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Sainathan S, Ryan J, Mullinari L, Sanchez P. Influence of cardiac diagnosis on outcomes of pediatric heart-lung transplantation. Clin Transplant 2024; 38:e15318. [PMID: 38634157 DOI: 10.1111/ctr.15318] [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: 11/21/2023] [Revised: 03/13/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Pediatric Heart-lung transplant (HLTX) is performed for endstage congenital heart disease (CHD) with irreversible pulmonary hypertension or non-congenital heart disease (NCHD) with end-stage heart and lung disease. CHD could influence the outcomes of HTLX due to increased complexity of the operation as compared to NCHD. In this study we evaluated the influence of cardiac diagnosis on outcomes of pediatric HTLX. METHODS The UNOS database (1987-2022) was queried for primary HTLX in patients <18 years. The data were extracted for demographics, pretransplant characteristics, post-transplant outcomes, and analyzed for the impact of cardiac diagnosis on post-transplant outcomes. Standard statistical tests were used. Survival was compared using the Kaplan-Meier method. RESULTS Ninety of the 213 patients who underwent HLTX had CHD. There were no demographic differences. Heart listing status was similar but with a higher LAS score for NCHD. NCHD had higher pre-operative life support use (mechanical ventilation, inotropes or dialysis) but the use of ECMO as a bridge to transplantation was similar. Wait-list times were longer for CHD. The ischemic times were similar. Post-transplant dialysis, stroke, prolonged mechanical ventilation, and rejection were similar. Survival at 30-days, 1-year, and long-term survival at 17 years was similar. Non-survivors at 30-days post-transplant were on life support, used ECMO as a bridge, had lower wait-list times, longer ischemic times and had strokes. Non-survivors at 1-year had similar factors in addition to a higher dialysis use. CONCLUSION Cardiac diagnosis had no impact on outcomes after Pediatric HLTX. Patients on life support or ECMO before transplantation were transplanted faster but with lower survival.
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Affiliation(s)
| | - John Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, USA
| | | | - Pablo Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, USA
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Brocklebank P, Shorbaji K, Welch BA, Achurch MM, Kilic A. Trends and Outcomes of Combined Heart-Kidney and Heart-Lung Transplantation Over the Past Two Decades. J Surg Res 2024; 295:574-586. [PMID: 38091867 DOI: 10.1016/j.jss.2023.11.013] [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: 03/07/2023] [Revised: 09/26/2023] [Accepted: 11/09/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Combined heart-kidney transplantation (HKTx) and combined heart-lung transplantation (HLTx) remain the definitive therapy for patients with end-stage heart failure with concomitant end-stage renal or lung failure. We sought to study trends and outcomes of HKTx and HLTx over the last two decades. METHODS The United Network for Organ Sharing registry was used to identify all adult patients (aged >18 y) who underwent HKTx and HLTx between 2001 and 2021. Patients were divided into 5-y groups by the year of transplantation (2001-2006, 2007-2011, 2012-2016, and 2017-2021). Primary outcome was 1-y posttransplantation mortality. Kaplan-Meier and multivariable Cox proportional hazards models were used for unadjusted and risk-adjusted survival analyses, respectively. RESULTS A total of 2301 HKTx and 567 HLTx patients were included. Between 2001 and 2021, HKTx volume increased from 25 to 344 patients (P < 0.001) and centers performing HKTx increased from 19 to 76 (P < 0.001). On unadjusted analysis, 1-y survival after HKTx improved from 86.7% in 2001-2006 to 89.0% in 2017-2021 (log-rank, P = 0.005). On risk-adjusted analysis, the hazard ratio of 1-y mortality for 2017-2021 was 0.62 (0.39-1.00, P = 0.048) compared with that for 2001-2006. Between 2001 and 2021, HLTx volume increased from 21 to 43 patients (P < 0.001) and centers performing HLTx increased from 12 to 20 (P = 0.047). On unadjusted analysis, 1-y survival after HLTx improved from 68.9% in 2001-2006 to 83.9% in 2017-2021 (log-rank, P = 0.600). On risk-adjusted analysis, the hazard ratio of 1-y mortality for 2017-2021 was 0.37 (0.21-0.67, P = 0.001) compared with that for 2001-2006. CONCLUSIONS Over the last two decades, HKTx volume substantially increased and HLTx experienced resurgent growth. One-year survival persistently improved for both procedures, especially over the past 5 y.
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Affiliation(s)
- Paul Brocklebank
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Khaled Shorbaji
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Brett A Welch
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Mary Margaret Achurch
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Arman Kilic
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
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Dipchand AI, Webber SA. Pediatric heart transplantation: Looking forward after five decades of learning. Pediatr Transplant 2024; 28:e14675. [PMID: 38062996 DOI: 10.1111/petr.14675] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 02/07/2024]
Abstract
Heart transplantation has become the standard of care for pediatric patients with end-stage heart disease throughout the world. Since the first transplant was performed in 1967, the number of transplants has grown dramatically with 13 449 pediatric heart transplants being reported to The International Society of Heart and Lung Transplant (ISHLT) between January 1992 and June 30, 2018. Outcomes have consistently improved over the last few decades, specifically short-term outcomes. Most recent survival data demonstrate that recipients who survive to 1-year post-transplant have excellent long-term survival with more than 60% of those who were transplanted as infants being alive 25 years later. Nonetheless, the rates of graft loss beyond the first year have remained relatively constant over time; driven primarily by our poor understanding and lack of treatments for chronic allograft vasculopathy (CAV). Acute rejection, CAV, graft failure, and infection continue to be the major causes of death within the first 5 years post-transplant. In addition, renal dysfunction, malignancy, and the need for re-transplantation remain as significant issues that require close follow-up. Looking forward, key challenges include improving donor utilization rates (including donation after cardiac death (DCD) and the use of ex vivo perfusion devices), the development of non-invasive biomarkers for rejection, efforts to mitigate the long-term effects of immunosuppression, and prevention of CAV. It is not possible to cover the entire evolution of pediatric heart transplantation over the last five decades, but in this review, we hope to touch on key observations, lessons learned, and practice changes that have advanced the field, as well as glance ahead to the next decade.
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Affiliation(s)
- Anne I Dipchand
- Department of Paediatrics, Head, Heart Transplant, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt University School of Medicine, Pediatrician-in-Chief, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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4
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Kim D, Choi KH, Kim H, Lee JH, Kim Y, Byun JH. Right lower lung midline herniation as a rare complication in an infant with heart-lung transplantation: A case report. Pediatr Transplant 2024; 28:e14656. [PMID: 37984827 DOI: 10.1111/petr.14656] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Lung herniation is a rare complication of heart-lung transplantation that can be fatal owing to vascular compromise and airway obstruction. To date, only five cases of lung herniation related to heart-lung transplantation have been reported in the literature; however, to the best of our knowledge, this is the first worldwide report of heart-lung transplantation-related lung herniation in an infant. METHODS We describe the case of lung herniation as a rare heart-lung transplantation-related complication in an infant. A 12-month-old female baby developed severe bronchopulmonary dysplasia with severe pulmonary hypertension, and she underwent extracorporeal membrane oxygenation for cardiac collapse and lung support. Then, we performed heart-lung transplantation to manage the irreversible deterioration of her lung function. After the heart-lung transplantation, we found the radiological abnormalities persisted on follow-up chest radiographs until the 13th postoperative day diagnosed as lung herniation of the right lower lobe on chest computed tomography. RESULTS After the relocation of the herniated lung, the clinical condition of the patient improved, and the patient is currently growing without any respiratory symptoms. CONCLUSIONS In this case report, we emphasize that clinical awareness and high suspicion of this rare complication are needed for early diagnosis and proper treatment to prevent post-transplantation morbidity and mortality related to potential ischemic injury.
