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Supphapipat K, Leurcharusmee P, Chattipakorn N, Chattipakorn SC. Impact of air pollution on postoperative outcomes following organ transplantation: Evidence from clinical investigations. Clin Transplant 2024; 38:e15180. [PMID: 37987510 DOI: 10.1111/ctr.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Air pollution is a worldwide problem affecting human health via various body systems, resulting in numerous significant adverse events. Air pollutants, including particulate matter < or = 2.5 microns (PM2.5), particulate matter < or = 10 microns (PM10), ozone (O3 ), nitrogen dioxide (NO2 ), and traffic-related air pollution (TRAP), have demonstrated the negative effects on human health (e.g., increased cerebrovascular, cardiovascular, and respiratory diseases, malignancy, and mortality). Organ transplant patients, who are taking immunosuppressive agents, are especially vulnerable to the adverse effects of air pollutants. The evidence from clinical investigation has shown that exposure to air pollution after organ transplantation is associated with organ rejection, cardiovascular disease, coronary heart disease, cerebrovascular disease, infection-related mortality, and vitamin D deficiency. OBJECTIVES AND METHOD This review aims to summarize and discuss the association of exposure to air pollutants and serum 25-hydroxyvitamin D level and outcomes after transplantation. Controversial findings are also included and discussed. CONCLUSION All of the findings suggest that air pollution results in a hazardous environment, which not only impacts human health worldwide but also affects post-transplant outcomes.
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Affiliation(s)
- Kittitorn Supphapipat
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Prangmalee Leurcharusmee
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Hirschi S, Le Pavec J, Schuller A, Bunel V, Pison C, Mordant P. [Contraindications to lung transplantation]. Rev Mal Respir 2023; 40 Suppl 1:e13-e21. [PMID: 36610849 DOI: 10.1016/j.rmr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- S Hirschi
- Service de pneumologie et transplantation pulmonaire, hôpitaux universitaires de Strasbourg, université de Strasbourg, Strasbourg, France.
| | - J Le Pavec
- Service de pneumologie et transplantation pulmonaire, hôpital Marie-Lannelongue, groupe hospitalier Paris Saint-Joseph, Le Plessis-Robinson, France; Faculté de médecine, université Paris-Sud, université Paris-Saclay, Le Kremlin-Bicêtre, France; Inserm, UMR_S 999, hôpital Marie Lannelongue, université Paris-Sud, Le Plessis-Robinson, France
| | - A Schuller
- Service de pneumologie et transplantation pulmonaire, hôpitaux universitaires de Strasbourg, université de Strasbourg, Strasbourg, France
| | - V Bunel
- Service de pneumologie, hôpital Bichat, AP-HP, Paris, France
| | - C Pison
- Inserm 1055, Service hospitalier universitaire de pneumologie physiologie, université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - P Mordant
- Service de chirurgie vasculaire, thoracique, et de transplantation pulmonaire, hôpital Bichat, université de Paris, Assistance publique-Hôpitaux de Paris, Paris, France
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Le Pavec J, Pison C, Hirschi S, Bunel V, Mordant P, Brugière O, Guen ML, Olland A, Coiffard B, Renaud-Picard B, Tissot A, Brioude G, Borie R, Crestani B, Deslée G, Stelianides S, Mal H, Schuller A, Falque L, Lorillon G, Tazi A, Burgel PR, Grenet D, De Miranda S, Bergeron A, Launay D, Cottin V, Nunes H, Valeyre D, Uzunhan Y, Prévot G, Sitbon O, Montani D, Savale L, Humbert M, Fadel E, Mercier O, Mornex JF, Dauriat G, Reynaud-Gaubert M. 2022 Update of indications and contraindications for lung transplantation in France. Respir Med Res 2022; 83:100981. [PMID: 36565563 DOI: 10.1016/j.resmer.2022.100981] [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: 11/07/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Lung transplantation (LTx) is a steadily expanding field. The considerable developments have been driven over the years by indefatigable work conducted at LTx centers to improve donor and recipient selection, combined with multifaceted efforts to overcome challenges raised by the surgical procedure, perioperative care, and long-term medical complications. One consequence has been a pruning away of contraindications over time, which has, in some ways, complicated the patient selection process. The Francophone Pulmonology Society (Société de Pneumology de Langue Française, SPLF) set up a task force to produce up-to-date working guidelines designed to assist pulmonologists in managing end-stage respiratory insufficiency, determining which patients may be eligible for LTx, and appropriately timing LTx-center referral. The task force examined the most recent literature and evaluated the risk factors that limit patient survival after LTx. Ideally, the objectives of LTx are to prolong life while also improving quality of life. The guidelines developed by the task force apply to a limited resource and are consistent with the ethical principles described below.
