1
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Kandasamy S, Lau CL, Krupnick AS. Pulmonary transplantation-is it a long-term solution? J Thorac Dis 2023; 15:4148-4150. [PMID: 37691647 PMCID: PMC10482618 DOI: 10.21037/jtd-23-956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/21/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Sivaveera Kandasamy
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christine L Lau
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexander Sasha Krupnick
- Division of Thoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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2
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Miggins JJ, Reul RM, Barrett S, Rana A, Alnajar A, Dunson J, Shafii A, Garcha P, Goss J, Loor G. Twenty-year survival following lung transplantation. J Thorac Dis 2023; 15:2997-3012. [PMID: 37426158 PMCID: PMC10323557 DOI: 10.21037/jtd-22-1414] [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] [Received: 11/10/2022] [Accepted: 03/03/2023] [Indexed: 07/11/2023]
Abstract
Background Lung transplantation median survival has seen improvements due to recognition of short-term survival factors but continues to trail behind other solid organs due to limited understanding of long-term survivorship. Given the creation of the United Network for Organ Sharing (UNOS) database in 1986, it was difficult to accrue data on long-term survivors until recently. This study characterizes factors impacting lung transplant survival beyond 20 years, conditional to 1-year survival. Methods Lung transplant recipients listed in UNOS from 1987 to 2002 who survived to 1 post-transplant year were reviewed. Kaplan-Meier and adjusted Cox regression analyses were performed at 20 and 10 years to identify risk factors associated with long-term outcomes independent of their short-term effects. Results A total of 6,172 recipients were analyzed, including 472 (7.6%) recipients who lived 20+ years. Factors associated with increased likelihood of 20-year survival were female-to-female gender match, recipient age 25-44, waitlist time >1 year, human leukocyte antigen (HLA) mismatch level 3, and donor cause of death: head trauma. Factors associated with decreased 20-year survival included recipient age ≥55, chronic obstructive pulmonary disease/emphysema (COPD/E) diagnosis, donor smoking history >20 pack-years, unilateral transplant, blood groups O&AB, recipient glomerular filtration rate (GFR) <10 mL/min, and donor GFR 20-29 mL/min. Conclusions This is the first study identifying factors associated with multiple-decade survival following lung transplant in the United States. Despite its challenges, long-term survival is possible and more likely in younger females in good waitlist condition without COPD/E who receive a bilateral allograft from a non-smoking, gender-matched donor of minimal HLA mismatch. Further analysis of the molecular and immunologic implications of these conditions are warranted.
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Affiliation(s)
| | - Ross M. Reul
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Abbas Rana
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Ahmed Alnajar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami, Miami, FL, USA
| | - Jordan Dunson
- Department of Orthopaedic Surgery, UT College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Alexis Shafii
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Puneet Garcha
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Loor
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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3
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Green CL, Gulack BC, Keshavjee S, Singer LG, McCurry K, Budev MM, Reece TL, Lidor AO, Palmer SM, Davis RD. Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study. Ann Thorac Surg 2023; 115:1024-1032. [PMID: 36216086 DOI: 10.1016/j.athoracsur.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/06/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aspiration has been associated with graft dysfunction after lung transplantation, leading some to advocate for selective use of fundoplication despite minimal data supporting this practice. METHODS We performed a multicenter retrospective study at 4 academic lung transplant centers to determine the association of gastroesophageal reflux disease and fundoplication with bronchiolitis obliterans syndrome and survival using Cox multivariable regression. RESULTS Of 542 patients, 136 (25.1%) underwent fundoplication; 99 (18%) were found to have reflux disease without undergoing fundoplication. Blanking the first year after transplantation, fundoplication was not associated with a benefit regarding freedom from bronchiolitis obliterans syndrome (hazard ratio [HR], 0.93; 95% CI, 0.58-1.49) or death (HR, 0.97; 95% CI, 0.47-1.99) compared with reflux disease without fundoplication. However, a time-dependent adjusted analysis found a slight decrease in mortality (HR, 0.59; 95% CI, 0.28-1.23; P = .157), bronchiolitis obliterans syndrome (HR, 0.68; 95% CI, 0.42-1.11; P = .126), and combined bronchiolitis obliterans syndrome or death (HR, 0.66; 95% CI, 0.42-1.04; P = .073) in the fundoplication group compared with the gastroesophageal reflux disease group. CONCLUSIONS Although a statistically significant benefit from fundoplication was not determined because of limited sample size, follow-up, and potential for selection bias, a randomized, prospective study is still warranted.
