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Gupta VF, Halpern SE, Pontula A, Krischak MK, Reynolds JM, Klapper JA, Hartwig MG, Haney JC. Short-term outcomes after third-time lung transplantation: A single institution experience. J Heart Lung Transplant 2024; 43:771-779. [PMID: 38141895 DOI: 10.1016/j.healun.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Reoperative lung transplantation (LTx) survival has improved over time such that a growing number of patients may present for third-time LTx (L3Tx). To understand the safety of L3Tx, we evaluated perioperative outcomes and 3-year survival after L3Tx at a high-volume US LTx center. METHODS This retrospective study included all patients who underwent bilateral L3Tx at our institution. Using an optimal matching technique, a primary LTx (L1Tx) cohort was matched 1:2 and a second-time LTx (L2Tx) cohort 1:1. Recipient, operative, and donor characteristics, perioperative outcomes, and 3-year survival were compared among L1Tx, L2Tx, and L3Tx groups. RESULTS Eleven L3Tx, 11 L2Tx, and 22 L1Tx recipients were included. Among L3Tx recipients, median age at transplant was 37 years and most (73%) had cystic fibrosis. L3Tx was performed median 6.0 and 10.6 years after L2Tx and L1Tx, respectively. Compared to L1Tx and L2Tx recipients, L3Tx recipients had greater intraoperative transfusion requirements, a higher incidence of postoperative complications, and a higher rate of unplanned reoperation. Rates of grade 3 primary graft dysfunction at 72 hours, extracorporeal membrane oxygenation at 72 hours, reintubation, and in-hospital mortality were similar among groups. There were no differences in 3-year patient (log-rank p = 0.61) or rejection-free survival (log-rank p = 0.34) after L1Tx, L2Tx, and L3Tx. CONCLUSIONS At our institution, L3Tx was associated with similar perioperative outcomes and 3-year patient survival compared to L1Tx and L2Tx. L3Tx represents the only safe treatment option for patients with allograft failure after L2Tx; however, further investigation is needed to understand the long-term survival and durability of L3Tx.
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Affiliation(s)
- Vikram F Gupta
- Duke University School of Medicine, Durham, North Carolina.
| | - Samantha E Halpern
- Duke University School of Medicine, Durham, North Carolina; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Arya Pontula
- University of Manchester Medical School, Manchester, UK; Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Madison K Krischak
- Duke University School of Medicine, Durham, North Carolina; Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - John M Reynolds
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jacob A Klapper
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John C Haney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Tasoudis P, Lobo LJ, Coakley RD, Agala CB, Egan TM, Haithcock BE, Mody GN, Long JM. Outcomes Following Lung Transplant for COVID-19-Related Complications in the US. JAMA Surg 2023; 158:1159-1166. [PMID: 37585215 PMCID: PMC10433141 DOI: 10.1001/jamasurg.2023.3489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/25/2023] [Indexed: 08/17/2023]
Abstract
Importance The COVID-19 pandemic led to the use of lung transplant as a lifesaving therapy for patients with irreversible lung injury. Limited information is currently available regarding the outcomes associated with this treatment modality. Objective To describe the outcomes following lung transplant for COVID-19-related acute respiratory distress syndrome or pulmonary fibrosis. Design, Setting, and Participants In this cohort study, lung transplant recipient and donor characteristics and outcomes following lung transplant for COVID-19-related acute respiratory distress syndrome or pulmonary fibrosis were extracted from the US United Network for Organ Sharing database from March 2020 to August 2022 with a median (IQR) follow-up period of 186 (64-359) days in the acute respiratory distress syndrome group and 181 (40-350) days in the pulmonary fibrosis group. Overall survival was calculated using the Kaplan-Meier method. Cox proportional regression models were used to examine the association of certain variables with overall survival. Exposures Lung transplant following COVID-19-related acute respiratory distress syndrome or pulmonary fibrosis. Main Outcomes and Measures Overall survival and graft failure rates. Results Among 385 included patients undergoing lung transplant, 195 had COVID-19-related acute respiratory distress syndrome (142 male [72.8%]; median [IQR] age, 46 [38-54] years; median [IQR] allocation score, 88.3 [80.5-91.1]) and 190 had COVID-19-related pulmonary fibrosis (150 male [78.9%]; median [IQR] age, 54 [45-62]; median [IQR] allocation score, 78.5 [47.7-88.3]). There were 16 instances of acute rejection (8.7%) in the acute respiratory distress syndrome group and 15 (8.6%) in the pulmonary fibrosis group. The 1-, 6-, and 12- month overall survival rates were 0.99 (95% CI, 0.96-0.99), 0.95 (95% CI, 0.91-0.98), and 0.88 (95% CI, 0.80-0.94) for the acute respiratory distress syndrome cohort and 0.96 (95% CI, 0.92-0.98), 0.92 (95% CI, 0.86-0.96), and 0.84 (95% CI, 0.74-0.90) for the pulmonary fibrosis cohort. Freedom from graft failure rates were 0.98 (95% CI, 0.96-0.99), 0.95 (95% CI, 0.90-0.97), and 0.88 (95% CI, 0.79-0.93) in the 1-, 6-, and 12-month follow-up periods in the acute respiratory distress cohort and 0.96 (95% CI, 0.92-0.98), 0.93 (95% CI, 0.87-0.96), and 0.85 (95% CI, 0.74-0.91) in the pulmonary fibrosis cohort, respectively. Receiving a graft from a donor with a heavy and prolonged history of smoking was associated with worse overall survival in the acute respiratory distress syndrome cohort, whereas the characteristics associated with worse overall survival in the pulmonary fibrosis cohort included female recipient, male donor, and high recipient body mass index. Conclusions and Relevance In this study, outcomes following lung transplant were similar in patients with irreversible respiratory failure due to COVID-19 and those with other pretransplant etiologies.
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Affiliation(s)
- Panagiotis Tasoudis
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Leonard J. Lobo
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Raymond D. Coakley
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Chris B. Agala
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Thomas M. Egan
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Benjamin E. Haithcock
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Gita N. Mody
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Jason M. Long
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
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Gorton AJ, Keshavamurthy S, Toyoda Y. Lung transplant after cardiothoracic surgery. Eur J Cardiothorac Surg 2023; 63:ezad223. [PMID: 37296291 DOI: 10.1093/ejcts/ezad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/30/2023] [Indexed: 06/01/2023] Open
Affiliation(s)
- Andrew J Gorton
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, KY, USA
| | - Suresh Keshavamurthy
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, KY, USA
| | - Yoshiya Toyoda
- Department of Surgery, Division of Cardiovascular Surgery, Temple University Hospital, Philadelphia, PA, USA
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Roach A, Chikwe J, Catarino P, Rampolla R, Noble PW, Megna D, Chen Q, Emerson D, Egorova N, Keshavjee S, Kirklin JK. Lung Transplantation for Covid-19-Related Respiratory Failure in the United States. N Engl J Med 2022; 386:1187-1188. [PMID: 35081299 PMCID: PMC8809503 DOI: 10.1056/nejmc2117024] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Amy Roach
- Cedars-Sinai Medical Center, Los Angeles, CA
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Rodriguez PJ, Veenstra DL, Heagerty PJ, Goss CH, Ramos KJ, Bansal A. A Framework for Using Real-World Data and Health Outcomes Modeling to Evaluate Machine Learning-Based Risk Prediction Models. Value Health 2022; 25:350-358. [PMID: 35227445 PMCID: PMC9311314 DOI: 10.1016/j.jval.2021.11.1360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/19/2021] [Accepted: 11/16/2021] [Indexed: 05/06/2023]
Abstract
OBJECTIVES We propose a framework of health outcomes modeling with dynamic decision making and real-world data (RWD) to evaluate the potential utility of novel risk prediction models in clinical practice. Lung transplant (LTx) referral decisions in cystic fibrosis offer a complex case study. METHODS We used longitudinal RWD for a cohort of adults (n = 4247) from the Cystic Fibrosis Foundation Patient Registry to compare outcomes of an LTx referral policy based on machine learning (ML) mortality risk predictions to referral based on (1) forced expiratory volume in 1 second (FEV1) alone and (2) heterogenous usual care (UC). We then developed a patient-level simulation model to project number of patients referred for LTx and 5-year survival, accounting for transplant availability, organ allocation policy, and heterogenous treatment effects. RESULTS Only 12% of patients (95% confidence interval 11%-13%) were referred for LTx over 5 years under UC, compared with 19% (18%-20%) under FEV1 and 20% (19%-22%) under ML. Of 309 patients who died before LTx referral under UC, 31% (27%-36%) would have been referred under FEV1 and 40% (35%-45%) would have been referred under ML. Given a fixed supply of organs, differences in referral time did not lead to significant differences in transplants, pretransplant or post-transplant deaths, or overall survival in 5 years. CONCLUSIONS Health outcomes modeling with RWD may help to identify novel ML risk prediction models with high potential real-world clinical utility and rule out further investment in models that are unlikely to offer meaningful real-world benefits.
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Affiliation(s)
- Patricia J Rodriguez
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA.
| | - David L Veenstra
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | | | - Christopher H Goss
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA; Division of Pulmonology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Kathleen J Ramos
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Aasthaa Bansal
- The Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA.
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Jawitz OK, Raman V, Becerra D, Klapper J, Hartwig MG. Factors associated with short- versus long-term survival after lung transplant. J Thorac Cardiovasc Surg 2022; 163:853-860.e2. [PMID: 33168166 PMCID: PMC8024421 DOI: 10.1016/j.jtcvs.2020.09.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/10/2020] [Accepted: 09/12/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A small but growing proportion of lung transplant recipients survive longer than a decade post-transplant. The aim of this study was to identify factors associated with survival beyond a decade after lung transplant. METHODS We queried the United Network for Organ Sharing registry for adult (age ≥18 years) recipients undergoing first-time isolated lung transplantation between the introduction of the Lung Allocation Score in 2005 and 2009. Recipients were stratified into 3 cohorts: those who survived less than 1 year, 1 to 10 years, and greater than 10 years. Multivariable logistic regression was used to identify factors independently associated with early mortality (<1 year) and long-term (>10 years) survival. RESULTS A total of 5171 lung transplant recipients and their associated donors met inclusion criteria, including 964 (18.6%) with early mortality, 2843 (55.0%) with intermediate survival, and 1364 (26.3%) long-term survivors. Factors independently associated with early mortality included donor Black race, cigarette use, arterial oxygen partial pressure/fractional inspired oxygen ratio, diabetes, recipient Lung Allocation Score, total bilirubin, extracorporeal membrane oxygenation bridge requirement, single lung transplantation, and annual lung transplant center volume. The only factors independently associated with long-term survival among those who survived at least 1 year was donor age and single lung transplantation. CONCLUSIONS Of patients undergoing lung transplantation after the implementation of the Lung Allocation Score, approximately one-quarter survived 10 years post-transplant. There was minimal overlap between the factors associated with 1-year and 10-year survival. Of note, the Lung Allocation Score was not associated with long-term survival. Further research is needed to better refine patient selection and optimize management strategies to increase the number of long-term survivors.
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Affiliation(s)
- Oliver K Jawitz
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
| | - Vignesh Raman
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - David Becerra
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jacob Klapper
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
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Kurihara C, Manerikar A, Querrey M, Felicelli C, Yeldandi A, Garza-Castillon R, Lung K, Kim S, Ho B, Tomic R, Arunachalam A, Budinger GRS, Pesce L, Bharat A. Clinical Characteristics and Outcomes of Patients With COVID-19-Associated Acute Respiratory Distress Syndrome Who Underwent Lung Transplant. JAMA 2022; 327:652-661. [PMID: 35085383 PMCID: PMC8796055 DOI: 10.1001/jama.2022.0204] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/07/2022] [Indexed: 02/03/2023]
Abstract
Importance Lung transplantation is a potentially lifesaving treatment for patients who are critically ill due to COVID-19-associated acute respiratory distress syndrome (ARDS), but there is limited information about the long-term outcome. Objective To report the clinical characteristics and outcomes of patients who had COVID-19-associated ARDS and underwent a lung transplant at a single US hospital. Design, Setting, and Participants Retrospective case series of 102 consecutive patients who underwent a lung transplant at Northwestern University Medical Center in Chicago, Illinois, between January 21, 2020, and September 30, 2021, including 30 patients who had COVID-19-associated ARDS. The date of final follow-up was November 15, 2021. Exposures Lung transplant. Main Outcomes and Measures Demographic, clinical, laboratory, and treatment data were collected and analyzed. Outcomes of lung transplant, including postoperative complications, intensive care unit and hospital length of stay, and survival, were recorded. Results Among the 102 lung transplant recipients, 30 patients (median age, 53 years [range, 27 to 62]; 13 women [43%]) had COVID-19-associated ARDS and 72 patients (median age, 62 years [range, 22 to 74]; 32 women [44%]) had chronic end-stage lung disease without COVID-19. For lung transplant recipients with COVID-19 compared with those without COVID-19, the median lung allocation scores were 85.8 vs 46.7, the median time on the lung transplant waitlist was 11.5 vs 15 days, and preoperative venovenous extracorporeal membrane oxygenation (ECMO) was used in 56.7% vs 1.4%, respectively. During transplant, patients who had COVID-19-associated ARDS received transfusion of a median of 6.5 units of packed red blood cells vs 0 in those without COVID-19, 96.7% vs 62.5% underwent intraoperative venoarterial ECMO, and the median operative time was 8.5 vs 7.4 hours, respectively. Postoperatively, the rates of primary graft dysfunction (grades 1 to 3) within 72 hours were 70% in the COVID-19 cohort vs 20.8% in those without COVID-19, the median time receiving invasive mechanical ventilation was 6.5 vs 2.0 days, the median duration of intensive care unit stay was 18 vs 9 days, the median post-lung transplant hospitalization duration was 28.5 vs 16 days, and 13.3% vs 5.5% required permanent hemodialysis, respectively. None of the lung transplant recipients who had COVID-19-associated ARDS demonstrated antibody-mediated rejection compared with 12.5% in those without COVID-19. At follow-up, all 30 lung transplant recipients who had COVID-19-associated ARDS were alive (median follow-up, 351 days [IQR, 176-555] after transplant) vs 60 patients (83%) who were alive in the non-COVID-19 cohort (median follow-up, 488 days [IQR, 368-570] after lung transplant). Conclusions and Relevance In this single-center case series of 102 consecutive patients who underwent a lung transplant between January 21, 2020, and September 30, 2021, survival was 100% in the 30 patients who had COVID-19-associated ARDS as of November 15, 2021.