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Affiliation(s)
- Dohyung Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Korea
| | - Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Korea
| | - Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Korea
| | - Younga Kim
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Korea
| | - Joung-Hee Byun
- Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, Korea
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Spencer PJ, Saddoughi SA, Choi K, Dickinson TA, Richman A, Reynolds FA, Villavicencio MA. Heart-Lung Transplantation From Donation After Circulatory Death Using Mobile Normothermic Regional Perfusion. ASAIO J 2024; 70:e13-e15. [PMID: 37549658 DOI: 10.1097/mat.0000000000002029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Combined heart-lung transplant (HTLx) is the most durable treatment available for end-stage heart and lung failure. Many patients are unable to receive combined organs due to organ availability and allocation policies prioritizing separate heart or lung transplantation. While an average of 45 HTLxs have been performed per year in the United States half the listed patients do not receive organs. Recently, donation after circulatory death (DCD) utilizing normothermic regional perfusion (NRP) has been utilized for heart allografts with excellent results, and here, we present a case utilizing mobile NRP to procure a heart and lung block from a circulatory death donor and successful implantation for a recipient in a separate center.
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Affiliation(s)
- Philip J Spencer
- From the Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Ochoa CO, Navarro JC, Ávila OS, Bellorín AF, Gonzalez SA, Aixelá AM, Aragón CJ, Badia GS. Prognosis factors in heart-lung transplantation: 30 years experience in a reference center. Cir Esp 2024; 102:11-18. [PMID: 37984725 DOI: 10.1016/j.cireng.2023.08.004] [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: 03/13/2023] [Accepted: 08/08/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Heart-lung transplantation has shown a progressive decrease in the number of procedures. There is a lack of information about this field in Spain. The main goal of this study is to analyze the experience of a national reference hospital. METHODS We performed a retrospective study of a historical cohort of heart-lung transplanted patients in a single center, during a 30 years period (from 1990 to 2021). The associations between variables were evaluated using the χ2 test or Fisher's exact test. Survival was analyzed using the Kaplan-Meier method. Differences were evaluated using the log-rank test and multivariate analysis with the Cox method. RESULTS A decrease in the number of procedures performed in the last decade was observed [2000-2009: 19 procedures (44.2%); 2010-2021: 15 procedures (34.8%)]. Early postoperative mortality was 23.3%, falling to 13.3% from 2010. In-hospital mortality was 41%, falling to 33% from 2010. Main factors related to higher mortality: previous thoracic surgery, corticosteroid therapy, extracorporeal circulation (ECLS) greater than 200 min, ischemia time greater than 300 min, and tracheal dehiscence (p < 0.005). Overall survival at one, five, and ten years was 58%, 44.7%, and 36.1%, respectively. Factors associated with lower survival rates: previous thoracic surgery, male donor, extracorporeal circulation greater than 200 min, ischemia time greater than 300 min, tracheal dehiscence and weight difference (p < 0.005). CONCLUSIONS There has been a progressive decrease in the number of heart-lung transplantations, being more evident in the last decade, but showing an improvement in both mortality and survival.
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Affiliation(s)
- Carlos Ordoñez Ochoa
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Jose Cerón Navarro
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain.
| | - Olga Salamea Ávila
- Servicio de Neumología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Alilis Fontana Bellorín
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Stephania Aguilar Gonzalez
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Alfonso Morcillo Aixelá
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Carlos Jorda Aragón
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Gabriel Sales Badia
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
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Shudo Y, He H, Elde S, Woo YJ. Revised Heart Allocation Policy Improved Waitlist Mortality and Waiting Time With Maintained Outcomes in En-Bloc Heart-Lung Transplant Candidates and Recipients. Transpl Int 2023; 36:11956. [PMID: 38152546 PMCID: PMC10751310 DOI: 10.3389/ti.2023.11956] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023]
Abstract
The revised United Network for Organ Sharing heart allocation policy was implemented in October 2018. Using a national transplant database, this study evaluated the transplant rate, waitlist mortality, waiting time, and other outcomes of en-bloc heart-lung transplantation recipients. Adult patients registered on the national database for heart-lung transplants before and after the policy update were selected as cohorts. Baseline characteristics, transplant rates, waitlist mortality, waiting times, and other outcomes were compared between the two periods. In total, 370 patients were registered for heart-lung transplants during the pre- and post-periods. There were significantly higher transplant rates, shorter waitlist times, and substantially reduced waitlist mortality in the post-period. Registered patients waitlisted in the post-period had significantly higher utilization of intra-aortic balloon pumps, extracorporeal membrane oxygenation, and overall life support, including ventricular assist devices. Transplant recipients had significantly longer ischemic times, increased transport distances, and shorter waiting times before transplantation in the post-policy period. Transplant recipients held similar short-term survival before and after the policy change (log-rank test, p = 0.4357). Therefore, the revised policy significantly improved access to en-bloc heart-lung allografts compared with the prior policy, with better waitlist outcomes and similar post-transplant outcomes.
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Singh TP, Cherikh WS, Hsich E, Lewis A, Perch M, Kian S, Hayes D, Potena L, Stehlik J, Zuckermann A, Cogswell R. Graft survival in primary thoracic organ transplant recipients: A special report from the International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2023; 42:1321-1333. [PMID: 37549773 PMCID: PMC10901564 DOI: 10.1016/j.healun.2023.07.017] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Tajinder P Singh
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Wida S Cherikh
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Eileen Hsich
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Alexandra Lewis
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Michael Perch
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Shaina Kian
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Don Hayes
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Luciano Potena
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Josef Stehlik
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Andreas Zuckermann
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Rebecca Cogswell
- The International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Chicago, Illinois..
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Yan HJ, Zheng XY, Huang H, Xu L, Tang HT, Wang JJ, Li CH, Zhang SX, Fu SY, Wen HY, Tian D. Double-lung versus heart-lung transplantation for end-stage cardiopulmonary disease: a systematic review and meta-analysis. Surg Today 2023; 53:1001-1012. [PMID: 36068414 DOI: 10.1007/s00595-022-02579-4] [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: 03/15/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
We compared posttransplant outcomes following double-lung transplantation (DLTx) and heart-lung transplantation (HLTx), based on a search of PubMed, Cochrane Library, and Embase, from inception to March 8, 2022, for studies that report outcomes of these procedures. We then performed a meta-analysis of baseline characteristics and posttransplant outcomes. Subgroup analyses were implemented according to indication, publication year, and center. This study was registered on PROSPERO (number CRD42020223493). Ten studies were included in this meta-analysis, involving 1230 DLTx patients and 1022 HLTx patients. The DLTx group was characterized by older donors (P = 0.04) and a longer allograft ischemia time (P < 0.001) than the HLTx group. The two groups had comparable 1-year, 3-year, 5-year, 10-year survival rates (all P > 0.05), with similar results identified in subgroup analyses. We found no significant differences in 1-year, 5-year, and 10-year chronic lung allograft dysfunction (CLAD)-free survival, length of intensive care unit stay and hospital stay, length of postoperative ventilation, in-hospital mortality, or surgical complications between the groups (all P > 0.05). Thus, DLTx provides similar posttransplant survival to HLTx for end-stage cardiopulmonary disease. These two procedures have a comparable risk of CLAD and other posttransplant outcomes.
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Affiliation(s)
- Hao-Ji Yan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Xiang-Yun Zheng
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Heng Huang
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Lin Xu
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Hong-Tao Tang
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Jun-Jie Wang
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Cai-Han Li
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Sheng-Xuan Zhang
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Si-Yi Fu
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Hong-Ying Wen
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
| | - Dong Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China.