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Affiliation(s)
- Jérôme Le Pavec
- Service de Pneumologie et Transplantation Pulmonaire, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France.
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Av. des Maquis du Grésivaudan, 38700 La Tronche, France; INSERM 1055, Laboratoire de Bioénergétique Fondamentale et Appliquée, Bâtiment B Biologie, 2280 Rue de la piscine 38400 Saint Martin d'Hères, France; Université Grenoble Alpes, Av. des Maquis du Grésivaudan, 38700 La Tronche, France
| | - Sandrine Hirschi
- Service de Pneumologie et Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Hôpital Civil, 1 place de l'hôpital BP 426, 67091 Strasbourg, France
| | - Vincent Bunel
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP, Inserm U1152, Université de Paris, 46 Rue Henri Huchard, 75018 Paris, France
| | - Pierre Mordant
- Service de chirurgie vasculaire, thoracique, et de transplantation pulmonaire, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, Université de Paris, 46 Rue Henri Huchard, 75018, Paris, France
| | - Olivier Brugière
- Centre de Transplantation Pulmonaire et CRCM, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Morgan Le Guen
- Département d'Anesthésie, Hôpital Foch, 40 Rue Worth, 92150 Suresnes, France; INRA UMR 892 VIM, équipe Vaccins Immunopathologie Immunomodulation, Domaine de Vilvert, 78350, Jouy-en-Josas, France; Université Versailles Saint Quentin, 45 Av. des États Unis, 78000 Versailles France
| | - Anne Olland
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France; INSERM (French institute for health and medical research) 1260 Regenerative, University Hospital Strasbourg, 1 place de l'hôpital, BP 426, 67091 Strasbourg, France
| | - Benjamin Coiffard
- Service de Pneumologie et Equipe de Transplantation Pulmonaire, Centre Hospitalo-Universitaire Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Benjamin Renaud-Picard
- Service de Pneumologie et Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Hôpital Civil, 1 place de l'hôpital BP 426, 67091 Strasbourg, France; INSERM (French institute for health and medical research) 1260 Regenerative, University Hospital Strasbourg, 1 place de l'hôpital, BP 426, 67091 Strasbourg, France
| | - Adrien Tissot
- Nantes Université, CHU Nantes, Service de Pneumologie, l'institut du thorax, F-44000 Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, 8 Quai Moncousu, 44007, Nantes, France
| | - Geoffrey Brioude
- Service de Chirurgie Thoracique, Centre Hospitalo-Universitaire Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin des Bourrely, 13915 Marseille cedex 20, France
| | - Raphaël Borie
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Bruno Crestani
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Gaétan Deslée
- Service de Pneumologie, Inserm U1250, CHU Reims, Université Reims Champagne Ardenne, 45 Rue Cognacq-Jay, 51092, Reims, France
| | - Sandrine Stelianides
- Institut de réadaptation d'Achères, 7, place Simone-Veil, 78260, Achères, France
| | - Hervé Mal
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP, Inserm U1152, Université de Paris, 46 Rue Henri Huchard, 75018 Paris, France
| | - Armelle Schuller
- Service de Pneumologie et Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Hôpital Civil, 1 place de l'hôpital BP 426, 67091 Strasbourg, France
| | - Loïc Falque
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Av. des Maquis du Grésivaudan, 38700 La Tronche, France
| | - Gwenaëlle Lorillon
- Université de Paris, INSERM UMR 976 HIPI, F-75006; Centre national de référence des histiocytoses, Service de Pneumologie, Hôpital Saint Louis, 1 Av. Claude Vellefaux, 75010, Paris, AP-HP, France
| | - Abdellatif Tazi
- Université de Paris, INSERM UMR 976 HIPI, F-75006; Centre national de référence des histiocytoses, Service de Pneumologie, Hôpital Saint Louis, 1 Av. Claude Vellefaux, 75010, Paris, AP-HP, France
| | - Pierre Regis Burgel
- Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France; Pulmonary Department and National Cystic Fibrosis Reference Centre, Cochin Hospital; Assistance Publique Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Dominique Grenet
