Sample records for awaiting lung transplantation

  1. Chest computed tomography scores are predictive of survival in patients with cystic fibrosis awaiting lung transplantation

    DEFF Research Database (Denmark)

    Loeve, Martine; Hop, Wim C. J.; de Bruijne, Marleen;


    Rationale: Up to a third of cystic fibrosis (CF) patients awaiting lung transplantation (LTX) die while waiting. Inclusion of computed tomography (CT) scores may improve survival prediction models such as the lung allocation score (LAS). Objectives: This study investigated the association between....../inflammation" (INF), air trapping/hypoperfusion (AT), normal/hyperperfusion (NOR) and bulla/cysts (BUL). The volume of each component was computed using semi-automated software. Survival analysis included Kaplan-Meier curves, and Cox-regression models. Measurements and main results: 366 (186 males) out of 411....... These results indicated that INF and LAS had significant, independent predictive value for survival. Conclusions: CT score INF correlates with survival, and adds to the predictive value of LAS....

  2. Outcomes of Chinese Patients with End-stage Pulmonary Disease while Awaiting Lung Transplantation: A Single-center Study

    Institute of Scientific and Technical Information of China (English)

    Wen-Xin He; Yu-Ling Yang; Yan Xia; Nan Song; Ming Liu; Peng Zhang; Jiang Fan


    Background: The factors affecting the outcome of patients referred for lung transplantation (LTx) still have not been investigated extensively.The aim of this study was to characterize the patient outcomes and identify the prognostic factors for death while awaiting the LTx.Methods: From January 2003 to November 2013, the clinical data of 103 patients with end-stage lung disease that had been referred for LTx to Department of Thoracic Surgery, Shanghai Pulmonary Hospital were analyzed retrospectively.The relationship between predictors and survival was evaluated using the Kaplan-Meier method and the Cox proportional hazards model.Results: Twenty-five patients (24.3%) died while awaiting the LTx.Fifty patients (48.5%) underwent LTx, and 28 patients (27.2%) were still on the waitlist.Compared to the candidates with chronic obstructive pulmonary disease (COPD), patients with idiopathic pulmonary fibrosis (IPF) had a higher mortality while awaiting the LTx (40.0% vs.12.3%, P =0.003).Patients requiring mechanical ventilation (MV) had a higher mortality while waiting than others (50.0% vs.20.2%, P =0.038).Two variables, using MV and IPF but not COPD as primary disease, emerged as significant independent risk factors for death on the waitlist (hazard ratio [HR] =56.048, 95% confidence interval [CI]: 3.935-798.263, P =0.003 and HR =14.859, 95% CI: 2.695-81.932, P =0.002, respectively).Conclusion: The type of end-stage lung disease, pulmonary hypertension, and MV may be distinctive prognostic factors for death while awaiting the LTx.

  3. Lung transplant (United States)

    Solid organ transplant - lung ... the chance that the body will reject the transplant . Lungs can also be given by living donors. ... the person who is receiving it. During lung transplant surgery, you are asleep and pain-free (under ...

  4. Lung transplantation (United States)

    Afonso, José Eduardo; Werebe, Eduardo de Campos; Carraro, Rafael Medeiros; Teixeira, Ricardo Henrique de Oliveira Braga; Fernandes, Lucas Matos; Abdalla, Luis Gustavo; Samano, Marcos Naoyuki; Pêgo-Fernandes, Paulo Manuel


    ABSTRACT Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first transplant successfully performed in 1983, more than 40 thousand transplants have been performed worldwide. Of these, about seven hundred were in Brazil. However, survival of the transplant is less than desired, with a high mortality rate related to primary graft dysfunction, infection, and chronic graft dysfunction, particularly in the form of bronchiolitis obliterans syndrome. New technologies have been developed to improve the various stages of lung transplant. To increase the supply of lungs, ex vivo lung reconditioning has been used in some countries, including Brazil. For advanced life support in the perioperative period, extracorporeal membrane oxygenation and hemodynamic support equipment have been used as a bridge to transplant in critically ill patients on the waiting list, and to keep patients alive until resolution of the primary dysfunction after graft transplant. There are patients requiring lung transplant in Brazil who do not even come to the point of being referred to a transplant center because there are only seven such centers active in the country. It is urgent to create new centers capable of performing lung transplantation to provide patients with some advanced forms of lung disease a chance to live longer and with better quality of life. PMID:26154550

  5. Lung Transplant (United States)

    ... will recover in the hospital’s intensive care unit (ICU) before moving to a hospital room for one to three weeks. Your doctor may recommend pulmonary rehabilitation after your lung transplant surgery to help you ...

  6. Exercise training before and after lung transplantation. (United States)

    Mathur, Sunita; Hornblower, Elizabeth; Levy, Robert D


    The benefits of exercise training in individuals with chronic lung diseases such as chronic obstructive pulmonary disease, cystic fibrosis, and interstitial lung disease have been well documented. Although there is limited research available, it appears that exercise is safe and beneficial for people with severe end-stage chronic lung disease who are awaiting lung transplantation in addition to recipients of lung transplants. Evidence-based guidelines for exercise training in the pre- and post-lung transplantation phases have not yet been developed. However, by considering exercise guidelines for people with chronic lung disease and in older adults in light of the physiological changes that can occur either pre- or post-lung transplantation, a safe and appropriate exercise training program can be developed. Depending on the individual's exercise capacity and goals, the training program may include aerobic and resistance exercise, and flexibility and balance training. In the pre-transplant and acute post-transplant phases, the intensity of exercise is dictated primarily by symptom limitation and adequate rest, which is required between exercise bouts to allow for recovery. In the post-transplant phase, it is possible for lung transplant recipients to increase their exercise capacity and even participate in sports. Further research needs to be conducted to determine the optimal training guidelines and the long-term benefits of exercise, both in lung transplant candidates and recipients.


    Directory of Open Access Journals (Sweden)

    A. A. Piontek


    Full Text Available The selection of recipients for the orthotopic heart transplantation is of great importance. In 2006–2009 we examined 25 tests on reversibility of pulmonary hypertension, i.e. in 14 patients with dilated cardiomyopathy (DCM (11 males and 3 females aged 41,1 ± 9,3 and in 11 patients with coronary artery disease (CAD (all males aged 50 ± 4.9. Initial pulmonary vascular resistance (PVR was 3,61 ± 1,02 and 3,59 ± 0,98 respectively. Alprostadil was infused to all the patients. Pulmonary hypertension was irreversible in 4 (28,5% DCM patients and in 2 (18% CAD patients. Initial PVR in those patients was 6,27 ± 3,2 and 5,7 ± 2,4 respectively. The average alprostadil dose necessary for the reverse of pulmonary hypertension was 0,054 ± 0,027 μg/kg/min in DCM patients, and 0,047 ± 0,022 μg/kg/min in CAD patients. Thus, the application of alprostadil for the pharmacological correction of pulmonary vascular resistance is most effective in patients with moderate pulmonary hypertension according to Rich classification. 

  8. Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation

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    Pompili, Maurizio, E-mail: mpompili@rm.unicatt.i [Department of Internal Medicine, Universita Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma (Italy); Pacella, Claudio Maurizio, E-mail: [Department of Diagnostic Imaging and Interventional Radiology, Ospedale Regina Apostolorum, Via S. Francesco D' Assisi, 50, 00041 Albano Laziale (RM) (Italy); Francica, Giampiero, E-mail: giampierofrancica@tin.i [Department of Interventional Ultrasound, Presidio Ospedaliero Camilliani, S. Maria della Pieta, Via S. Rocco, 9, 80026 Casoria (Namibia) (Italy); Angelico, Mario, E-mail: angelico@med.uniroma2.i [Hepatology Unit, Universita di Tor Vergata, Viale Oxford, 81, 00133 Rome (Italy); Tisone, Giuseppe, E-mail: tisone@med.uniroma2.i [Transplant and General Surgery Unit, Universita di Tor Vergata, Ospedale S. Eugenio, Piazzale dell' Umanesimo 10-00144 Rome (Italy); Craboledda, Paolo, E-mail: paolo.craboledda@virgilio.i [Department of Pathology, Ospedale S. Eugenio, Piazzale dell' Umanesimo, 10-00144 Rome (Italy); Nicolardi, Erica; Rapaccini, Gian Ludovico; Gasbarrini, Giovanni [Department of Internal Medicine, Universita Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma (Italy)


    Objective: The aim of this study was to determine the effectiveness and safety of percutaneous laser ablation for the treatment of cirrhotic patients with hepatocellular carcinoma awaiting liver transplantation. Materials and methods: The data of 9 male cirrhotic patients (mean age 50 years, range 45-60 years) with 12 biopsy proven nodules of hepatocellular carcinoma (mean diameter 2.0 cm, range 1.0-3.0 cm) treated by laser ablation before liver transplantation between June 2000 and January 2006 were retrospectively reviewed. Laser ablation was carried out by inserting 300 nm optical fibers through 21-Gauge needles (from two to four) positioned under ultrasound guidance into the target lesions. A continuous wave Neodymium:Yttrium Aluminium Garnet laser was used. Transarterial chemoembolization prior to liver transplantation was performed in two incompletely ablated tumors. Results: No procedure-related major complications were recorded. During the waiting time to liver transplantation local tumor progression after ablation occurred in 3 nodules (25%). At histological examination of the explanted livers complete necrosis was found in 8 nodules (66.7%, all treated exclusively with laser ablation), partial necrosis >50% in 3 nodules (25%), and partial necrosis <50% in 1 nodule. Conclusion: In patients with cirrhotic livers awaiting liver transplantation, percutaneous laser ablation is safe and effective for the management of small hepatocellular carcinoma.

  9. Lung transplant - slideshow (United States)

    ... this page: // Lung transplant - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 5 Go to slide 2 out of ... to slide 5 out of 5 Overview The lungs, which reside in the thorax, or chest cavity, ...

  10. Lung transplantation for cystic fibrosis

    NARCIS (Netherlands)

    Adler, Frederick R; Aurora, Paul; Barker, David H; Barr, Mark L; Blackwell, Laura S; Bosma, Otto H; Brown, Samuel; Cox, D R; Jensen, Judy L; Kurland, Geoffrey; Nossent, George D; Quittner, Alexandra L; Robinson, Walter M; Romero, Sandy L; Spencer, Helen; Sweet, Stuart C; van der Bij, Wim; Vermeulen, J; Verschuuren, Erik A M; Vrijlandt, Elianne J L E; Walsh, William; Woo, Marlyn S; Liou, Theodore G


    Lung transplantation is a complex, high-risk, potentially life-saving therapy for the end-stage lung disease of cystic fibrosis (CF). The decision to pursue transplantation involves comparing the likelihood of survival with and without transplantation as well as assessing the effect of wait-listing

  11. Loco-regional therapies for patients with hepatocellular carcinoma awaiting liver transplantation: Selecting an optimal therapy. (United States)

    Byrne, Thomas J; Rakela, Jorge


    Hepatocellular carcinoma (HCC) is a common, increasingly prevalent malignancy. For all but the smallest lesions, surgical removal of cancer via resection or liver transplantation (LT) is considered the most feasible pathway to cure. Resection - even with favorable survival - is associated with a fairly high rate of recurrence, perhaps since most HCCs occur in the setting of cirrhosis. LT offers the advantage of removing not only the cancer but the diseased liver from which the cancer has arisen, and LT outperforms resection for survival with selected patients. Since time waiting for LT is time during which HCC can progress, loco-regional therapy (LRT) is widely employed by transplant centers. The purpose of LRT is either to bridge patients to LT by preventing progression and waitlist dropout, or to downstage patients who slightly exceed standard eligibility criteria initially but can fall within it after treatment. Transarterial chemoembolization and radiofrequency ablation have been the most widely utilized LRTs to date, with favorable efficacy and safety as a bridge to LT (and for the former, as a downstaging modality). The list of potentially effective LRTs has expanded in recent years, and includes transarterial chemoembolization with drug-eluting beads, radioembolization and novel forms of extracorporal therapy. Herein we appraise the various LRT modalities for HCC, and their potential roles in specific clinical scenarios in patients awaiting LT.