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Affiliation(s)
- Chitaru Kurihara
- Division of Thoracic Surgery, Northwestern University, Chicago, Illinois
| | - Adwaiy Manerikar
- Division of Thoracic Surgery, Northwestern University, Chicago, Illinois
| | - Melissa Querrey
- Division of Thoracic Surgery, Northwestern University, Chicago, Illinois
| | | | - Anjana Yeldandi
- Department of Pathology, Northwestern University, Chicago, Illinois
| | | | - Kalvin Lung
- Division of Thoracic Surgery, Northwestern University, Chicago, Illinois
| | - Samuel Kim
- Division of Thoracic Surgery, Northwestern University, Chicago, Illinois
| | - Bing Ho
- Division of Nephrology, Northwestern University, Chicago, Illinois
| | - Rade Tomic
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Ambalavanan Arunachalam
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - G. R. Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
| | - Lorenzo Pesce
- Division of Thoracic Surgery, Northwestern University, Chicago, Illinois
| | - Ankit Bharat
- Division of Thoracic Surgery, Northwestern University, Chicago, Illinois
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Oh DK, Hong SB, Shim TS, Kim DK, Choi S, Lee GD, Kim W, Park SI. Effects of the duration of bridge to lung transplantation with extracorporeal membrane oxygenation. PLoS One 2021; 16:e0253520. [PMID: 34197496 PMCID: PMC8248733 DOI: 10.1371/journal.pone.0253520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/08/2021] [Indexed: 11/26/2022] Open
Abstract
Background Although bridge to lung transplantation (BTT) with extracorporeal membrane oxygenation (ECMO) is increasingly performed, the impact of BTT and its duration on post-transplant outcomes are unclear. Methods We retrospectively reviewed medical records of adult patients who underwent lung or heart-lung transplantation in our institution between January 2008 and December 2018. Data were compared in patients who did (n = 41; BTT) and did not (n = 36; non-BTT) require pre-transplant ECMO support. Data were also compared in patients who underwent short-term (<14 days; n = 21; ST-BTT) and long-term (≥14 days; n = 20; LT-BTT) BTTs. Results Among 77 patients included, 51 (66.2%) were male and median age was 53 years. The median bridging time in the BTT group was 13 days (interquartile range [IQR], 7–19 days). Although simplified acute physiologic score II was significantly higher in the BTT group (median, 35; IQR, 31–49 in BTT group vs. median, 12; IQR, 7–19 in non-BTT group; p<0.001), 1-year (73.2% vs. 80.6%; p = 0.361) and 5-year (61.5% vs. 61.5%; p = 0.765) post-transplant survival rates were comparable in both groups. Comparison of ST- and LT-BTT subgroups showed that 1-year (90.5% vs. 55.0%; p = 0.009) and 5-year (73.0% vs. 48.1%; p = 0.030) post-transplant survival rates were significantly higher in ST-BTT group. In age and sex adjusted model, the LT-BTT was an independent risk factor for 1-year post-transplant mortality (hazard ratio, 3.019; 95% confidence interval, 1.119–8.146; p = 0.029), whereas the ST-BTT was not. Conclusions Despite the severe illness, the BTT group showed favorable post-transplantation outcomes, particularly those bridged for less than 14 days.
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Affiliation(s)
- Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Kwan Kim
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sehoon Choi
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Il Park
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Stephenson AL, Ramos KJ, Sykes J, Ma X, Stanojevic S, Quon BS, Marshall BC, Petren K, Ostrenga JS, Fink AK, Faro A, Elbert A, Chaparro C, Goss CH. Bridging the survival gap in cystic fibrosis: An investigation of lung transplant outcomes in Canada and the United States. J Heart Lung Transplant 2021; 40:201-209. [PMID: 33386232 PMCID: PMC7925420 DOI: 10.1016/j.healun.2020.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Previous literature in cystic fibrosis (CF) has shown a 10-year survival gap between Canada and the United States (US). We hypothesized that differential access to and survival after lung transplantation may contribute to the observed gap. The objectives of this study were to compare CF transplant outcomes between Canada and the US and estimate the potential contribution of transplantation to the survival gap. METHODS Data from the Canadian CF Registry and the US Cystic Fibrosis Foundation Patient Registry supplemented with data from United Network for Organ Sharing were used. The probability of surviving after transplantation between 2005 and 2016 was calculated using the Kaplan‒Meier method. Survival by insurance status at the time of transplantation and transplant center volume in the US were compared with those in Canada using Cox proportional hazard models. Simulations were used to estimate the contribution of transplantation to the survival gap. RESULTS Between 2005 and 2016, there were 2,653 patients in the US and 470 in Canada who underwent lung transplantation for CF. The 1-, 3-, and 5-year survival rates were 88.3%, 71.8%, and 60.3%, respectively, in the US compared with 90.5%, 79.9%, and 69.7%, respectively, in Canada. Patients in the US were also more likely to die on the waitlist (p < 0.01) than patients in Canada. If the proportion of who underwent transplantation and post-transplant survival in the US were to increase to those observed in Canada, we estimate that the survival gap would decrease from 10.8 years to 7.5 years. CONCLUSIONS Differences in waitlist mortality and post-transplant survival can explain up to a third of the survival gap observed between the US and Canada.
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Affiliation(s)
- Anne L Stephenson
- Department of Respirology, St Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Kathleen J Ramos
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Jenna Sykes
- Department of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Xiayi Ma
- Department of Respirology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bradley S Quon
- Centre for Heart Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland
| | | | - Cecilia Chaparro
- Department of Respirology, St Michael's Hospital, Toronto, Ontario, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Christopher H Goss
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle, Washington; Division of Pediatric Pulmonary, Department of Pediatrics, University of Washington Medical Center, Seattle, Washington
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10
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Purvis J, McLeod C, Smith B, Orandi BJ, Kale C, Goldberg DS, Eckhoff DE, Locke JE, Cannon RM. Survival following simultaneous liver-lung versus liver alone transplantation: Results of the US National experience. Am J Surg 2021; 222:813-818. [PMID: 33589242 DOI: 10.1016/j.amjsurg.2021.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/24/2021] [Accepted: 01/31/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are little data to compare the post-transplant survival between lung-liver transplant (LLT) and liver-alone recipients. This study was undertaken to compare survival between LLT and liver-alone transplant. METHODS UNOS data for patients undergoing LLT from 2002 to 2017 was analyzed. LLT recipients (n = 81) were matched 1:4 to liver-alone recipients (n = 324) by propensity score and patient survival was compared in the matched cohorts. RESULTS Unadjusted 1, 3, and 5-year patient survival in the matched cohort was significantly worse in the LLT (82.5%, 72.2%, and 62.2%) versus liver-alone (92.2%, 82.8%, and 80.9%; p = 0.005). This difference persisted after adjusting for covariates with residual imbalance (HR 2.05, 95% CI 1.37-3.08; p = 0.001). CONCLUSION LLT has significantly worse survival than liver-alone transplant. With an increasing organ shortage, medical necessity criteria such as those developed for simultaneous liver-kidney transplantation should be developed for simultaneous lung-liver transplants to assure liver allografts are only allocated when truly needed.
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Affiliation(s)
- Joshua Purvis
- University of Alabama at Birmingham, Department of Surgery, Division of Transplantation, Birmingham, AL, USA
| | - Chandler McLeod
- University of Alabama at Birmingham, Department of Surgery, Division of Transplantation, Birmingham, AL, USA
| | - Blair Smith
- University of Alabama at Birmingham, Department of Anesthesia, Birmingham, AL, USA
| | - Babak J Orandi
- University of Alabama at Birmingham, Department of Surgery, Division of Transplantation, Birmingham, AL, USA
| | - Cozette Kale
- University of Alabama at Birmingham, Department of Surgery, Division of Transplantation, Birmingham, AL, USA
| | - David S Goldberg
- University of Miami Miller School of Medicine, Department of Medicine, Miami, FL, USA
| | - Devin E Eckhoff
- Beth Israel Deaconess Medical Center, Department of Surgery, Boston, MA, USA
| | - Jayme E Locke
- University of Alabama at Birmingham, Department of Surgery, Division of Transplantation, Birmingham, AL, USA
| | - Robert M Cannon
- University of Alabama at Birmingham, Department of Surgery, Division of Transplantation, Birmingham, AL, USA.
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11
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Bertani A, Miceli V, De Monte L, Occhipinti G, Pagano V, Liotta R, Badami E, Tuzzolino F, Arcadipane A. Donor Preconditioning with Inhaled Sevoflurane Mitigates the Effects of Ischemia-Reperfusion Injury in a Swine Model of Lung Transplantation. Biomed Res Int 2021; 2021:6625955. [PMID: 33506025 PMCID: PMC7815409 DOI: 10.1155/2021/6625955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
Primary graft dysfunction (PGD) and ischemia-reperfusion injury (IRI) occur in up to 30% of patients undergoing lung transplantation and may impact on the clinical outcome. Several strategies for the prevention and treatment of PGD have been proposed, but with limited use in clinical practice. In this study, we investigate the potential application of sevoflurane (SEV) preconditioning to mitigate IRI after lung transplantation. The study included two groups of swines (preconditioned and not preconditioned with SEV) undergoing left lung transplantation after 24-hour of cold ischemia. Recipients' data was collected for 6 hours after reperfusion. Outcome analysis included assessment of ventilatory, hemodynamic, and hemogasanalytic parameters, evaluation of cellularity and cytokines in BAL samples, and histological analysis of tissue samples. Hemogasanalytic, hemodynamic, and respiratory parameters were significantly favorable, and the histological score showed less inflammatory and fibrotic injury in animals receiving SEV treatment. BAL cellular and cytokine profiling showed an anti-inflammatory pattern in animals receiving SEV compared to controls. In a swine model of lung transplantation after prolonged cold ischemia, SEV showed to mitigate the adverse effects of ischemia/reperfusion and to improve animal survival. Given the low cost and easy applicability, the administration of SEV in lung donors may be more extensively explored in clinical practice.
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Affiliation(s)
- Alessandro Bertani
- 1Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | | | - Lavinia De Monte
- 1Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Giovanna Occhipinti
- 3Department of Anesthesiology and Critical Care, IRCCS-ISMETT, Palermo, Italy
| | | | - Rosa Liotta
- 5Department of Pathology, IRCCS-ISMETT, Palermo, Italy
| | - Ester Badami
- 4Fondazione Ri.MED, Palermo, Italy
- 6Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS-ISMETT, Palermo, Italy
| | | | - Antonio Arcadipane
- 3Department of Anesthesiology and Critical Care, IRCCS-ISMETT, Palermo, Italy
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12
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Mosher CL, Weber JM, Frankel CW, Neely ML, Palmer SM. Risk factors for mortality in lung transplant recipients aged ≥65 years: A retrospective cohort study of 5,815 patients in the scientific registry of transplant recipients. J Heart Lung Transplant 2021; 40:42-55. [PMID: 33208278 PMCID: PMC7770611 DOI: 10.1016/j.healun.2020.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lung transplantation is increasingly performed in recipients aged ≥65 years. However, the risk factors for mortality specific to this population have not been well studied. In lung transplant recipients aged ≥65 years, we sought to determine post-transplant survival and clinical factors associated with post-transplant mortality. METHODS We investigated 5,815 adult lung transplants recipients aged ≥65 years in the Scientific Registry of Transplant Recipients. Mortality was defined as a composite of recipient death or retransplantation. The Kaplan-Meier method was used to estimate the median time to mortality. Univariable and multivariable Cox proportional hazards regression models were used to examine the association between time to mortality and 23 donor, recipient, or center characteristics. RESULTS Median survival in lung transplant recipients aged ≥65 years was 4.41 years (95% CI: 4.21-4.60 years) and significantly worsened by increasing age strata. In the multivariable model, increasing recipient age strata, creatinine level, bilirubin level, hospitalization at the time of transplantation, single lung transplant operation, steroid use at the time of transplantation, donor diabetes, and cytomegalovirus mismatch were independently associated with increased mortality. CONCLUSIONS Among the 8 risk factors we identified, 5 factors are readily available, which can be used to optimize post-transplant survival by informing risk during candidate selection of patients aged ≥65 years. Furthermore, bilateral lung transplantation may confer improved survival in comparison with single lung transplantation. Our results support that after careful consideration of risk factors, lung transplantation can provide life-extending benefits in individuals aged ≥65 years.