- Centre de Transplantation Pulmonaire et CRCM, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Sandra De Miranda
- Centre de Transplantation Pulmonaire et CRCM, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Anne Bergeron
- Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland; Université de Paris, UMR 1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, Parvis Notre-Dame - Pl. Jean-Paul II, 75004, Paris, France
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, rue Michel Polonowski, 5900, Lille, France; Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, rue Michel Polonowski, 5900, Lille France; Inserm, rue Michel Polonowski, 5900, Lille, France
| | - Vincent Cottin
- Université de Lyon, INRA, IVPC, Lyon; Centre national de référence des maladies pulmonaires rares, hôpital Louis Pradel, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Bron, France
| | - Hilario Nunes
- INSERM UMR 1272, Université Sorbonne Paris Nord, AP-HP, Hôpital Avicenne Service de Pneumologie, 125 Rue de Stalingrad, 93000, Bobigny, France; Service de Pneumologie, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Dominique Valeyre
- INSERM UMR 1272, Université Sorbonne Paris Nord, AP-HP, Hôpital Avicenne Service de Pneumologie, 125 Rue de Stalingrad, 93000, Bobigny, France; Hôpital Saint Joseph, Groupe Hospitalier Paris Saint Joseph, 185 Rue Raymond Losserand, 75014, Paris, France
| | - Yurdagul Uzunhan
- INSERM UMR 1272, Université Sorbonne Paris Nord, AP-HP, Hôpital Avicenne Service de Pneumologie, 125 Rue de Stalingrad, 93000, Bobigny, France; Service de Pneumologie, Hôpital Avicenne, Assistance Publique Hôpitaux de Paris, 125 Rue de Stalingrad, 93000, Bobigny, France
| | - Grégoire Prévot
- Pôle des voies respiratoires-Hôpital Larrey, Centre Hopitalo-Universitaire, 24 Chem. de Pouvourville, 31400, Toulouse, France
| | - Olivier Sitbon
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - David Montani
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Laurent Savale
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Marc Humbert
- AP-HP, Service de Pneumologie, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Elie Fadel
- Service de Chirurgie Thoracique et Transplantation Cardio-pulmonaire, Groupe Hospitalier Marie-Lannelongue -Paris Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Olaf Mercier
- Service de Chirurgie Thoracique et Transplantation Cardio-pulmonaire, Groupe Hospitalier Marie-Lannelongue -Paris Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Saclay, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Jean François Mornex
- Université de Lyon, université Lyon 1; PSL, EPHE; INRAE; IVPC; 69007, Lyon, France; Hospices civils de Lyon, GHE, service de pneumologie; RESPIFIL, Orphalung; Inserm, CIC1407, 59 Bd Pinel, 69500 Bron, France
| | - Gaëlle Dauriat
- Service de Pneumologie et Transplantation Pulmonaire, Groupe hospitalier Marie-Lannelongue -Saint Joseph, 133 avenue de la résistance, 92350 Le Plessis-Robinson, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie et Equipe de Transplantation Pulmonaire, Centre Hospitalo-Universitaire Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin des Bourrely, 13915 Marseille cedex 20, France
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Le Pavec J, Pison C, Hirschi S, Bunel V, Mordant P, Brugière O, Le Guen M, Olland A, Coiffard B, Renaud-Picard B, Tissot A, Brioude G, Borie R, Crestani B, Deslée G, Stelianides S, Mal H, Schuller A, Falque L, Lorillon G, Tazi A, Burgel P, Grenet D, De Miranda S, Bergeron A, Launay D, Cottin V, Nunes H, Valeyre D, Uzunhan Y, Prévot G, Sitbon O, Montani D, Savale L, Humbert M, Fadel E, Mercier O, Mornex J, Dauriat G, Reynaud-Gaubert M. Transplantation pulmonaire en France : actualisation des indications et contre-indications en 2022. Rev Mal Respir 2022; 39:855-872. [DOI: 10.1016/j.rmr.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
