1
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Swartz K, Mansour A, Alsunaid S. Lung Transplant for Chronic Obstructive Pulmonary Disease. Semin Respir Crit Care Med 2024. [PMID: 39029509 DOI: 10.1055/s-0044-1787560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) carries a high burden of morbidity and mortality to patient and a high cost to health care systems. Lung transplantation is a last resort available for end-stage COPD patients interested in pursuing it and meeting the strict transplant requirements. It requires commitment from patients and their loved ones to support them through this tough process. This review will cover history of transplant, indications, candidate selection, evaluation testing, transplant listing, type of transplant (single versus bilateral), posttransplant complications, immunosuppression, and rejection. It is tailored to the COPD patient when applicable; however, many aspects of lung transplantation are shared amongst all lung diseases eligible for transplant.
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Affiliation(s)
- Kyle Swartz
- Department of Pulmonary and Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ali Mansour
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York
- Department of Cardiovascular & Thoracic Surgery, Albert Einstein College of Medicine, Bronx, New York
| | - Sammar Alsunaid
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York
- Department of Cardiovascular & Thoracic Surgery, Albert Einstein College of Medicine, Bronx, New York
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2
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Everaerts S, Vandervelde CM, Shah P, Slebos DJ, Ceulemans LJ. Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema. Eur Respir Rev 2023; 32:230004. [PMID: 38123230 PMCID: PMC10731473 DOI: 10.1183/16000617.0004-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/17/2023] [Indexed: 12/23/2023] Open
Abstract
COPD is a highly prevalent, chronic and irreversible obstructive airway disease without curative treatment. Standard therapeutic strategies, both non-pharmacological and pharmacological, have only limited effects on lung function parameters of patients with severe disease. Despite optimal pharmacological treatment, many patients with severe COPD still have a high burden of dyspnoea and a poor quality of life. If these patients have severe lung emphysema, with hyperinflation as the driver of symptoms and exercise intolerance, lung volume reduction may be an effective treatment with a significant impact on lung function, exercise capacity and quality of life. Currently, different lung volume reduction approaches, both surgical and bronchoscopic, have shown encouraging results and have been implemented in COPD treatment recommendations. Nevertheless, choosing the optimal lung volume reduction strategy for an individual patient remains challenging. Moreover, there is still room for improving durability of effect and safety in all available procedures. Ongoing and innovative research is essential to push this field forwards. This review provides an overview of results and limitations of the current lung volume reduction options for patients with severe lung emphysema and hyperinflation.
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Affiliation(s)
- Stephanie Everaerts
- Department of Pulmonary Diseases, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Christelle M. Vandervelde
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pallav Shah
- Department of Pulmonology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Department of Pulmonology, Chelsea and Westminster Hospital, London, UK
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Both authors contributed equally
| | - Laurens J. Ceulemans
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Both authors contributed equally
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3
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Bunel V, Brioude G, Deslée G, Stelianides S, Mal H. [Selection of candidates for lung transplantation for chronic obstructive pulmonary disease]. Rev Mal Respir 2023; 40 Suppl 1:e22-e32. [PMID: 36641354 DOI: 10.1016/j.rmr.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- V Bunel
- Inserm U1152, service de pneumologie B et transplantation pulmonaire, université de Paris, hôpital Bichat, AP-HP, Paris, France.