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Affiliation(s)
- Christopher L Mosher
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Jeremy M Weber
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Courtney W Frankel
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
| | - Megan L Neely
- Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Scott M Palmer
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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13
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Amor MS, Rosengarten D, Shitenberg D, Pertzov B, Shostak Y, Kramer MR. Lung Transplantation in Idiopathic Pulmonary Fibrosis: Risk Factors and Outcome. Isr Med Assoc J 2020; 22:741-746. [PMID: 33381944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) has poor prognosis. Anti-fibrotic treatment has been shown to slow disease progression. Lung transplantation (LTx) offers a survival benefit. The 5-year survival after LTx in IPF is between 40 and 50. OBJECTIVES To evaluate which IPF patients have better prognosis following LTx. METHODS A retrospective study was conducted with all IPF patients who had undergone LTx in the Rabin Medical Center between 2010 and 2018. We collected data on pre-evaluation of pulmonary function tests, echocardiographic and right heart catherization, and anti-fibrotic treatments. The Kaplan-Meier method was used for survival analysis. RESULTS Among148 patients who underwent LTx, 58 were double LTx (DLT) and 90 single LTx (SLT). Mean age was 58.07 ± 9.78 years; 104 males and 44 females. DLT patients had significantly lower survival rates than SLT in the short and medium term after LTx. Patients with saturation above 80% after the 6-minute walk test (6MWT) had higher survival rates. Patients over 65 years of age had a lower survival rates. Those with pulmonary hypertension (PHT) above 30 mmHg had a poorer prognosis with lower survival rates. CONCLUSIONS IPF patients with higher mean PHT, older age (> 65 years), and desaturation following 6MWT had lower survival rates following LTx. DLT may decrease survival rate compared to SLT just for the short and medium period of time after LTx. These results may lead to better selection of IPF patient candidates for LTx. Additional studies are warranted for choosing which patients will have better prognosis after LTx.
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Affiliation(s)
- Moshe Shai Amor
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Shitenberg
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Pertzov
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shostak
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Reuven Kramer
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Yang Z, Gerull WD, Gauthier JM, Meyers BF, Kozower BD, Patterson GA, Nava RG, Hachem RR, Witt CA, Byers DE, Marklin GF, Ridolfi G, Liu J, Kreisel D, Puri V. Shipping Lungs Greater Distances Increases Costs Without Cutting Waitlist Mortality. Ann Thorac Surg 2020; 110:1691-1697. [PMID: 32511997 DOI: 10.1016/j.athoracsur.2020.04.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/30/2020] [Accepted: 04/19/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND On November 24, 2017, a change in lung allocation policy was initiated to replace the donor service area with a 250-nautical-mile radius circle around the donor hospital. We aim to analyze the consequences of this change, including organ acquisition cost and transplant outcomes, at the national level. METHODS Data on adult patients undergoing lung transplantation between April 27, 2017, and June 22, 2018 (30 weeks before to 30 weeks after allocation policy change) were extracted from the Scientific Registry of Transplant Recipients database. Patients were classified into pre-change and post-change subgroups. Six-month overall survival was evaluated by Kaplan-Meier analysis. Organ acquisition costs were compared between the pre-change and post-change groups. RESULTS Of the 3317 adult patients removed from the waiting list during the study period (pre-change 1637 vs post-change 1680), 2734 underwent transplantation (pre-change 1371 of 1637 [83.8%] vs post-change 1363 of 1680 [81.1%]), and 382 died or became too sick to be transplanted (pre-change 168 of 1637 [10.3%] vs post-change 214 of 1680 [12.7%], P = .077). Six-month survival rates of transplanted patients were similar between the two groups. However, average organ acquisition costs increased after policy change (pre-change $50,735 ± $10,858 vs post-change $53,440 ± $10,247, P < .001) with an increase in nonlocal donors (pre-change 44.3% vs post-change 68.9%, P < .001). CONCLUSIONS Organ acquisition costs and resource utilization increased with the new lung allocation policy, whereas deaths on the waiting list or after transplantation did not decrease. Further optimization of the allocation policy is necessary to balance access to transplant and proper stewardship of human and financial resources.
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Affiliation(s)
- Zhizhou Yang
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri
| | - William D Gerull
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri
| | - Jason M Gauthier
- Department of Surgery, Washington University, St Louis, Missouri
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri
| | - Ramsey R Hachem
- Division of Pulmonology and Critical Care, Washington University, St Louis, Missouri
| | - Chad A Witt
- Division of Pulmonology and Critical Care, Washington University, St Louis, Missouri
| | - Derek E Byers
- Division of Pulmonology and Critical Care, Washington University, St Louis, Missouri
| | | | | | - Jingxia Liu
- Department of Surgery, Washington University, St Louis, Missouri
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri.
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15
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Li D, Liu Y, Wang B. Single versus bilateral lung transplantation in idiopathic pulmonary fibrosis: A systematic review and meta-analysis. PLoS One 2020; 15:e0233732. [PMID: 32437437 PMCID: PMC7241801 DOI: 10.1371/journal.pone.0233732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/11/2020] [Indexed: 02/05/2023] Open
Abstract
Objective Lung transplantation remains the only curative treatment for end-stage lung disease, conferring a better survival for some IPF patients, but whether they should receive double lung transplantation (DLT) or single lung transplantation (SLT) is still controversial. The aim of this study was to determine which type of lung transplantation was more effective and relatively safe in IPF patients by meta-analysis. Methods Publications comparing overall survival (OS) or other perioperative characteristics between IPF patients undergoing SLT and DLT were selected from electronic databases. The hazard ratios (HRs) were abstracted or calculated to evaluate the survival outcome. Odds ratios (ORs) or mean differences (MDs) were used to compare the causes of death or perioperative parameters. A random-effect model was used to combine data. Heterogeneity was quantified by means of an I2 with 95% confidence interval (95% CI). The publication bias was estimated using the Eggers test with Begg’s funnel plots. Results 16 studies with 17,872 IPF cases who met the inclusion criteria were included in this meta-analysis. SLT was associated with declined post-transplant FEV1% (MD = -15.37, 95% CI:-22.28,-8.47; P<0.001), FVC % (MD = -12.52, 95% CI:-19.45,-5.59; P<0.001) and DLCO% (MD = -13.85, 95% CI:-20.42,-7.29; P<0.001), but no significant advantage of DLT over SLT was seen in the overall survival outcome (HR = 1.08, 95% CI: 0.91–1.29; P = 0.391). Subgroup analyses for studies of follow-up period ≥ 60 months also showed similar results (all P-values>0.05). Moreover, there was fewer deaths attributable to primary graft dysfunction in SLT recipients (OR = 0.31, 95% CI: 0.2–0.48; P<0.001), while more patients with SLT died of malignancy (OR = 3.44, 95% CI: 2.06–5.77; P<0.001). Conclusion Our findings suggest that DLT was associated with better postoperative pulmonary function, but there was no difference in long-term overall survival between patients undergoing DLT and SLT. However, further high-quality and large-scale studies are needed to confirm these findings.
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Affiliation(s)
- Diandian Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yi Liu
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Bo Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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16
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Krishnan A, Hsu J, Ha JS, Broderick SR, Shah PD, Higgins RS, Merlo CA, Bush EL. Elevated neutrophil to lymphocyte ratio is associated with poor long-term survival and graft failure after lung transplantation. Am J Surg 2020; 221:731-736. [PMID: 32334799 DOI: 10.1016/j.amjsurg.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE We aimed to assess the prognostic value of Neutrophil to Lymphocyte Ratio (NLR) on long-term outcomes and graft dysfunction after lung transplantation. METHODS We retrospectively reviewed all patients receiving a lung transplant at our institution from 2011 to 2014. The primary exposure was elevated NLR at the time of transplant, defined by NLR>4. The primary outcomes were graft failure and three-year all-cause mortality. Multivariate logistic regression and Kaplan-Meier survival analysis were used to analyze outcomes. RESULTS 95 patients were included. 40 patients (42%) had an elevated NLR. Elevated NLR was associated with graft failure (OR: 4.7 [1.2-18.8], p = 0.02), and three-year mortality (OR: 5.4 [1.3-23.2], p = 0.03) on multivariate logistic regression. Patients with elevated NLR demonstrated significantly lower survival on Kaplan-Meier analysis (50% versus 74%, p = 0.02). The c-statistic for our multivariate model was 0.91. CONCLUSION Elevated neutrophil to lymphocyte ratio is associated with poor long-term survival and graft failure after lung transplantation.
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Affiliation(s)
- Aravind Krishnan
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, USA
| | - Joshua Hsu
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, USA
| | - Jinny S Ha
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, USA
| | - Stephen R Broderick
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, USA
| | - Pali D Shah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Robert Sd Higgins
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, USA
| | - Christian A Merlo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, USA
| | - Errol L Bush
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, USA.
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17
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Kurosaki T, Otani S, Miyoshi K, Okazaki M, Sugimoto S, Suno M, Yamane M, Kobayashi M, Oto T, Toyooka S. Favorable survival even with high disease-specific complication rates in lymphangioleiomyomatosis after lung transplantation-long-term follow-up of a Japanese center. Clin Respir J 2020; 14:116-123. [PMID: 31729820 DOI: 10.1111/crj.13108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/19/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lung transplantation (LT) is a reliable therapeutic option for end-stage pulmonary lymphangioleiomyomatosis (LAM). Long-term outcome of LAM recipients after LT remains unknown. The aim of this study was to describe the outcomes of LT for LAM with a long-term follow-up, comparing those for other diseases in the same period. METHODS We retrospectively reviewed consecutive 145 LT recipients between 1998 and 2015 at Okayama University Hospital with minimum 3-year follow-up. RESULTS Twelve LAM recipients including nine sporadic-LAM and three tuberous sclerosis complex -LAM were identified. Nine of 12 underwent bilateral LT including four living-donor lobar LT. There was no significant difference in overall survival between the two groups. (P = 0.15). Chronic lung allograft dysfunction free survival rate in LAM compared with other diseases tended to be better (P = 0.058). However, the rate of requiring hemodialysis was significantly higher in LAM recipients than in the recipients of other diseases (P = 0.047). Notably, 8 of 12 (67%) LAM patients encountered LAM-related complication including chylothorax and pneumothorax, seven (58%) had proliferative diseases consisting of renal angiomyolipoma and recurrent LAM. Nine patients required mTOR inhibitors for LAM-related problems, contributing to improved control of LAM-related problems. While all nine recipients of bilateral LT have still survived, two patients died of diseases in their native lungs and one required re-LT among three recipients of single LT. CONCLUSION Although the rates of LAM-related complications were unexpectedly high in the long term, LT is a feasible therapeutic option for patients with advanced pulmonary LAM.
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Affiliation(s)
- Takeshi Kurosaki
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Shinji Otani
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Mikio Okazaki
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Manabu Suno
- Division of Oncology Pharmaceutical Care & Science, Okayama University Hospital, Okayama, Japan
| | - Masaomi Yamane
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Motomu Kobayashi
- Anesthesiology & Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Oto
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan
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18
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Reig Mezquida JP, Sales Badía G, Tudela Cuenca J. [Age limitation to lung transplant recipients. Ethical aspects]. Cuad Bioet 2020; 31:43-56. [PMID: 32304198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 05/03/2019] [Indexed: 06/11/2023]
Abstract
We present a review of bioethical aspects of limiting patients 65 years or older to lung transplantation. Lung transplantation is a therapeutic option in patients with severe advanced respiratory diseases, progressive despite medical treatment to prolong the expected survival. It is an aggressive surgical treatment, and the patient must complete a lifelong immunosuppressive treatment. Given the donor shortage, access to this treatment is regulated by organ transplant societies, which develop patient selection guidelines. One contraindication to transplantation has been the age of 65 years, sustained by the poor results of older patients and following utilitarian bioethics concept. For the time being there is no unified selection criteria to identify older patients susceptible to have a worse outcome after transplantation. Applying a personalist bioethics, we propose to use selection criteria based on frailty scales to identify those frail patients more likely to die after the transplant procedure.