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Affiliation(s)
- Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
| | - Brian C Gulack
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Lianne G Singer
- Toronto Lung Transplant Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Kenneth McCurry
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Marie M Budev
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tammy L Reece
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Anne O Lidor
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Scott M Palmer
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - R Duane Davis
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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4
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Wagner MJ, Hatami S, Freed DH. Thoracic organ machine perfusion: A review of concepts with a focus on reconditioning therapies. FRONTIERS IN TRANSPLANTATION 2023; 2:1060992. [PMID: 38993918 PMCID: PMC11235380 DOI: 10.3389/frtra.2023.1060992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/06/2023] [Indexed: 07/13/2024]
Abstract
Thoracic organ transplantation, including lung, heart, and heart-lung transplants are highly regarded as gold standard treatments for patients suffering from heart failure or chronic end stage lung conditions. The relatively high prevalence of conditions necessitating thoracic organ transplants combined with the lack of available organs has resulted in many either dying or becoming too ill to receive a transplant while on the waiting list. There is a dire need to increase both the number of organs available and the utilization of such organs. Improved preservation techniques beyond static storage have shown great potential to lengthen the current period of viability of thoracic organs while outside the body, promising better utilization rates, increased donation distance, and improved matching of donors to recipients. Ex-situ organ perfusion (ESOP) can also make some novel therapeutic strategies viable, and the combination of the ESOP platform with such reconditioning therapies endeavors to better improve functional preservation of organs in addition to making more organs viable for transplantation. Given the abundance of clinical and pre-clinical studies surrounding reconditioning of thoracic organs in combination with ESOP, we summarize in this review important concepts and research regarding thoracic organ machine perfusion in combination with reconditioning therapies.
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Affiliation(s)
| | - Sanaz Hatami
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Darren H Freed
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
- Alberta Transplant Institute, Edmonton, AB, Canada
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5
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AKDENİZ FATMATUBA, AKBULUT ZEYNEP, VAYVADA MUSTAFA, KALAMANOĞLU BALCI MERİH, YEGİNSU ALİ, YANIKKAYA DEMİREL GULDEREN, KUTLU CEMALASIM. Monitoring T-Cell Kinetics in the Early Recovery Period of Lung Transplantation Cases by Copy Number Levels of T-Cell Receptor Excision Circle. In Vivo 2023; 37:310-319. [PMID: 36593057 PMCID: PMC9843769 DOI: 10.21873/invivo.13081] [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: 09/15/2022] [Revised: 10/21/2022] [Accepted: 11/10/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND/AIM Lung transplantation is a life-saving procedure for patients with end-stage lung diseases. T-Cell receptor excision circle (TREC) is circular DNA produced during T-cell receptor gene rearrangement in the thymus and indicates naive T-cell migration from the thymus. Therefore, its levels represent thymic T-cell output. Post-transplant lymphocyte kinetics correlate with graft tolerance. The aim of this study was to investigate T-lymphocyte kinetics in the early recovery period after lung transplantation. For this purpose, copy numbers of TREC were determined in patients with a lung transplant. In addition, TREC copy numbers were evaluated according to age, diagnosis and the forced expiratory volume in 1 second (FEV1) of lung transplant patients. MATERIALS AND METHODS Peripheral blood samples were taken from patients aged 23 to 59 years who underwent lung transplantation at the Thoracic Surgery Clinic, Kartal-Koşuyolu High Specialization Educational and Research Hospital. This study included peripheral blood samples from 11 lung transplant patients (comprising four with chronic obstructive pulmonary disease, three with idiopathic pulmonary fibrosis, one with cystic fibrosis, one with silicosis and two with bronchiectasis; three females in total). Samples were taken at three different timepoints: Before transplant, and 24 hours and 7 days post transplant. TREC copy numbers were analyzed with real time reverse transcriptase-polymerase chain reaction. RESULTS Post-transplant TREC numbers and density values were higher compared to pre-transplant values, although these differences were statistically insignificant. TREC copy numbers were found to be significantly higher in patients younger than 45 years compared to patients older than 45 years. At 24 hours after the transplant, the average TREC copy number/peripheral blood mononuclear cells of the cases with an FEV1 value of or below 50% was found to be statistically significantly higher than that of cases with an FEV1 value above 50% (p=0.046). There was no statistically significant difference in TREC copy numbers between male and female patients or by diagnostic group. CONCLUSION TREC copy numbers can be evaluated as a prognostic marker for lung transplantation. There is a need for multicenter studies with more patients.