| | - G Brioude
- Service de chirurgie thoracique et des maladies de l'œsophage, Aix-Marseille université, assistance publique-hôpitaux de Marseille, hôpital Nord, chemin des Bourrely, 13915 Marseille, France
| | - G Deslée
- Inserm U1250, service de pneumologie, CHU de Reims, université Reims Champagne Ardenne, Reims, France
| | - S Stelianides
- Institut de réadaptation d'Achères, 7, place Simone-Veil, 78260 Achères, France
| | - H Mal
- Inserm U1152, service de pneumologie B et transplantation pulmonaire, université de Paris, hôpital Bichat, AP-HP, Paris, France
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4
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Slama A, Ceulemans LJ, Hedderich C, Boehm PM, Van Slambrouck J, Schwarz S, Vandervelde CM, Kamler M, Jaksch P, Van Raemdonck D, Hoetzenecker K, Aigner C. Lung Volume Reduction Followed by Lung Transplantation in Emphysema-A Multicenter Matched Analysis. Transpl Int 2022; 35:10048. [PMID: 35497884 PMCID: PMC9047703 DOI: 10.3389/ti.2022.10048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Objective: The impact of previous lung volume reduction surgery (LVRS) or endoscopic lung volume reduction (ELVR) on lung transplantation (LuTX) remains unclear. This study assesses the risk of previous lung volume reduction on the outcome of a later LuTX. Methods: Patients suffering from emphysema who underwent bilateral LuTX were included in this multicenter analysis. Study groups were defined as: previous LVRS, previous ELVR, controls. Imbalances were corrected by coarsened exact matching for center, gender, age, diagnosis, and BMI. A comparative analysis of intraoperative characteristics, perioperative outcome and long-term survival was performed. Results: 615 patients were included (LVRS = 26; ELVR = 60). Compared to controls, LVRS patients had a higher rate of postoperative ECMO (15.4 vs. 3.9%; p = 0.006), whereas ELVR patients suffered more often from wound infections (8.9% vs. 2.5%; p = 0.018). Perioperative outcome, duration of ventilation, ICU stay, and hospital stay were comparable between groups. Bacterial colonization of the airway differed significantly between both LVR groups and controls in pre- and post-LuTX cultures. Survival was not impacted (1-/3-/5-year survival for LVRS: 92.3%/85.7%/77.1%; controls: 91.3%/82.4%/76.3%; p = 0.58 | ELVR: 93.1%/91%/91%; controls 91.2%/81.7%/75.3%; p = 0.17). Conclusion: Lung volume reduction does not impact short and long-time survival after bilateral LuTX. Due to differences in airway colonization after LVR, caution to prevent infectious complications is warranted.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Ruhrlandklinik, Essen, Germany.,West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Celia Hedderich
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Ruhrlandklinik, Essen, Germany
| | - Panja M Boehm
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Stefan Schwarz
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Markus Kamler
- West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
| | - Peter Jaksch
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | | | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Ruhrlandklinik, Essen, Germany.,West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
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5
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Gesierich WJ, Darwiche K, Döllinger F, Eberhardt R, Eisenmann S, Grah C, Heußel CP, Huebner RH, Ley-Zaporozhan J, Stanzel F, Welter S, Hoffmann H. Joint Statement of the German Respiratory Society and German Society of Thoracic Surgery in Cooperation with the German Radiological Society: Structural Prerequisites of Centres for Interventional Treatment of Emphysema. Respiration 2021; 100:52-58. [PMID: 33412545 DOI: 10.1159/000511599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022] Open
Abstract
Interventional treatment of emphysema offers a wide range of surgical and endoscopic options for patients with advanced disease. Multidisciplinary collaboration of pulmonology, thoracic surgery, and imaging disciplines in patient selection, therapy, and follow-up ensures treatment quality. The present joint statement describes the required structural and quality prerequisites of treatment centres. This is a translation of the German article "Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Thoraxchirurgie in Kooperation mit der Deutschen Röntgengesellschaft: Strukturvoraussetzungen von Zentren für die interventionelle Emphysemtherapie" Pneumologie. 2020;74:17-23.
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Affiliation(s)
- Wolfgang Johannes Gesierich
- Department of Pulmonology, Asklepios Fachkliniken Munich-Gauting, Center for Pulmonology and Thoracic Surgery, Munich-Gauting, Germany,
| | - Kaid Darwiche
- Department of Interventional Pulmonology, Ruhrlandklinik - University Medicine Essen, Essen, Germany
| | - Felix Döllinger
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Ralf Eberhardt
- Department of Pulmonology and Respiratory Medicine, Thoraxklinik, Heidelberg University, Heidelberg, Germany.,Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I/Pulmonology, University Hospital, Halle (Saale), Germany
| | - Christian Grah
- Department of Respiratory Medicine and Lung Cancer Center, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Claus Peter Heußel
- Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, Heidelberg University, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Ralf-Harto Huebner
- Department of Infectious Diseases and Respiratory Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Franz Stanzel
- Department of Pulmonology - Thoracic Endoscopy, Lung Clinic, Hemer, Germany
| | - Stefan Welter
- Department of Thoracic Surgery, Lung Clinic, Hemer, Germany
| | - Hans Hoffmann
- Division of Thoracic Surgery, Department of Surgery, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
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6
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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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7
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Scatliffe KD, Mody M, Seethamraju H, Yanagida R. Bronchoscopic lung volume reduction for vanishing lung in a patient with systemic lupus erythematous. Prog Transplant 2020; 30:286-287. [PMID: 32602398 DOI: 10.1177/1526924820933831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kristen D Scatliffe
- Division of Pulmonary Medicine and Critical Care, 24055Newark Beth Israel Medical Center, NJ, USA
| | - Mohit Mody
- Division of Pulmonary Medicine and Critical Care, 24055Newark Beth Israel Medical Center, NJ, USA
| | - Harish Seethamraju
- Division of Pulmonary Medicine and Critical Care, 24055Newark Beth Israel Medical Center, NJ, USA