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Affiliation(s)
- Juan Pablo Reig Mezquida
- Hospital Universitari i Politècnic La Fe, Valencia. España. C/ Sagunto 151 p/13 Valencia. España.
| | - Gabriel Sales Badía
- Hospital Universitari i Politècnic La Fe, Valencia. España. C/ Sagunto 151 p/13 Valencia. España
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19
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Tague LK, Scozzi D, Wallendorf M, Gage BF, Krupnick AS, Kreisel D, Byers D, Hachem R, Gelman AE. Lung transplant outcomes are influenced by severity of neutropenia and granulocyte colony-stimulating factor treatment. Am J Transplant 2020; 20:250-261. [PMID: 31452317 PMCID: PMC6940547 DOI: 10.1111/ajt.15581] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 08/01/2019] [Accepted: 08/10/2019] [Indexed: 01/25/2023]
Abstract
Although neutropenia is a common complication after lung transplant, its relationship with recipient outcomes remains understudied. We evaluated a retrospective cohort of 228 adult lung transplant recipients between 2008 and 2013 to assess the association of neutropenia and granulocyte colony-stimulating factor (GCSF) treatment with outcomes. Neutropenia was categorized as mild (absolute neutrophil count 1000-1499), moderate (500-999), or severe (<500) and as a time-varying continuous variable. Associations with survival, acute rejection, and chronic lung allograft dysfunction (CLAD) were assessed with the use of Cox proportional hazards regression. GCSF therapy impact on survival, CLAD, and acute rejection development was analyzed by propensity score matching. Of 228 patients, 101 (42.1%) developed neutropenia. Recipients with severe neutropenia had higher mortality rates than those of recipients with no (adjusted hazard ratio [aHR] 2.97, 95% confidence interval [CI] 1.05-8.41, P = .040), mild (aHR 14.508, 95% CI 1.58-13.34, P = .018), or moderate (aHR 3.27, 95% CI 0.89-12.01, P = .074) neutropenia. Surprisingly, GCSF treatment was associated with a higher risk for CLAD in mildly neutropenic patients (aHR 3.49, 95% CI 0.93-13.04, P = .063), although it did decrease death risk in severely neutropenic patients (aHR 0.24, 95% CI 0.07-0.88, P = .031). Taken together, our data point to an important relationship between neutropenia severity and GCSF treatment in lung transplant outcomes.
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Affiliation(s)
- Laneshia K. Tague
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University, St. Louis, Missouri
| | - Davide Scozzi
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St. Louis, Missouri
| | | | - Brian F. Gage
- Division of General Medical Sciences, Washington University, St. Louis, Missouri
| | - Alexander S. Krupnick
- Department of Surgery and Carter Center for Immunology, University of Virginia, Charlottesville, Virginia
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St. Louis, Missouri
| | - Derek Byers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University, St. Louis, Missouri
| | - Ramsey Hachem
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University, St. Louis, Missouri
| | - Andrew E. Gelman
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St. Louis, Missouri
- Department of Pathology & Immunology Washington University, St. Louis, Missouri
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20
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Vazquez Guillamet R. Chronic Obstructive Pulmonary Disease and the Optimal Timing of Lung Transplantation. Medicina (Kaunas) 2019; 55:medicina55100646. [PMID: 31561607 PMCID: PMC6843760 DOI: 10.3390/medicina55100646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) accounts for the largest proportion of respiratory deaths worldwide and was historically the leading indication for lung transplantation. The success of lung transplantation procedures is measured as survival benefit, calculated as survival with transplantation minus predicted survival without transplantation. In chronic obstructive pulmonary disease, it is difficult to show a clear and consistent survival benefit. Increasing knowledge of the risk factors, phenotypical heterogeneity, systemic manifestations, and their management helps improve our ability to select candidates and list those that will benefit the most from the procedure.
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21
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Hjortshøj CS, Gilljam T, Dellgren G, Pentikäinen MO, Möller T, Jensen AS, Turanlahti M, Thilén U, Gustafsson F, Søndergaard L. Outcome after heart-lung or lung transplantation in patients with Eisenmenger syndrome. Heart 2019; 106:127-132. [PMID: 31434713 PMCID: PMC6993032 DOI: 10.1136/heartjnl-2019-315345] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/08/2019] [Accepted: 07/31/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The optimal timing for transplantation is unclear in patients with Eisenmenger syndrome (ES). We investigated post-transplantation survival and transplantation-specific morbidity after heart-lung transplantation (HLTx) or lung transplantation (LTx) in a cohort of Nordic patients with ES to aid decision-making for scheduling transplantation. METHODS We performed a retrospective, descriptive, population-based study of patients with ES who underwent transplantation from 1985 to 2012. RESULTS Among 714 patients with ES in the Nordic region, 63 (9%) underwent transplantation. The median age at transplantation was 31.9 (IQR 21.1-42.3) years. Within 30 days after transplantation, seven patients (11%) died. The median survival was 12.0 (95% CI 7.6 to 16.4) years and the overall 1-year, 5-year, 10-year and 15-year survival rates were 84.1%, 69.7%, 55.8% and 40.6%, respectively. For patients alive 1 year post-transplantation, the median conditional survival was 14.8 years (95% CI 8.0 to 21.8), with 5-year, 10-year and 15-year survival rates of 83.3%, 67.2% and 50.0%, respectively. There was no difference in median survival after HLTx (n=57) and LTx (n=6) (14.9 vs 10.6 years, p=0.718). Median cardiac allograft vasculopathy, bronchiolitis obliterans syndrome and dialysis/kidney transplantation-free survival rates were 11.2 (95% CI 7.8 to 14.6), 6.9 (95% CI 2.6 to 11.1) and 11.2 (95% CI 8.8 to 13.7) years, respectively. The leading causes of death after the perioperative period were infection (36.7%), bronchiolitis obliterans syndrome (23.3%) and heart failure (13.3%). CONCLUSIONS This study shows that satisfactory post-transplantation survival, comparable with contemporary HTx and LTx data, without severe comorbidities such as cardiac allograft vasculopathy, bronchiolitis obliterans syndrome and dialysis, is achievable in patients with ES, with a conditional survival of nearly 15 years.
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Affiliation(s)
| | - Thomas Gilljam
- Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Dellgren
- Transplant Institute, Sahlgrenska Academy, University of Gothenburg, Gothenburg, UK
| | - Markku O Pentikäinen
- Department of Paediatric Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Thomas Möller
- Department of Paediatric Cardiology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Maila Turanlahti
- Department of Paediatric Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ulf Thilén
- Department of Cardiology, Lund University Hospital, Lund, Sweden
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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Wijesinha M, Hirshon JM, Terrin M, Magder L, Brown C, Stafford K, Iacono A. Survival Associated With Sirolimus Plus Tacrolimus Maintenance Without Induction Therapy Compared With Standard Immunosuppression After Lung Transplant. JAMA Netw Open 2019; 2:e1910297. [PMID: 31461151 PMCID: PMC6716294 DOI: 10.1001/jamanetworkopen.2019.10297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022] Open
Abstract
Importance Median survival after lung transplant is less than 6 years. Standard maintenance therapy typically includes tacrolimus and an antimetabolite (mycophenolate mofetil or azathioprine). Replacing the antimetabolite with sirolimus after postoperative wound healing may improve long-term survival due to antifibrotic, antiproliferative, and antiaging effects of sirolimus. Objectives To compare survival between patients receiving sirolimus plus tacrolimus vs mycophenolate mofetil plus tacrolimus (the most common maintenance therapy) and to identify the combination of induction and maintenance therapy associated with the highest survival. Design, Setting, and Participants This cohort study of US recipients of lung transplants from January 1, 2003, through August 31, 2016, analyzed United Network for Organ Sharing (UNOS) data from January 1 through September 13, 2018. Because initiation of sirolimus therapy is usually delayed 3 to 12 months after lung transplant, primary analyses were based on patients alive and free of chronic rejection and malignant disease at 1 year in all groups, whereas sensitivity analyses used appropriate methods to include all patients from transplant time. Regression models adjusted for available potential confounders, including transplant center performance. Exposures Cell cycle inhibitor maintenance therapies, including sirolimus (n = 219), mycophenolate mofetil (n = 5782), mycophenolate sodium (n = 408), azathioprine (n = 2556), and concurrent sirolimus plus mycophenolate mofetil (n = 54), were compared within a tacrolimus-based regimen. Combinations of each induction (basiliximab, daclizumab, antithymocyte globulin, alemtuzumab, or none) and maintenance (tacrolimus plus sirolimus, mycophenolate mofetil, or azathioprine) therapy were also compared. Main Outcomes and Measures Survival was the primary outcome; chronic rejection incidence and subsequent mortality were secondary outcomes. Results Among this population of 9019 patients (median age, 57 years [interquartile range {IQR}, 46-63 years]; 5194 men [57.6%]), sirolimus plus tacrolimus was associated with better survival than mycophenolate mofetil plus tacrolimus (median, 8.9 years [IQR, 4.4-12.7 years] vs 7.1 years [IQR, 3.6-12.1 years]; adjusted hazard ratio [aHR], 0.71; 95% CI, 0.56-0.89; P = .003). Chronic rejection incidence (aHR, 0.75; 95% CI, 0.61-0.92) and mortality after chronic rejection (aHR, 0.52; 95% CI, 0.31-0.81) were lower with sirolimus plus tacrolimus. Compared with mycophenolate mofetil plus tacrolimus, survival differences for sirolimus plus mycophenolate mofetil plus tacrolimus (aHR, 1.14; 95% CI, 0.79-1.65), mycophenolate sodium plus tacrolimus (aHR, 0.95; 95% CI, 0.77-1.17), and azathioprine plus tacrolimus (aHR, 0.93; 95% CI, 0.84-1.02) were not significant. The induction-maintenance combination with the highest survival was sirolimus plus tacrolimus without induction therapy (median survival, 10.7 years [IQR, 7.3-12.7 years]; aHR, 0.48; 95% CI, 0.31-0.76; P = .002) compared with mycophenolate mofetil plus tacrolimus with induction therapy (median survival, 7.4 years [IQR, 3.9-12.6 years]). Conclusions and Relevance Sirolimus plus tacrolimus was associated with improved patient survival after lung transplant compared with mycophenolate mofetil plus tacrolimus; no antibody induction therapy with sirolimus plus tacrolimus was associated with maximal survival.
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Affiliation(s)
- Marniker Wijesinha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Jon Mark Hirshon
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore
| | - Michael Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Laurence Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Clayton Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Kristen Stafford
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Aldo Iacono
- Department of Medicine, University of Maryland School of Medicine, Baltimore
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23
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Hamad Y, Pilewski JM, Morrell M, D'Cunha J, Kwak EJ. Outcomes in Lung Transplant Recipients With Mycobacterium abscessus Infection: A 15-Year Experience From a Large Tertiary Care Center. Transplant Proc 2019; 51:2035-2042. [PMID: 31303416 DOI: 10.1016/j.transproceed.2019.02.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mycobacterium abscessus (M abscessus) infection is a serious complication post-lung transplant (LTx). We examined determinants of outcomes in LTx recipients infected with M abscessus. METHODS Electronic records of all patients who underwent LTx in a single transplant center between 2000 and 2015 were screened for isolation of M abscessus before or after LTx. RESULTS Twenty-six cases of M abscessus isolation were identified. Twenty-four had M abscessus isolation post-LTx. Two had M abscessus isolated from a surgical site, while the others were pulmonary isolates. Out of these 22 with pulmonary isolates, 12 had clinical disease. In 73% of patients, treatment had to be temporarily held or switched due to intolerance and toxicity. There was a statistically significant worsening in survival in those who developed clinical disease compared to matched controls. Among the 12 patients with clinical pulmonary disease, use of clofazimine was significantly associated with a favorable outcome. Six patients had M abscessus isolation pretransplant. Four developed M abscessus recurrence at a median of 2 months post-LTx. Two recurrences were surgical site infections, and 2 were pulmonary infections. CONCLUSION M abscessus infection is difficult to treat as tolerance to medications used is poor. M abscessus pneumonia is associated with worse survival post-LTx. Use of clofazimine is associated with 1-year infection-free survival.
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Affiliation(s)
- Yasir Hamad
- Department of Internal Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh PA.
| | - Joseph M Pilewski
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh Medical Center, Pittsburgh PA
| | - Matthew Morrell
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Pittsburgh Medical Center, Pittsburgh PA
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh PA
| | - Eun Jeong Kwak
- Department of Internal Medicine, Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh PA
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24
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Foroutan F, Guyatt G, Friesen E, Lozano LEC, Sidhu A, Meade M. Predictors of 1-year mortality in adult lung transplant recipients: a systematic review and meta-analysis. Syst Rev 2019; 8:131. [PMID: 31159866 PMCID: PMC6547526 DOI: 10.1186/s13643-019-1049-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/21/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Upon surviving the first year post-lung transplantation, recipients can expect a median survival of 8 years. Within the first year, graft failure and multi-organ failure (possibly secondary to graft failure) are common causes of mortality. To better understand the prognosis within the first year, we plan on conducting a systematic review and meta-analysis of observational studies addressing the association between the patient, donor, and transplant operative factors and graft loss 1-year post-lung transplant. METHODS We searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register, and PubMed supplemental for non-MEDLINE records for observational studies identifying independent risk factors for early mortality (1 year) in adult lung transplant recipients. We plan on including cohort studies and secondary analyses of randomized controlled trials studying adult lung transplant recipients undergoing their first lung transplant, without any simultaneous organ transplant. We will conduct a random-effects meta-analysis that pools the effect estimates from all eligible studies to obtain a summary estimate and confidence interval for all independent non-therapeutic factors identified in the primary studies. DISCUSSION The results from this study may inform future guidelines on the selection of candidates and donors for transplantation and predictive model development and inform the decision-making process that the physician and patient undertake together. Furthermore, through the conduction of this review, we can identify the limitations with the current best evidence, which will encourage the need for studies with a better methodology to reassess the predictors of mortality.
