview of such complications as they pertain to the practitioners caring for post-operative lung transplant recipients. Causes and treatment of conditions affecting early morbidity and mortality in lung transplant recipients will be detailed, including primary graft dysfunction, cardiovascular and surgical complications, and immunologic and infectious issues. Additionally, lung donor management issues and bridging the critically ill potential lung transplant recipient to transplantation will be discussed.
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Affiliation(s)
- James C. Lee
- Penn Lung Transplant Program, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, 826 West Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Joshua M. Diamond
- Penn Lung Transplant Program, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, 826 West Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Jason D. Christie
- Department of Biostatistics and Epidemiology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104 USA
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