  12. Risk Factors for Portal Vein Thrombosis in Patients With Cirrhosis Awaiting Liver Transplantation in Shiraz, Iran

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    Bagheri Lankarani


    Full Text Available Background Portal vein thrombosis is a fairly common and potentially life-threatening complication in patients with liver cirrhosis. The risk factors for portal vein thrombosis in these patients are still not fully understood. Objectives This study aimed to investigate the associations between various risk factors in cirrhotic patients and the development of portal vein thrombosis. Patients and Methods In this case-control study performed at the Shiraz organ transplantation center, Iran, we studied 219 patients (> 18 years old with liver cirrhosis, who were awaiting liver transplants in our unit, from November 2010 to May 2011. The patients were evaluated by history, physical examination, and laboratory tests, including factor V Leiden, prothrombin gene mutation, Janus Kinase 2 (JAK2 mutation, and serum levels of protein C, protein S, antithrombin III, homocysteine, factor VIII, and anticardiolipin antibodies. Results There was no statistically significant difference in the assessed hypercoagulable states between patients with or without portal vein thrombosis. A history of previous variceal bleeding with subsequent endoscopic treatment in patients with portal vein thrombosis was significantly higher than in those without it (P = 0.013, OR: 2.526, 95% CI: 1.200 - 5.317. Conclusions In our population of cirrhotic patients, treatment of variceal bleeding predisposed the patients to portal vein thrombosis, but hypercoagulable disorders by themselves were not associated with portal vein thrombosis.

  13. Trasplante pulmonar Lung transplant

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    M. Espinosa


    Full Text Available El transplante pulmonar suele ser la última opción terapéutica para pacientes con insuficiencia respiratoria. A pesar de los muchos avances en inmunología y el manejo de las complicaciones, la mortalidad y morbilidad asociadas a este trasplante son muy superiores a los demás. El rechazo agudo es casi un problema universal en el primer año, mientras que la bronquiolitis obliterante limita la supervivencia a largo plazo. Las infecciones respiratorias también cumplen un papel importante en las complicaciones asociadas al trasplante pulmonar por la constante exposición del injerto al medio exterior. No obstante, los éxitos de esta opción terapéutica que depende fundamentalmente de una correcta selección de donante y receptor, son evidentes, sobre todo en cuanto a calidad de vida se refiere.A lung transplant is usually the final therapeutic option for patients with respiratory insufficiency. In spite of the many advances in immunology and the management of complications, mortality and morbidity associated with this transplant are far higher than with others. Acute rejection is an almost universal problem in the first year, while obliterative bronchitis reduces long term survival. Respiratory infections also play a significant role in the complications associated with lung transplants due to the constant exposure of the graft to the outside. However, the success of this therapeutic option, which basically depends on a suitable selection of donor and recipient, are evident, above all with respect to quality of life.

  14. Current status and problems of lung transplantation in Japan (United States)


    Lung transplantation has been performed worldwide and recognized as an effective treatment for patients with various end-stage lung diseases. Shortage of lung donors is one of the main obstacles in most of the countries, especially in Japan. Every effort has been made to promote organ donation during the past 20 years. In 2010, Japanese transplant low was revised so that the family of the brain dead donors can make a decision for organ donation. Since then, the number of cadaveric lung donor has increased by 5-fold. However, the average waiting time is still more than 800 days resulting in considerable number of deaths on the waiting list. Lung transplantation in the use of donation after cardiac death (DCD) has now been increasingly performed in Europe, Australia and North America with promising results. However, controlled death is not permitted in Japan making it difficult to accept this strategy. Use of marginal donors is one of the strategies for organ shortage. In Japan, the rate of lung usage is now well over 60% because of careful donor management by medical consultants and aggressive use of marginal donors. Living-donor lobar lung transplantation (LDLLT) has been developed to offset the mismatch between supply and demand for those patients awaiting cadaveric lung transplantation (CLT) and it is often the most realistic option for very ill patients. Between 1998 and 2015, lung transplantation has been performed in 464 patients (55 children, 419 adults) at 9 lung transplant centers in Japan. CLT was performed in 283 patients (61%) and LDLLT was performed in 181 patients (39%). The 5-year survival was 72.3% and 71.6%, respectively. Of note, only seven children received CLT. In conclusion, lung transplantation in Japan has grown significantly with excellent results but the shortage of cadaveric lung donor remains to be an important unsolved problem. LDLLT is often the only realistic option for very ill patients especially for children. PMID:27651939

  15. Human leucocyte antigens: their association with end-stage renal disease in Saudi patients awaiting transplantation. (United States)

    Almogren, A; Shakoor, Z; Hamam, K D


    Most patients with chronic renal failure develop end-stage renal disease (ESRD) that requires renal transplantation. This study investigates the possible associations between human leucocyte antigen (HLA) Class I and Class II molecules with ESRD. Genotyping data (HLA) obtained between 2005 and 2009 on 235 unrelated Saudi patients (147 males, 88 females; mean age: 58 +/- 7 years) with ESRD awaiting renal transplantation were assessed retrospectively at the King Khalid University Hospital. Data were compared with the results on 60 normal, healthy, unrelated Saudi individuals (37 males and 23 females; mean age: 51 +/- 5 years). HLA Class I and Class II antigens were detected by lymphocytotoxicity and a polymerase chain reaction (PCR) method using DNA sequence-specific primers. Although present in small numbers, HLA Cw2 was found in significantly fewer patients (n = 11; 4.68%) compared to normal subjects (n = 9; 15%) and was found to confer protection against ESRD (P = 0.005; relative risk [RR]: 3.594, 95% confidence interval [CI]: 1.415-9.126). Among the HLA Class II antigens, HLA DQB1*03(8) was detected more frequently in the patient group (n = 65; 27.6%) than in the normal controls (n = 9; 15%) and was positively associated with risk of ESRD (P = 0.04; RR: 0.462, 95% CI: 0.215-0.991). No significant differences were observed between the two groups in respect of HLA-A2, HLA-B50(21), HLA-B51(5) and HLA-Cw7 (HLA Class I), and HLA-DRB1*04, HLA-DRB1*07 and HLA-DQB1*02 (HLA Class II). Occurrence of the most frequent HLA alleles was no different between the ESRD group and the controls. The protective role of HLA-Cw2 and the marginal susceptibility associated with HLA-DQBI*03(8) for ESRD requires further investigation.

  16. Antibody induction therapy for lung transplant recipients

    DEFF Research Database (Denmark)

    Penninga, Luit; Møller, Christian H; Penninga, Ida Elisabeth Irene


    Lung transplantation has become a valuable and well-accepted treatment option for most end-stage lung diseases. Lung transplant recipients are at risk of transplanted organ rejection, and life-long immunosuppression is necessary. Clear evidence is essential to identify an optimal, safe...... and effective immunosuppressive treatment strategy for lung transplant recipients. Consensus has not yet been achieved concerning use of immunosuppressive antibodies against T-cells for induction following lung transplantation....

  17. Lung Transplantation for Pulmonary Hypertension (United States)

    ... the page. Answers about Lung Transplantation for PULMONARY HYPERTENSION Part One: Overview From the development of epoprostenol ... decades, expansion of medical treatment of pulmonary arterial hypertension (PAH) has improved survival and quality of life ...

  18. Early laparotomy after lung transplantation

    DEFF Research Database (Denmark)

    Bredahl, Pia; Zemtsovski, Mikhail; Perch, Michael;


    BACKGROUND: Gastrointestinal complications after lung transplantation have been reported with incidence rates ranging from 3% to 51%, but the reasons are poorly understood. We aimed to investigate the correlations between pulmonary diseases leading to lung transplantation and early gastrointestinal...... complications requiring laparotomy after transplantation with outcomes for patients at increased risk. METHODS: In this study we performed a retrospective analysis of data of patients who underwent lung transplantation at our institution from 2004 to 2012. The study period was limited to the first 90 days after...... for time on mechanical ventilation. Among pulmonary diseases and demographics of the patients, no other risk factors were identified for laparotomy. CONCLUSIONS: A1AD was the only significant risk factor identified for gastrointestinal complications that required laparotomy within 3 months after lung...

  19. Heart-lung transplant - slideshow (United States)

    ... page: // Heart-lung transplant - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 out of ... to slide 4 out of 4 Overview The heart and lungs are located in the thorax, or chest cavity. ...

  20. Airway complications after lung transplantation. (United States)

    Machuzak, Michael; Santacruz, Jose F; Gildea, Thomas; Murthy, Sudish C


    Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.

  1. Bioengineering Lungs for Transplantation. (United States)

    Gilpin, Sarah E; Charest, Jonathan M; Ren, Xi; Ott, Harald C


    Whole lung extracellular matrix scaffolds can be created by perfusion of cadaveric organs with decellularizing detergents, providing a platform for organ regeneration. Lung epithelial engineering must address both the proximal airway cells that function to metabolize toxins and aid mucociliary clearance and the distal pneumocytes that facilitate gas exchange. Engineered pulmonary vasculature must support in vivo blood perfusion with low resistance and intact barrier function and be antithrombotic. Repopulating the native lung matrix with sufficient cell numbers in appropriate anatomic locations is required to enable organ function.

  2. Pediatric lung transplantation: 10 years of experience (United States)

    Camargo, Priscila C. L. B.; Pato, Eduardo Z. S.; Campos, Silvia V.; Afonso, José E.; Carraro, Rafael M.; Costa, André N.; Teixeira, Ricardo H. O. B.; Samano, Marcos N.; Pêgo-Fernandes, Paulo M.


    Lung transplantation is a well-established treatment for advanced lung diseases. In children, the diseases that most commonly lead to the need for a transplantation are cystic fibrosis, pulmonary hypertension, and bronchiolitis. However, the number of pediatric lung transplantations being performed is low compared with the number of transplants performed in the adult age group. The objective of this study was to demonstrate our experience with pediatric lung transplants over a 10-year period in a program initially designed for adults. PMID:24860860

  3. [Lung hyperinflation after single lung transplantation to treat emphysema]. (United States)

    Samano, Marcos Naoyuki; Junqueira, Jader Joel Machado; Teixeira, Ricardo Henrique de Oliveira Braga; Caramori, Marlova Luzzi; Pêgo-Fernandes, Paulo Manuel; Jatene, Fabio Biscegli


    Despite preventive measures, lung hyperinflation is a relatively common complication following single lung transplantation to treat pulmonary emphysema. The progressive compression of the graft can cause mediastinal shift and respiratory failure. In addition to therapeutic strategies such as independent ventilation, the treatment consists of the reduction of native lung volume by means of lobectomy or lung volume reduction surgery. We report two cases of native lung hyperinflation after single lung transplantation. Both cases were treated by means of lobectomy or lung volume reduction surgery.