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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Chen Q, Emerson D, Megna D, Osho A, Roach A, Chan J, Rowe G, Gill G, Esmailian F, Chikwe J, Egorova N, Kirklin JK, Kobashigawa J, Catarino P. Heart transplantation using donation after circulatory death in the United States. J Thorac Cardiovasc Surg 2023; 165:1849-1860.e6. [PMID: 36049965 DOI: 10.1016/j.jtcvs.2022.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 02/14/2022] [Revised: 04/14/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Heart donation after circulatory death was recently reintroduced in the United States with hopes of increasing donor heart availability. We examined its national use and outcomes. METHODS The United Network for Organ Sharing database was used to identify validated adult patients undergoing heart transplantation using donation after circulatory death donors (n = 266) and donation after brain death donors (n = 5998) between December 1, 2019, and December 31, 2021, after excluding heart-lung transplants. Propensity score matching was used to create more balanced groups for comparison. RESULTS The monthly percentage of donation after circulatory death heart transplant increased from 2.5% in December 2019 to 6.8% in December 2021 (P < .001). Twenty-two centers performed donation after circulatory death heart transplants, ranging from 1 to 75 transplants per center. Four centers performed 70% of the national volume. Recipients of donation after circulatory death hearts were more likely to be clinically stable (80.4% vs 41.1% in status 3-6, P < .001), to have type O blood (58.3% vs 39.9%, P < .001), and to wait longer after listing (55, interquartile range, 15-180 days vs 32, interquartile range, 9-160 days, P = .003). Six-month survival was 92.1% (95% confidence interval, 91.3-92.8) after donation after brain death heart transplants and 92.6% (95% confidence interval, 88.1-95.4) after donation after circulatory death heart transplants (hazard ratio, 0.94, 95% confidence interval, 0.57-1.54, P = .79). Outcomes in propensity-matched patients were similar except for higher rates of treated acute rejection in donation after circulatory death transplants before discharge (14.4% vs 8.8%, P = .01). In donation after circulatory death heart recipients, outcomes did not differ based on the procurement technique (normothermic regional perfusion vs direct procurement and perfusion). CONCLUSIONS Heart transplantation with donation after circulatory death donors has short-term survival comparable to donation after brain death transplants. Broader implementation could substantially increase donor organ availability.
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Affiliation(s)
- Qiudong Chen
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Dominic Emerson
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Dominick Megna
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Asishana Osho
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Amy Roach
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Joshua Chan
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Georgina Rowe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - George Gill
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Fardad Esmailian
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Ala
| | - Jon Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Pedro Catarino
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
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Greenberg JW, Fatuzzo SH, Ramineni A, Chin C, Wittekind SG, Lorts A, Lehenbauer DG, Louis LB, Zafar F, Morales DLS. Heart transplant offers are less likely to be accepted on weekends, holidays, and conferences. J Heart Lung Transplant 2023; 42:345-353. [PMID: 36509608 DOI: 10.1016/j.healun.2022.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/20/2022] [Revised: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The existence of a "weekend effect" in heart transplantation (HTx) is understudied. The present study sought to determine whether the odds of (HTx) offer acceptance differed for adult and pediatric candidates depending upon the day on which the offer occurred. METHODS United Network for Organ Sharing data were used to identify all HTx offers to adult (listing age ≥18) and pediatric candidates from 2000-2019. Odds of offer acceptance were studied, comparing weekends, holidays, and conferences (Society of Thoracic Surgeons [STS], American Association for Thoracic Surgery [AATS], International Society for Heart and Lung Transplantation [ISHLT]) to "baseline" (all other days). Multivariable binary logistic regression analyses were performed to determine independent predictors of offer nonacceptance, controlling for the impacts of program transplant volume, region, and candidate characteristics. RESULTS A total of 323,953 offers occurred - 298,405 to adults and 25,548 to pediatric candidates. Clinically significant differences did not exist in donor or candidate characteristics between baseline or other events. The number of offers per day was stable throughout the year for both adults (p = 0.191) and pediatrics (p = 0.976). In adults, independently lower odds of acceptance existed on weekends (OR 0.88 [95% CI 0.84-0.92]), conferences in aggregate (0.86 [0.77-0.95]), and holidays in aggregate (0.81 [0.72-0.91]). In children, independently lower odds of acceptance were seen on weekends (0.88 [0.79-0.98]), during STS (0.46 [0.25-0.83], and during Christmas (0.32 [0.14-0.76]). CONCLUSIONS The day on which a HTx offer occurs significantly impacts its likelihood of acceptance. Further work can determine the impacts of human behavior or resource distribution, but knowledge of this phenomenon can inform efforts to ensure ideal organ allocation throughout the year.
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Affiliation(s)
- Jason W Greenberg
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Stephen H Fatuzzo
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Aadhyasri Ramineni
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Clifford Chin
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Samuel G Wittekind
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David G Lehenbauer
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Louis B Louis
- Division of Cardiothoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Pérot P, Fourgeaud J, Rouzaud C, Regnault B, Da Rocha N, Fontaine H, Le Pavec J, Dolidon S, Garzaro M, Chrétien D, Morcrette G, Molina TJ, Ferroni A, Leruez-Ville M, Lortholary O, Jamet A, Eloit M. Circovirus Hepatitis Infection in Heart-Lung Transplant Patient, France. Emerg Infect Dis 2023; 29:286-293. [PMID: 36596569 PMCID: PMC9881760 DOI: 10.3201/eid2902.221468] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In March 2022, a 61-year-old woman in France who had received a heart-lung transplant sought treatment with chronic hepatitis mainly characterized by increased liver enzymes. After ruling out common etiologies, we used metagenomic next-generation sequencing to analyze a liver biopsy sample and identified an unknown species of circovirus, tentatively named human circovirus 1 (HCirV-1). We found no other viral or bacterial sequences. HCirV-1 shared 70% amino acid identity with the closest known viral sequences. The viral genome was undetectable in blood samples from 2017-2019, then became detectable at low levels in September 2020 and peaked at very high titers (1010 genome copies/mL) in January 2022. In March 2022, we found >108 genome copies/g or mL in the liver and blood, concomitant with hepatic cytolysis. We detected HCirV-1 transcripts in 2% of hepatocytes, demonstrating viral replication and supporting the role of HCirV-1 in liver damage.
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Affiliation(s)
| | | | | | - Béatrice Regnault
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Nicolas Da Rocha
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Hélène Fontaine
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Jérôme Le Pavec
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Samuel Dolidon
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Margaux Garzaro
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Delphine Chrétien
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Guillaume Morcrette
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Thierry Jo Molina
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Agnès Ferroni
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
| | - Marianne Leruez-Ville
- Institut Pasteur Pathogen Discovery Laboratory, Paris, France (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- The OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Paris (P. Pérot, B. Regnault, N. Da Rocha, D. Chrétien, M. Eloit)
- Institut Imagine, Paris (J. Fourgeaud, M. Leruez-Ville); Université Paris Cité, Paris (J. Fourgeaud, A. Jamet)
- Necker-Enfants Malades Hospital, Paris (J. Fourgeaud, G. Morcrette, T.J. Molina, A. Ferroni, M. Leruez-Ville, A. Jamet)
- Hôpital Necker Enfants-Malades Centre d'Infectiologie Necker-Pasteur, Paris (C. Rouzaud, M. Garzaro, O. Lortholary)
- Groupe Hospitalier Paris Saint Joseph-Marie Lannelongue, Équipe Mobile de Microbiologie Clinique, Paris (C. Rouzaud)
- Hôpital Cochin Département d'Hépatologie-Addictologie, Paris (H. Fontaine)
- Université Paris–Sud, Paris (J. Le Pavec)
- Hôpital Marie Lannelongue Service de Pneumologie et Transplantation Pulmonaire, Le Plessis-Robinson, France (J. Le Pavec, S. Dolidon)
- Institut Necker Enfants Malades, Paris (A. Jamet)
- Ecole Nationale Vétérinaire d’Alfort, Maisons-Alfort, France (M. Eloit)
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Weder MM, Aslam S, Ison MG. Lung Transplantation for COVID-19-related Lung Disease: Clinical Experience and Call for a Global Registry. Transplantation 2023; 107:18-20. [PMID: 35969003 PMCID: PMC9746226 DOI: 10.1097/tp.0000000000004327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/13/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Max M. Weder
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Michael G. Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL
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Yang Z, Takahashi T, Terada Y, Meyers BF, Kozower BD, Patterson GA, Nava RG, Hachem RR, Witt CA, Byers DE, Kulkarni HS, Guillamet RV, Yan Y, Chang SH, Kreisel D, Puri V. A comparison of outcomes after lung transplantation between European and North American centers. J Heart Lung Transplant 2022; 41:1729-1735. [PMID: 35970646 PMCID: PMC10305841 DOI: 10.1016/j.healun.2022.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/25/2022] [Revised: 06/19/2022] [Accepted: 07/14/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With advancements in basic science and clinical medicine, lung transplantation (LT) has evolved rapidly over the last three decades. However, it is unclear if significant regional variations exist in long-term outcomes after LT. METHODS To investigate potential differences, we performed a retrospective, comparative cohort analysis of adult patients undergoing deceased donor single or double LT in North America (NA) or Europe between January 2006 and December 2016. Data up to April 2019 were abstracted from the International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Registry. We compared overall survival (OS) between North American and European LT centers in a propensity score matched analysis. RESULTS In 3,115 well-matched pairs, though 30-day survival was similar between groups (NA 96.2% vs Europe 95.4%, p = 0.116), 5-year survival was significantly higher in European patients (NA 60.1% vs Europe 70.3%, p < 0.001). CONCLUSIONS This survival difference persisted in a sensitivity analysis excluding Canadian patients. Prior observations suggest that these disparities are at least partly related to better access to care via universal healthcare models prevalent in Europe. Future studies are warranted to confirm our findings and explore other causal mechanisms. It is likely that potential solutions will require concerted efforts from healthcare providers and policymakers.