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Galiatsatos P, Ekpo P, Schreiber R, Barker L, Shah P. Smoking Mechanics and Impact on Smoking Cessation: Two Cases of Smoking Lapse Status Post Lung Transplantation. Tob Use Insights 2022; 15:1179173X211069634. [PMID: 35023981 PMCID: PMC8744156 DOI: 10.1177/1179173x211069634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Smoking behavior includes mechanisms taken on by persons to adjust for certain
characteristic changes of cigarettes. However, as lung function declines due to
lung-specific diseases, it is unclear how mechanical smoking behavior changes affect
persons who smoke. We review two cases of patients who stopped smoking prior to and then
subsequently resumed smoking after lung transplantation. Methods A retrospective review of two patients who were recipients of lung transplantation and
sustained from cigarette usage prior to transplantation. Results Patient A was a 54-year-old woman who received a double lung transplant secondary to
chronic obstructive pulmonary disease (COPD) in October 2017. She had stopped smoking
cigarettes in July 2015 (FEV1 .56 L). Patient B was a 40-year-old man who received a
double lung transplantation due to sarcoidosis in January 2015. He stopped smoking
cigarettes in February 2012 (FEV1 1.15 L). Post-transplant, Patient A resumed smoking on
March 2018 where her FEV1 was at 2.12 L (5 months post-transplantation), and Patient B
resumed smoking in April 2017 where his FEV1 was 2.37 L (26 months
post-transplantation). Conclusion We report on two patients who resumed smoking after lung transplantation. While
variations of smoking mechanics have been identified as a function of nicotine yield and
type of cigarette, it lung mechanics may play a role in active smoking as well.
Therefore, proper screening for tobacco usage post-lung transplantation should be
considered a priority in order to preserve transplanted lungs.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Tobacco Treatment Clinic, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Princess Ekpo
- Tobacco Treatment Clinic, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Raiza Schreiber
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Tobacco Treatment Clinic, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Lindsay Barker
- Office of Transplantation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Pali Shah
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Office of Transplantation, Johns Hopkins Hospital, Baltimore, MD, USA
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Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2021; 40:1349-1379. [PMID: 34419372 DOI: 10.1016/j.healun.2021.07.005] [Citation(s) in RCA: 295] [Impact Index Per Article: 98.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Tens of thousands of patients with advanced lung diseases may be eligible to be considered as potential candidates for lung transplant around the world each year. The timing of referral, evaluation, determination of candidacy, and listing of candidates continues to pose challenges and even ethical dilemmas. To address these challenges, the International Society for Heart and Lung Transplantation appointed an international group of members to review the literature, to consider recent advances in the management of advanced lung diseases, and to update prior consensus documents on the selection of lung transplant candidates. The purpose of this updated consensus document is to assist providers throughout the world who are caring for patients with pulmonary disease to identify potential candidates for lung transplant, to optimize the timing of the referral of these patients to lung transplant centers, and to provide transplant centers with a framework for evaluating and selecting candidates. In addition to addressing general considerations and providing disease specific recommendations for referral and listing, this updated consensus document includes an ethical framework, a recognition of the variability in acceptance of risk between transplant centers, and establishes a system to account for how a combination of risk factors may be taken into consideration in candidate selection for lung transplantation.