| | - Roh Yanagida
- Department of Cardiothoracic Surgery, 24055Newark Beth Israel Medical Center, NJ, USA
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8
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Herth F, Slebos DJ, Criner G, Valipour A, Sciurba F, Shah P. Endoscopic Lung Volume Reduction: An Expert Panel Recommendation – Update 2019. Respiration 2019; 97:548-557. [DOI: 10.1159/000496122] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022] Open
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9
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Lung transplantation for chronic obstructive pulmonary disease: past, present, and future directions. Curr Opin Pulm Med 2019; 24:199-204. [PMID: 29227305 DOI: 10.1097/mcp.0000000000000452] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Lung transplantation offers an effective treatment modality for patients with end-stage chronic obstructive pulmonary disease (COPD). The exact determination of when to refer, list, and offer transplant as well as the preferred transplant procedure type remains unclear. Additionally, there are special considerations specific to patients with COPD being considered for lung transplantation, including the implications of single lung transplantation on lung cancer risk, native lung hyperinflation, and overall survival. RECENT FINDINGS The International Society for Heart and Lung Transplantation's most recent recommendations rely on an assessment of COPD severity based on BODE index. Despite the lack of evidence supporting a mortality benefit of bilateral over single lung transplantation for COPD patients, the majority of transplants performed in this population remain bilateral. Some of the concerns specific to single lung transplantation remain the possibility of de novo native lung cancer and the hemodynamic and physiologic implications of acute native lung hyperinflation. SUMMARY COPD remains the most common worldwide indication for lung transplantation. Ongoing study is still required to assess the overall survival benefit of lung transplantation and assess the overall quality of life impact on the COPD patient population.
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10
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Slama A, Taube C, Kamler M, Aigner C. Lung volume reduction followed by lung transplantation-considerations on selection criteria and outcome. J Thorac Dis 2018; 10:S3366-S3375. [PMID: 30450243 DOI: 10.21037/jtd.2018.06.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lung transplantation (LuTX) and lung volume reduction (LVR), either surgical (LVRS: lung volume reduction surgery) or endoscopic (ELVR: endoscopic lung volume reduction), are established therapies in the treatment of end-stage chronic obstructive pulmonary disease (COPD) patients. Careful patient selection is crucial for each intervention. If these techniques are sequentially applied there is a paucity of available data and individual center experiences vary depending on details in selection criteria and operative technique. This review aims to summarize the published data with a focus on LuTX after LVRS. This review covers patient selection for LuTX and LVR, technical considerations, limitations and outcomes. Published literature was identified by systematic search on Medline and appropriate papers were reviewed. Seven case reports/series, 7 comparative observational studies and one multicenter database analysis incorporating a total of 284 patients with LuTX and LVR were evaluated. Prior LVR can significantly affect intraoperative and postoperative risks after subsequent LuTX. Careful patient selection and timing and the choice of appropriate techniques such as minimal invasive LVRS and using ECMO as extracorporeal support during LuTX if required can minimize those risks, ultimately leading to very good postoperative outcomes in terms of lung function and survival. LVRS has the potential to delay listing and to bridge patients to LuTX by improving their physical condition while on the waiting list. After single lung transplantation (SLuTX) contralateral LVRS can counteract the deleterious effects of native lung hyperinflation (NLH). LVR and LuTX are adjunct therapies in the treatment of end-stage COPD. The combination of both can safely be considered in selected patients.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery, West German Center for Lung Transplantation, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Christian Taube
- Department of Pneumology, West German Center for Lung Transplantation, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Markus Kamler
- Department of Thoracic Transplantation, West German Center for Lung Transplantation, University Medicine Essen - University Clinic, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, West German Center for Lung Transplantation, University Medicine Essen - Ruhrlandklinik, Essen, Germany
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11
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Darwiche K, Aigner C. Clinical management of lung volume reduction in end stage emphysema patients. J Thorac Dis 2018; 10:S2732-S2737. [PMID: 30210825 DOI: 10.21037/jtd.2018.02.69] [Citation(s) in RCA: 8] [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
Following the evaluation of surgical lung volume reduction (LVR) in the National Emphysema Treatment (NETT) trial, different endoscopic LVR procedures have been developed for severe emphysema. Among those, endobronchial valve placement is the best evaluated method. All these therapies aim at reducing hyperinflation and at improving respiratory mechanics. It has been shown that these procedures can improve quality of life, lung function and exercise capacity in a significant and clinically meaningful way in suitable patients. Optimal medical therapy, physical rehabilitation, smoking cessation and respiratory insufficiency assessments should been thoroughly evaluated by a multi-disciplinary team before considering any LVR procedure. Clinical experience is necessary to decide if a patient is an appropriate candidate for a surgical or an interventional LVR procedure, to choose the optimal treatment strategy and to provide a high-level of care after the intervention, particularly when complications such as pneumothorax or persistent air leak occur in this already severely ill patient population. High volume emphysema care centers, providing a broad spectrum of different LVR procedures and involving a multidisciplinary team in the diagnostic process, are best suited to provide an optimal outcome. The aim of this manuscript is to describe the structures and procedures required to achieve the best possible outcome even in patients with advanced stage of their emphysema disease, including patients who are candidates for lung transplantation.