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Affiliation(s)
- Zhizhou Yang
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Tsuyoshi Takahashi
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri.
| | - Yuriko Terada
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | | | - Ruben G Nava
- Division of Cardiothoracic 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
| | - Hrishikesh S Kulkarni
- Division of Pulmonology and Critical Care, Washington University, St. Louis, Missouri
| | | | - Yan Yan
- Division of Public Health Sciences, Washington University, St. Louis, Missouri
| | - Su-Hsin Chang
- Division of Public Health Sciences, Washington University, St. Louis, Missouri
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
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15
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Israni AK, David SD, Bruin MJ, Chu S, Snyder JJ, Hertz M, Valapour M, Kasiske B, McKinney WT, Schaffhausen CR. Deconstructing Silos of Knowledge Around Lung Transplantation to Support Patients: A Patient-specific Search of Scientific Registry of Transplant Recipients Data. Transplantation 2022; 106:1517-1519. [PMID: 35152256 PMCID: PMC9329153 DOI: 10.1097/tp.0000000000004051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ajay K. Israni
- Hennepin Healthcare Research Institute, Nephrology Division, Minneapolis, MN
- Scientific Registry of Transplant Recipients (SRTR), Minneapolis, MN
- Nephrology Division, Hennepin Healthcare, Minneapolis, MN
| | | | | | - Sauman Chu
- College of Design, University of Minnesota, Minneapolis, MN
| | - Jon J. Snyder
- Scientific Registry of Transplant Recipients (SRTR), Minneapolis, MN
| | - Marshall Hertz
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN
| | | | - Bertram Kasiske
- Scientific Registry of Transplant Recipients (SRTR), Minneapolis, MN
- Nephrology Division, Hennepin Healthcare, Minneapolis, MN
| | - Warren T. McKinney
- Hennepin Healthcare Research Institute, Nephrology Division, Minneapolis, MN
- Scientific Registry of Transplant Recipients (SRTR), Minneapolis, MN
| | - Cory R. Schaffhausen
- Hennepin Healthcare Research Institute, Nephrology Division, Minneapolis, MN
- Scientific Registry of Transplant Recipients (SRTR), Minneapolis, MN
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Shudo Y, Elde S, Lingala B, He H, Casselman KG, Zhu Y, Kasinpila P, Woo YJ. Extracorporeal Membrane Oxygenation Bridge to Heart-Lung Transplantation. ASAIO J 2022; 68:e44-e47. [PMID: 34843181 DOI: 10.1097/mat.0000000000001457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yasuhiro Shudo
- From the Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
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17
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Chambers DC, Zuckermann A, Cherikh WS, Harhay MO, Hayes D, Hsich E, Khush KK, Potena L, Sadavarte A, Singh TP, Stehlik J. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: 37th adult lung transplantation report - 2020; focus on deceased donor characteristics. J Heart Lung Transplant 2020; 39:1016-1027. [PMID: 32782073 PMCID: PMC7737221 DOI: 10.1016/j.healun.2020.07.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Daniel C Chambers
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Andreas Zuckermann
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Wida S Cherikh
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Michael O Harhay
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Don Hayes
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Eileen Hsich
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Kiran K Khush
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Luciano Potena
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Aparna Sadavarte
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Tajinder P Singh
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas
| | - Josef Stehlik
- International Thoracic Organ Transplant Registry, International Society for Heart and Lung Transplantation, Dallas, Texas.
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18
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Albinni S, Marx M, Lang IM. Focused Update on Pulmonary Hypertension in Children-Selected Topics of Interest for the Adult Cardiologist. Medicina (Kaunas) 2020; 56:E420. [PMID: 32825190 PMCID: PMC7559541 DOI: 10.3390/medicina56090420] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/16/2022]
Abstract
Pulmonary hypertensive vascular disease (PHVD), and pulmonary hypertension (PH), which is a broader term, are severe conditions associated with high morbidity and mortality at all ages. Treatment guidelines in childhood are widely adopted from adult data and experience, though big differences may exist regarding aetiology, concomitant conditions and presentation. Over the past few years, paediatric aspects have been incorporated into the common guidelines, which currently address both children and adults with pulmonary hypertension (PH). There are multiple facets of PH in the context of cardiac conditions in childhood. Apart from Eisenmenger syndrome (ES), the broad spectrum of congenital heart disease (CHD) comprises PH in failing Fontan physiology, as well as segmental PH. In this review we provide current data and novel aspects on the pathophysiological background and individual management concepts of these conditions. Moreover, we focus on paediatric left heart failure with PH and its challenging issues, including end stage treatment options, such as mechanical support and paediatric transplantation. PH in the context of rare congenital disorders, such as Scimitar Syndrome and sickle cell disease is discussed. Based on current data, we provide an overview on multiple underlying mechanisms of PH involved in these conditions, and different management strategies in children and adulthood. In addition, we summarize the paediatric aspects and the pros and cons of the recently updated definitions of PH. This review provides deeper insights into some challenging conditions of paediatric PH in order to improve current knowledge and care for children and young adults.
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Affiliation(s)
- Sulaima Albinni
- Paediatric Heart Centre Vienna, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Wien, Austria;
| | - Manfred Marx
- Paediatric Heart Centre Vienna, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Wien, Austria;
| | - Irene M. Lang
- AKH-Vienna, Department of Cardiology, Medical University of Vienna, 1090 Wien, Austria;
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19
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Briasoulis A, Akintoye E, Kuno T, Alvarez P. Characteristics and Outcomes of Patients Undergoing Combined Organ Transplantation (from the United Network for Organ Sharing). Am J Cardiol 2020; 129:42-45. [PMID: 32540168 DOI: 10.1016/j.amjcard.2020.05.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/06/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022]
Abstract
Studies have shown that highly selected patients who underwent combined heart-kidney (HK) and heart-liver transplants (HLv) have short- and long-term outcomes comparable to those observed in primary heart transplantation (HT). Adults patients with stage D heart failure that underwent combined HK, HLv, and heart-lung (HL) were identified in the United Network for Organ Sharing registry from 1991 to 2016, with follow-up through March 2018. We conducted inverse probability of treatment weighting survival analysis of long-term survival stratified by type of combined organ transplant, accounting for donor, recipient, and operative characteristics. We identified 2,300 patients who underwent combined organ transplant (HK 1,257, HLv 212, HL 831). HL recipients were more likely white (77%), women (58%), with congenital heart disease (44.5%), and longer waiting list time (median 195 days). HK transplant increased significantly during the study period where as HL decreased significantly. Median survival was 12.2 years for HK (95% confidence intervals [CI] 10.8 to 12.8), 12 for HLv (95% CI 8.6 to 17.6) but significantly lower at 4.5 years for HL (95% CI 3.6 to 5.8). Combined HK and HLv transplantation rates are increasing and long-term survival is comparable to primary HT, unlike HL which is associated with decreasing trends and significantly lower survival.