  4. Lung transplantation for chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Liou TG


    Full Text Available Theodore G Liou, Sanjeev M Raman, Barbara C CahillDivision of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USAAbstract: Patients with end-stage chronic obstructive pulmonary disease (COPD comprise the largest single lung disease group undergoing transplantation. Selection of appropriate candidates requires consideration of specific clinical characteristics, prognosis in the absence of transplantation, and likely outcome of transplantation. Increased availability of alternatives to transplantation for end-stage patients and the many efforts to increase the supply of donor organs have complicated decision making for selecting transplant candidates. Many years of technical and clinical refinements in lung transplantation methods have improved survival and quality of life outcomes. Further advances will probably come from improved selection methods for the procedure. Because no prospective trial has been performed, and because of confounding and informative censoring bias inherent in the transplant selection process in studies of the existing experience, the survival effect of lung transplant in COPD patients remains undefined. There is a lack of conclusive data on the impact of lung transplantation on quality of life. For some patients with end-stage COPD, lung transplantation remains the only option for further treatment with a hope of improved survival and quality of life. A prospective trial of lung transplantation is needed to provide better guidance concerning survival benefit, resource utilization, and quality of life effects for patients with COPD.Keywords: outcomes, emphysema, COPD, alpha-1-antitrypsin deficiency, survival, single lung transplant, bilateral sequential single lung transplant, lung volume reduction, referral, guidelines, health related quality of life

  5. Limitations of the MELD score in predicting mortality or need for removal from waiting list in patients awaiting liver transplantation

    Directory of Open Access Journals (Sweden)

    Schmidt Jan


    Full Text Available Abstract Background Decompensated cirrhosis is associated with a poor prognosis and liver transplantation provides the only curative treatment option with excellent long-term results. The relative shortage of organ donors renders the allocation algorithms of organs essential. The optimal strategy based on scoring systems and/or waiting time is still under debate. Methods Data sets of 268 consecutive patients listed for single-organ liver transplantation for nonfulminant liver disease between 2003 and 2005 were included into the study. The Model for End-Stage Liver Disease (MELD and Child-Turcotte-Pugh (CTP scores of all patients at the time of listing were used for calculation. The predictive ability not only for mortality on the waiting list but also for the need for withdrawal from the waiting list was calculated for both scores. The Mann-Whitney-U Test was used for the univariate analysis and the AUC-Model for discrimination of the scores. Results In the univariate analysis comparing patients who are still on the waiting list and patients who died or were removed from the waiting list due to poor conditions, the serum albumin, bilirubin INR, and CTP and MELD scores as well as the presence of ascites and encephalopathy were significantly different between the groups (p Comparing the predictive abilities of CTP and MELD scores, the best discrimination between patients still alive on the waiting list and patients who died on or were removed from the waiting list was achieved at a CTP score of ≥9 and a MELD score of ≥14.4. The sensitivity and specificity to identify mortality or severe deterioration for CTP was 69.0% and 70.5%, respectively; for MELD, it was 62.1% and 72.7%, respectively. This result was supported by the AUC analysis showing a strong trend for superiority of CTP over MELD scores (AUROC 0.73 and 0.68, resp.; p = 0.091. Conclusion The long term prediction of mortality or removal from waiting list in patients awaiting liver



    田, 大力; "青木, 稔; 山崎, 文郎; 和田, 洋巳; 人見, 滋樹; 乾, 健二


    This report describes the technique of the allo-transplantation of the right lung of an adult mongrel dog. Compare to the transplantation of the left lung, we found several pitfalls in the right lung transplantation. 1) The intraatrial groove of the recipient must be divided carefully just at the middle of the right and the left atrium in order to make a generous cuff for the left atrial anastomosis. 2) It is preferable to divide azygos vein to perfom easy anastomosis of right pulmonary arter...

  7. Sarcopenia in lung transplantation: a systematic review. (United States)

    Rozenberg, Dmitry; Wickerson, Lisa; Singer, Lianne G; Mathur, Sunita


    Lung transplant candidates and recipients have significant impairments in skeletal muscle mass, strength and function--individual measures of sarcopenia. Skeletal muscle dysfunction has been observed in the pre-transplant and post-transplant period and could have an important effect on transplant outcomes. A systematic review was performed to characterize the techniques used to study sarcopenia and assess the level of impairment throughout the transplant process. Electronic databases were searched (inception to July 2013) for prospective studies measuring at least 1 element of sarcopenia (muscle mass, strength, or function) in lung transplant patients. Eighteen studies were included, and study quality was assessed using the Downs and Black scale. A variety of measurements were used to evaluate sarcopenia in 694 lung transplant patients. Muscle mass in 7 studies was assessed using bioelectrical impedance (n = 4), computed tomography or magnetic resonance imaging (n = 2), or skin folds (n = 1), and was significantly reduced. Quadriceps strength was examined in 14 studies with computerized dynamometer (n = 10) and hand-held dynamometer (n = 4). Quadriceps strength was reduced in the pre-transplant period (mean range, 49%-86% predicted; n = 455 patients), further reduced immediately after transplant (51%-72%, n = 126), and improved beyond 3 months after transplant (58%-101%, n = 164). Only 2 studies measured lower extremity function (sit-to-stand test). A multitude of measurement techniques have been used to assess individual measures of sarcopenia, with reduced muscle mass and quadriceps strength observed in the pre-transplant and post-transplant period. Further standardization of measurement techniques is needed to assess the clinical effect of sarcopenia in lung transplantation.

  8. A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot Study

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    Patrícia Forestieri

    Full Text Available Abstract Objective: The purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support. Methods: Patients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1 Control Group (n=11 - conventional protocol; and 2 Intervention Group (n=7 - stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols. Results: Both groups demonstrated an increase in six-minute walk test distance after the experimental procedure compared to baseline; however, only the intervention group had a significant increase (P =0.08 and P =0.001 for the control and intervention groups, respectively. Intergroup comparison revealed a greater increase in the intervention group compared to the control (P <0.001. Regarding the inspiratory muscle strength evaluation, the intragroup analysis demonstrated increased strength after the protocols compared to baseline for both groups; statistical significance was only demonstrated for the intervention group, though (P =0.22 and P <0.01, respectively. Intergroup comparison showed a significant increase in the intervention group compared to the control (P <0.01. Conclusion: Stationary cycle ergometer exercise training shows positive results on exercise capacity and inspiratory muscle strength in patients with heart failure awaiting cardiac transplantation while on intravenous inotropic support.

  9. A Cycle Ergometer Exercise Program Improves Exercise Capacity and Inspiratory Muscle Function in Hospitalized Patients Awaiting Heart Transplantation: a Pilot Study (United States)

    Forestieri, Patrícia; Guizilini, Solange; Peres, Monique; Bublitz, Caroline; Bolzan, Douglas W.; Rocco, Isadora S.; Santos, Vinícius B.; Moreira, Rita Simone L.; Breda, João R.; de Almeida, Dirceu R.; Carvalho, Antonio Carlos de C.; Arena, Ross; Gomes, Walter J.


    Objective The purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support. Methods Patients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1) Control Group (n=11) - conventional protocol; and 2) Intervention Group (n=7) - stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols. Results Both groups demonstrated an increase in six-minute walk test distance after the experimental procedure compared to baseline; however, only the intervention group had a significant increase (P=0.08 and P=0.001 for the control and intervention groups, respectively). Intergroup comparison revealed a greater increase in the intervention group compared to the control (P<0.001). Regarding the inspiratory muscle strength evaluation, the intragroup analysis demonstrated increased strength after the protocols compared to baseline for both groups; statistical significance was only demonstrated for the intervention group, though (P=0.22 and P<0.01, respectively). Intergroup comparison showed a significant increase in the intervention group compared to the control (P<0.01). Conclusion Stationary cycle ergometer exercise training shows positive results on exercise capacity and inspiratory muscle strength in patients with heart failure awaiting cardiac transplantation while on intravenous inotropic support. PMID:27982348

  10. Belatacept for Maintenance Immunosuppression in Lung Transplantation

    Directory of Open Access Journals (Sweden)

    Christine Hui PharmD


    Full Text Available Belatacept is a novel immunosuppressant that blocks a T-cell costimulation pathway and is approved for use in adult kidney transplant recipients. Its safety and efficacy have not been established after lung transplantation. We present a case of a lung transplant recipient treated with belatacept. A 56-year-old man underwent bilateral lung retransplantation for bronchiolitis obliterans syndrome (BOS. In the third year posttransplant, he developed hemolytic uremic syndrome (HUS attributed to tacrolimus. Tacrolimus was changed to sirolimus. One month later, he presented with worsening renal function and HUS attributed to sirolimus. Plasmapheresis and steroid pulse were initiated with clinical improvement, and sirolimus was switched to belatacept. He experienced no episodes of cellular rejection but developed recurrent BOS. Complications during treatment included anemia and recurrent pneumonias. The safety and efficacy of belatacept in lung transplantation remains unclear; further studies are needed.

  11. Bronchoscopic procedures and lung biopsies in pediatric lung transplant recipients. (United States)

    Wong, Jackson Y; Westall, Glen P; Snell, Gregory I


    Bronchoscopy remains a pivotal diagnostic and therapeutic intervention in pediatric patients undergoing lung transplantation (LTx). Whether performed as part of a surveillance protocol or if clinically indicated, fibre-optic bronchoscopy allows direct visualization of the transplanted allograft, and in particular, an assessment of the patency of the bronchial anastomosis (or tracheal anastomosis following heart-lung transplantation). Additionally, bronchoscopy facilitates differentiation of infective processes from rejection episodes through collection and subsequent assessment of bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) samples. Indeed, the diagnostic criteria for the grading of acute cellular rejection is dependent upon the histopathological assessment of biopsy samples collected at the time of bronchoscopy. Typically, performed in an out-patient setting, bronchoscopy is generally a safe procedure, although complications related to hemorrhage and pneumothorax are occasionally seen. Airway complications, including stenosis, malacia, and dehiscence are diagnosed at bronchoscopy, and subsequent management including balloon dilatation, laser therapy and stent insertion can also be performed bronchoscopically. Finally, bronchoscopy has been and continues to be an important research tool allowing a better understanding of the immuno-biology of the lung allograft through the collection and analysis of collected BAL and TBBx samples. Whilst new investigational tools continue to evolve, the simple visualization and collection of samples within the lung allograft by bronchoscopy remains the gold standard in the evaluation of the lung allograft. This review describes the use and experience of bronchoscopy following lung transplantation in the pediatric setting.


    NARCIS (Netherlands)



    Pulmonary infections occur so frequently in recipients of lung transplants as well as of combined heart and lung transplants that it has been suggested that the function of the defense system in lung transplants is impaired. Therefore, we investigated in rats whether antibody responses against intra

  13. A spirometric journey following lung transplantation (United States)

    Fuller, Jeremy; Paraskeva, Miranda; Thompson, Bruce; Snell, Greg; Westall, Glen


    Spirometry is regarded as the primary tool for the evaluation of lung function in lung transplant (LTx) recipients. Spirometry is crucial in detecting the various phenotypes of chronic lung allograft dysfunction (CLAD), including restrictive allograft syndrome (RAS) and bronchiolitis obliterans syndrome (BOS) – note that these phenotypes potentially have different etiologies and therapies. Following LTx for idiopathic pulmonary fibrosis, a 60-year-old male recipient’s lung function began to gradually improve, peaking at 5 months post-LTx. Subsequently, with increasing impairment of graft function, the diagnosis of BOS was made. A second LTx was performed and lung function subsequently began to increase again. Unfortunately, another year on, lung function deteriorated again – this time due to the development of RAS, antibody-mediated rejection was implicated as the possible underlying cause. This case report highlights the importance of spirometry in assessing the patterns of CLAD following LTx. PMID:25473588

  14. Lung transplantation: overall approach regarding its major aspects (United States)

    de Camargo, Priscila Cilene León Bueno; Teixeira, Ricardo Henrique de Oliveira Braga; Carraro, Rafael Medeiros; Campos, Silvia Vidal; Afonso, José Eduardo; Costa, André Nathan; Fernandes, Lucas Matos; Abdalla, Luis Gustavo; Samano, Marcos Naoyuki; Pêgo-Fernandes, Paulo Manuel