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Affiliation(s)
- FATMA TUBA AKDENİZ
- Department of Medical Biology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - ZEYNEP AKBULUT
- Department of Medical Biology and Genetic, Faculty of Medicine, Maltepe University, Istanbul, Turkey
| | - MUSTAFA VAYVADA
- Thoracic Surgery Clinic, Kartal-Koşuyolu High Specialization Educational and Research Hospital, Istanbul, Turkey
| | | | - ALİ YEGİNSU
- Thoracic Surgery Clinic, Liv Hospital Vadi, Istanbul, Turkey
| | | | - CEMAL ASIM KUTLU
- Department of Chest Disease, Faculty of Medicine, Bahçeşehir University, Istanbul, Turkey
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6
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Starke H, von Dossow V, Karsten J. Intraoperative Circulatory Support in Lung Transplantation: Current Trend and Its Evidence. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071005. [PMID: 35888094 PMCID: PMC9322250 DOI: 10.3390/life12071005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Lung transplantation has a high risk of haemodynamic complications in a highly vulnerable patient population. The effects on the cardiovascular system of the various underlying end-stage lung diseases also contribute to this risk. Following a literature review and based on our own experience, this review article summarises the current trends and their evidence for intraoperative circulatory support in lung transplantation. Identifiable and partly modifiable risk factors are mentioned and corresponding strategies for treatment are discussed. The approach of first identifying risk factors and then developing an adjusted strategy is presented as the ERSAS (early risk stratification and strategy) concept. Typical haemodynamic complications discussed here include right ventricular failure, diastolic dysfunction caused by left ventricular deconditioning, and reperfusion injury to the transplanted lung. Pre- and intra-operatively detectable risk factors for the occurrence of haemodynamic complications are rare, and the therapeutic strategies applied differ considerably between centres. However, all the mentioned risk factors and treatment strategies can be integrated into clinical treatment algorithms and can influence patient outcome in terms of both mortality and morbidity.
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Affiliation(s)
- Henning Starke
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, 44801 Bochum, Germany;
| | - Vera von Dossow
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, 44801 Bochum, Germany;
- Correspondence: ; Tel.: +49-(0)-5731-97-1128; Fax: +49-(0)-5731-97-2196
| | - Jan Karsten
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany;
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8
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Hirdman G, Niroomand A, Olm F, Lindstedt S. Taking a Deep Breath: an Examination of Current Controversies in Surgical Procedures in Lung Transplantation. CURRENT TRANSPLANTATION REPORTS 2022; 9:160-172. [PMID: 35601346 PMCID: PMC9108015 DOI: 10.1007/s40472-022-00367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose of Review
This article reviews controversial questions within the field of lung transplantation, with a focus on data generated within the last 3 years. We aim to summarize differing opinions on a selection of topics, including bridge-to-transplantation, intraoperative machine circulatory support, bronchial anastomosis, size mismatch, delayed chest closure, and ex vivo lung perfusion.
Recent Findings
With the growing rate of lung transplantations worldwide and increasing numbers of patients placed on waiting lists, the importance of determining best practices has only increased in recent years. Factors which promote successful outcomes have been identified across all the topics, with certain approaches promoted, such as ambulation in bridge-to-transplant and widespread intraoperative ECMO as machine support.
Summary
While great strides have been made in the operative procedures involved in lung transplantation, there are still key questions to be answered. The consensus which can be reached will be instrumental in further improving outcomes in recipients.