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Affiliation(s)
- Alexandros Briasoulis
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Emmanuel Akintoye
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Toshiki Kuno
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Paulino Alvarez
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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20
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Chambers DC, Cherikh WS, Harhay MO, Hayes D, Hsich E, Khush KK, Meiser B, Potena L, Rossano JW, Toll AE, Singh TP, Sadavarte A, Zuckermann A, Stehlik J. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult lung and heart-lung transplantation Report-2019; Focus theme: Donor and recipient size match. J Heart Lung Transplant 2019; 38:1042-1055. [PMID: 31548030 PMCID: PMC6816340 DOI: 10.1016/j.healun.2019.08.001] [Citation(s) in RCA: 485] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Daniel C Chambers
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Wida S Cherikh
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Michael O Harhay
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Don Hayes
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Eileen Hsich
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Kiran K Khush
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Bruno Meiser
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Luciano Potena
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Joseph W Rossano
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Alice E Toll
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Tajinder P Singh
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Aparna Sadavarte
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Andreas Zuckermann
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas
| | - Josef Stehlik
- International Society for Heart and Lung Transplantation, International Thoracic Organ Transplant Registry, Dallas, Texas.
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21
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Ruygrok PN. Transplantation: the final hurdle to longevity in patients with congenital heart disease. Heart 2019; 105:582-583. [PMID: 30636221 DOI: 10.1136/heartjnl-2018-314262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Zhang J, Patel S, Clavijo L, Laughrun D. Successful Implementation of Extracorporeal Membrane Oxygenation Support as a Bridge to Heart-Lung Transplantation in an Eisenmenger's Syndrome Patient With Paradoxical Coronary Embolism. J Investig Med High Impact Case Rep 2019; 7:2324709619846575. [PMID: 31053036 PMCID: PMC6505230 DOI: 10.1177/2324709619846575] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 11/24/2022] Open
Abstract
We report a case of a 23-year-old female with a history of unrepaired ventricular septal defect and pulmonary arterial hypertension with Eisenmenger's syndrome (ES) presenting with chest pain. Electrocardiography demonstrated new anterior Q waves and anterolateral ST elevations, and coronary angiography revealed a large organized thrombus in the mid-left anterior descending artery consistent with paradoxical coronary embolism. Patient was treated with percutaneous coronary intervention and aggressive anticoagulation management. Intensive care unit course was complicated by respiratory failure requiring intubation due to hospital-acquired pneumonia in the setting of severe pulmonary hypertension. Patient was emergently initiated on veno-venous extracorporeal membrane oxygenation support (ECMO) as a bridge to heart-lung transplantation. After initiation of ECMO, patient displayed significant clinical improvement and underwent successful heart-lung transplantation. This case highlights veno-venous ECMO as a bridge to heart-lung transplantation in acutely decompensated patients with ES, and is the first reported case of paradoxical coronary embolism in a patient with ES.
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Affiliation(s)
- James Zhang
- University of Southern California, Los Angeles, CA, USA
| | - Sumit Patel
- University of Southern California, Los Angeles, CA, USA
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23
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Daoud D, Cheema FH, Morgan JA, Loor G. Sex-Related Differences in Outcomes of Thoracic Organ Transplantation and Mechanical Circulatory Support. Tex Heart Inst J 2018; 45:240-242. [PMID: 30374236 DOI: 10.14503/thij-18-6710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Matsumoto Y, Imada T, Kamibayashi T, Iritakenishi T, Shibata SC, Fujino Y. [Anesthetic Management for Heart-Lung Transplantation Report of 2 Cases from Japan]. Masui 2016; 65:1220-1225. [PMID: 30379458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Heart and lung transplantation (HLT) is the surgical procedure for congenital heart disease and cardiomy- opathy with pulmonary hypertension. HLT is rare in the world and has been performed only twice until October, 2014 at our hospital in Japan. We report the anesthetic management for HLT.
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25
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Jamieson SW. Heart and heart-lung transplantation. Adv Cardiol 2015; 36:267-9. [PMID: 3149140 DOI: 10.1159/000415643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- S W Jamieson
- Division of Cardiovascular and Thoracic Surgery, University of Minnesota Hospital, Minneapolis
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26
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Thistlethwaite PA. Invited commentary. Ann Thorac Surg 2015; 99:1038-9. [PMID: 25742824 DOI: 10.1016/j.athoracsur.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 12/31/2014] [Accepted: 01/05/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Patricia A Thistlethwaite
- Division of Cardiothoracic Surgery, University of California, San Diego, 9300 Campus Point Dr, La Jolla, CA92037-7892.
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27
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Bobylev D, Sommer W, Avsar M, Horke A, Haverich A, Warnecke G. Aortopulmonary window: a rare untreated adult case. Heart Lung Circ 2014; 23:e235-6. [PMID: 25035159 DOI: 10.1016/j.hlc.2014.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/09/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Dmitry Bobylev
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Wiebke Sommer
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Division of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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28
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Ormiston ML, Southgate L, Treacy C, Pepke-Zaba J, Trembath RC, Machado RD, Morrell NW. Assessment of a pulmonary origin for blood outgrowth endothelial cells by examination of identical twins harboring a BMPR2 mutation. Am J Respir Crit Care Med 2013; 188:258-60. [PMID: 23855704 DOI: 10.1164/rccm.201301-0078le] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Goldman A. The promise of young hearts in London: aided by F1 Racing. Interview by Barry Shurlock. Eur Heart J 2013; 34:708-710. [PMID: 23596630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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30
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Liu L, Ye Q, Wu Y, Hsieh WY, Chen CL, Shen HH, Wang SJ, Zhang H, Hitchens TK, Ho C. Tracking T-cells in vivo with a new nano-sized MRI contrast agent. Nanomedicine 2012; 8:1345-54. [PMID: 22406186 DOI: 10.1016/j.nano.2012.02.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/24/2012] [Accepted: 02/19/2012] [Indexed: 12/24/2022]
Abstract
UNLABELLED Non-invasive in vivo tracking of T-cells by magnetic resonance imaging (MRI) can lead to a better understanding of many pathophysiological situations, including AIDS, cancer, diabetes, graft rejection. However, an efficient MRI contrast agent and a reliable technique to track non-phagocytic T-cells are needed. We report a novel superparamagnetic nano-sized iron-oxide particle, IOPC-NH2 series particles, coated with polyethylene glycol (PEG), with high transverse relaxivity (250 s(-1) mM(-1)), thus useful for MRI studies. IOPC-NH2 particles are the first reported magnetic particles that can label rat and human T-cells with over 90% efficiency, without using transfection agents, HIV-1 transactivator peptide, or electroporation. IOPC-NH2 particles do not cause any measurable effects on T-cell properties. Infiltration of IOPC-NH2-labeled T-cells can be detected in a rat model of heart-lung transplantation by in vivo MRI. IOPC-NH2 is potentially valuable contrast agents for labeling a variety of cells for basic and clinical cellular MRI studies, e.g., cellular therapy. FROM THE CLINICAL EDITOR In this study, a novel PEG coated superparamagnetic nano-sized iron-oxide particle was investigated as a T-cell labeling agent for MRI studies. The reported particles can label T-cells with over 90% efficiency, without using transfection agents, HIV-1 transactivator peptide, or electroporation, therefore may enable more convenient preclinical call labeling studies.