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Affiliation(s)
- Farid Foroutan
- Department of Multi-Organ Transplant, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | | | - Aman Sidhu
- Department of Multi-Organ Transplant, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Maureen Meade
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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25
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Nilsson T, Wallinder A, Henriksen I, Nilsson JC, Ricksten SE, Møller-Sørensen H, Riise GC, Perch M, Dellgren G. Lung transplantation after ex vivo lung perfusion in two Scandinavian centres. Eur J Cardiothorac Surg 2019; 55:766-772. [PMID: 30376058 PMCID: PMC6421510 DOI: 10.1093/ejcts/ezy354] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We reviewed our combined clinical outcome in patients who underwent lung transplantation after ex vivo lung perfusion (EVLP) and compared it to the contemporary control group. METHODS At 2 Scandinavian centres, lungs from brain-dead donors, not accepted for donation but with potential for improvement, were subjected to EVLP (n = 61) and were transplanted if predefined criteria were met. Transplantation outcome was compared with that of the contemporary control group consisting of patients (n = 271) who were transplanted with conventional donor lungs. RESULTS Fifty-four recipients from the regular waiting list underwent transplantation with lungs subjected to EVLP (1 bilateral lobar, 7 single and 46 double). In the EVLP and control groups, arterial oxygen tension/inspired oxygen fraction ratio at arrival in the intensive care unit (ICU) was 30 ± 14 kPa compared to 36 ± 14 (P = 0.005); median time to extubation was 18 h (range 2-912) compared to 7 (range 0-2280) (P = 0.002); median ICU length of stay was 4 days (range 2-65) compared to 3 days (range 1-156) (P = 0.002); Percentage of expected forced expiratory volume at 1s (FEV1.0%) at 1 year was 75 ± 29 compared to 81 ± 26 (P = 0.18); and the 1-year survival rate was 87% [confidence interval (CI) 82-92%] compared to 83% (CI 81-85), respectively. Follow-up to a maximum of 5 years did not show any significant difference in survival between groups (log rank, P = 0.63). CONCLUSIONS Patients transplanted with lungs after EVLP showed outcomes comparable to patients who received conventional organs at medium-term follow-up. Although early outcome immediately after transplantation showed worse lung function in the EVLP group, no differences were observed at a later stage, and we consider EVLP to be a safe method for increasing the number of transplantable organs.
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Affiliation(s)
- Tobias Nilsson
- Department of Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Wallinder
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ian Henriksen
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Denmark
| | | | - Sven-Erik Ricksten
- Department of Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Gerdt C Riise
- Department of Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Göran Dellgren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
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26
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Corral-Blanco M, Prudencio-Ribera VC, Jarrín-Estupiñán ME, Alonso-Moralejo R, Pérez-González V, Meneses-Pardo JC, Hermira-Anchuelo A, De Pablo-Gafas A. Influence of Pulmonary Hypertension on Intrahospital Mortality in Lung Transplantation for Interstitial Lung Disease. Transplant Proc 2019; 51:380-382. [PMID: 30879546 DOI: 10.1016/j.transproceed.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is a comorbidity associated with interstitial lung disease (ILD). The purpose of this study was to evaluate the influence of PH on intrahospital mortality in lung transplantation (LT) for ILD. METHODS We conducted a retrospective cohort study of 66 patients who underwent LT for ILD at the 12 de Octubre University Hospital (Madrid, Spain) from October 2008 to June 2014. PH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg on right-sided heart catheterization and intrahospital mortality as any death taken place after the transplantation of patients not being discharged. RESULTS We retrospectively analyzed data of 66 patients; they were stratified by the presence or absence of PH before LT. Twenty-seven patients (41%) had PH. The PH group had a lower diffusing capacity of carbon monoxide (DLCO), carbon monoxide transfer coefficient (KCO), and 6-minute walk distance test (6MWT) and a higher total lung capacity (TLC), modified medical research council dyspnea scale (mMRC), and lung allocation score (LAS) than the non-PH group. Patients with PH more often underwent double lung transplantation (DLT; 59%) than single lung transplantation (SLT). Intrahospital mortality was 13% (9/66). No significant differences were observed in Kaplan-Meier survival curves for the PH and non-PH groups with a median survival time of 46 days versus 33 days (IQR 26-74; log-rank P = .056); however, the postoperative length of stay in the hospital was greater in the PH group. CONCLUSIONS In our cohort, pulmonary hypertension was not related to early mortality in lung transplantation recipients for interstitial lung diseases.
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Affiliation(s)
- M Corral-Blanco
- Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain.
| | | | | | - R Alonso-Moralejo
- Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - V Pérez-González
- Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - J C Meneses-Pardo
- Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - A Hermira-Anchuelo
- Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - A De Pablo-Gafas
- Lung Transplantation Unit, 12 de Octubre University Hospital, Madrid, Spain
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Harhay MO, Porcher R, Thabut G, Crowther MJ, DiSanto T, Rubin S, Penfil Z, Bing Z, Christie JD, Diamond JM, Cantu E. Donor Lung Sequence Number and Survival after Lung Transplantation in the United States. Ann Am Thorac Soc 2019; 16:313-320. [PMID: 30562050 PMCID: PMC6394123 DOI: 10.1513/annalsats.201802-100oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 12/11/2018] [Indexed: 11/20/2022] Open
Abstract
RATIONALE In the United States, an algorithm known as the "match-run" creates an ordered ranking of potential recipients for available lung allografts. A potential recipient's match-run position, or "sequence number," is available to the transplant center when contacted with a lung offer. Lung offers with higher sequence numbers may be interpreted as a crowd-sourced evaluation of poor organ quality, though the association between the sequence number at which a lung is accepted and its recipient's post-transplant outcomes is unclear. OBJECTIVES We sought to evaluate the primary reasons provided when a lung offer was refused by a transplant center, transplant center and donor/organ factors associated with a higher sequence number at acceptance, and the association of the sequence number at acceptance with post-transplant mortality and graft failure. METHODS Match-run outcomes for lung offers that occurred in the United States from May 2007 through June 2014 were merged with recipient follow-up data through December 2017. Associations between the sequence number at the time of acceptance and selected transplant center and donor characteristics were estimated using multivariable logistic and multinomial regression models. The associations between the final sequence number and recipient survival and graft survival were estimated using multivariable time-to-event models. RESULTS Of 10,981 lung offer acceptances, nearly 70% were accepted by one of the top 10 ranked candidates. Higher median annual center volume and potential indicators of organ quality (e.g., abnormal chest radiograph or bronchoscopy) were associated with a higher sequence number at acceptance. There was weak evidence for a small positive relationship between the sequence number at acceptance and both mortality and graft failure. For example, the unadjusted and adjusted hazard ratios for death associated with the log-sequence number at acceptance were 1.019 (95% confidence interval, 1.001-1.038) and 1.011 (95% confidence interval, 0.989-1.033), respectively. On the absolute scale, using the multivariable model, a 10-fold increase in the sequence number translated into a 0.8% absolute decline in the predicted 5-year survival. CONCLUSIONS Acceptance of a donor lung offer at a later point in the match-run was associated with measurable indicators of organ quality, but not with clinically meaningful differences in post-transplant mortality or graft failure.
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Affiliation(s)
- Michael O. Harhay
- Palliative and Advanced Illness Research Center
- Department of Biostatistics, Epidemiology and Informatics
| | - Raphaël Porcher
- Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
- Team METHODS, Centre de Recherche Epidémiologie et Statistiques Sorbonne Paris Cité, Institut National de la Santé et de la Recherche Médicale U1153, Paris, France
- Paris Descartes University, Paris, France
| | - Gabriel Thabut
- Service de Pneumologie et Transplantation Pulmonaire, Hôpital Bichat, Paris, France
| | - Michael J. Crowther
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom; and
| | | | | | | | - Zhou Bing
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jason D. Christie
- Department of Biostatistics, Epidemiology and Informatics
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua M. Diamond
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Benazzo A, Schwarz S, Frommlet F, Schweiger T, Jaksch P, Schellongowski P, Staudinger T, Klepetko W, Lang G, Hoetzenecker K. Twenty-year experience with extracorporeal life support as bridge to lung transplantation. J Thorac Cardiovasc Surg 2019; 157:2515-2525.e10. [PMID: 30922636 DOI: 10.1016/j.jtcvs.2019.02.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 01/21/2019] [Accepted: 02/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Extracorporeal life support is increasingly used to bridge deteriorating candidates to lung transplantation. Nevertheless, only few systematic reports with a limited number of patients exist describing this practice and its changes over time. METHODS We retrospectively reviewed our institutional database and performed an era analysis to identify trends over time and risk factors for mortality. After applying propensity score matching, outcomes of bridged patients were compared with those of standard lung transplantation recipients. RESULTS Extracorporeal life support was used in 120 patients as an intention to bridge to lung transplantation. Eleven patients (9.2%) were bridged between 1998 and 2004, 39 patients (32.5%) were bridged between 2005 and 2010, and 70 patients were bridged (58.3%) between 2010 and 2017. In the first era, the main bridging modality was venoarterial-extracorporeal membrane oxygenation (n = 10, 90.9%), whereas venovenous devices were primarily used in later eras (second era: n = 18, 46.2%; third era: n = 39, 55.8%). In the second and third eras, 9 patients (23.1%) and 24 patients (34.3%) could be bridged awake. Short-term outcome was poor in the first era, with only 36.4% of patients discharged alive but improved in later eras (53.8% and 77.1%; P = .002). Extracorporeal life support-bridged patients showed an impaired short-term outcome compared with standard recipients. However, survival conditional on 90 days did not differ among the groups (P = .178). In univariate and multivariate analyses, awake extracorporeal life support was protective for survival, whereas acute retransplantation was a risk factor for mortality. CONCLUSIONS Over the past 2 decades, the role of extracorporeal life support bridging evolved from an acute rescue therapy to a semi-elective procedure. Stratified outcome analysis revealed that extracorporeal life support bridging yielded similar long-term survival compared with nonbridged patients.
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Affiliation(s)
- Alberto Benazzo
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Schwarz
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Institute for Medical Statistics, CEMSII, Medical University of Vienna, Vienna, Austria
| | - Thomas Schweiger
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- Division of Intensive Care Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Division of Intensive Care Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - György Lang
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria; Department of Thoracic Surgery, Semmlweis University and National Institute for Oncology, Budapest, Hungary
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
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29
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Lay C, Law N, Holm AM, Benden C, Aslam S. Outcomes in cystic fibrosis lung transplant recipients infected with organisms labeled as pan-resistant: An ISHLT Registry‒based analysis. J Heart Lung Transplant 2019; 38:545-552. [PMID: 30733155 DOI: 10.1016/j.healun.2019.01.1306] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 01/09/2019] [Accepted: 01/22/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The presence of pan-resistant organisms in patients with cystic fibrosis (CF) potentially impacts mortality after lung transplant (LT). In this study we aimed to study LT mortality in CF patients with and without pan-resistant infection. METHODS The International Society for Heart and Lung Transplantation (ISHLT) Thoracic Transplant Registry was used to identify adults with CF, first-time, bilateral LT from 1991 to 2015. Extracted data included demographics, clinical characteristics, post-transplant outcomes, and mortality (infection-related, overall). Multivariate binary logistic regression models were created with 90-day and 1-year mortality as primary outcomes. RESULTS Among 3,256 LT recipients with CF, 697 were labeled as having pan-resistant infection, the others were included as controls (n = 2,649). Pre-transplant, those labeled as pan-resistant were more likely to require ventilator support, have an infection requiring intravenous antibiotics, and have had ≥2 pneumonia episodes within 1 year. Ninety-day and 1-year mortality was similar between groups, but infection-related mortality at 90days (3.3% vs 1.88%, p = 0.01) and 1 year (6.6% vs 4.6%, p < 0.001) was higher in those labeled as pan-resistant. In multivariate analysis, presence of organisms labeled as pan-resistant was not associated with 90-day (odds ratio [OR] 1.5, 95% confidence interval [CI] 0.93 to 2.42, p = 0.09) or 1-year mortality (OR 1.32, 95% CI 0.95 to 1.83, p = 0.097). CONCLUSIONS CF patients with pre-transplant infection from organisms labeled as pan-resistant had similar 90-day and 1-year mortality as those without. Despite increased infection-related mortality in these patients, it was not predictive of mortality in multivariate analysis. The higher occurrence of post-transplant infections in these patients warrants diligent follow-up. A multicenter cohort study will be required to validate the findings of our study.
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Affiliation(s)
- Cecilia Lay
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Nancy Law
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Are Martin Holm
- Department of Respiratory Medicine, University of Oslo, Oslo, Norway
| | - Christian Benden
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA.
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Abstract
BACKGROUND The BODE score (incorporating body mass index, airflow obstruction, dyspnea and exercise capacity) is used for the timing of listing for lung transplantation (LTx) in COPD, based on survival data from the original BODE cohort. This has limitations, because the original BODE cohort differs from COPD patients who are candidates for LTx and the BODE does not include parameters that may influence survival. Our goal was to assess whether parameters such as age, smoking status and diffusion indices significantly influence survival in the absence of LTx, independently of the BODE. METHODS In the present cohort study, the BODE was prospectively assessed in COPD patients followed in a tertiary care hospital with an LTx program. The files of 469 consecutive patients were reviewed for parameters of interest (age, gender, smoking status and diffusing capacity of the lungs for carbon monoxide [DL,CO]) at the time of BODE assessment, as well as for survival status. Their influence on survival independent of the BODE score was assessed, as well as their ability to predict survival in patients aged less than 65 years. RESULTS A Cox regression model showed that the BODE score, age and DL,CO were independently related to survival (P-values <0.001), as opposed to smoking status. Survival was better in patients aged less than 65 in the first (P=0.004), third (P=0.002) and fourth BODE quartiles (P=0.008). The difference did not reach significance in the second quartile (P=0.13). Median survival for patients aged less than 65 in the fourth BODE quartile was 55 months. According to a receiver operating characteristic curve analysis, the BODE score as well as FEV1 and DL,CO fared similarly in predicting survival status at 5 years in patients aged less than 65 years. CONCLUSION Age and DL,CO add to the BODE score to predict survival in COPD. Assessing survival using tools tested in cohorts of patients younger than 65 years is warranted for improving the listing of patients for LTx.