    ABSTRACT Lung transplantation is a well-established treatment for patients with advanced lung disease. The evaluation of a candidate for transplantation is a complex task and involves a multidisciplinary team that follows the patient beyond the postoperative period. Currently, the mean time on the waiting list for lung transplantation in the state of São Paulo, Brazil, is approximately 18 months. For Brazil as a whole, data from the Brazilian Organ Transplant Association show that, in 2014, there were 67 lung transplants and 204 patients on the waiting list for lung transplantation. Lung transplantation is most often indicated in cases of COPD, cystic fibrosis, interstitial lung disease, non-cystic fibrosis bronchiectasis, and pulmonary hypertension. This comprehensive review aimed to address the major aspects of lung transplantation: indications, contraindications, evaluation of transplant candidates, evaluation of donor candidates, management of transplant recipients, and major complications. To that end, we based our research on the International Society for Heart and Lung Transplantation guidelines and on the protocols used by our Lung Transplant Group in the city of São Paulo, Brazil. PMID:26785965

  15. Pre-transplant quality of life does not predict survival after lung transplantation

    NARCIS (Netherlands)

    Vermeulen, Karin M.; TenVergert, Elisabeth M.; Verschuuren, Erik A. M.; Erasmus, Michiel E.; van der Bij, Wim


    Background: Currently, the goal of lung transplantation is not only to improve survival but also includes' improvement of health-related quality of life (HRQL). Limited knowledge is available about the value of HRQL before lung transplantation with regard to predicting survival after lung transplant

  16. Reversible cortical blindness after lung transplantation. (United States)

    Knower, Mark T; Pethke, Scott D; Valentine, Vincent G


    Cyclosporine (CYA) is a calcineurin inhibitor widely used in immunosuppressive regimens after organ transplantation. Several neurologic side effects are frequently associated with CYA use; however, reversible cortical blindness is a rare manifestation of CYA toxicity traditionally seen after liver and bone marrow transplantation. This report presents a case of reversible cortical blindness after lung transplantation, then details the risk factors and clinical course of 28 previously well-documented cases of CYA-induced cortical blindness after transplantation. Identification of known risk factors, clinical clues, and typical radiographic findings may aid in the diagnosis of CYA-induced cortical blindness, since reduction in CYA dose or cessation of CYA therapy usually permits resolution of the neurologic effects.

  17. Continued Smoking in Lung Transplant Patients: A Cross Sectional Survey

    Directory of Open Access Journals (Sweden)

    Zmeškal Miroslav


    Full Text Available Smoking is associated with a higher incidence of post-lung transplantation complications and mortality. Prior to inclusion on the lung transplant waiting list in the Czech Republic, patients are supposed to be tobacco free for at least 6 months. Our aim was to determine the prevalence of smoking, validated by urinary cotinine, among patients post lung transplantation and prior to inclusion on the transplant waiting list.


    NARCIS (Netherlands)



    Worldwide more than 600 heart-lung or lung transplantations have been performed in patients with cystic fibrosis and end-stage respiratory disease. At the University Hospital in Groningen 10 patients with cystic fibrosis underwent bilateral sequential lung transplantation until April 1994. The 1-yea

  19. Lifetime costs of lung transplantation : Estimation of incremental costs

    NARCIS (Netherlands)

    VanEnckevort, PJ; Koopmanschap, MA; Tenvergert, EM; VanderBij, W; Rutten, FFH


    Despite an expanding number of centres which provide lung transplantation, information about the incremental costs of lung transplantation is scarce. From 1991 until 1995, in The Netherlands a technology assessment was performed which provided information about the incremental costs of lung transpla

  20. Children's conceptions of their parent's lung transplant. (United States)

    Fulbrook, Paul; Leisfield, Trish; Wiggins, Kay


    There has been no research that has investigated the psychosocial impact on children whose parents have undergone a lung transplant. The aim of this qualitative study was to describe children's concerns and understandings of their parent's transplant surgery. Artwork was used as a creative medium to enable children to portray their experiences in a safe, non-threatening environment. This was used as a visual primer for follow-up interviews. All children expressed similar and complementary views about uncertainty and anxiety, separation, disruption to family life, their desire for normality, and the importance of social support. Differences were evident in the way that some children managed well by adapting to the changing situations, whereas others tended towards avoidance. The findings provide several themes that may be used as a framework for family support and counselling by nurses, social workers, and other healthcare professionals who are caring for patients and their families during the transplant process.

  1. A Phase I Trial of Epstein-Barr Virus Gp350 Vaccine for Children With Chronic Kidney Disease Awaiting Transplantation

    NARCIS (Netherlands)

    Rees, L.; Tizard, E.J.; Morgan, A.J.; Cubitt, W.D.; Finerty, S.; Oyewole-Eletu, T.A.; Owen, K.; Royed, C.; Stevens, S.J.C.; Shroff, R.C.; Tanday, M.K.; Wilson, A.; Middeldorp, J.M.; Amlot, P.L.; Steven, N.M.


    Background. Vaccination against Epstein-Barr virus (EBV), inducing an antibody response to the envelope glycoprotein gp350, might protect EBV-negative children with chronic kidney disease from lymphoproliferative disease after transplantation. Methods. A phase I trial recruited children with chronic

  2. Recurrence of Intravenous Talc Granulomatosis following Single Lung Transplantation

    Directory of Open Access Journals (Sweden)

    Richard C Cook


    Full Text Available Advanced pulmonary disease is an unusual consequence of the intravenous injection of oral medications, usually developing over a period of several years. A number of patients with this condition have undergone lung transplantation for respiratory failure. However, a history of drug abuse is often considered to be a contraindication to transplantation in the context of limited donor resources. A patient with pulmonary talc granulomatosis secondary to intravenous methylphenidate injection who underwent successful lung transplantation and subsequently presented with recurrence of the underlying disease in the transplanted lung 18 months after transplantation is reported.

  3. Telaprevir-containing regimen for treatment of hepatitis C virus infection in patients with hepatocellular carcinoma awaiting liver transplantation: a case series

    Directory of Open Access Journals (Sweden)

    Torres HA


    Full Text Available Harrys A Torres,1 Ahmed Kaseb,2 Parag Mahale,1 Ethan Miller,3 Catherine Frenette4 1Department of Infectious Diseases, Infection Control and Employee Health, 2Department of Gastrointestinal Medical Oncology, 3Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 4Department of Liver Transplantation, Weill Cornell Medical College, The Methodist Hospital, Houston, TX, USA Abstract: In patients who undergo liver transplantation (LT, allograft failure secondary to hepatitis C virus (HCV recurrence after LT accounts for two-thirds of graft failures and deaths. Achievement of sustained virologic response before LT eliminates the risk of HCV recurrence. Only a limited number of studies have evaluated the role of antiviral treatment before LT. No published data are available regarding the use of HCV protease inhibitors before LT. We report our experience using the combination of telaprevir, pegylated interferon alfa-2a (PegIFN alfa-2a, and ribavirin in three patients with HCV-associated hepatocellular carcinoma (HCC awaiting LT. Two patients had not received, and one had had a partial response to HCV therapy (PegIFN alfa-2a plus ribavirin. All three patients had genotype 1b and were started on telaprevir and full doses of PegIFN alfa-2a and ribavirin. Treatment was planned to be continued until the day of LT or 48 weeks total, whichever came first. One patient still had detectable HCV RNA after 24 weeks of antivirals and was, therefore, excluded from further analysis. The other two patients had undetectable HCV RNA at the end of antiviral therapy. In one of these patients, HCV RNA remained undetectable after LT; the other patient experienced viral relapse. HCV therapy was tolerated by all patients; no patient required permanent discontinuation of therapy because of toxic effects. All three patients experienced hematologic toxic effects. Only one patient required treatment

  4. First Danish experience with ex vivo lung perfusion of donor lungs before transplantation

    DEFF Research Database (Denmark)

    Henriksen, Ian Sune Iversen; Møller-Sørensen, Hasse; Møller, Christian Holdfold;


    otherwise considered transplantable, but failed to meet the usual criteria due to possible contusions or because they were from donors with sepsis or unable to pass the oxygenation test. RESULTS: In the study period, seven of 33 Danish lung transplantations were made possible due to EVLP. One patient died......INTRODUCTION: The number of lung transplantations is limited by a general lack of donor organs. Ex vivo lung perfusion (EVLP) is a novel method to optimise and evaluate marginal donor lungs prior to transplantation. We describe our experiences with EVLP in Denmark during the first year after its...... introduction. MATERIAL AND METHODS: The study was conducted by prospective registration of donor offers and lung transplantations in Denmark from 1 May 2012 to 30 April 2013. Donor lungs without any contraindications were transplanted in the traditional manner. Taken for EVLP were donor lungs that were...

  5. The Diagnosis and Management of Airway Complications Following Lung Transplantation. (United States)

    Mahajan, Amit K; Folch, Erik; Khandhar, Sandeep J; Channick, Colleen L; Santacruz, Jose F; Mehta, Atul C; Nathan, Steven D


    Airway complications following lung transplantation result in considerable morbidity and are associated with a mortality of 2-4 percent. The incidence of lethal and non-lethal airway complications has decreased since the early experiences with double- and single-lung transplantation. The most common risk factor associated with post-lung transplant airway complications is anastomotic ischemia. Airway complications include development of exophytic granulation tissue, bronchial stenosis, bronchomalacia, airway fistula, endobronchial infection, and anastomotic dehiscence. The broadening array of bronchoscopic therapies has enhanced treatment options for lung transplant recipients with airway complications. This article reviews the risk factors, clinical manifestations, and treatments of airway complications following lung transplantation, and provides our expert opinion where evidence is lacking.

  6. Evolving practice: X-linked agammaglobulinemia and lung transplantation. (United States)

    Barnes, S; Kotecha, S; Douglass, J A; Paul, E; Hore-Lacy, F; Hore-Lacey, F; Stirling, R; Snell, G I; Westall, G P


    X-linked agammaglobulinemia (XLA) is a rare primary humoral immunodeficiency syndrome characterized by agammaglobulinemia, recurrent infections and bronchiectasis. Despite the association with end-stage bronchiectasis, the literature on XLA and lung transplantation is extremely limited. We report a series of 6 XLA patients with bronchiectasis who underwent lung transplantation. Short-term outcomes were excellent however long-term outcomes were disappointing with a high incidence of pulmonary sepsis and chronic lung allograft dysfunction (CLAD).

  7. The role of autophagy in lung ischemia/reperfusion injury after lung transplantation in rats (United States)

    Liu, Sheng; Zhang, Jun; Yu, Bentong; Huang, Lei; Dai, Bin; Liu, Jichun; Tang, Jian


    Background: The aim of this study was to explore the role of autophagy in the cold I/R injury following lung transplantation. Methods: The rat orthotopic lung transplantation model was established to perform the level of autophagy in the cold I/R injury in this study. The pretreatment of inhibitor (3-Methyladenine [3-MA]) and activator (rapamycin [RAPA]) of autophagy were performed to assess the role of autophagy in the cold I/R injury following lung transplantation in rats. Results: After lung transplantation, the autophagy, lung cell apoptosis and lung injury were aggravated and peaked at 6 h following the transplantation. The inhibition of autophagy by 3-MA induced downregulated of autophagy, decreased cell apoptosis. Meanwhile, the lung injury, which was indicated by calculating the peak inspiratory pressure (PIP), pulmonary vein blood gas analysis (PO2) and ratio of wet to dry in lung (W/D), was ameliorated after treatment with 3-MA. The activation of autophagy by RAPA causing the upregulated of autophagy and apoptosis of lung cells, and enhanced the lung injury. Conclusion: All the results suggested that the autophagy was involved in the cold I/R injury in lung transplantation model, and played a potential role on the regulation of I/R injury after lung transplantation. PMID:27648150

  8. Treatment of intractable interstitial lung injury with alemtuzumab after lung transplantation

    DEFF Research Database (Denmark)

    Kohno, M; Perch, M; Andersen, E;


    of transplantation. Routine examination of a lung biopsy, 4 months after transplantation, showed nonspecific, diffuse interstitial inflammation with alveolar septal fibrosis. The patient's clinical status and imaging studies, consistent with nonspecific interstitial pneumonitis, which was considered as signs......, posttransplant antirejection drug regimen. We have since successfully treated with alemtuzumab three additional patients who developed interstitial lung injury after lung transplantation, who are also summarized in this report.......A 44-year-old woman underwent left single-lung transplantation for end-stage emphysema due to α1-antitrypsin deficiency in January 2010. Cyclosporine, azathioprine, and prednisolone were administered for immunosuppression and antithymocyte globulin for induction therapy at the time...