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Affiliation(s)
- Li Liu
- Pittsburgh NMR Center for Biomedical Research and Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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31
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Affiliation(s)
- E Wesley Ely
- Pulmonary and Critical Care and Health Services Research, Vanderbilt University School of Medicine and VA-GRECC, Nashville, Tennessee, USA.
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32
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Rose J, Zimmerman H, Coelho-Anderson R, Copeland JG. Twenty-five-year survival after heart-lung transplantation: a milestone. J Heart Lung Transplant 2010; 30:385-8. [PMID: 21185204 DOI: 10.1016/j.healun.2010.10.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 10/02/2010] [Accepted: 10/22/2010] [Indexed: 11/19/2022] Open
Abstract
Limited information about long-term survivors of heart-lung transplant recipients exists. We report a 57-year-old man who has now survived 25 years after a heart-lung transplant. Initial induction and maintenance immunotherapy was rabbit anti-thymocyte globulin, cyclosporine, azathioprine, and methylprednisolone. This patient is currently alive and working 25 years later and has continued good function of the heart-lung graft,without evidence of bronchiolitis obliterans.
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Contat C, Vicente R, Ramos F, Moreno I, Barberá M. [Lung transplant in patients with sarcoidosis: 2 case reports and a pathophysiologic review]. Rev Esp Anestesiol Reanim 2009; 56:635-640. [PMID: 20151527 DOI: 10.1016/s0034-9356(09)70481-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Lung transplantation is an appropriate therapeutic option for patients with advanced sarcoidosis that has not responded to medical treatment. The causes of sarcoidosis are unknown and the course of disease and prognosis are highly variable. As it is difficult to determine the ideal timing for a transplant or the type of transplant to perform, this may influence the high perioperative mortality in these patients. Postoperative morbidity and mortality rates are high when pulmonary hypertension is present before the transplant or when primary graft failure, acute rejection, infection, or other complications develop afterwards. We describe 2 patients with a diagnosis of end-stage sarcoidosis who received a lung transplant and a heart-lung transplant. The outcomes were different in each case. We analyze factors related to morbidity and mortality that determined the outcomes.
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Affiliation(s)
- C Contat
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Fe, Valencia.
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Zhang X, Xiong M, Wang ZP, Yin SL, Wu ZK, Xu YQ, Tang BY, Yao JP, Chen GX. Heart-lung transplantation for end-stage heart disease with Eisenmenger's syndrome: report of two cases. Chin Med J (Engl) 2009; 122:2189-2192. [PMID: 19781310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Xi Zhang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
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35
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Paul S, Escareno CE, Clancy K, Jaklitsch MT, Bueno R, Lautz DB. Gastrointestinal complications after lung transplantation. J Heart Lung Transplant 2009; 28:475-9. [PMID: 19416776 DOI: 10.1016/j.healun.2009.02.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [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: 10/22/2008] [Revised: 01/20/2009] [Accepted: 02/19/2009] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Gastrointestinal complications after lung transplantation remain a common yet poorly defined problem. In this study we examine our experience with gastrointestinal complications after lung transplantation. METHODS Between August 1990 and June 2005, we retrospectively analyzed 208 patients who had undergone lung transplantation (single, 65% [137 of 212]; double, 34% [72 of 212]; heart-lung, 0.5% [2 of 212]; living related, 0.5% [1 of 212]). Four patients were retransplanted. Gastrointestinal complications were defined as any post-transplant diagnosis related to the gastrointestinal tract. RESULTS Ninety of 208 (43%) transplant patients developed 113 gastrointestinal complications during follow-up (median 3.5 years [62 days to 10.0 years]). Biliary etiology was the most common (12% [25 of 208]), requiring cholecystectomy in 13 patients. Diarrheal syndromes occurred in 21 patients (10%) with 2 patients requiring laparotomies. Small bowel obstruction and/or gastroparesis were present in 17 (5%) and 12 (6%) patients, respectively. Fourteen patients required surgical lysis of adhesions for small bowel obstruction and 7 patients underwent gastric drainage procedures. Three patients had peptic ulcer disease with 2 patients requiring laparotomy for perforated duodenal ulcer. Ten patients developed gastrointestinal bleeding with 1 requiring a colectomy. Three patients presented with diverticulitis and 2 required colectomy. Three patients required laparotomy due to intraperitoneal leakage of gastric secretions after gastromy tube placement. Eleven (16%) deaths were directly related to gastrointestinal complications. Of those patients who required a laparotomy for indications other than cholelithiasis, 9 (35%) died within 8 weeks. CONCLUSIONS Gastrointestinal complications are common after lung transplantation and are associated with considerable morbidity and mortality. Vigilance is required for early recognition and prompt treatment.
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Affiliation(s)
- Subroto Paul
- Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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36
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Dartevelle P, Fadel E, Mussot S, Le Roy Ladurie F. [Surgical treatment of pulmonary arterial hypertension]. Rev Prat 2008; 58:2031-2035. [PMID: 19143275] [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: 05/27/2023]
Abstract
The most accurate treatment of obstructive pulmonary arterial hypertension (PAH) is the obstruction relief by surgery. Pulmonary endarterectomy is the treatment of choice of chronic thromboembolic pulmonary disease, the major cause of obstructive PAH. This procedure is associated with a low mortality rate in experienced centres and results in a dramatic improvement of hemodynamic parameters, functional status and survival rate. This surgery must be performed as early as possible in the history of this disease, preferentially before arteriolitis development in the non obstructed territories. The other obstructive PAH such as angiosarcomas, echinococcosis, arteritis, fibrosing mediastinitis can also be surgically treated by endarterectomy, tumorectomy or by pass according to their aetiology. By contrast lung transplantation is a palliative treatment indicated only after failure of medical treatment in an end-stage disease. Lung and heart-lung transplantation for PAH are associated with a 5 and 10 year actuarial survival rate of 50% and 35% respectively related to a higher postoperative mortality rate than for other organ transplantation and frequent development of graft obliterans bronchiolitis.
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Affiliation(s)
- Philippe Dartevelle
- Université Paris-sud, département de chirurgie thoracique vasculaire et transplantation cardio-pulmonaire, hôpital Marie-Lannelongue, 92350 Le Plessis-Robinson, France.
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37
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Okada Y, Kondo T. [Current status of lung and heart-lung transplantation for pulmonary arterial hypertension]. Nihon Rinsho 2008; 66:2179-2184. [PMID: 19051740] [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: 05/27/2023]
Abstract
Lung transplantation (LT) or heart-lung transplantation (HLT) had been a mainstay of treatment for pulmonary arterial hypertension (PAH) since the 1980s. Considerable advances in the medical therapy over the past decade, however, changed the paradigm of treatment algorithm for PAH, and LT in any form became a therapeutic option for patients deteriorating despite the best available medical therapy. On the basis of a shortage of available organs for transplantation, most centers prefer bilateral LT to HLT as the procedure of choice. According to the international registry, survival rates following bilateral LT for PAH are 81% at 1 month, 68% at 1 year, and 50% at 5 years. Improvement in the survival rate in early post-operative periods is a matter of critical concern in LT for PAH.
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Affiliation(s)
- Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University
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Fakler U, Mebus S, Kaemmerer H, Will A, Eicken A, Weiss M, Reichard B, Hess J. A ticking time bomb--high pressure pulmonary artery aneurysm. Am J Med 2008; 121:777-80. [PMID: 18724967 DOI: 10.1016/j.amjmed.2008.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 05/31/2008] [Accepted: 06/02/2008] [Indexed: 11/18/2022]
Affiliation(s)
- Ullrich Fakler
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Technische Universität München, Germany.