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Affiliation(s)
- Lionel Pirard
- Service de Pneumologie, Department of Pneumology, Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, CHU-UCL-Namur, Site Godinne, Yvoir, Belgium,
| | - Eric Marchand
- Service de Pneumologie, Department of Pneumology, Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, CHU-UCL-Namur, Site Godinne, Yvoir, Belgium,
- Laboratoire de Physiologie Respiratoire, URPhyM, Namur Research Life Institute for Life Sciences (NARILIS), Université de Namur, Namur, Belgium,
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Affiliation(s)
- Daniela J Lamas
- From the Pulmonary and Critical Care Division (D.J.L., A.J.T., H.G.) and the Division of Palliative Medicine (J.R.L.), Brigham and Women's Hospital, Boston; and the Division of Pulmonary and Critical Care Medicine, Section of Advanced Lung Disease and Lung Transplantation, Hospital of the University of Pennsylvania, Philadelphia (A.C.)
| | - Joshua R Lakin
- From the Pulmonary and Critical Care Division (D.J.L., A.J.T., H.G.) and the Division of Palliative Medicine (J.R.L.), Brigham and Women's Hospital, Boston; and the Division of Pulmonary and Critical Care Medicine, Section of Advanced Lung Disease and Lung Transplantation, Hospital of the University of Pennsylvania, Philadelphia (A.C.)
| | - Anil J Trindade
- From the Pulmonary and Critical Care Division (D.J.L., A.J.T., H.G.) and the Division of Palliative Medicine (J.R.L.), Brigham and Women's Hospital, Boston; and the Division of Pulmonary and Critical Care Medicine, Section of Advanced Lung Disease and Lung Transplantation, Hospital of the University of Pennsylvania, Philadelphia (A.C.)
| | - Andrew Courtwright
- From the Pulmonary and Critical Care Division (D.J.L., A.J.T., H.G.) and the Division of Palliative Medicine (J.R.L.), Brigham and Women's Hospital, Boston; and the Division of Pulmonary and Critical Care Medicine, Section of Advanced Lung Disease and Lung Transplantation, Hospital of the University of Pennsylvania, Philadelphia (A.C.)
| | - Hilary Goldberg
- From the Pulmonary and Critical Care Division (D.J.L., A.J.T., H.G.) and the Division of Palliative Medicine (J.R.L.), Brigham and Women's Hospital, Boston; and the Division of Pulmonary and Critical Care Medicine, Section of Advanced Lung Disease and Lung Transplantation, Hospital of the University of Pennsylvania, Philadelphia (A.C.)
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Hsu J, Krishnan A, Lin CT, Shah PD, Broderick SR, Higgins RSD, Merlo CA, Bush EL. Sarcopenia of the Psoas Muscles Is Associated With Poor Outcomes Following Lung Transplantation. Ann Thorac Surg 2018; 107:1082-1088. [PMID: 30447192 DOI: 10.1016/j.athoracsur.2018.10.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/23/2018] [Accepted: 10/01/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sarcopenia, a known component of frailty, defined by diminished cross-sectional area of the psoas muscles, is associated with poor outcomes after a range of surgical procedures. However, little is known of the relationship between sarcopenia of the psoas muscles (SPM) and long-term survival, decline in pulmonary function, and graft failure after lung transplantation. METHODS We reviewed patients who underwent primary lung transplantation at our institution from 2011 to 2014. Cross-sectional areas of the psoas muscles at the L4 vertebral level were measured using preoperative computed tomography. Gender-based cutoff values for sarcopenia were generated and validated. The primary outcomes were 1-, 2-, and 3-year all-cause mortality, forced expiratory volume in 1 second values, and graft function. Adjusted logistic regression and survival analysis was used to analyze outcomes. RESULTS Ninety-five patients were included in this study; 39 (41.1%) patients were considered sarcopenic. SPM was significantly associated with short-term and midterm mortality on multivariate analysis (1 year: odds ratio [OR], 8.7, p = 0.017; 2 years: OR, 12.7, p < 0.01; 3 years: OR, 13.4, p < 0.01). Survival analysis showed significantly decreased survival in sarcopenic patients at 3 years (35.9% versus 76.8%; p < 0.01). SPM is also associated with decreased forced expiratory volume in 1 second (coefficient, -17.3; p = 0.03). Adjusted Cox analysis showed an increased hazard for all-cause mortality (hazard ratio, 5.8, p < 0.01) and graft failure (hazard ratio, 14.7, p < 0.01) in sarcopenic patients. CONCLUSIONS This study demonstrates a significant association between SPM and death, pulmonary function, and graft failure in patients receiving a lung transplant. Determining SPM preoperatively may be a useful component of frailty assessment and a predictor of survival in this patient population.
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Affiliation(s)
- Joshua Hsu
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aravind Krishnan
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cheng T Lin
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pali D Shah
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen R Broderick
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S D Higgins
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian A Merlo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Errol L Bush
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Chicotka S, Pedroso FE, Agerstrand CL, Rosenzweig EB, Abrams D, Benson T, Layton A, Burkhoff D, Brodie D, Bacchetta MD. Increasing Opportunity for Lung Transplant in Interstitial Lung Disease With Pulmonary Hypertension. Ann Thorac Surg 2018; 106:1812-1819. [PMID: 29852149 DOI: 10.1016/j.athoracsur.2018.04.068] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 03/24/2018] [Accepted: 04/23/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation for end-stage interstitial lung disease (ILD) and pulmonary hypertension (PH) has varying results based on ECMO configuration. We compare our experience using venovenous (VV) and venoarterial (VA) ECMO bridge to transplantation for ILD with PH on survival to successful transplantation. METHODS A single-center retrospective review was done of patients with ILD and secondary PH who were placed on either VV or VA ECMO as bridge to transplantation from 2010 to 2016. Comparisons for factors associated with survival to transplantation between VV and VA ECMO strategies were made using Cox proportional hazards model. Subgroup analysis included comparisons of VV ECMO patients who remained on VV or were converted to VA ECMO. RESULTS A total of 50 patients with ILD and PH were treated initially with either VV (n = 19) or VA (n = 31) ECMO as bridge to lung transplantation. Initial VA ECMO had a significantly higher survival to transplantation compared with initial VV ECMO (p = 0.03). Cox proportional hazards modeling showed a 59% reduction in risk of death for VA compared with VV ECMO (hazard reduction 0.41, 95% confidence interval: 0.18 to 0.92, p = 0.03). Patients converted from VV to VA ECMO had significantly longer survival awaiting transplant than patients who remained on VV ECMO (p = 0.03). Ambulation on ECMO before transplantation was associated with an 80% reduction in the risk of death (hazard reduction 0.20, 95% confidence interval: 0.08 to 0.48, p < 0.01). CONCLUSIONS Venoarterial ECMO upper body configuration for patients with end stage ILD and PH significantly improves overall survival to transplantation.
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Affiliation(s)
- Scott Chicotka
- Section of Thoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Felipe E Pedroso
- Section of Thoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Cara L Agerstrand
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Darryl Abrams
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Tom Benson
- Department of Physical Therapy, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital Columbia Campus, New York, New York
| | - Aimee Layton
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Daniel Burkhoff
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital Columbia Campus, New York, New York
| | - Daniel Brodie
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Matthew D Bacchetta
- Section of Thoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York.
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Crawford TC, Lui C, Magruder JT, Suarez-Pierre A, Ha JS, Higgins RS, Broderick SR, Merlo CA, Kim BS, Bush EL. Traumatically Brain-Injured Donors and the Impact on Lung Transplantation Survival. Ann Thorac Surg 2018; 106:842-847. [PMID: 29730351 DOI: 10.1016/j.athoracsur.2018.03.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Concern has been raised over inferior lung transplantation survival associated with traumatic brain injury (TBI) organ donors. Our purpose was to explore the relationship between TBI donors and lung transplantation survival in the lung allocation score (LAS) era. METHODS We queried the United Network for Organ Sharing Scientific Registry of Transplant Recipients and identified all adult (≥18 years) lung transplantations performed from May 4, 2005, to December 31, 2015. Recipients were dichotomized based on donor cause of death, TBI versus non-TBI, propensity score across eight variables (final LAS, intensive care unit admission before transplantation, extracorporeal membrane oxygenation before transplantation, donor age 50 years or older, cytomegalovirus antibody recipient-/donor+, ischemia time, annual center transplantation volume, single versus double lung transplantation), and matched 1:1 without replacement. Our primary outcomes were survival at 1, 3, and 5 years by Kaplan-Meier method. RESULTS A total of 17,610 patients underwent isolated lung transplantation over the study period at 75 different transplantation centers. TBI was the leading cause of death in the donor population: 47% of all donors. Propensity score matching generated 6,782 well-matched donor TBI versus non-TBI pairs (all covariate p > 0.2). Risk-adjusted survival was similar between recipients of TBI donors versus non-TBI donors at 1 year (86% versus 86%, log-rank p = 0.27), 3 years (68% versus 68%, log-rank p = 0.47), and 5 years (55% versus 54%, log-rank p = 0.40). CONCLUSIONS In the largest analysis of TBI donors and the impact on lung transplantation survival to date, we found similar survival out to 5 years in lung transplant recipients of TBI versus non-TBI donors, alleviating concerns over continued transplantation with this unique donor population.
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Affiliation(s)
- Todd C Crawford
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cecillia Lui
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J Trent Magruder
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alejandro Suarez-Pierre
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jinny S Ha
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Higgins
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen R Broderick
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian A Merlo
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bo S Kim
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Errol L Bush
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Kayawake H, Chen-Yoshikawa TF, Motoyama H, Hamaji M, Nakajima D, Aoyama A, Date H. Gastrointestinal complications after lung transplantation in Japanese patients. Surg Today 2018; 48:883-890. [PMID: 29713813 DOI: 10.1007/s00595-018-1666-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/13/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Gastrointestinal complications after lung transplantation (LTx) are an important postoperative morbidity associated with malnutrition and the malabsorption of drugs. We reviewed our experience of managing gastrointestinal complications after LTx. METHODS Between June, 2008 and April, 2017, 160 lung transplants were performed at our institution, as living-donor lobar lung transplants in 77 patients, and as deceased-donor lung transplants in 83. We reviewed, retrospectively, the incidence, type and management of gastrointestinal complications. RESULTS Among the 160 LTx recipients, 58 (36.3%) suffered a collective 70 gastrointestinal complications, the most frequent being gastroparesis, followed by gastroesophageal reflux disease. Two complications were managed surgically, by Nissen fundoplication for gastroesophageal reflux disease in one recipient and Hartmann's operation for sigmoid colon perforation in one. The other 68 complications were managed medically. Two patients died of complications: one, of aspiration pneumonia caused by gastroparesis; and one, of panperitonitis caused by a gastric ulcer. There were no significant differences in overall survival or chronic lung allograft dysfunction-free survival between the patients with and those without gastrointestinal complications. CONCLUSIONS Gastrointestinal complications are not uncommon in LTx recipients and may be serious; therefore, early detection and appropriate treatment are imperative. Surgical management is required for some complications, but most can be managed medically.
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Affiliation(s)
- Hidenao Kayawake
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hideki Motoyama
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masatsugu Hamaji
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Sugimoto S, Yamane M, Otani S, Kurosaki T, Okahara S, Hikasa Y, Toyooka S, Kobayashi M, Oto T. Airway complications have a greater impact on the outcomes of living-donor lobar lung transplantation recipients than cadaveric lung transplantation recipients. Surg Today 2018; 48:848-855. [PMID: 29680912 DOI: 10.1007/s00595-018-1663-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/02/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Airway complications (ACs) after living-donor lobar lung transplantation (LDLLT) could have different features from those after cadaveric lung transplantation (CLT). We conducted this study to compare the characteristics of ACs after LDLLT vs. those after CLT and investigate their impact on outcomes. METHODS We reviewed, retrospectively, data on 163 recipients of lung transplantation, including 83 recipients of LDLLT and 80 recipients of CLT. RESULTS The incidence of ACs did not differ between LDLLT and CLT. The initial type of AC after LDLLT was limited to stenosis in all eight patients, whereas that after CLT consisted of stenosis in three patients and necrosis in ten patients (p = 0.0034). ACs after LDLLT necessitated significantly earlier initiation of treatment than those after CLT (p = 0.032). The overall survival rate of LDLLT recipients with an AC was significantly lower than that of those without an AC (p = 0.030), whereas the overall survival rate was comparable between CLT recipients with and those without ACs (p = 0.25). CONCLUSION ACs after LDLLT, limited to bronchial stenosis, require significantly earlier treatment and have a greater adverse impact on survival than ACs after CLT.