  9. Current perspectives on antibody-mediated rejection after lung transplantation

    Directory of Open Access Journals (Sweden)

    Witt CA


    Full Text Available Chad A Witt, Ramsey R Hachem Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO, USA Abstract: The role of donor-specific antibodies (DSA to human leukocyte antigens and the burden of antibody-mediated rejection (AMR in lung transplantation remain enigmatic. Over the past several years, evidence has been emerging that humoral immunity plays an important role in the development of both acute and chronic lung allograft dysfunction (CLAD. Multiple case reports and case series have identified lung allograft recipients with clinical findings consistent with acute AMR. However, there is currently no widely accepted definition for AMR in lung transplantation, and this has been a significant barrier to furthering our understanding of this form of rejection. Nonetheless, the development of DSA after transplantation has consistently been identified as an independent risk factor for persistent and high-grade acute cellular rejection and CLAD. This has raised the possibility that chronic AMR may be a distinct phenotype of CLAD although evidence supporting this paradigm is still lacking. Additionally, antibodies to lung-restricted self-antigens (collagen V and K-α 1 tubulin have been associated with primary graft dysfunction early and the development of CLAD late after transplantation, and emerging evidence underscores significant interactions between autoimmunity and alloimmunity after transplantation. There is currently an active International Society for Heart and Lung Transplantation working group that is developing an operational definition for AMR in lung transplantation. This will be critical to improve our understanding of this form of rejection and conduct clinical trials to identify optimal treatment strategies. This review will summarize the literature on DSA and AMR in lung transplantation and discuss the impact of antibodies to self-antigens on lung

  10. Aortic homograft for pulmonary artery augmentation in single lung transplantation. (United States)

    Rueda, Pablo; Morales, Jose; Guzman, Enrique; Tellez, Jose L; Niebla, Benito A; Avalos, Alejandro; Patiño, Hilda


    We present a case of unilateral lung transplantation in which a segment of the donor's descending aorta was used as a homograft for pulmonary artery augmentation in the donor lung. This technique can be used when the donor's lung artery has been cut at the base of the hilum during the harvesting procedure.

  11. Persistent disruption of ciliated epithelium following paediatric lung transplantation. (United States)

    Thomas, Biju; Aurora, Paul; Spencer, Helen; Elliott, Martin; Rutman, Andrew; Hirst, Robert A; O'Callaghan, Christopher


    It is unclear whether ciliary function following lung transplantation is normal or not. Our aim was to study the ciliary function and ultrastructure of epithelium above and below the airway anastomosis and the peripheral airway of children following lung transplantation. We studied the ciliary beat frequency (CBF) and beat pattern, using high speed digital video imaging and ultrastructure by transmission electron microscopy, of bronchial epithelium from above and below the airway anastomosis and the peripheral airway of 10 cystic fibrosis (CF) and 10 non-suppurative lung disease (NSLD) paediatric lung transplant recipients. Compared to epithelium below the anastomosis, the epithelium above the anastomosis in the CF group showed reduced CBF (median (interquartile range): 10.5 (9.0-11.4) Hz versus 7.4 (6.4-9.2) Hz; pepithelium above the anastomosis, the epithelium below the anastomosis showed marked ultrastructural abnormalities (median duration post-transplant 7-12 months). Ciliary dysfunction is a feature of native airway epithelium in paediatric CF lung transplant recipients. The epithelium below the airway anastomosis shows profound ultrastructural abnormalities in both CF and NSLD lung transplant recipients, many months after transplantation.

  12. Lung transplantation for severe antineutrophilic cytoplasmic antibody-associated vasculitis. (United States)

    Weinkauf, J; Puttagunta, L; Stewart, K; Humar, A; Homik, J; Caldwell, S; Fenton, M; Nador, R; Lien, Dale


    Antineutrophil cytoplasmic antibody-associated vasculitis is a life-threatening disorder for which medical therapy has greatly improved survival. However, there is still significant mortality associated with antineutrophil cytoplasmic antibody-associated vasculitis. Little data exists on the utility of lung transplantation for patients, especially with an acute and severe form of this disease. Herein, we report successful lung transplantation for a patient with life-threatening pulmonary hemorrhage and respiratory failure as a consequence of this pulmonary renal syndrome.

  13. Imaging in Lung Transplantation: Surgical Considerations of Donor and Recipient. (United States)

    Backhus, Leah M; Mulligan, Michael S; Ha, Richard; Shriki, Jabi E; Mohammed, Tan-Lucien H


    Modifications in recipient and donor criteria and innovations in donor management hold promise for increasing rates of lung transplantation, yet availability of donors remains a limiting resource. Imaging is critical in the work-up of donor and recipient including identification of conditions that may portend to poor posttransplant outcomes or necessitate modifications in surgical technique. This article describes the radiologic principles that guide selection of patients and surgical procedures in lung transplantation.

  14. Credential Application Awaiting Information (United States)

    Department of Homeland Security — When a Credential application or required documentation is incomplete, an Awaiting Information letter is issued. The application process cannot continue until all...

  15. Chronic lung allograft dysfunction after lung transplantation: novel insights into immunological mechanisms

    NARCIS (Netherlands)

    Budding, K.


    Lung transplantation (LTx) is the final treatment option for patients suffering from end-stage lung diseases. Survival after LTx is hampered by the development of chronic lung allograft dysfunction which presents itself in an obstructive form as the bronchiolitis obliterans syndrome (BOS). BOS is ha

  16. Initial experience with heart and lung transplantation. (United States)

    Reichenspurner, H; Odell, J A; Cooper, D K; Novitzky, D; Rose, A G; Klinner, W; Reichart, B


    Between February 1983 and July 1987, twelve patients underwent heart-lung transplantation at the University of Cape Town and the University of Munich. The patients included eight men and four women, whose ages ranged from 15 to 49 years (mean, 27 years). The underlying pathologic condition was idiopathic primary pulmonary hypertension in five cases, Eisenmenger's syndrome in four cases, idiopathic pulmonary fibrosis in one case, diffuse fibrosing alveolitis in one case, and chronic emphysema in one case. The immunosuppressive regimen consisted of cyclosporine A, azathioprine, and rabbit antithymocyte globulin (RATG) during the first 2 postoperative weeks; RATG was subsequently replaced by methylprednisolone. Pulmonary rejection frequently occurred in the absence of cardiac rejection; in one case, however, this situation was reversed. Two patients required retransplantation, which was undertaken for caseating pulmonary tuberculosis with obliterative bronchiolitis after 1 year in one case and for early pulmonary insufficiency after 2 days in the other case. There were no operative deaths, but three early deaths occurred, owing to respiratory insufficiency of unknown origin (10 days postoperatively), multiorgan failure (10 days postoperatively), and acute liver dystrophy (11 days postoperatively). Five weeks after operation, a fourth patient died of multi-organ failure. There were five late deaths, all of which resulted from infectious complications. Three patients, including one who underwent retransplantation, remain alive and well, 10 to 36 months postoperatively.

  17. Challenging immunosuppression treatment in lung transplant recipients with kidney failure. (United States)

    Högerle, Benjamin A; Kohli, Neeraj; Habibi-Parker, Kirsty; Lyster, Haifa; Reed, Anna; Carby, Martin; Zeriouh, Mohamed; Weymann, Alexander; Simon, André R; Sabashnikov, Anton; Popov, Aron-Frederik; Soresi, Simona


    Kidney failure after lung transplantation is a risk factor for chronic kidney disease. Calcineurin inhibitors are immunosuppressants which play a major role in terms of postoperative kidney failure after lung transplantation. We report our preliminary experience with the anti-interleukin-2 monoclonal antibody Basiliximab utilized as a "calcineurin inhibitor-free window" in the setting of early postoperative kidney failure after lung transplantation. Between 2012 and 2015 nine lung transplant patients who developed kidney failure for more than 14 days were included. Basiliximab was administrated in three doses (Day 0, 4, and 20) whilst Tacrolimus was discontinued or reduced to maintain a serum level between 2 and 4 ng/mL. Baseline glomerular filtration rate pre transplant was normal for all patients. Seven patients completely recovered from kidney failure (67%, mean eGFR pre and post Basiliximab: 42.3 mL/min/1.73 m(2) and 69 mL/min/1.73 m(2)) and were switched back on Tacrolimus. Only one of these patients still needs ongoing renal replacement therapy. Two patients showed no recovery from kidney failure and did not survive. Basiliximab might be a safe and feasible therapeutical option in patients which are affected by calcineurin inhibitor-related kidney failure in the early post lung transplant period. Further studies are necessary to confirm our preliminary results.

  18. Lung transplantation: chronic allograft dysfunction and establishing immune tolerance. (United States)

    Gracon, Adam S A; Wilkes, David S


    Despite significant medical advances since the advent of lung transplantation, improvements in long-term survival have been largely unrealized. Chronic lung allograft dysfunction, in particular obliterative bronchiolitis, is the primary limiting factor. The predominant etiology of obliterative bronchiolitis involves the recipient's innate and adaptive immune response to the transplanted allograft. Current therapeutic strategies have failed to provide a definitive treatment paradigm to improve long-term outcomes. Inducing immune tolerance is an emerging therapeutic strategy that abrogates allograft rejection, avoids immunosuppression, and improves long-term graft function. The aim of this review is to discuss the key immunologic components of obliterative bronchiolitis, describe the state of establishing immune tolerance in transplantation, and highlight those strategies being evaluated in lung transplantation.

  19. Translational Insights on Lung Transplantation: Learning from Immunology. (United States)

    Mohamed, Mohamed Shehata Ali


    The introduction of ex vivo lung perfusion (EVLP) in the practice of lung transplantation has allowed the reconditioning of the marginal grafts and their conversion into transplantable grafts. In addition, EVLP can provide a platform for the application of various preventive measures to decrease the incidence of post-transplant complications. While the Toronto team targets the attenuation of the cytokine production within the graft through gene therapy to up-regulate IL-10, other measures could be applied to achieve significant attenuation of the cytokine load of the graft. This manuscript provides a short overview on the importance of the attenuation of the cytokine production within the transplanted lung grafts and some possible strategies to achieve this goal.

  20. Lung and heart lung transplantation at the University of Alberta 1986-2010. (United States)

    Lien, Dale C; Weinkauf, Justin; Jackson, Kathleen; Kapasi, Ali; Nador, Roland; Meyer, Steven; Stewart, Kenneth; Modry, Dennis; Mullen, John


    The lung transplantation program at the University of Alberta has been in existence for 25 years. The current volume is 35-40 new lung transplants per year. We offer single-lung, bilateral lung, heart/lung and bilateral living lobar transplantation as options. Experience has allowed for widening of the indications and acceptance of patients with more risk. Donor evaluation and management has allowed for extended donors to be included in the donor pool. Results will likely continue to improve with increased understanding of the mechanisms and management of bronchiolitis obliterans syndrome. Our research interests have been in the areas of risk analysis, outcome assessment, and quality of life changes from transplantation.