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Vos R, Van Herck A. Pseudomonas aeruginosa and chronic lung allograft dysfunction: does evading an iceberg prevent the ship from sinking? Eur Respir J 2021; 58:13993003.00041-2021. [PMID: 34326173 DOI: 10.1183/13993003.00041-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/09/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Robin Vos
- Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium .,Dept CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Anke Van Herck
- Dept of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
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Klapper J, Denlinger C, Sade RM. Smoking Relapse After Lung Transplantation: Is a Second Transplant Justified? Ann Thorac Surg 2021; 112:373-378. [PMID: 33905727 DOI: 10.1016/j.athoracsur.2021.03.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/15/2023]
Affiliation(s)
- Jacob Klapper
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Robert M Sade
- Department of Surgery and Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina.
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Abstract
PURPOSE OF REVIEW Over the past two decades, lung transplant has become the mainstay of treatment for several end-stage lung diseases. As the field continues to evolve, the criteria for referral and listing have also changed. The last update to these guidelines was in 2014 and several studies since then have changed how patients are transplanted. Our article aims to briefly discuss these updates in lung transplantation. RECENT FINDINGS This article discusses the importance of early referral of patients for lung transplantation and the concept of the 'transplant window'. We review the referral and listing criteria for some common pulmonary diseases and also cite the updated literature surrounding the absolute and relative contraindications keeping in mind that they are a constantly moving target. Frailty and psychosocial barriers are difficult to assess with the current assessment tools but continue to impact posttransplant outcomes. Finally, we discuss the limited data on transplantation in acute respiratory distress syndrome (ARDS) due to COVID19 as well as extracorporeal membrane oxygenation bridge to transplantation. SUMMARY The findings discussed in this article will strongly impact, if not already, how we select candidates for lung transplantation. It also addresses some aspects of lung transplant such as frailty and ARDS, which need better assessment tools and clinical data.
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Ohiomoba RO, Youmans QR, Akanyirige PW, Ezema AU, Anderson AS, Bryant A, Jackson K, Mandieka E, Pham DT, Raza Y, Rich JD, Yancy CW, Okwuosa IS. History of cigarette smoking and heart transplant outcomes. IJC HEART & VASCULATURE 2020; 30:100599. [PMID: 32775604 PMCID: PMC7398935 DOI: 10.1016/j.ijcha.2020.100599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 11/17/2022]
Abstract
Background: Active cigarette smoking (CS) is a contraindication for Orthotopic Heart Transplantation (OHT) with a recommendation that HT candidates be free from CS for at minimum 6 months prior to HT. Animal studies have shown that a history of CS is associated with increased risk of allograft rejection, but few studies have examined the association of past CS and HT outcomes. Methods: Data were analyzed from HT recipients captured in the United Network for Organ Sharing (UNOS) transplant registry. Adults aged 18–79 who underwent HT from 1987 to 2018 and with data for all covariates (N = 32,260) were included in this study. The cohort was categorized by past smoking history (CS vs non-CS). Post-transplant outcomes of interest included survival, graft failure, treated rejection, malignancy and hospitalization for infection. Baseline characteristics were compared between the two groups using the chi-squared analysis. Unadjusted associations between CS and patient survival were determined using the Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. Results: HT recipients with a history of CS were older (55 vs 50, p = <0.0001), more likely to be Caucasian (75.7 vs 62.3, p = <0.0001), male (81.7 vs 68.2, p =< 0.0001), and diabetic (27.4 vs 24.4, p =< 0.0001). CS was associated with significantly worse survival (HR: 1.23, p < 0.0001). A history of CS was also associated with increased risk of acute rejection (OR: 1.20, p < 0.0001), hospitalization for infection (OR:1.24, p < 0.0001), graft failure (OR:1.23, p < 0.0001) and post-transplant malignancy (OR:1.43, p < 0.0001). Conclusion: A history of CS is associated with increased risk of adverse events post OHT.