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Affiliation(s)
- Gabriel Hirdman
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Anna Niroomand
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Franziska Olm
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Sandra Lindstedt
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital, Lund University, Lund, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Lund Stem Cell Center, Lund University, Lund, Sweden
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9
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Pulmonary graft-versus-host disease and chronic lung allograft dysfunction: two sides of the same coin? THE LANCET RESPIRATORY MEDICINE 2022; 10:796-810. [DOI: 10.1016/s2213-2600(22)00001-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022]
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10
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Loebe M, Breda JR, Sinha N. Risk factors of bronchial dehiscence after primary lung transplantation. J Card Surg 2022; 37:958-959. [PMID: 35141941 DOI: 10.1111/jocs.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Complications of the bronchial anastomosis in lung transplantation, once the Achilles heel of the procedure, have become quite rare. The surgical technique is well established and safe. Risks contributing to anastomotic complications are primarily related to patients pre-existing conditions. The key factor is good blood flow to the bronchial stump. Postoperative infection can also contribute to the breakdown of the anastomosis. This may be the reason why different immunosuppressive regimes lead to differences in the incidence of bronchial dehiscence.
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11
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Toulan HF, El Derh MS, Abdel Twab SM. Airway nerve block versus nebulization by lignocaine during diagnostic flexible bronchoscopy under moderate sedation: A randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.2013066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Heba F. Toulan
- Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maha S. El Derh
- Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Samar M. Abdel Twab
- Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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12
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Immunosuppression in Lung Transplantation. Handb Exp Pharmacol 2021; 272:139-164. [PMID: 34796380 DOI: 10.1007/164_2021_548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Immunosuppression in lung transplantation is an area devoid of robust clinical data. This chapter will review the history of immunosuppression in lung transplantation. Additionally, it will evaluate the three classes of induction, maintenance, and rescue immunosuppression in detail. Induction immunosuppression in lung transplantation aims to decrease incidence of lung allograft rejection, however infectious risk must be considered when determining if induction is appropriate and which agent is most favorable. Similar to other solid organ transplant patient populations, a multi-drug approach is commonly prescribed for maintenance immunosuppression to minimize single agent drug toxicities. Emphasis of this review is placed on key medication considerations including dosing, adverse effects, and drug interactions. Clinical considerations will be reviewed per drug class given available literature. Finally, acute cellular, antibody mediated, and chronic rejection are reviewed.
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13
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Rice AJ. Non-neoplastic respiratory fluid cytology including cell differential counts for interstitial lung disease. Cytopathology 2021; 33:44-56. [PMID: 34628692 DOI: 10.1111/cyt.13067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/23/2022]
Abstract
Bronchioloalveolar lavage (BAL) is a non-invasive and well-tolerated procedure that plays a key role in the diagnosis of a variety of non-neoplastic pulmonary diseases, including acute respiratory failure, infection, diffuse parenchymal lung disease (DLPD), paediatric and occupational lung disease, and in the evaluation of the lung allograft. A variety of analytic techniques are commonly performed on BAL fluid, including cytology, cell differential count, microbiology and virology, as well as a number of additional techniques in specific circumstances.
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Affiliation(s)
- Alexandra J Rice
- Department of Histopathology, Royal Brompton Hospital, London, UK
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14
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Burke JF, Chan AK, Mayer RR, Garcia JH, Pennicooke B, Mann M, Berven SH, Chou D, Mummaneni PV. Clamshell thoracotomy for en bloc resection of a 3-level thoracic chordoma: technical note and operative video. Neurosurg Focus 2021; 49:E16. [PMID: 32871571 DOI: 10.3171/2020.6.focus20382] [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: 05/04/2020] [Accepted: 06/16/2020] [Indexed: 11/06/2022]
Abstract
The clamshell thoracotomy is often used to access both hemithoraxes and the mediastinum simultaneously for cardiothoracic pathology, but this technique is rarely used for the excision of spinal tumors. We describe the use of a clamshell thoracotomy for en bloc excision of a 3-level upper thoracic chordoma in a 20-year-old patient. The lesion involved T2, T3, and T4, and it invaded both chest cavities and indented the mediastinum. After 2 biopsies to confirm the diagnosis, the patient underwent a posterior spinal fusion followed by bilateral clamshell thoracotomy for 3-level en bloc resection with simultaneous access to both chest cavities and the mediastinum. To demonstrate how the clamshell thoracotomy was used to facilitate the tumor resection, an operative video and illustrations are provided, which show in detail how the clamshell thoracotomy can be used to access both hemithoraxes and the mediastinum.