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Affiliation(s)
- Kaid Darwiche
- Department of Pneumology, Division of Interventional Bronchology, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Surgical Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
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12
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Sarmand N, Gompelmann D, Kontogianni K, Polke M, Herth FJ, Eberhardt R. New bacterial growth in bronchial secretions after bronchoscopic valve implantation. Int J Chron Obstruct Pulmon Dis 2018; 13:565-570. [PMID: 29445273 PMCID: PMC5810521 DOI: 10.2147/copd.s148196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Bronchoscopic valve implantation is an established treatment in selected patients with severe lung emphysema. There is evidence in literature of increased bacterial colonization of various implants. So far, it is unclear if an increased bacterial colonization can also be observed after endoscopic valve therapy. Methods Retrospective analysis of patients with examination of the bronchial secretions for presence or change of bacterial growth before and after valve implantation. Results Overall, 144 patients who underwent bronchoscopic follow-up after valve implantation were included in this analysis. Prior to valve placement, only 7 out of 144 consecutive emphysema patients (5%) presented with evidence of bacterial colonization, whereas 137 patients (95%) showed no bacterial growth prior to valve placement. One hundred seven out of the 137 patients (78%) showed new bacterial growth after valve implantation. Almost 38% of the patients who presented with a new bacterial growth had evidence of Viridans streptococci, Rothia mucilaginousa and Neisseria species simultaneously, as bacterial colonization. Pathogenic bacterial growth was recorded for Staphylococcus aureus (18%), Pseudomonas aeruginosa (13%) and Stenotrophomonas maltophilia (9%) microorganisms. There was also a significant bacterial growth by Moraxella catarrhalis (26%) and anaerobic bacteria (23%), especially in patients with complete atelectasis after successful endoscopic lung volume reduction. For all of the 7 patients, the presented initial bacterial colonization showed a change in the flora after bronchoscopy valve implantation. Conclusion In this study we observed an increased bacterial colonization in the long term after valve implantation. This finding needs further evaluation regarding its possible clinical relevance but should be taken into consideration in the follow-up of these patients.
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Affiliation(s)
- Nilab Sarmand
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik, at the University of Heidelberg, Heidelberg
| | - Daniela Gompelmann
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik, at the University of Heidelberg, Heidelberg.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, at the University of Heidelberg, Heidelberg, Germany
| | - Konstantina Kontogianni
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik, at the University of Heidelberg, Heidelberg
| | - Markus Polke
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik, at the University of Heidelberg, Heidelberg
| | - Felix Jf Herth
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik, at the University of Heidelberg, Heidelberg.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, at the University of Heidelberg, Heidelberg, Germany
| | - Ralf Eberhardt
- Department of Pulmonology and Respiratory Care Medicine, Thoraxklinik, at the University of Heidelberg, Heidelberg.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, at the University of Heidelberg, Heidelberg, Germany
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13
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Trudzinski FC, Höink AJ, Leppert D, Fähndrich S, Wilkens H, Graeter TP, Langer F, Bals R, Minko P, Lepper PM. Endoscopic Lung Volume Reduction Using Endobronchial Valves in Patients with Severe Emphysema and Very Low FEV1. Respiration 2016; 92:258-265. [PMID: 27603781 DOI: 10.1159/000448761] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/26/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with a forced expiratory volume in 1 s (FEV1) below 20% of the predicted normal values (pred.) and either homogeneous emphysema or low diffusing capacity for carbon monoxide (DLCO) have a high risk for adverse events including death when undergoing surgical lung volume reduction. OBJECTIVES We hypothesized that selected patients can benefit from endoscopic lung volume reduction (eLVR) despite a very low FEV1. METHODS This study is a retrospective analysis of consecutive patients with severe airflow obstruction, an FEV1 ≤20% of pred., and low DLCO who were treated by eLVR with endobronchial valves (EBV) between June 2012 and January 2015. Pre- and postinterventional lung function parameters, the 6-min walking test (6-MWT) distance, adverse events, and follow-up were recorded. RESULTS In 20 patients, there was an overall improvement in lung function with an increase in FEV1 (16.97-21.03% of pred.) and a decrease in residual volume (322-270% of pred.) and total lung capacity (144-129.06% of pred.). The 6-MWT distance improved (from 239 ± 77 to 267± 97 m overall, and from 184 ± 50 to 237 ± 101 m if patients developed an atelectasis of the target lobe). Pneumothorax occurred in 5 of the 20 patients (25%). 30-day mortality was 0%, and all patients survived to discharge. CONCLUSIONS The patients benefitted moderately from EBV treatment despite an initially low FEV1. Some patients improved remarkably. EBV treatment in patients with an FEV1 ≤20% of pred. is generally feasible and safe. The greatest risk is pneumothorax with prolonged chest tube duration.