  1. A rare occurrence of pulmonary alveolar proteinosis after lung transplantation. (United States)

    Albores, Jeffrey; Seki, Atsuko; Fishbein, Michael C; Abtin, Fereidoun; Lynch, Joseph P; Wang, Tisha; Weigt, S Samuel


    We present a case of pulmonary alveolar proteinosis (PAP) initially diagnosed 28 months after left single-lung transplantation for idiopathic pulmonary fibrosis. The diagnosis was based upon the presence of periodic acid-Schiff (PAS)-positive and surfactant immunostain-positive acellular lipoproteinaceous material within alveoli seen on transbronchial biopsy as well as in bronchoalveolar lavage fluid. The patient eventually also displayed a characteristic "crazy paving" pattern on radiographic imaging. Granulocyte macrophage-colony stimulating factor antibodies were negative, consistent with secondary PAP. PAP is a rare interstitial lung disease with only a few reported cases occurring after lung transplantation. The etiology is thought to be related to a defect in macrophage function caused by immunosuppression. Reduced immunosuppression has been associated with stabilization, but not reversal, of the condition in the case reported here. PAP is an exceptionally rare cause of dyspnea and radiographic infiltrates after lung transplantation and may be related to toxicity of immune-suppressive medications.

  2. Establishing of the Transplanted Animal Models for Human Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    Xingli Zhang; Jinchang Wu


    Lung cancer is the leading cause of cancer mortality worldwide.Even with the applications of excision,radiotherapy,chemotherapy,and gene therapy,the 5 year survival rate is only 15% in the USA.Clinically relevant laboratory animal models of the disease could greatly facilitate understanding of the pathogenesis of lung cancer,its progression,invasion and metastasis.Transplanted lung cancer models are of special interest and are widely used today.Such models are essential tools in accelerating development of new therapies for lung cancer.In this communication we will present a brief overview of the hosts,sites and pathways used to establish transplanted animal lung tumor models.

  3. Long-term outcome of lung transplantation in previous intravenous drug users with talc lung granulomatosis. (United States)

    Weinkauf, J G; Puttagunta, L; Nador, R; Jackson, K; LaBranche, K; Kapasi, A; Mullen, J; Modry, D L; Stewart, K C; Thakrar, M; Doucette, K; Lien, D C


    Talc lung granulomatosis results from the intravenous use of medication intended for oral use. Talc (magnesium silicate) acts as filler in some oral medications; when injected intravenously, it deposits in the lungs leading to airflow obstruction and impaired gas exchange. Allocation of donor lungs to previous intravenous drug users is controversial. After a careful selection process, 19 patients with talc lung granulomatosis have received lung allografts in our program. Long-term survival for these patients is excellent and our results suggest the previous use of intravenous drugs should not necessarily preclude lung transplantation.

  4. Predicting Delayed Ventilator Weaning after Lung Transplantation: The Role of Body Mass Index

    Directory of Open Access Journals (Sweden)

    Sarah Soh


    CONCLUSIONS: Low BMI might be associated with delayed ventilator weaning in lung transplantation patients. In addition, instead of the traditional weaning predictors of RSBI and RR, TV might be a better predictor for ventilator weaning after lung transplantation.

  5. Practical Guidelines: Lung Transplantation in Patients with Cystic Fibrosis

    Directory of Open Access Journals (Sweden)

    T. O. Hirche


    Full Text Available There are no European recommendations on issues specifically related to lung transplantation (LTX in cystic fibrosis (CF. The main goal of this paper is to provide CF care team members with clinically relevant CF-specific information on all aspects of LTX, highlighting areas of consensus and controversy throughout Europe. Bilateral lung transplantation has been shown to be an important therapeutic option for end-stage CF pulmonary disease. Transplant function and patient survival after transplantation are better than in most other indications for this procedure. Attention though has to be paid to pretransplant morbidity, time for referral, evaluation, indication, and contraindication in children and in adults. This review makes extensive use of specific evidence in the field of lung transplantation in CF patients and addresses all issues of practical importance. The requirements of pre-, peri-, and postoperative management are discussed in detail including bridging to transplant and postoperative complications, immune suppression, chronic allograft dysfunction, infection, and malignancies being the most important. Among the contributors to this guiding information are 19 members of the ECORN-CF project and other experts. The document is endorsed by the European Cystic Fibrosis Society and sponsored by the Christiane Herzog Foundation.

  6. Pre-transplant plasma Torque Teno virus load and increase dynamics after lung transplantation.

    Directory of Open Access Journals (Sweden)

    Irene Görzer

    Full Text Available The human Torque Teno virus (TTV causes persistent viremia in most immunocompetent individuals. Elevated TTV levels are observed after solid organ transplantation and are related to the extent of immunosuppression especially during the phase of maintenance immunosuppression. However, the extent to which the TTV increase in the early phase post-transplantation is associated with the patient's immunosuppressive state is unclear.In this study, we assessed the TTV increase dynamics in detail during the first three months after lung transplantation under a defined immunosuppressive regimen and in relation to the pre-transplant TTV level.Forty-six lung transplant recipients (LTRs were included in this prospective longitudinal study. All received alemtuzumab induction combined with tacrolimus and corticosteroids immunosuppressive therapy. Plasma TTV DNA was monitored before transplantation and regularly within the first three months post-transplantation (n = 320 samples; mean sampling interval: 12.2 days.In 43/46 LTRs (93%, TTV DNA was detectable before transplantation (median 4.4 log10 copies/mL; range: 2.0-6.4. All 46 LTRs showed a TTV increase post-transplantation, which followed a sigmoidal-shaped curve before the median peak level of 9.4 log10 copies/mL (range: 7.6-10.7 was reached at a median of day 67 (range: 41-92. The individual TTV DNA doubling times (range: 1.4-20.1 days significantly correlated with the pre-transplant TTV levels calculated over 30 or 60 days post-transplantation (r = 0.61, 0.54, respectively; both P < 0.001, but did not correlate with the mean tacrolimus blood levels. Pre-transplant TTV levels were not associated with time and level of the patients' post-transplant TTV peak load.The TTV level may be used to mirror the state of immunosuppression only after the patients' initial peak TTV level is reached.

  7. Pulmonary rehabilitation programs in lung transplant: a literature review

    Directory of Open Access Journals (Sweden)

    Juliana Maria de Sousa Pinto


    Full Text Available Objective: To analyze, using a literature review, Pulmonary Rehabilitation (RP Programs in lung transplant. Methods: A literature review in July 2014 in Ebsco Host, Periódicos Capes, BVS and Science Direct data bases using descriptors in English (“lung transplantation”, “lung transplant” AND/OR “rehabilitation” and Portuguese (“reabilitação” AND/OR “transplante pulmonar”. The eligibility criterions were interventional studies of PR before and/or after lung transplant; participants who were candidates to lung transplant or lung transplant recipients; studies that applied any kind of PR program (hospital-based, homebased or outpatient and articles published in English, Spanish or Portuguese. Literature reviews, guidelines and case reports were excluded. The search process yielded 46 articles of which two were duplicated. After title and abstract screening 13 articles remained for full text reading. Six studies met the inclusion eligibility and were included in the review. Results: The studies involved patients with Chronic Obstructive Pulmonary Disease, Cystic Fibrosis, Pulmonary Hypertension, Interstitial Lung Disease and Pulmonary Fibrosis. Pulmonary function, exercise capacity, quality of life (QoL and quadriceps force were evaluated. Most interventions were outpatient programs with three months duration, three times a week and session with at least one hour. Protocols included physical training, educational approach and just one included nutritional, psychiatric and social assistant follow-up. The studies presented significant change in the six-minute walking distance, QoL and quadriceps force after PR programs. Conclusion: This review showed the benefits of the PR in the QoL and exercise capacity contributing to the Health Promotion of the patients.

  8. P. aeruginosa in the paranasal sinuses and transplanted lungs have similar adaptive mutations as isolates from chronically infected CF lungs

    DEFF Research Database (Denmark)

    Ciofu, Oana; Johansen, Helle Krogh; Aanaes, Kasper;


    BACKGROUND: Pseudomonas aeruginosa cells are present as biofilms in the paranasal sinuses and the lungs of chronically infected cystic fibrosis (CF) patients. Since different inflammatory responses and selective antibiotic pressures are acting in the sinuses compared with the lungs, we compared......-lung transplantation isolates. RESULTS: The same phenotypes caused by similar mutations and similar gene expression profiles were found in mucoid and non-mucoid isolates from the paranasal sinuses and from the lungs before and after transplantation. CONCLUSION: Bilateral exchange of P. aeruginosa isolates between...... the paranasal sinuses and the lungs occurs in chronically infected patients and extensive sinus surgery before the lung transplantation might prevent infection of the new lung....

  9. Primary non-small cell lung cancer in a transplanted lung treated with stereotactic body radiation therapy. A case study

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    Oskan, F. [Munich Univ. (Germany). Dept. of Radiation Oncology; University Hospital of Saarland, Homburg (Saar) (Germany). Dept. of Radiation Oncology; Ganswindt, U.; Belka, C.; Manapov, F. [Munich Univ. (Germany). Dept. of Radiation Oncology


    The first case of primary lung cancer in a transplanted lung was described in 2001. Since then, only 5 cases of lung cancer in donated lung have been reported. We present one more patient with non-small cell cancer in the transplanted lung treated with stereotactic body radiation therapy. In most cases of primary lung cancer in transplanted lung, rapid progression of the cancer was reported. Occurrence of the locoregional failure in our case could be explained by factors related to the treatment protocol and also to underlying immunosuppression.

  10. Spirometric assessment of lung transplant patients: one year follow-up

    Directory of Open Access Journals (Sweden)

    Paulo M. Pêgo-Fernandes


    Full Text Available OBJECTIVE: The purpose of this study was to compare spirometry data between patients who underwent single-lung or double-lung transplantation the first year after transplantation. INTRODUCTION: Lung transplantation, which was initially described as an experimental method in 1963, has become a therapeutic option for patients with advanced pulmonary diseases due to improvements in organ conservation, surgical technique, immunosuppressive therapy and treatment of post-operative infections. METHODS: We retrospectively reviewed the records of the 39 patients who received lung transplantation in our institution between August 2003 and August 2006. Twenty-nine patients survived one year post-transplantation, and all of them were followed. RESULTS: The increase in lung function in the double-lung transplant group was more substantial than that of the single-lung transplant group, exhibiting a statistical difference from the 1st month in both the forced expiratory volume in one second (FEV1 and the forced vital capacity (FVC in comparison to the pre-transplant values (p <0.05. Comparison between double-lung transplant and single lung-transplant groups of emphysema patients demonstrated a significant difference in lung function beginning in the 3rd month after transplantation. DISCUSSION: The analyses of the whole group of transplant recipients and the sub-group of emphysema patients suggest the superiority of bilateral transplant over the unilateral alternative. Although the pre-transplant values of lung function were worse in the double-lung group, this difference was no longer significant in the subsequent months after surgery. CONCLUSION: Although both groups demonstrated functional improvement after transplantation, there was a clear tendency to greater improvement in FVC and FEV1 in the bilateral transplant group. Among our subjects, double-lung transplantation improved lung function.

  11. Bronchiolitis obliterans syndrome after lung transplantation: biomarkers for inflammation and fibrogenesis

    NARCIS (Netherlands)

    Kastelijn, E.A.


    Lung transplantation is the treatment of choice for patients with end-stage lung disease. However, long-term survival is limited due to the development of chronic rejection in the donor lung of the transplant recipient, called bronchiolitis obliterans syndrome (BOS). BOS is diagnosed after lung tr

  12. Limiting factors of exercise performance 1 year after lung transplantation

    NARCIS (Netherlands)

    Reinsma, G. D.; ten Hacken, N. H. T.; Grevink, R. G.; van der Bij, W.; Koer, G. H.; van Weert, E.