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Affiliation(s)
| | | | | | | | | | - Michael Mann
- 3Department of Surgery, Division of Adult Cardiothoracic Surgery, and
| | - Sigurd H Berven
- 4Department of Orthopedic Surgery, University of California, San Francisco, California
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15
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Abstract
Interstitial lung diseases (ILDs) are heterogenous and complex chronic lung diseases that even today are challenging to diagnose and classify. The terminology and mechanistic understanding of specific ILDs have evolved substantially over the last centuries and decades, and clinicians, pathologists, radiologists, and researchers are continuously working to untangle the various ILDs of differing causes. Despite many drawbacks and negative clinical trials, the unremitting work of ILD researchers have resulted in great therapeutic successes over the last decade. In this chapter, the authors present historical aspects of ILD and build a foundation to understand current and emerging concepts in ILD.
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Affiliation(s)
- Sabina A Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Tamera J Corte
- Respiratory Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia
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16
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Keshavamurthy S, Rodgers-Fischl P. Donation after circulatory death (DCD)-lung procurement. Indian J Thorac Cardiovasc Surg 2021; 37:425-432. [PMID: 33821109 PMCID: PMC8012413 DOI: 10.1007/s12055-021-01156-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/01/2022] Open
Abstract
The number of lungs available for lung transplantation is far lower than the number of patients awaiting them. Consequently, there is a significant attrition rate while awaiting transplantation. Lung procurement rates are lower than those of other solid organs. Lungs are procured from only 15–20% of donors compared with 30% of decreased donors for hearts. The reason for this low retrieval rate is related to a number of factors. Brain death is associated with neurogenic pulmonary edema. Additionally, injury to the lung itself may occur before or after brain death. Aspiration of gastric contents, pneumonia, previous thoracic trauma, ventilator-associated injury, atelectasis, and pulmonary thrombosis/embolism may all contribute to lung injury before consideration for harvest. Donation after circulatory death (DCD) is one category of nontraditional organ donation now being performed in increasing numbers as a way to increase the number of lungs available for transplantation. In some studies, estimates show that utilization of DCD lung procurement could increase the number of lungs available by up to 50%.
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Affiliation(s)
- Suresh Keshavamurthy
- Department of Surgery, Division of Cardiothoracic Surgery, Surgical Director,Lung Transplantation, University of Kentucky College of Medicine, 740 S. Limestone, A-301, Lexington, KY 40536 USA
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17
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Lu K, Li H, Chen Y, Wu B, Zhang J, Huang M, Chen J. Can the preoperative nutritional risk score be a predictor of the outcomes in critically ill patients of lung transplantation: a retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:40. [PMID: 32154285 DOI: 10.21037/atm.2019.09.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Nutritional Risk Screening 2002 (NRS2002) and prognostic nutrition index (PNI) are nutritional risk screening instruments that are also used to predict the complications and morbidity after surgery. Our study aims to evaluate whether preoperative nutrition status at admission or postoperative nutrition treatment during admission for lung transplantation (LTX) was linked to clinical outcomes. Methods This study is a retrospective observational cohort study of 42 patients undergoing LTX. Using PNI and NRS-2002 screening instruments, patients were tested for dietary danger upon admission. Univariate and multivariate analyzes were performed to investigate the independent nutritional risk predictive value for post-operative complications, hospital length or intensive care unit (ICU) stay, and mortality. Results Age, the average calorie intake, parenteral nutrition within 7 days, furosemide, the time of postoperative mechanical ventilation (MV), postoperative extracorporeal membrane oxygenation (ECMO) between survivor and non-survivor had a significant difference. Univariate analyses of death in LTX, age [HR 1.06 (1.00-1.13), P=0.04], the average calorie intake first 3 days [HR 0.99 (0.99-1.00), P=0.02], parenteral nutrition within 7 days [HR 0.20 (0.05-0.77), P=0.02], furosemide [HR 0.08 (0.01-0.76), P=0.02] and postoperative ECMO [HR 6.40 (1.65-24.77), P=0.00] were independent predictors for increased mortality. And multivariate analyses found that only postoperative ECMO [HR 9.59 (1.07-86.13), P=0.04] was independent predictors for increased mortality, whereas PNI and NRS2002 were not. Conclusions PNI and NRS2002 was not an independent predictor for post-operative mortality, and postoperative ECMO was only independent predictors for increased mortality in this study.