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Goerler H, Simon A, Gohrbandt B, Hagl C, Oppelt P, Weidemann J, Haverich A, Strueber M. Heart-lung and lung transplantation in grown-up congenital heart disease: long-term single centre experience. Eur J Cardiothorac Surg 2007; 32:926-31. [PMID: 17900918 DOI: 10.1016/j.ejcts.2007.08.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [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: 04/06/2007] [Revised: 07/10/2007] [Accepted: 08/24/2007] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Because of considerable progress in paediatric cardiac surgery life expectancy of patients with congenital heart disease (CHD) has improved significantly over the years. There are a growing number of adults with CHD presenting with progressive decline of cardiopulmonary function and Eisenmenger's syndrome. We analysed our experience with heart-lung and lung transplantation in this patient group. METHODS Since 1988, a total of 46 heart-lung transplantations and 5 double lung transplantations have been performed in adults with CHD at our institution. Underlying diagnoses were: ventricular septal defect, atrial septal defect, persistent ductus arteriosus and others. Pulmonary hypertension was present in all patients. Twelve patients had undergone previous cardiac procedures. All patients were included in this retrospective analysis. Mean follow up was 5.1+/-4.7 years. Patient survival was estimated with the Kaplan-Meier method and analysed using the log-rank test. RESULTS Thirty-day mortality was 11.8% (n=6). Survival was 80% at 1 year, 69% at 5 years and 53% at 10 years. Major causes of death were infection and sepsis, chronic rejection, initial graft failure and acute rejection. Compared to the overall mortality after lung and heart-lung transplantation for other indications at our institution there was no significant difference (1 year, 5 years, 10 years: 76%; 60%; 45%), but a tendency towards a better long-time survival of the CHD patients. CONCLUSIONS Lung and heart-lung transplantation can be performed with an acceptable risk and a favourable long-term outcome in patients with grown-up CHD. Careful patient selection and planning of the surgical strategy is essential in this high-risk patient population.
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Affiliation(s)
- Heidi Goerler
- Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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Place S, Knoop C, Remmelink M, Baldassarre S, Van Vooren JP, Jacobs F, Mascart F, Estenne M. Paradoxical worsening of tuberculosis in a heart?lung transplant recipient. Transpl Infect Dis 2007; 9:219-24. [PMID: 17692068 DOI: 10.1111/j.1399-3062.2006.00194.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED We report on a heart-lung transplant recipient who presented with pulmonary tuberculosis (TB) 2.5 months after transplantation and then developed a paradoxical reaction after 4 months of adequate anti-TB treatment. She eventually recovered with anti-TB and high-dose steroid treatments. METHODS Using sequential bronchoalveolar lavages, we assessed the inflammatory response in the lung and investigated the alveolar immune response against a Mycobacterium tuberculosis antigen. RESULTS The paradoxical reaction was characterized by a massive infiltration of the alveolar space by M. tuberculosis antigen-specific CD4(+) T cells and by the presence of a CD4(-)CD8(-) T lymphocyte subpopulation bearing phenotypic markers (CD16(+)/56(+)) classically associated with NK cells. CONCLUSION This case report illustrates that even solid organ transplant recipients receiving intense triple-drug immune suppression may be able to develop a paradoxical reaction during TB treatment. Transplant physicians should be aware of this phenomenon in order to differentiate it from treatment failure.
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Affiliation(s)
- S Place
- Laboratory of Vaccinology and Mucosal Immunity, Erasme Univeristy Hospital, Free University of Brussels, Brussels, Belgium
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Pérez-Enguix D, Morales P, Tomás JM, Vera F, Lloret RM. Computed Tomographic Screening of Pulmonary Arterial Hypertension in Candidates for Lung Transplantation. Transplant Proc 2007; 39:2405-8. [PMID: 17889203 DOI: 10.1016/j.transproceed.2007.07.055] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Computed tomography (CT) is essential to evaluate candidates for lung transplantation (LT) We sought to correlate identification of pulmonary arterial hypertension (PAH) via CT to echocardiographic (Eco) and/or hemodynamic observations (Hd) as well as the pathological findings (Path) at posttransplant pneumonectomy. MATERIALS AND METHODS The study included 24 consecutive months follow-up of 71 patients who were referred for LT evaluation with 54 undergoing LT. Study parameters included CT [diameter of the principal pulmonary artery (PPA) >or= 29 mm), PPA/diameter of the ascending aorta (AA) ratio > 1; diameter of the lobar artery (LA)/diameter of the lobar bronchiole (LB) ratio > 1 in three or more lobes; thickening of the anterosuperior pericardial recess (>15 mm); mosaic lung density pattern]; PAPs via Eco and/or Hd, and findings Path of PAH. Statistical analysis included chi-square and Pearson correlation coefficient. RESULTS Thirty-five patients had PAH. Significant relationships (P < .05) were observed between PAH (Eco and/or Hd) and PPA, PPA/AA, and LA/LB. The sensitivity of the finding PPA >or= 29 mm was 65.9%, and 85.7% when combined with LA/LB > 1. In the Path study, 14/54 patients revealed alterations compatible with PAH. Significant relationships (P < .05) were observed between PAH via Path and PPA (CT) and between PAH via Path and PAH (Eco and/or Hd). CONCLUSIONS CT is useful for the detection of PAH. Findings of PAH via CT were indicative of the need for further confirmatory studies. In contrast, the absence of findings with CT does not exclude the possible presence of PAH.
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Affiliation(s)
- D Pérez-Enguix
- Radiology Department, La Fe Universitary Hospital, Valencia, Spain.
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Pipet A, Mallet JP, Marty C, Sandron D, Benard L, Leberre JY, Thibaut F, Morin O, Bettembourg A. [Pulmonary mucormycosis: difficulties in diagnosis and treatment]. Rev Mal Respir 2007; 24:617-21. [PMID: 17519813 DOI: 10.1016/s0761-8425(07)91129-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Mucormycosis is a rare opportunistic fungal infection due to filamentous fungi of the order Mucorales in the class Zygomycetes. Rhino-cerebral and pulmonary manifestations predominate on account of the airborn spread of the spores. Gastro-intestinal, cutaneous and disseminated disease is less common. The principal risk factors are immuno-suppression and diabetic keto-acidosis. CASE REPORTS One case of fatal pulmonary mucormycosis and two cases of colonisation illustrate both the extreme severity of this disease and the diagnostic difficulties facing the physician. The ubiquitous nature of the organism leads to frequent colonisation and, moreover, the symptomatology readily mimics that of invasive pulmonary aspergillosis. The diagnosis of mucormycosis can only be confirmed by pathological and mycological examination of biopsy specimens. These requirements conflict with the need for urgent treatment with surgical debridement, amphotericin B and control of the underlying pathology. Sadly the mortality remains very high, between 50 and 80% in published series. CONCLUSION Currently there is hope of new therapeutic approaches with posaconozole but the ineffectiveness of voriconozole and the echinocandines, used more and more against aspergillus, raises the possibility of an increase in mucormycosis by selection.
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Affiliation(s)
- A Pipet
- Service de Pneumologie, Centre Hospitalo-Universitaire de Nantes, France.