    Background: After lung transplantation (LTx). exercise capacity frequently remains limited, despite significantly improved pulmonary function. The aim of this study was to evaluate maximal exercise capacity and peripheral muscle force before and 1 year after LTx, and to determine whether peripheral

  13. Lung function after allogeneic hematopoietic stem cell transplantation in children

    DEFF Research Database (Denmark)

    Uhlving, Hilde Hylland; Larsen Bang, Cæcilie; Christensen, Ib Jarle


    Reduction in pulmonary function (PF) has been reported in up to 85% of pediatric patients during the first year after hematopoietic stem cell transplantation (HSCT). Our understanding of the etiology for this decrease in lung function is, however, sparse. The aim of this study was to describe PF...... experienced a decline in lung function of more than 10% during the first 3 to 9 months after HSCT. The decline in forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity and diffusion capacity of the lung for carbon monoxide were strongly associated with acute graft...

  14. Size matching in lung transplantation using predicted total lung capacity

    NARCIS (Netherlands)

    Ouwens, JP; van der Mark, TW; van der Bij, W; Koeter, GH


    Height is used in allocation of donor lungs as an indirect estimate of thoracic size. Total lung capacity (TLC), determined by both height and sex, could be a more accurate functional estimation of thoracic size. Size-matching criteria based on height versus predicted TLC was retrospectively evaluat

  15. Surgical issues in lung transplantation: options, donor selection, graft preservation, and airway healing. (United States)

    Daly, R C; McGregor, C G


    To present an overview of the surgical issues in lung transplantation, including the historical context and the rationale for choosing a particular procedure for a specific patient, we reviewed and summarized the current medical literature and our personal experience. Several surgical options are available, including single lung transplantation; double lung transplantation; heart-lung transplantation; bilateral, sequential single lung transplantation; and (recently) single lobe transplantation. Although single lung transplantation is preferred for maximal use of the available organs, bilateral lung transplantation is necessary for septic lung diseases and may be appropriate for pulmonary hypertension and bullous emphysema. Heart-lung transplantation is performed for Eisenmenger's syndrome and for primary pulmonary hypertension with severe right ventricular failure. General factors for consideration in assessment of compatibility of the donor and potential recipient include ABO blood group, height (the donor should be within +/- 20% of the recipient's height), and length of the lungs (determined on an anteroposterior chest roentgenogram). Graft preservation and minimal duration of ischemia are important. Complications associated with airway healing are related to ischemia of the donor bronchus. We have addressed the issue of donor bronchial ischemia by direct revascularization of the donor bronchial arteries with use of the recipient's internal thoracic artery. Currently, lung transplantation offers a realistic therapeutic option to patients with end-stage pulmonary parenchymal or vascular disease.

  16. Invasive Scedosporium sternal osteomyelitis following lung transplant: Cured

    Directory of Open Access Journals (Sweden)

    E.J. Denton


    Full Text Available Scedosporium is an important pathogen in cystic fibrosis (CF and post-transplant but rarely causes invasive infection. Treatment remains challenging, particularly due to inherent resistance to multiple antifungal agents. We present a young man with CF who developed invasive sternal and rib infection 10-months following lung transplant. The infection has been clinically and radiologically cured with extensive surgery and triazole therapy. This case highlights the importance of adjunctive surgery in addition to prolonged triazole treatment to manage invasive Scedosporium infections in immunosuppressed patients.

  17. Early experience with lung transplantation using donors after cardiac death. (United States)

    Mason, David P; Murthy, Sudish C; Gonzalez-Stawinski, Gonzalo V; Budev, Marie M; Mehta, Atul C; McNeill, Ann M; Pettersson, Gösta B


    Lung transplantations that utilize donor organs after cardiac death (DCD) can substantially increase the number of available allografts for waiting recipients. Unfortunately, reported clinical outcomes are limited and widespread acceptance is slow. To further examine the potential of this modality, the results of 4 patients transplanted with DCD organs, implementing a protocol of controlled organ retrieval (Maastricht Classification III), were reviewed. There were no operative deaths; extracorporeal membrane oxygenation was required in 1 patient secondary to severe primary graft dysfunction. Three patients are alive and well at 4, 15 and 21 months; 1 patient died at 34 months with bronchiolitis obliterans syndrome, in part attributable to medication non-compliance.

  18. Bronchoscopic lung volume reduction in a single-lung transplant recipient with natal lung hyperinflation: a case report. (United States)

    Pato, O; Rama, P; Allegue, M; Fernández, R; González, D; Borro, J M


    After single lung transplantation for emphysema native lung hyperinflation is a common complication that may cause respiratory failure. Herein we have reported satisfactory bronchoscopic lung volume reduction in a left single-lung transplant recipient with native lung hyperinflation, who suffered from Medical Research Council (MRC) class 3 dyspnea and chest pain. Three endobronchial valves (Zephyr; Emphasys Medical, Redwood, Calif, United States) were placed into the segmental bronchi of the right upper lobe, using videobronchoscopy under general anesthesia. Postoperative chest computed tomography revealed subsegmental atelectasis in that lobe. The clinical benefit was an improved MRC dyspnea class from 3 to 2, which was still present at 4 months after the procedure, although there were no remarkable changes in spirometric parameters.

  19. Surfactant treatment before reperfusion improves the immediate function of lung transplants in rats

    NARCIS (Netherlands)

    Erasmus, ME; Petersen, AH; Hofstede, G; Haagsman, HP; Oetomo, SB; Prop, J


    An impaired function of alveolar surfactant can cause lung transplant dysfunction early after reperfusion. In this study it was investigated whether treatment with surfactant before reperfusion improves the immediate function of lung transplants and whether an improved transplant function was associ


    NARCIS (Netherlands)



    To differentiate between acute and chronic lung rejection in an early stage, phenotypes of infiltrating inflammatory cells were analyzed in 34 transbronchial biopsies (TBBs) of 24 patients after heart-lung transplantation. TBBs were taken during during acute lung rejection and chronic lung rejection

  1. Treatment of intractable interstitial lung injury with alemtuzumab after lung transplantation

    DEFF Research Database (Denmark)

    Kohno, M; Perch, M; Andersen, E;


    of acute rejection, worsened within 2 weeks, despite high-dose steroids, change of calcineurin inhibitor, and plasmapheresis. Within a few days after a single, 10-mg, intravenous dose of alemtuzumab, the patient's health improved markedly. She has remained stable for 4 months on a standard, ambulatory......, posttransplant antirejection drug regimen. We have since successfully treated with alemtuzumab three additional patients who developed interstitial lung injury after lung transplantation, who are also summarized in this report....

  2. First Danish experience with ex vivo lung perfusion of donor lungs before transplantation

    DEFF Research Database (Denmark)

    Henriksen, Ian Sune Iversen; Møller-Sørensen, Hasse; Møller, Christian Holdfold


    % improved oxygenation. The median time to extubation, time in intensive care unit and the admission period were 1, 7 and 39 days, respectively. CONCLUSION: In the first year after the introduction of EVLP in Denmark, seven pairs of donor lungs that previously would have been rejected have been transplanted...

  3. Pulmonary hypertension as a risk factor of mortality after lung transplantation

    DEFF Research Database (Denmark)

    Andersen, Kasper H; Schultz, Hans Henrik L; Nyholm, Benjamin;


    PURPOSE: Pulmonary hypertension (PH) is recognized as a risk factor in lung transplantation as reflected in the lung allocation score (LAS). We examined the impact of PH on outcome after lung transplantation, with special emphasis on pre- and post-capillary PH. METHODS: Consecutive lung transplant...... recipients were evaluated according to ISHLT criteria including right heart catheterization in the period from 1992 to October 2014. Post-transplant survival was assessed according to hemodynamic characteristics: post-capillary PH (mean pulmonary arterial pressure [mPAP] ≥ 25 mmHg and pulmonary arterial...

  4. Rehabilitation and transition after lung transplantation in children. (United States)

    Burton, J H; Marshall, J M; Munro, P; Moule, W; Snell, G I; Westall, G P


    We describe the key components of an outpatient pediatric recovery and rehabilitation program set up within the adult lung transplant service at the Alfred Hospital, Melbourne. Following discharge, pediatric lung transplant recipients and their families participated in an intensive 3-month outpatient rehabilitation program. Weekly sessions included education regarding transplant issues, physiotherapy, and occupational therapy sessions. The overall aim of the program was to comprehensively address physical rehabilitation and psychosocial and educational needs. Sessions tailored to meet the individual needs of the child were presented at an appropriate cognitive level. Education sessions for both the children and parents focused on medications, identification of infection and rejection, nutrition, physiotherapy/rehabilitation, occupational roles and stress management, donor issues, psychosocial readjustment, and transition issues. Physiotherapy included a progressive aerobic and strength training program, postural reeducation, and core stability. We incorporate Age-appropriate play activities: running, dancing, jumping, ball skills, and so on. Occupational therapy sessions addressed the primary roles of patient, students, and player. Transitions such as returning to school, friends, and the community were explored. Issues discussed included adjustment to new health status, strategies to manage side effects of medications, and altered body image issues. Weekly multidisciplinary team meetings were used to discuss and plan the rehabilitation progress. School liaison and visits occurred prior to school commencement with follow-up offered to review the ongoing transition process. Both patients and parents have reported a high level of satisfaction with the rehabilitation program. We plan to formally evaluate the program in the future.

  5. Preoperative Cardiac Variables of Diastolic Dysfunction and Clinical Outcomes in Lung Transplant Recipients



    Background. Orthotopic lung transplantation is now widely performed in patients with advanced lung disease. Patients with moderate or severe ventricular systolic dysfunction are typically excluded from lung transplantation; however, there is a paucity of data regarding the prognostic significance of abnormal left ventricular diastolic function and elevated pretransplant pulmonary pressures. Methods. We reviewed the characteristics of 111 patients who underwent bilateral and unilateral lung tr...

  6. Telephone-adapted mindfulness-based stress reduction (tMBSR) for patients awaiting kidney transplantation: trial design, rationale and feasibility (United States)

    Reilly-Spong, Maryanne; Reibel, Diane; Pearson, Terry; Koppa, Pat; Gross, Cynthia R.