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Affiliation(s)
- R O Ohiomoba
- Northwestern University, Feinberg School of Medicine, United States
| | - Q R Youmans
- Northwestern University, Division of Cardiology, United States
| | - P W Akanyirige
- Northwestern University, Feinberg School of Medicine, United States
| | - A U Ezema
- Northwestern University, Feinberg School of Medicine, United States
| | - A S Anderson
- University of Texas San Antonio, Division of Cardiology, United States
| | - A Bryant
- Mehary Medical College, United States
| | - K Jackson
- Northwestern University, Department of Medicine, United States
| | - E Mandieka
- Northwestern University, Department of Medicine, United States
| | - D T Pham
- Northwestern University, Department of Cardiac Surgery, United States
| | - Y Raza
- Northwestern University, Division of Cardiology, United States
| | - J D Rich
- Northwestern University, Division of Cardiology, United States
| | - C W Yancy
- Northwestern University, Division of Cardiology, United States
| | - I S Okwuosa
- Northwestern University, Division of Cardiology, United States
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11
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Greer M, Welte T. Chronic Obstructive Pulmonary Disease and Lung Transplantation. Semin Respir Crit Care Med 2020; 41:862-873. [PMID: 32726838 DOI: 10.1055/s-0040-1714250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection-currently referred to as chronic lung allograft dysfunction-represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.
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Affiliation(s)
- Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
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12
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Veit T, Munker D, Leuschner G, Mümmler C, Sisic A, Kauke T, Schneider C, Irlbeck M, Michel S, Eser-Valerie D, Huber M, Barton J, Milger K, Meiser B, Behr J, Kneidinger N. High prevalence of falsely declaring nicotine abstinence in lung transplant candidates. PLoS One 2020; 15:e0234808. [PMID: 32555678 PMCID: PMC7302701 DOI: 10.1371/journal.pone.0234808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
Tobacco use after lung transplantation is associated with adverse outcome. Therefore, active smoking is regarded as a contraindication for lung transplantation and should be excluded prior to placement on the waiting list. The aim of the study was to compare self-reporting with a systematic cotinine based screening approach to identify patients with active nicotine abuse. Nicotine use was systematically assessed by interviews and cotinine test in all lung transplant candidates at every visit in our center. Patients were classified according to the stage prior to transplantation and cotinine test results were compared to self-reports and retrospectively analyzed until June 2019. Of 620 lung transplant candidates, 92 patients (14.8%) had at least one positive cotinine test. COPD as underlying disease (OR 2.102, CI 1.110–3.981; p = 0.023), number of pack years (OR 1.014, CI 1.000–1.028; p = 0.047) and a time of cessation less than one year (OR 2.413, CI 1.410–4.128; p = 0.001) were associated with a positive cotinine test in multivariable regression analysis. The majority of non-COPD patients (n = 13, 72.2%) with a positive test had a cessation time of less than one year. 78 patients (84.7%) falsely declared not consuming any nicotine-based products prior to the test. Finally, all never smokers were test negative. In conclusion, our data demonstrate that active nicotine use is prevalent in transplant candidates with a high prevalence of falsely declaring nicotine abstinence. COPD was the main diagnosis in affected patients. Short cessation time and a high number of pack years are risk factors for continued nicotine abuse.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Carlo Mümmler
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Alma Sisic
- Transplant Center, University of Munich, Munich, Germany
| | - Teresa Kauke
- Department of Thoracic Surgery, University of Munich, Munich, Germany
| | | | - Michael Irlbeck
- Department of Anaesthesiology, University of Munich, LMU, Munich, Germany
| | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich, LMU, Munich, Germany
| | - Daniela Eser-Valerie
- Department of Psychiatry and Psychotherapy, University of Munich, LMU, Munich, Germany
| | - Maximilian Huber
- Department of Psychiatry and Psychotherapy, University of Munich, LMU, Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Bruno Meiser
- Transplant Center, University of Munich, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
- * E-mail:
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13
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Tobacco Use After Lung Transplantation: A Retrospective Analysis of Patient Characteristics, Smoking Cessation Interventions, and Cessation Success Rates. Transplantation 2019; 103:1260-1266. [DOI: 10.1097/tp.0000000000002576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Hofmann P, Benden C, Kohler M, Schuurmans MM. Smoking resumption after heart or lung transplantation: a systematic review and suggestions for screening and management. J Thorac Dis 2018; 10:4609-4618. [PMID: 30174913 DOI: 10.21037/jtd.2018.07.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Smoking remains the leading cause of preventable disease and death in the developed world and kills half of all long-term users. Smoking resumption after heart or lung transplantation is associated with allograft dysfunction, higher incidence of cancer, and reduced overall survival. Although self-reporting is considered an unreliable method for tobacco use detection, implementing systematic cotinine-based screening has proven challenging. This review examines the prevalence of smoking resumption in thoracic transplant patients, explores the risk factors associated with a post-transplant smoking resumption and discusses the currently available smoking cessation interventions for transplant patients.