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Affiliation(s)
- Kongmiao Lu
- General ICU, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Huixing Li
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Yinglun Chen
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Bo Wu
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Ji Zhang
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi 214023, China
| | - Man Huang
- General ICU, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Jingyu Chen
- Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi 214023, China
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18
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Optimizing organs for transplantation; advancements in perfusion and preservation methods. Transplant Rev (Orlando) 2019; 34:100514. [PMID: 31645271 DOI: 10.1016/j.trre.2019.100514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/20/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023]
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19
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Panchabhai TS, Abdelrazek HA, Bremner RM. Lung Transplant in Patients with Connective Tissue Diseases. Clin Chest Med 2019; 40:637-654. [DOI: 10.1016/j.ccm.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Galway U, Zura A, Khanna S, Wang M, Turan A, Ruetzler K. Anesthetic considerations for bronchoscopic procedures: a narrative review based on the Cleveland Clinic experience. J Thorac Dis 2019; 11:3156-3170. [PMID: 31463144 DOI: 10.21037/jtd.2019.07.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The advent of advanced diagnostic bronchoscopy has shown an increased demand for anesthesiologists to administer anesthesia in the bronchoscopy suite. Procedures such as navigational bronchoscopy, airway stenting and advanced therapeutic procedures often require the presence of an anesthesiologist to manage these more complex patients and procedures. In this review we describe the various bronchoscopic procedures and anesthetic management and complications of these procedures at our institution The Cleveland Clinic, Cleveland Ohio.
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Affiliation(s)
- Ursula Galway
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Zura
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sandeep Khanna
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mi Wang
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kurt Ruetzler
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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21
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Yaron JR, Kwiecien JM, Zhang L, Ambadapadi S, Wakefield DN, Clapp WL, Dabrowski W, Burgin M, Munk BH, McFadden G, Chen H, Lucas AR. Modifying the Organ Matrix Pre-engraftment: A New Transplant Paradigm? Trends Mol Med 2019; 25:626-639. [DOI: 10.1016/j.molmed.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 02/06/2023]
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22
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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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23
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Spratt JR, Brown RZ, Rudser K, Goswami U, Hertz MI, Patil J, Cich I, Shumway SJ, Loor G. Greater survival despite increased complication rates following lung transplant for alpha-1-antitrypsin deficiency compared to chronic obstructive pulmonary disease. J Thorac Dis 2019; 11:1130-1144. [PMID: 31179055 DOI: 10.21037/jtd.2019.04.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Alpha-1-antitrypsin (A1AT) deficiency (A1ATD) is characterized by accelerated degradation of lung function. We examined our experience with lung transplantation for chronic obstructive pulmonary disease (COPD) with and without A1ATD to compare survival and rates of postoperative surgical complications. Methods Patients with A1ATD and non-A1ATD COPD undergoing lung transplantation from 1988-2015 at our institution were analyzed. Complications were categorized into non-gastroenteritis gastrointestinal (GI), wound, airway, and reoperation for bleeding. Overall and complication-free survival were evaluated using Kaplan-Meier curves and Cox proportional hazards models. Results Three hundred and eighty-five patients underwent lung transplant for COPD (98 A1ATD). For A1ATD, 56.1% underwent single lung transplantation (80.6% for COPD). Early overall and complication-free survival was worse for A1ATD, but this trend reversed at longer follow up. Unadjusted estimated survival showed advantage for COPD at 90 days and 1 year, which attenuated by 5 years and reversed at 10 years (P<0.001). On adjusted analysis, A1ATD was associated with a trend toward lower complication-free survival at 90 days and 1 year, due partly to increased rates of post-transplant GI pathology, particularly in the era of the lung allocation score (LAS). Conclusions A1ATD lung recipients had worse short-term complication-free survival but improved long-term survival compared to COPD patients. A1ATD was associated with greater risk of new GI pathology after transplant. Close monitoring of A1ATD patients with timely evaluation of GI complaints after transplant is warranted.
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Affiliation(s)
- John R Spratt
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Roland Z Brown
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Umesh Goswami
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Marshall I Hertz
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jagadish Patil
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Irena Cich
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Sara J Shumway
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Gabriel Loor
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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