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Affiliation(s)
- Franziska C Trudzinski
- Department of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center, Homburg, Germany
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14
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Tuleta I, Pizarro C, Molitor E, Kristiansen G, Nickenig G, Skowasch D. Recurrent Chronic Obstructive Pulmonary Disease Exacerbations after Endobronchial Valve Implantation Are Associated with the Presence of Pseudomonas aeruginosa. Respiration 2016; 91:510-6. [PMID: 27300677 DOI: 10.1159/000446925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic lung volume reduction by means of endobronchial valve implantation is an established therapy in patients with severe emphysema. However, long-term complications such as chronic obstructive pulmonary disease (COPD) exacerbations are a limitation of this method. OBJECTIVES As the mechanisms underlying increased rates of COPD exacerbations are unknown, the aim of our study was to determine whether infectious or inflammatory factors may contribute to these events and to investingate the consequent need for valve explantation. METHODS Tissue surrounding explanted endobronchial Zephyr valves was examined by microbiological, histological and cytological methods. Additionally, we performed a microbiological analysis of tracheal aspirates before both valve implantation and valve explantation. Moreover, blood samples were collected for the analysis of inflammatory markers. RESULTS Endobronchial valves were explanted from 16 patients. Reasons for explantation were frequent postprocedural COPD exacerbations (group 1: 8 patients) or loss of clinical benefit (group 2: 8 patients). Compared to group 2, the microbiological examinations of valve lavage and tracheal aspirates from patients in group 1 showed a higher detection of Gram-negative bacteria. In particular, infection with Pseudomonas aeruginosa was more predominant in group 1, while no presence could be detected in group 2. Blood inflammatory markers tended to be slightly higher in group 1 than in group 2; however, without reaching statistical significance. CONCLUSIONS Increased rates of COPD exacerbations after endobronchial valve implantation are associated with the presence of P. aeruginosa. The finding warrants further investigation.
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Affiliation(s)
- Izabela Tuleta
- Department of Internal Medicine II - Cardiology and Pulmonology, University of Bonn, Bonn, Germany
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Herth FJ, Slebos DJ, Rabe KF, Shah PL. Endoscopic Lung Volume Reduction: An Expert Panel Recommendation. Respiration 2016; 91:241-50. [DOI: 10.1159/000444090] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 01/16/2016] [Indexed: 11/19/2022] Open
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Lane CR, Tonelli AR. Lung transplantation in chronic obstructive pulmonary disease: patient selection and special considerations. Int J Chron Obstruct Pulmon Dis 2015; 10:2137-46. [PMID: 26491282 PMCID: PMC4608618 DOI: 10.2147/copd.s78677] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity. Lung transplantation is one of the few treatments available for end-stage COPD with the potential to improve survival and quality of life. The selection of candidates and timing of listing present challenges, as COPD tends to progress fairly slowly, and survival after lung transplantation remains limited. Though the natural course of COPD is difficult to predict, the use of assessments of functional status and multivariable indices such as the BODE index can help identify which patients with COPD are at increased risk for mortality, and hence which are more likely to benefit from lung transplantation. Patients with COPD can undergo either single or bilateral lung transplantation. Although many studies suggest better long-term survival with bilateral lung transplant, especially in younger patients, this continues to be debated, and definitive recommendations about this cannot be made. Patients may be more susceptible to particular complications of transplant for COPD, including native lung hyperinflation, and development of lung cancer.
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Affiliation(s)
- C Randall Lane
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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