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Glorion M, Sarsam M, Roux A, Stern M, Belousova N, Fessler J, Pricopi C, De Wolf J, Picard C, Brugière O, De Miranda S, Grenet D, Tachon G, Cerf C, Parquin F, Le Guen M, Chapelier A, Vallée A, Sage E. Results of Lung Transplantation for Cystic Fibrosis With Selected Donors Over 65 Years Old. Transpl Int 2023; 36:11180. [PMID: 37404718 PMCID: PMC10316425 DOI: 10.3389/ti.2023.11180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/16/2023] [Indexed: 07/06/2023]
Abstract
Lung transplantation is limited by the shortage of suitable donors. Many programs have begun to use extended criteria donors. Donors over 65 years old are rarely reported, especially for young cystic fibrosis recipients. This monocentric study was conducted for cystic fibrosis recipients from January 2005 to December 2019, comparing two cohorts according to lung donor age (<65 years or ≥65 years). The primary objective was to assess the survival rate at 3 years using a Cox multivariable model. Of the 356 lung recipients, 326 had donors under 65 years, and 30 had donors over 65 years. Donors' characteristics did not differ significantly in terms of sex, time on mechanical ventilation before retrieval, and partial pressure of arterial oxygen/fraction of inspired oxygen ratio. There were no significant differences in post-operative mechanical ventilation duration and incidence of grade 3 primary graft dysfunction between the two groups. At 1, 3, and 5 years, the percentage of predicted forced expiratory volume in 1 s (p = 0.767) and survival rate did not differ between groups (p = 0.924). The use of lungs from donors over 65 years for cystic fibrosis recipients allows extension of the donor pool without compromising results. Longer follow-up is needed to assess the long-term effects of this practice.
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Affiliation(s)
- Matthieu Glorion
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Matthieu Sarsam
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Antoine Roux
- Service de Pneumologie, Hopital Foch, Suresnes, France
- Université Paris-Saclay, UVSQ, INRAE, VIM, Jouy-en-Josas, France
| | - Marc Stern
- Service de Pneumologie, Hopital Foch, Suresnes, France
| | | | - Julien Fessler
- Département d’Anesthésiologie, Hôpital Foch, Suresnes, France
| | - Ciprian Pricopi
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Julien De Wolf
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | | | | | | | | | | | - Charles Cerf
- Service de Réanimation, Hôpital Foch, Suresnes, France
| | - Francois Parquin
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Morgan Le Guen
- Université Paris-Saclay, UVSQ, INRAE, VIM, Jouy-en-Josas, France
- Département d’Anesthésiologie, Hôpital Foch, Suresnes, France
| | - Alain Chapelier
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | | | - Edouard Sage
- Service de Chirurgie Thoracique et Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
- Université Paris-Saclay, UVSQ, INRAE, VIM, Jouy-en-Josas, France
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Foroutan F, Malik A, Clark KE, Buchan TA, Yang H, Cheong GHL, Pezzutti O, Kim I, Gupta R, Tan C, Samman A, Friesen EL, Akhtar A, Rigobon A, Stein M, Nunez JJY, Sidhu A, Heels-Ansdell D, Guyatt G, Meade MO. Predictors of 1-year Mortality after Adult Lung Transplantation: Systematic Review and Meta-analyses. J Heart Lung Transplant 2022; 41:937-951. [DOI: 10.1016/j.healun.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 03/07/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022] Open
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Abstract
PURPOSE OF REVIEW Primary graft dysfunction (PGD) is a devastating complication in the acute postoperative lung transplant period, associated with high short-term mortality and chronic rejection. We review its definition, pathophysiology, risk factors, prevention, treatment strategies, and future research directions. RECENT FINDINGS New analyses suggest donation after circulatory death and donation after brain death donors have similar PGD rates, whereas donors >55 years are not associated with increased PGD risk. Recipient pretransplant diastolic dysfunction and overweight or obese recipients with predominant abdominal subcutaneous adipose tissue have increased PGD risk. Newly identified recipient biomarkers and donor and recipient genes increase PGD risk, but their clinical utility remains unclear. Mixed data still exists regarding cold ischemic time and PGD risk, and increased PGD risk with cardiopulmonary bypass remains confounded by transfusions. Portable ex vivo lung perfusion (EVLP) may prevent PGD, but its use is limited to a handful of centers. Although updates to current PGD treatment are lacking, future therapies are promising with targeted therapy and the use of EVLP to pharmacologically recondition donor lungs. SUMMARY There is significant progress in defining PGD and identifying its several risk factors, but effective prevention and treatment strategies are needed.