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Affiliation(s)
- Patrick Hofmann
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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15
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Hu L, Lingler JH, Sereika SM, Burke LE, Malchano DK, DeVito Dabbs A, Dew MA. Nonadherence to the medical regimen after lung transplantation: A systematic review. Heart Lung 2017; 46:178-186. [DOI: 10.1016/j.hrtlng.2017.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 01/09/2023]
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16
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Qiu F, Fan P, Nie GD, Liu H, Liang CL, Yu W, Dai Z. Effects of Cigarette Smoking on Transplant Survival: Extending or Shortening It? Front Immunol 2017; 8:127. [PMID: 28239383 PMCID: PMC5300974 DOI: 10.3389/fimmu.2017.00127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/25/2017] [Indexed: 01/23/2023] Open
Abstract
Cigarette smoking (CS) regulates both innate and adaptive immunity and causes numerous diseases, including cardiovascular, respiratory, and autoimmune diseases, allergies, cancers, and transplant rejection. Therefore, smoking poses a serious challenge to the healthcare system worldwide. Epidemiological studies have always shown that CS is one of the major risk factors for transplant rejection, even though smoking plays redundant roles in regulating immune responses. The complex roles for smoking in immunoregulation are likely due to molecular and functional diversities of cigarette smoke components, including carbon monoxide (CO) and nicotine. Especially, CO has been shown to induce immune tolerance. Although CS has been shown to impact transplantation by causing complications and subsequent rejection, it is overlooked whether CS interferes with transplant tolerance. We have previously demonstrated that cigarette smoke exposure reverses long-term allograft survival induced by costimulatory blockade. Given that CS impacts both adaptive and innate immunity and that it hinders long-term transplant survival, our perspective is that CS impacts transplant tolerance. Here, we review impacts of CS on major immune cells that are critical for transplant outcomes and propose the cellular and molecular mechanisms underlying its effects on alloimmunity and transplant survival. Further investigations are warranted to fully understand why CS exerts deleterious rather than beneficial effects on transplant survival even if some of its components are immunosuppressive.
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Affiliation(s)
- Feifei Qiu
- Section of Immunology, Guangdong Provincial Academy of Chinese Medical Sciences , Guangzhou , China
| | - Ping Fan
- Department of Nephrology, Shaanxi Provincial Hospital of Chinese Medicine , Xi'an , China
| | - Golay D Nie
- School of Medicine, University of Texas Medical Branch , Galveston, TX , USA
| | - Huazhen Liu
- Section of Immunology, Guangdong Provincial Academy of Chinese Medical Sciences , Guangzhou , China
| | - Chun-Ling Liang
- Section of Immunology, Guangdong Provincial Academy of Chinese Medical Sciences , Guangzhou , China
| | - Wanlin Yu
- Section of Immunology, Guangdong Provincial Academy of Chinese Medical Sciences , Guangzhou , China
| | - Zhenhua Dai
- Section of Immunology, Guangdong Provincial Academy of Chinese Medical Sciences , Guangzhou , China
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17
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Correlates and Outcomes of Posttransplant Smoking in Solid Organ Transplant Recipients. Transplantation 2016; 100:2252-2263. [DOI: 10.1097/tp.0000000000001335] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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