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Affiliation(s)
- Seiichiro Sugimoto
- Department of General Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Masaomi Yamane
- Department of General Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinji Otani
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Takeshi Kurosaki
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Shuji Okahara
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Yukiko Hikasa
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Motomu Kobayashi
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Oto
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan
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Ananiadou O, Schmack B, Zych B, Sabashnikov A, Garcia-Saez D, Mohite P, Weymann A, Mansur A, Zeriouh M, Marczin N, De Robertis F, Simon AR, Popov AF. Suicidal hanging donors for lung transplantation: Is this chapter still closed? Midterm experience from a single center in United Kingdom. Medicine (Baltimore) 2018; 97:e0064. [PMID: 29620623 PMCID: PMC5902298 DOI: 10.1097/md.0000000000010064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In the context of limited donor pool in cardiothoracic transplantation, utilization of organs from high risk donors, such as suicidal hanging donors, while ensuring safety, is under consideration. We sought to evaluate the outcomes of lung transplantations (LTx) that use organs from this group.Between January 2011 and December 2015, 265 LTx were performed at our center. Twenty-two recipients received lungs from donors after suicidal hanging (group 1). The remaining 243 transplantations were used as a control (group 2). Analysis of recipient and donor characteristics as well as outcomes was performed.No statistically significant difference was found in the donor characteristics between analyzed groups, except for higher incidence of cardiac arrest, younger age and smoking history of hanging donors (P < .001, P = .022 and P = .0042, respectively). Recipient preoperative and perioperative characteristics were comparable. Postoperatively in group 1 there was a higher incidence of extracorporeal life support (27.3 vs 9.1%, P = .019). There were no significant differences in chronic lung allograft dysfunction-free survival between group 1 and 2: 92.3 vs 94% at 1 year and 65.9 vs 75.5% at 3 years (P = .99). The estimated cumulative survival rate was also similar between groups: 68.2 vs 83.2% at 1 year and 68.2% versus 72% at 3 years (P = .3758).Hanging as a donor cause of death is not associated with poor mid-term survival or chronic lung allograft dysfunction following transplantation. These results encourage assessment of lungs from hanging donors, and their consideration for transplantation.
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Affiliation(s)
- Olga Ananiadou
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Bastian Schmack
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Bartlomiej Zych
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Diana Garcia-Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Prashant Mohite
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Alexander Weymann
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Ashham Mansur
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Nandor Marczin
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, Heart Science Centre, Harefield Hospital, Harefield
- Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Andre Rüdiger Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
- Department of Cardiothoracic Surgery, University of Frankfurt, Frankfurt, Germany
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de Souza Carraro D, Carraro RM, Campos SV, Iuamoto LR, de Oliveira Braga KA, de Oliveira LC, Sabino EC, Rossi F, Pêgo-Fernandes PM. Burkholderia cepacia, cystic fibrosis and outcomes following lung transplantation: experiences from a single center in Brazil. Clinics (Sao Paulo) 2018; 73:e166. [PMID: 29538493 PMCID: PMC5840825 DOI: 10.6061/clinics/2018/e166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation. METHODS We prospectively analyzed clinical data and respiratory tract samples (sputum and bronchoalveolar lavage) collected from suppurative lung disease patients between January 2008 and November 2013. We also subtyped different Burkholderia cepacia complex genotypes via DNA sequencing using primers against the recA gene in samples collected between January 2012 and November 2013. RESULTS From 2008 to 2013, 34 lung transplants were performed on cystic fibrosis patients at our center. Burkholderia cepacia complex was detected in 13 of the 34 (38.2%) patients. Seven of the 13 (53%) strains were subjected to genotype analysis, from which three strains of B. metallica and four strains of B. cenocepacia were identified. The mortality rate was 1/13 (7.6%), and this death was not related to B. cepacia infection. CONCLUSION The results of our study suggest that colonization by B. cepacia complex and even B. cenocepacia in patients with cystic fibrosis should not be considered an absolute contraindication to lung transplantation in Brazilian centers.
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Affiliation(s)
- Danila de Souza Carraro
- Divisao de Cirurgia Toracica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Rafael Medeiros Carraro
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Silvia Vidal Campos
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Leandro Ryuchi Iuamoto
- Divisao de Cirurgia Toracica, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Lea Campos de Oliveira
- Laboratorio de Investigacao Medica (LIM3), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ester Cerdeira Sabino
- Departamento de Biologia Molecular Divisao de Sorologia, Fundacao Pro Sangue Hemocentro de Sao Paulo, Secretaria de Saude do Estado de São Paulo, São Paulo, SP, BR
| | - Flavia Rossi
- Microbiologia, Divisao de Laboratorio Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Fernandez R, Safaeinili N, Kurihara C, Odell DD, Jain M, DeCamp MM, Budinger GRS, Bharat A. Association of body mass index with lung transplantation survival in the United States following implementation of the lung allocation score. J Thorac Cardiovasc Surg 2017; 155:1871-1879.e3. [PMID: 29249487 DOI: 10.1016/j.jtcvs.2017.11.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/12/2017] [Accepted: 11/11/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The association of body mass index (BMI) with survival after lung transplantation remains controversial, owing to conflicting evidence in the literature. Previous reports have used traditional BMI categories, included patients who underwent transplantation before implementation of the lung allocation score (LAS), or were limited by single-center experiences. Here we evaluated the association of individual BMI units with short-term and long-term mortality in a large national database following implementation of the LAS. METHODS The Scientific Registry of Transplant Recipients database was used to collect data for 17,233 adult lung transplantations performed between May 2005 and June 2016. The primary outcome was all-cause mortality at 90 days and 1 year posttransplantation. Logistic regression modeling was used to independently predict mortality per BMI unit, adjusting for donor and recipient factors. RESULTS BMI was an independent predictor of mortality at both 90 days and 1 year. At 90 days, a BMI of 25 was associated with the lowest predicted probability of death (0.053; 95% confidence interval [CI], 0.047-0.049), with increased odds of mortality at BMI ≤20 and ≥28. At 1 year, a BMI of 26 was associated with the lowest predicted probability of death (0.12; 95% CI, 0.11-0.13), with increased odds of mortality at BMI ≤24 and ≥28. CONCLUSIONS Each individual BMI unit has a quantifiable effect on posttransplantation survival, and the patterns of effect do not fit into the predefined BMI categories. The mortality risk associated with BMI should be considered by transplant centers when making listing decisions and by regulatory bodies for estimating expected outcomes.
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Affiliation(s)
- Ramiro Fernandez
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Niloufar Safaeinili
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Chitaru Kurihara
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David D Odell
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Manu Jain
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Malcolm M DeCamp
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - G R Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Crawford TC, Magruder JT, Grimm JC, Suarez-Pierre A, Zhou X, Ha JS, Higgins RS, Broderick SR, Orens JB, Shah P, Merlo CA, Kim BS, Bush EL. Impaired Renal Function Should Not Be a Barrier to Transplantation in Patients With Cystic Fibrosis. Ann Thorac Surg 2017; 104:1231-1236. [PMID: 28822537 DOI: 10.1016/j.athoracsur.2017.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have demonstrated an association between pretransplantation renal dysfunction (PRD) and increased mortality after lung transplantation (LT). The purpose of this study was to determine whether PRD impacts survival after LT in patients with cystic fibrosis (CF). METHODS We queried the United Network for Organ Sharing (UNOS) database to identify all adult (≥18 years) recipients with CF who underwent isolated LT from May 4, 2005 to December 31, 2014. We separated recipients into those with and those without PRD (glomerular filtration rate [GFR] ≤60 mL/min). We excluded patients who required dialysis before transplantation. Kaplan-Meier analysis was used to assess unadjusted survival differences. Cox proportional hazards modeling was then performed across 26 variables to assess the risk-adjusted impact of PRD on 1-, 3-, and 5-year mortality. RESULTS Isolated LT was performed on 1,830 patients with CF; 17 patients were excluded because of pretransplantation dialysis. Eighty-two of 1,813 patients (4.5%) had PRD (GFR ≤60 mL/min). Kaplan-Meier analysis revealed no survival differences between PRD and non-PRD groups at 1 year (85.3% versus 89.5%; log-rank p = 0.23), 3 years (71.0% versus 72.5%; p = 0.57), or 5 years (63.3% versus 59.8%; p = 0.95). After risk adjustment, PRD was not independently associated with an increased hazard for mortality at 1 year (hazard ratio [HR], 1.38 [95% confidence interval [CI], 0.74-2.58]; p = 0.31), 3 years (HR, 1.44 [95% CI, 0.92-2.24]; p = 0.11), or 5 years (HR, 1.30 [95% CI, 0.86-1.94]; p = 0.29). CONCLUSIONS Although PRD has historically served as a relative contraindication to LT, our study is the first to suggest that among CF recipients, PRD was not associated with increased hazard for mortality out to 5 years after LT.
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Affiliation(s)
- Todd C Crawford
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J Trent Magruder
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua C Grimm
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alejandro Suarez-Pierre
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xun Zhou
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jinny S Ha
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Higgins
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen R Broderick
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan B Orens
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pali Shah
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian A Merlo
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bo S Kim
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Errol L Bush
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Mulvihill MS, Gulack BC, Ganapathi AM, Speicher PJ, Englum BR, Hirji SA, Snyder LD, Davis RD, Hartwig MG. The association of donor age and survival is independent of ischemic time following deceased donor lung transplantation. Clin Transplant 2017; 31:10.1111/ctr.12993. [PMID: 28470765 PMCID: PMC5503472 DOI: 10.1111/ctr.12993] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Early research suggests prolonged ischemic time in older donor lungs is associated with decreased survival following lung transplantation. The purpose of this study was to determine whether this association holds in the post-lung allocation score era. METHODS We analyzed the United Network for Organ Sharing database 2005-2013 for adult recipients of cadaveric lung transplants. Cox proportional hazards modeling was utilized to determine the association of donor age, ischemic time, and the interaction of donor age and ischemic time with transplant-free survival. RESULTS Eleven thousand eight hundred thirty-five patients met criteria. Median donor age was 32 years, and median ischemic time was 4.9 hours. Cox modeling demonstrated that donor age 50-60 (adjusted hazard ratio (HR): 1.11) and ≥60 (adjusted HR: 1.42) were associated with reduced overall survival. Neither ischemic time nor interaction of ischemic time and donor age were significantly associated with overall survival. Subanalysis demonstrated that this finding held true for patients undergoing either single or bilateral lung transplantation. CONCLUSIONS Prolonged ischemic time is not associated with decreased overall survival in patients undergoing lung transplantation regardless of the donor's age. However, donor age >50 is independently associated with decreased survival. The lack of an association between ischemic time and survival should encourage broader geographic allocation of pulmonary allografts.
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Affiliation(s)
| | - Brian C Gulack
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Asvin M Ganapathi
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Paul J Speicher
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian R Englum
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Sameer A Hirji
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Laurie D Snyder
- Departments of Medicine, Duke University Medical Center, Durham, NC, USA
| | - R Duane Davis
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Matthew G Hartwig
- Departments of Surgery, Duke University Medical Center, Durham, NC, USA
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Dobbels F, De Bleser L, Berben L, Kristanto P, Dupont L, Nevens F, Vanhaecke J, Verleden G, De Geest S. Efficacy of a medication adherence enhancing intervention in transplantation: The MAESTRO-Tx trial. J Heart Lung Transplant 2017; 36:499-508. [PMID: 28162931 DOI: 10.1016/j.healun.2017.01.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Well-designed randomized controlled trials (RCTs) testing efficacy of post-transplant medication adherence enhancing interventions and clinical outcomes are scarce. METHODS This randomized controlled trial enrolled adult heart, liver, and lung transplant recipients who were >1 year post-transplant and on tacrolimus twice daily (convenience sample) (visit 1). After a 3-month run-in period, patients were randomly assigned 1:1 to intervention group (IG) or control group (CG) (visit 2), followed by a 6-month intervention (visits 2-4) and a 6-month adherence follow-up period (visit 5). All patients used electronic monitoring for 15 months for adherence measurement, generating a daily binary adherence score per patient. Post-intervention 5-year clinical event-free survival (mortality or retransplantation) was evaluated. The IG received staged multicomponent tailored behavioral interventions (visits 2-4) building on social cognitive theory and trans-theoretical model (e.g., electronic monitoring feedback, motivational interviewing). The CG received usual care and attended visits 1-5 only. Intention-to-treat analysis used generalized estimating equation modeling and Kaplan-Meier survival analysis. RESULTS Of 247 patients, 205 were randomly assigned (103 IG, 102 CG). At baseline, average daily proportions of patients with correct dosing (82.6% IG, 78.4% CG) and timing adherence (75.8% IG, 72.2% CG) were comparable. The IG had a 16% higher dosing adherence post-intervention (95.1% IG, 79.1% CG; p < 0.001), resulting in odds of adherence being 5 times higher in the IG than in the CG (odds ratio 5.17, 95% confidence interval 2.86-9.38). This effect was sustained at end of follow-up (similar results for timing adherence). In the IG, 5-year clinical event-free survival was 82.5% vs 72.5% in the CG (p = 0.18). CONCLUSION Our intervention was efficacious in improving adherence and sustainable. Further research should investigate clinical impact, cost-effectiveness, and scalability.