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Bacterial Re-Colonization Occurs Early after Lung Transplantation in Cystic Fibrosis Patients. J Clin Med 2021; 10:jcm10061275. [PMID: 33808547 PMCID: PMC8003282 DOI: 10.3390/jcm10061275] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022] Open
Abstract
Most cystic fibrosis (CF) patients referred for lung transplantation are chronically infected with Gram-negative opportunistic pathogens. It is well known that chronic infections in CF patients have a significant impact on lung-function decline and survival before transplantation. The rate and timing of re-colonization after transplantation have been described, but the impact on survival after stratification of bacteria is not well elucidated. We did a single-center retrospective analysis of 99 consecutive CF patients who underwent lung transplantation since the beginning of the Copenhagen Lung Transplant program in 1992 until October 2014. Two patients were excluded due to re-transplantation. From the time of CF diagnosis, patients had monthly sputum cultures. After transplantation, CF-patients had bronchoscopy with bronchoalveolar lavage at 2, 4, 6 and 12 weeks and 6, 12, 18 and 24 months after transplantation, as well as sputum samples if relevant. Selected culture results prior to and after transplantation were stored. We focused on colonization with the most frequent bacteria: Pseudomonas aeruginosa (PA), Stenotrophomonas maltophilia (SM), Achromobacter xylosoxidans (AX) and Burkholderia cepacia complex (BCC). Pulsed-field gel electrophoresis (PFGE) was used to identify clonality of bacterial isolates obtained before and after lung transplantation. Time to re-colonization was defined as the time from transplantation to the first positive culture with the same species. Seventy-three out of 97 (75%) had sufficient culture data for analyses with a median of 7 (1–91) cultures available before and after transplantation. Median colonization-free survival time was 23 days until the first positive culture after transplantation. After 2 years, 59 patients (81%) were re-colonized, 33 (48.5%) with PA, 7 (10.3%) with SM, 12 (17.6%) with AX, and 7 (10.3%) with BCC. No difference in survival was observed between the patients colonized within the first 2 years and those not colonized. Re-colonization of bacteria in the lower airways occurred at a median of 23 days after transplantation in our cohort. In our patient cohort, survival was not influenced by re-colonization or bacterial species.
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Soyseth TS, Dew MA, Lund MB, Haugstad GK, Soyseth V, Malt UF. Coping Patterns and Emotional Distress in Patients With Chronic Obstructive Lung Disease Who Are Undergoing Lung Transplant Evaluation. Prog Transplant 2020; 30:228-234. [PMID: 32578510 DOI: 10.1177/1526924820933817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Living with severe lung disease like chronic obstructive pulmonary disease (COPD) is a very stressful situation. The way patients cope may impact their symptoms of anxiety and depression and physical function as well. We studied how ways of coping are associated with levels of emotional distress and lung function in patients with COPD being evaluated for lung transplantation. METHODS Sixty-five (mean age 57 years, 46% females) patients completed the General Health Questionnaire-30 (GHQ-30) assessing emotional distress and the Ways of Coping Questionnaire. Measurements of lung function and 6-minute walk test were included. RESULTS Seventeen (26%) patients had elevated emotional distress. Logistic regression of chronic GHQ score with gender, age, body mass index, lung function, and coping scales as covariates showed that escape avoidance and self-controlling coping and forced vital lung capacity were significantly associated with high emotional distress. Odds ratio of emotional distress increased with 5.2 per tertile (P = .011) in escape avoidance coping score. Moreover, we revealed that emotionally distressed patients cope with their current situation by refusing to believe the current situation and taking their distress out on other people. CONCLUSION Among patients with COPD, a high level of emotional distress was uniquely associated with escape-avoidance coping and lung function. Future work should ascertain whether coping style predicts distress or whether distress increases the use of escape-avoidance coping. Nevertheless, our findings indicate that if either element is present, health care professionals should be attentive to the need for interventions to improve patients' well-being.
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Affiliation(s)
- Torunn S Soyseth
- Department of Clinical Service, Division of Cancer Medicine, 155272Oslo University Hospital, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, 6595University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, USA
| | - May Brit Lund
- Department of Respiratory Medicine, Division of Cardiovascular and Pulmonary Diseases, 155272Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway
| | - Gro Killi Haugstad
- Department of Physiotherapy, 60499Oslo Metropolitan University, Oslo, Norway.,Unit for C-L Psychiatry and Psychosomatic Medicine, Division of Mental health and Dependency, 155272Oslo University Hospital, Oslo, Norway
| | - Vidar Soyseth
- Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway.,Department of Respiratory Diseases and Allergy, 60483Akershus University Hospital, Nordbyhagen, Norway
| | - Ulrik Fredrik Malt
- Faculty of Medicine, Institute of Clinical Medicine, 6305University of Oslo, Norway.,Unit for C-L Psychiatry and Psychosomatic Medicine, Division of Mental health and Dependency, 155272Oslo University Hospital, Oslo, Norway.,Department of Research and Education, Division of Clinical Neuroscience, 155272Oslo University Hospital, Oslo, Norway
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Affiliation(s)
- Lara Schaheen
- Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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Tawil JN, Adams BA, Nicoara A, Boisen ML. Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation. Semin Cardiothorac Vasc Anesth 2019; 23:171-187. [PMID: 31064319 DOI: 10.1177/1089253219845408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.
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Affiliation(s)
| | | | | | - Michael L Boisen
- 4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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