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Roithmaier S, Haydon AM, Loi S, Esmore D, Griffiths A, Bergin P, Williams TJ, Schwarz MA. Incidence of Malignancies in Heart and/or Lung Transplant Recipients: A Single-Institution Experience. J Heart Lung Transplant 2007; 26:845-9. [PMID: 17692790 DOI: 10.1016/j.healun.2007.05.019] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [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: 12/22/2006] [Revised: 04/11/2007] [Accepted: 05/30/2007] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the incidence and type of malignancies in heart and/or lung transplant recipients at a single institution in Victoria, Australia, and to compare these findings with the non-transplant general Victorian population. METHODS Recipients of heart and/or lung transplants at the Alfred Hospital between February 1989 and January 2004 were cross-referenced with the Victorian Cancer Registry. The medical records of all patients with a cancer diagnosis by January 1, 2005 were reviewed. Data were collected on baseline demographics, including cancer type, stage, treatment and survival. Cancer incidence was then compared with rates found in the Victorian population. RESULTS There were 907 transplants (Tx) conducted between February 1989 and January 1, 2004 on 905 patients, which included 424 heart (HTx), 56 heart-lung (HLTx), 200 single-lung (SLTx), and 227 double-lung (DLTx) procedures. Of these patients, 606 (67%) were male and 299 (33%) were female. Mean age at transplantation was 46.4 years (range 12.6 to 70.4 years). Four hundred twenty-four (47%) deaths have occurred. Median survival for all patients after transplantation was 8.6 years. One hundred two cancers were confirmed, translating to a 7.1-fold increased incidence compared with the non-transplant population. The most common cancer diagnoses were lymphoproliferative disorders (692 per 100,000 person-years), head and neck cancer (336 per 100,000 person-years) and lung cancer (251 per 100,000 person-years). Compared with the non-transplant population this translates into a 26.2-, 21.0- and 9.3-fold increased risk for developing these cancers, respectively, after cardio-pulmonary transplantation. CONCLUSIONS Certain malignancies are more common after heart and/or lung transplantation. The most predominant in our cohort were lymphoproliferative disorders, head and neck cancer and lung cancer.
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Abstract
Recently, the self-expandable metallic stent (SEMS) has been added to our armamentarium. However, in the case presented here placement of the self-expandable metallic stent had catastrophic consequences 11 months later. We are of the opinion that airway stent placement may result in severe complications including clinical infection, and if it must be deployed, the proper size and positioning of the stent is always of the utmost importance.
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Affiliation(s)
- Jiming Sha
- Department of Cardiac Surgery, AnHui Provincial Hospital, HeFei, China
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Kallenbach K, Simon AR, Haverich A, Strüber M. Heart–lung transplantation in a patient with large aortopulmonary collaterals by means of an extended approach. J Thorac Cardiovasc Surg 2007; 134:543-4. [PMID: 17662819 DOI: 10.1016/j.jtcvs.2007.02.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Affiliation(s)
- Klaus Kallenbach
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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Isnard J, Trogrlic S, Haloun A, Sagan C, Germaud P, Bommart S, Dupas B. [Heart and heart-lung transplants thorax complications: major radiologic forms]. ACTA ACUST UNITED AC 2007; 88:339-48. [PMID: 17457265 DOI: 10.1016/s0221-0363(07)89830-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bipulmonary and cardiopulmonary transplantations are among the most difficult to perform, with a 10-year survival rate estimated at 33%. This low rate can be attributed to thoracic complications that can be classified into three distinct groups: 1) early complications, occurring in the first 30 days after transplantation (hemothorax, diaphragmatic paralysis, reperfusion edema, hydric overloading, acute rejection); 2) late complications that occur beyond the first month (bronchiolitis obliterans syndrome, bronchic stenosis, sirolimus-induced lung disorders, initial disease recurrence); and 3) infections classed separately because of their high morbidity and mortality (thoracic wall abscess, bacterial and viral pneumonia, CMV, pneumocystosis, Aspergillus necrotizing bronchitis). Imaging is essential in screening and diagnosing these complications as part of the clinician's monitoring throughout the rest of the transplant recipient's life. In diagnosis, combined with clinical and biological data, imaging has its place in delaying the onset of these diseases.
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Affiliation(s)
- J Isnard
- Service de Radiologie Générale, Site Hospitalier Nord, Boulevard Jean Monod, Saint Herblain Cedex, France.
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García-Covarrubias L, Salerno TA, Panos AL, Pham SM. [Lung transplantation. State of the art]. GAC MED MEX 2007; 143:323-332. [PMID: 17969841] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Lung transplantation is currently considered an established treatment for some advanced lung diseases. The beginning of experimental lung transplantation dates back to the 1940's when the Soviet Vladimir P. Demikhov performed the first lung transplants in animals. Two decades later, James Hardy performed the first lung transplant in humans. Unfortunately, the beginning of clinical lung transplantation was hampered by technical complications and the excessive toxicity of immunosuppressive drugs. Improvement in the surgical technique along with the development of more effective and less toxic immunosuppressive drugs has led to a better outcome in lunt transplant recipients. Donor selection and management before organ procurement play a key role in the receptor's outcome. Due to the shortage of donors, some institutions are using more liberal selection criteria, reporting satisfactory outcomes. The approach of the lung and heart-lung transplant patient is multidisciplinary and includes the cardiothoracic transplant surgeon, pulmonologist, anesthesiologist, and intensivist, among others. Herein, we review some relevant historical aspects and recent advances in the management of lung transplant recipients, including indications and contraindications, evaluation of donors and recipients, surgical techniques and peripost-operative care.
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Affiliation(s)
- Lisardo García-Covarrubias
- Cirugía de trasplantes cardiotorácicos, Universidad de Miami/Jackson Memorial Hospital, Miami, Florida 33136, EUA.
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48
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Reading M. Chest X-ray quiz. Pulmonary hypertension. Intensive Crit Care Nurs 2007; 23:181-2. [PMID: 17577951 DOI: 10.1016/j.iccn.2007.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Maria Reading
- CNC, St. Vincent's Hospital, Sydney and Australia Catholic University, North Sydney, Australia.
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Tang T, Hu JG, Yin BL, Zhou XM, Liu LM, Li JM, Yang JF, Liu F, Song FL, Zhang W, Song GB, Tang H. [Experience in treatment of Eisenmenger's syndrome by heart-lung transplantation]. Zhonghua Yi Xue Za Zhi 2007; 87:1493-5. [PMID: 17785091] [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: 05/17/2023]
Abstract
OBJECTIVE To summarize the experience in treatment of Eisenmenger's syndrome by heart-lung transplantation (HLT). METHODS Two cases of congenital heart disease with Eisenmenger's syndrome, aged 20 and 22, underwent bicaval orthotopic HLT. Modified St. Thomas cardioplegic solution and modified LPD solution were used to preserve the donor heart and lung. After removing the heart and lung of the recipient and thorough hemostasis in thoracic cavity and mediastinal septum, the donor heart and lung was implanted, and trachea, superior/inferior vena cava and aortic artery were anastomosed gradually. Intensive care against infection, rejection and other complications were performed after operation. RESULTS The operations were successful. Tracheal anastomotic stenosis happened in one case seven months after HLT and was cured by sleeve resection of the stenosed trachea segment. Acute rejection happened in one case 10 days after HLT and was cured by stoss therapy. Both patients recovered to normal life and work. CONCLUSION The success of HLT is related to perfect organ preservation, precise surgical performance and proper peri-operative treatment.
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Affiliation(s)
- Tao Tang
- Department of Thoracic and Cardiac Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China
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Abstract
Surgical therapies for the treatment of pulmonary arterial hypertension typically are reserved for patients who are deemed to be refractory to medical therapy and have evidence of progressive right-sided heart failure. Atrial septostomy, a primarily palliative procedure, may stave off hemodynamic collapse from right-sided heart failure long enough to permit a more definitive surgical treatment such as lung or combined heart-lung transplantation. This article discusses indications for and results of atrial septostomy and lung and heart-lung transplantation in patients who have pulmonary arterial hypertension.
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Affiliation(s)
- Jeffrey S Sager
- Lung Transplantation Program, Pulmonary, Allergy and Critical Care Division, University of Pennsylvania Medical Center, 828 West Gates Building, 3600 Spruce Street, Philadelphia, PA 19104, USA.
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