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Affiliation(s)
- Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Institute of Nursing Science, University of Basel, Basel, Switzerland.
| | - Leentje De Bleser
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Lut Berben
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | | | - Lieven Dupont
- Lung Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Frederik Nevens
- Liver Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Johan Vanhaecke
- Heart Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Geert Verleden
- Lung Transplant Program, University Hospitals of Leuven, Leuven, Belgium
| | - Sabina De Geest
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Institute of Nursing Science, University of Basel, Basel, Switzerland
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Takahashi M, Ohsumi A, Ohata K, Kondo T, Motoyama H, Hijiya K, Aoyama A, Date H, Chen-Yoshikawa TF. Immune function monitoring in lung transplantation using adenosine triphosphate production: time trends and relationship to postoperative infection. Surg Today 2016; 47:762-769. [PMID: 27853868 DOI: 10.1007/s00595-016-1440-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/29/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The ImmuKnow (IK) assay is a comprehensive immune function test that involves measuring adenosine triphosphate produced by the cluster of differentiation 4+ T lymphocytes in peripheral blood. The aim of this study was to analyze the time trends of IK values and assess the relationship between IK values and infections in lung transplants. METHODS We prospectively collected 178 blood samples from 22 deceased-donor lung transplant (DDLT) recipients and 17 living-donor lobar lung transplant (LDLLT) recipients. A surveillance IK assay was performed postoperatively, then after 1 week and 1, 3, 6, and 12 months. RESULTS Time trends of IK values in stable recipients peaked 1 week after DDLT (477 ± 247 ATP ng/ml), and 1 month after LDLLT (433 ± 134 ng/ml), followed by a gradual decline over 1 year. The mean IK values in infections were significantly lower than those in the stable state (119 vs 312 ATP ng/ml, p = 0.0002). CONCLUSIONS IK values increased sharply after lung transplantation and then decreased gradually over time in the first year, suggesting a natural history of immune function. IK values were also significantly reduced during infections. These results may provide new insights into the utility of immune monitoring after lung transplantation.
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Affiliation(s)
- Mamoru Takahashi
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Akihiro Ohsumi
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Keiji Ohata
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Takeshi Kondo
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Hideki Motoyama
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Kyoko Hijiya
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan.
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Bibevski S, Ruzmetov M, Fortuna RS, Turrentine MW, Brown JW, Ohye RG. Performance of SynerGraft Decellularized Pulmonary Allografts Compared With Standard Cryopreserved Allografts: Results From Multiinstitutional Data. Ann Thorac Surg 2016; 103:869-874. [PMID: 27788940 DOI: 10.1016/j.athoracsur.2016.07.068] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Structural deterioration of allografts over time is believed to be at least partly related to an immune response mounted against human leukocyte antigen specific to the transplanted tissue. SynerGraft (SG) processing (CryoLife, Kennesaw, GA) is a technology that decellularizes an allograft leaving only connective tissue, therefore, reducing immunogenicity and potentially increasing durability of the implant. METHODS We performed a retrospective review of 163 SG patients and 124 standard allograft controls from 3 medical centers. Patient demographics were tabulated, and conduit stenosis and insufficiency were measured by echocardiography. RESULTS There were 28 deaths (15 of 163 [9%] SG patients vs 13 of 124 [11%] standard patients; p = 0.72), but no deaths were attributed to structural failure of the conduit. The actuarial survival for SG vs standard cohorts was not different at 5 and 10 years. Among the 274 hospital survivors, 17% SG vs 42% standard had evidence for significant conduit dysfunction at the most recent follow-up or before conduit replacement. Freedom from conduit dysfunction was significantly worse at 10 years in the standard group (58%) than in the SG group (83%, p < 0.001). CONCLUSIONS This study represents a multiinstitutional retrospective comparison of SG and standard cryopreserved allografts used in right ventricular outflow tract reconstruction in a broad range of patient ages. Our results demonstrate that at an intermediate-term to long-term follow-up, conduit dysfunction and pulmonary insufficiency and stenosis are higher among patients receiving standard allografts. We postulate that the improved durability of SG is related to decreased immunogenicity of the SG technology.
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Affiliation(s)
- Steve Bibevski
- Section of Pediatric and Congenital Cardiac Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Mark Ruzmetov
- Section of Pediatric Heart Surgery, Children Hospital of Illinois, Peoria, Illinois
| | - Randall S Fortuna
- Section of Pediatric Cardiothoracic Surgery, Banner Children's Hospital, University of Arizona College of Medicine, Phoenix, Arizona
| | - Mark W Turrentine
- Section of Pediatric Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - John W Brown
- Section of Pediatric Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Richard G Ohye
- Section of Pediatric Cardiovascular Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan.
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De Oliveira NC, Julliard W, Osaki S, Maloney JD, Cornwell RD, Sonetti DA, Meyer KC. Lung transplantation for high-risk patients with idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33:235-241. [PMID: 27758988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/26/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Survival for patients with idiopathic pulmonary fibrosis (IPF) and high lung allocation score (LAS) values may be significantly reduced in comparison to those with lower LAS values. OBJECTIVES To evaluate outcomes for high-risk IPF patients as defined by LAS values ≥46 (N=42) versus recipients with LAS values <46 (N=89). METHODS We retrospectively reviewed records of 131 consecutive patients with IPF who received lung transplants at our institution between 1999 and 2013. RESULTS The mean LAS was significantly higher (59.5, interquartile range 43.9-75.9 vs. 39.3, interquartile range 37.7-44.3; p<0.01) for the high-risk cohort. The higher LAS cohort had significantly lower percent predicted forced vital capacity (FVC) versus recipients with LAS <46 (41.3±14.1% vs. 53.2±16.2%; p<0.01) and required more supplemental oxygen (7±5 vs. 4±2 L/min, p<0.01) prior to transplant versus recipients with LAS <46. Although the incidence of early post-LTX pulmonary complications was increased for the higher LAS group versus recipients with LAS <46, 30-day mortality and actuarial survival did not differ between the two cohorts. CONCLUSIONS Although lung transplantation in patients with IPF and high LAS values is associated with increased risk of early post-transplant complications, long-term post-transplant survival for our high-LAS cohort was equivalent to that for the lower LAS recipients.
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Abstract
Home monitoring by lung transplant recipients has been effective for early detection of clinical problems. This study used an electronic diary for home monitoring by lung transplant candidates to improve communication between candidates and the transplant team. Candidates were randomized into control (52 subjects following standard telephone reporting procedures) and intervention (67 subjects using an electronic diary to record and transmit a range of health-related measures) groups. Outcome measures were monitoring adherence and level of communication (for monitor acceptability and utilization), hospital length of stay after transplantation and survival at 4 months (for clinical effectiveness). Subjects used the diary without difficulty and with good adherence. Subjects and coordinator contacts were similar between groups; intervention group subjects were positive regarding contact based on diary use. There were no significant differences in clinical outcomes between groups. Changing diary questions might improve the effectiveness of electronic monitoring for lung transplant candidates.
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Affiliation(s)
- Beth Mullan
- University of Minnesota, Minneapolis, Minn, USA
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Izhakian S, Wasser WG, Vainshelboim B, Fox BD, Kramer MR. Effect of Jewish-Arab Ancestry and Gender Matching on Clinical Outcome of Lung Transplantation in Israel. Isr Med Assoc J 2016; 18:470-473. [PMID: 28471578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Studies in lung transplantation demonstrate that the ancestry and gender dissimilarities of donor-recipients lead to a decrease in survival of the recipient. OBJECTIVES To evaluate the survival of lung transplant recipients in Israel based on whether the donors and recipients are of Jewish or Arab ancestry as well as survival based on gender match or mismatch. METHODS We performed a retrospective observational cohort study of 345 lung transplant recipients at the Rabin Medical Center, Petah Tikva, Israel between January 1997 and January 2013. We compared the survival of lung transplant recipients in two ancestry categories: ancestry matched (Jewish donors to Jewish recipients or Arab donors to Arab recipients) and ancestry mismatched (Jewish donors to Arab recipients and vice versa). We also compared the survival among the four gender donor and recipient combinations (male to male, female to female, male to female, and female to male). RESULTS Survival analysis revealed no significant differences between the two ancestry groups (P = 0.51) and among the four gender combinations (P = 0.58). On Cox multivariate analysis, younger donor age was the only significant parameter for longer survival (hazards ratio 1.025, 95% confidence interval 1.012-1.037). CONCLUSIONS Gender and ancestry mismatches in these two Israeli populations do not appear to alter the clinical outcomes following lung transplantation.
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Affiliation(s)
- Shimon Izhakian
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Walter G Wasser
- Division of Nephrology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
- Division of Nephrology, Rambam Health Care Campus, Haifa, Israel
| | - Baruch Vainshelboim
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benjamin D Fox
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Pulmonary Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Arango Tomás E, Cerezo Madueño F, Salvatierra Velázquez A. Technique Resource for Difficult Auricular Anastomosis in Lung Transplantation. Transplant Proc 2015; 47:2653-5. [PMID: 26680063 DOI: 10.1016/j.transproceed.2015.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/18/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Atrial anastomosis in lung transplantation (LT) can present significant technical difficulties, especially when there is a very posterior left inferior pulmonary vein, in donor-recipient disproportion or excessive separation of the receptor's pulmonary veins owing to atrial dilatation; hence, its implementation requires excessive heart handling and longer ischemia time, which result in increased perioperative complications. This technique, which uses the recipient's superior pulmonary vein, avoids these problems, although it is not applicable in all cases because no pressure gradient at the suture level is required. Therefore, the suture diameter must be equal or greater than the sum of both graft pulmonary veins diameters. METHODS This retrospective study recorded the age/gender (donor and recipient), preoperative morbidity, type of surgery, perioperative, vascular complications, mortality, and postoperative stay. Descriptive and inferential statistical study was made by SPSS. RESULTS We performed 82 LTs between January 2009 and June 2012, 18 with the new technique (14 men/4 women; 52 ± 15 years). There were 14 single lung and 4 double lung transplants. The new technique does not increase the ischemic times when compared with the classic technique. No vascular dehiscence, fistulas, or thrombosis were found. There were observed fewer vascular complications (P = .042). Early mortality was presented in 4 cases (22.2%). CONCLUSIONS This new technique achieves the objectives described (no increases in ischemic time, fewer vascular complications). However, an absolute confirmation requires a study comparing similar technical LT given that the new resource was only used in highly complex procedures.
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Affiliation(s)
- E Arango Tomás
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain.
| | - F Cerezo Madueño
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain
| | - A Salvatierra Velázquez
- Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain
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Affiliation(s)
- Marcos Naoyuki Samano
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração (INCOR), Divisão de Cirurgia Torácica, São Paulo/SP, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração (INCOR), Divisão de Cirurgia Torácica, São Paulo/SP, Brazil
- Corresponding author: E-mail:
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Ius F, Sommer W, Tudorache I, Avsar M, Siemeni T, Salman J, Molitoris U, Gras C, Juettner B, Puntigam J, Optenhoefel J, Greer M, Schwerk N, Gottlieb J, Welte T, Hoeper MM, Haverich A, Kuehn C, Warnecke G. Five-year experience with intraoperative extracorporeal membrane oxygenation in lung transplantation: Indications and midterm results. J Heart Lung Transplant 2015; 35:49-58. [PMID: 26496786 DOI: 10.1016/j.healun.2015.08.016] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/18/2015] [Accepted: 08/27/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Since April 2010, extracorporeal membrane oxygenation (ECMO) has replaced cardiopulmonary bypass for intraoperative support during lung transplantation at our institution. The aim of this study was to present our 5-year experience with this technique. METHODS Records of patients who underwent transplantation between April 2010 and January 2015 were retrospectively reviewed. Patients who underwent transplantation without ECMO formed Group A. Patients in whom the indication for ECMO support was set a priori before the beginning of the operation formed Group B. The remaining patients in whom the indication for ECMO support was set during transplantation formed Group C. RESULTS Among 595 patients, 425 (71%) patients (Group A) did not require intraoperative ECMO; the remaining 170 (29%) patients did. Among these patients, 95 (56%) patients formed Group B, and the remaining 75 (44%) patients comprised Group C. Pulmonary fibrosis and pre-operative dilated or hypertrophied right ventricle emerged as risk factors for the indication of non-a priori intraoperative ECMO. Patients in Groups B and C showed a higher pre-operative risk profile and higher prevalence of post-operative complications than patients in Group A. Overall survival at 1 year was 93%, 83%, and 82% and at 4 years was 73%, 68%, and 69% in Groups A, B, and C (p = 0.11). The intraoperative use of ECMO did not emerge as a risk factor for in-hospital mortality or mortality after hospital discharge. CONCLUSIONS Intraoperative ECMO filled the gap between pre-operative and post-operative ECMO in lung transplantation. Although complications and in-hospital mortality were higher in patients who received ECMO, survival was similar among patients who underwent transplantation with or without ECMO.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Wiebke Sommer
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Ulrich Molitoris
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | | | | | - Jakob Puntigam
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Joerg Optenhoefel
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | | | - Nicolaus Schwerk
- Department of Paediatrics, Hanover Medical School, Hanover, Germany
| | - Jens Gottlieb
- Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany; Department of Respiratory Medicine
| | - Tobias Welte
- Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany; Department of Respiratory Medicine
| | - Marius M Hoeper
- Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany; Department of Respiratory Medicine
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany.
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