    Background Mindfulness-based stress reduction (MBSR) has demonstrated benefits for stress-related symptoms; however, for patients with burdensome treatment regimens, multiple co-morbidities and mobility impairment, time and travel requirements pose barriers to MBSR training. Purpose To describe the design, rationale and feasibility results of Journeys to Wellness, a clinical trial of mindfulness training delivered in a novel workshop and teleconference format. The trial aim is to reduce symptoms and improve quality of life in people waiting for a kidney transplant. Methods The standard 8-week MBSR program was reconfigured for delivery as two in-person workshops separated in time by six weekly teleconferences (tMBSR). A time and attention comparison condition (tSupport) was created using the workshop-telephone format. Feasibility results Kidney transplant candidates (N=63) were randomly assigned to tMBSR or tSupport: 87% (n=55) attended ≥1 class, and for these, attendance was high (6.6 ± 1.8 tMBSR and 7.0 ± 1.4 tSupport sessions). Fidelity monitoring found all treatment elements were delivered as planned and few technical problems occurred. Patients in both groups reported high treatment satisfaction, but more tMBSR (83%) than tSupport (43%) participants expected their intervention to be quite a bit or extremely useful for managing their health. Symptoms and quality of life outcomes collected before (baseline, 8 weeks and 6 months) and after kidney transplantation (2, 6 and 12 months) will be analyzed for efficacy. Conclusions tMBSR is an accessible intervention that may be useful to people with a wide spectrum of health conditions. NCT01254214 PMID:25847578

  7. Lung Transplantation from Nonheparinized Category III Non-Heart-Beating Donors. A Single-Centre Report

    NARCIS (Netherlands)

    Erasmus, Michiel E.; Verschuuren, Erik A. M.; Nijkamp, Danielle M.; Vermeyden, J. Wytse; van der Bij, Wim


    Background. Despite the increasing use of extended lung donors, the shortage of lung donors remains. Usage of non-heart-beating (NHB) lung donors contributes to fight this shortage. We describe our experience in 21 consecutive adult lung transplantations using nonheparinized category III NHB donors

  8. Silicosis y trasplante pulmonar Lung transplantation in silicosis

    Directory of Open Access Journals (Sweden)



    Full Text Available La silicosis es una enfermedad prevalente en Chile, que es un país minero y en desarrollo. Existe escasa bibliografía sobre trasplante pulmonar, como alternativa de tratamiento en silicosis avanzada. Objetivo: Describir el tiempo y forma de exposición a la sílice y las características clínicas de enfermos silicóticos tratados con trasplante pulmonar en la Clínica Las Condes de Santiago. Pacientes y Métodos: De un total de 38 pacientes en los que se practicó trasplante pulmonar entre 1999 y 2006, cuatro de ellos fueron trasplantados por padecer de silicosis avanzada. En estos 38 enfermos la fibrosis pulmonar idiopática fue la enfermedad subyacente predominante (55%. Resultados: Los 4 pacientes silicóticos fueron trasplantados a una edad que fluctuó entre 34 y 65 años. Su período de exposición varió entre 5 y 30 años y sus síntomas comenzaron a manifestarse 4 a 30 años después de iniciada la exposición. Dos pacientes eran mineros, otro trabajó en la molienda de cuarzo y el 4º enfermo fue pulidor de prótesis dentales. La cirugía fue compleja debido a la distorsión de la anatomía pulmonar de estos enfermos. La estadía hospitalaria fue más prolongada en los trasplantados silicóticos que en los no silicóticos (41 versus 21 días, p Silicosis is a prevalent disease in Chile, a developing miner country. Scarce information about lung transplantation as an alternative for treating severe silicosis is available. Objective: To describe the time and way of exposure to silica and the clinical characteristics of silicotic patients subjected to lung transplantation at Clinica Las Condes, Santiago. Patients and Methods: From 38 patients subjected to lung transplantation between 1999 and 2006, four of them were transplanted because of severe silicosis. Ldiopathic pulmonary fibrosis was the predominant underlying disease (55% of these 38 patients. Results: The four silicotic patients were transplanted at an age ranging from 34 to 65

  9. [A complete ventilation-perfusion mismatch following one-sided lung transplantation and postoperative hemothorax]. (United States)

    Jellinek, H; Klepetko, W; Hiesmayr, M


    Eight days after single-lung transplantation for pulmonary hypertension, a patient presented with a hemothorax on the side of the transplanted lung that required acute thoracotomy. Pulmonary artery pressure had decreased from 78/32/58 mmHg prior to the transplant to 42/18/27 mmHg on the 2nd postoperative day. Therefore, a predominance of perfusion to the transplanted lung was expected. During induction of anesthesia, in spite of ventilation with pure oxygen the patient developed a hypoxic cardiac arrest (paO2 26 mmHg, 40% saturation measured by pulse oximetry) requiring external chest compression. Auscultation and chest movements suggested that the transplanted lung was not ventilated. Because blood flow went mainly to the transplanted lung, ventilation of the native lung was almost totally dead-space ventilation. To enable ventilation of the compressed transplanted lung, the patient was intubated using a single-lumen bronchial blocker tube to block the mainstem bronchus of the native lung. The transplanted lung could then be ventilated. Saturation increased and epinephrine re-established a stable circulation; 2500 ml blood were removed from the pleura without further complications. On the 7th postoperative day the patient was discharged from the intensive care unit without neurological deficits. A perfusion scan 28 days post-transplant revealed 89% of the perfusion going to the transplanted lung. Atelectasis of this lung resulted in a large intrapulmonary right-to-left shunt. Hypoxic pulmonary vasoconstriction could not ameliorate the shunt because of the high pulmonary vascular resistance of the native lung.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Thymic Hyperplasia after Lung Transplantation Imitating Posttransplant Lymphoproliferative Disorder

    Directory of Open Access Journals (Sweden)

    Christina Maria Steger


    Full Text Available Thymic hyperplasia is usually associated with the treatment of malignant tumours and is sometimes linked with endocrine diseases. For the first time, we report a case of thymic hyperplasia in a patient 2 years after bilateral lung transplantation. Contrast-enhanced chest CT scan was highly suspicious for a posttransplant lymphoma or thymoma. Therefore, the patient received total thymectomy. Excised specimens were sent to the Department of Pathology. Unexpectedly, the histological examination revealed hyperplastic thymic tissue without evidence for a posttransplant lymphoproliferative disorder or malignancy.

  11. Bronchogenic Carcinoma after Lung Transplantation: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Yeming WANG


    Full Text Available Background and objective Lung transplantation is an efficient therapeutic option for patients with end-stage pulmonary diseases, but less is known about lung cancer after lung transplantation. The aim of this study is to improve the awareness, diagnosis and treatment of bronchogenic carcinoma after lung transplantation with a case report and related literatures. Methods We reported a 65-year-old male with idiopathic pulmonary fibrosis (IPF who underwent right lung transplantation under extracorporeal membrane oxygenation (ECMO support in May 2007 in our hospital. The patient recovered smoothly and discharged from the hospital 46 days after the procedure with regular follow-up. Immunosuppression therapy was triple drug maintenance regimen including tacrolimus (Tac, mycophenolate mofetil (MMF and steroids. Results Small cell lung cancer in the left lung with multiple osseous metastases was found 13 months after the lung transplantation. Symptoms were relieved a bit by administering chemotherapeutics (etoposide and cisplatin for 4 cycles. However, the patient was succumbed to his illness within 11 months after the diagnosis of lung cancer. Conclusion Lung cancer after lung transplantation has been suggested as one of causes of late mortality with the risk factors such as chronic obstructive pulmonary disease (COPD, IPF, cigarette smoking history and immunosuppression etc. Early diagnosis and treatment are very important to improve the prognosis.

  12. Bronchiolitis obliterans syndrome after lung transplantation: medical treatment. (United States)

    Verleden, G M


    Obliterative bronchiolitis (OB) or the clinical correlate bronchiolitis obliterans syndrome (BOS) is the main cause of late morbidity and mortality after heart-lung and lung transplantation. Although several risk factors for the development of OB/BOS have already been identified, very effective preventive therapy remains Utopian, although there has been much improvement in recent years. This paper attempts to summarize current experience in the medical treatment of OB/BOS, either by tackling the known risk factors for the development of OB/BOS or by changing the immunosuppressive drug regimen for treating established OB/BOS. The current treatment options, however, are rather anecdotal and mostly single-centre experiences. Therefore, multicentre studies are definitely needed to try to identify the most appropriate drug regimen either to prevent and to treat obliterative bronchiolitis/bronchiolitis obliterans syndrome.

  13. Recurrence of sarcoid granulomas in lung transplant recipients is common and does not affect overall survival

    DEFF Research Database (Denmark)

    Schultz, Hans Henrik; Andersen, C B; Steinbrüchel, D;


    Background: Sarcoidosis represents 2,5% of all indications for lung transplantation and criteria are generally assumed to be the same as for pulmonary fibrosis. Recurrence of granulomas in transplanted lungs has earlier been proved to derive from recipient immune cells, but its role in relation t...

  14. Nontuberculous Mycobacterial Disease Is Not a Contraindication to Lung Transplantation in Patients With Cystic Fibrosis

    DEFF Research Database (Denmark)

    Qvist, Tavs; Pressler, Tanja; Thomsen, V O;


    Whether nontuberculous mycobacterial (NTM) disease is a contraindication to lung transplantation remains controversial. We conducted a nationwide study to evaluate the clinical importance of NTM infection among lung transplant patients with cystic fibrosis (CF) in Denmark and to determine if NTM...

  15. Cost-effectiveness of lung transplantation in relation to type of end-stage pulmonary disease

    NARCIS (Netherlands)

    Groen, H; van der Bij, W; Koeter, GH; TenVergert, EM


    The purpose of this study was to explore the relationship between diagnosis and the cost-effectiveness and cost-utility of lung transplantation. A microsimulation model was used, based on empirical data from the Dutch lung transplantation program, collected between 1991 and 1999. We assessed life-ye

  16. First successful bilateral living-donor lobar lung transplantation in China

    Institute of Scientific and Technical Information of China (English)

    CHEN Qian-kun; JIANG Ge-ning; DING Jia-an; GAO Wen; CHEN Chang; ZHOU Xiao


    @@ Lung transplantation has been performed internationally as an effective treatment for a variety of end-stage lung diseases. A great disparity between the supply of donor organs and the demand of potential recipients has resulted in longer waiting time and annual increases in deaths on the lung transplant waiting list. Living-donor lobar lung transplantation (LDLLT) has become an established strategy to deal with the shortage of cadaveric donors. Encouraged by Starnes et al1 and Date et al,2 we began to apply the operation to a critically ill patient with bronchopulmonary dysplasia (BPD) firstly at Shanghai Pulmonary Hospital in China.

  17. Proteome Profiling in Lung Injury after Hematopoietic Stem Cell Transplantation. (United States)

    Bhargava, Maneesh; Viken, Kevin J; Dey, Sanjoy; Steinbach, Michael S; Wu, Baolin; Jagtap, Pratik D; Higgins, LeeAnn; Panoskaltsis-Mortari, Angela; Weisdorf, Daniel J; Kumar, Vipin; Arora, Mukta; Bitterman, Peter B; Ingbar, David H; Wendt, Chris H


    Pulmonary complications due to infection and idiopathic pneumonia syndrome (IPS), a noninfectious lung injury in hematopoietic stem cell transplant (HSCT) recipients, are frequent causes of transplantation-related mortality and morbidity. Our objective was to characterize the global bronchoalveolar lavage fluid (BALF) protein expression of IPS to identify proteins and pathways that differentiate IPS from infectious lung injury after HSCT. We studied 30 BALF samples from patients who developed lung injury within 180 days of HSCT or cellular therapy transfusion (natural killer cell transfusion). Adult subjects were classified as having IPS or infectious lung injury by the criteria outlined in the 2011 American Thoracic Society statement. BALF was depleted of hemoglobin and 14 high-abundance proteins, treated with trypsin, and labeled with isobaric tagging for relative and absolute quantification (iTRAQ) 8-plex reagent for two-dimensional capillary liquid chromatography (LC) and data dependent peptide tandem mass spectrometry (MS) on an Orbitrap Velos system in higher-energy collision-induced dissociation activation mode. Protein identification employed a target-decoy strategy using ProteinPilot within Galaxy P. The relative protein abundance was determined with reference to a global internal standard consisting of pooled BALF from patients with respiratory failure and no history of HSCT. A variance weighted t-test controlling for a false discovery rate of ≤5% was used to identify proteins that showed differential expression between IPS and infectious lung injury. The biological relevance of these proteins was determined by using gene ontology enrichment analysis and Ingenuity Pathway Analysis. We characterized 12 IPS and 18 infectious lung injury BALF samples. In the 5 iTRAQ LC-MS/MS experiments 845, 735, 532, 615, and 594 proteins were identified for a total of 1125 unique proteins and 368 common proteins across all 5 LC-MS/MS experiments. When comparing IPS to

  18. Lung Transplantation in Gaucher Disease: A Learning Lesson in Trying to Avoid Both Scylla and Charybdis. (United States)

    de Boer, Geertje M; van Dussen, Laura; van den Toorn, Leon M; den Bakker, Michael A; Hoek, Rogier A S; Hesselink, Dennis A; Hollak, Carla E M; van Hal, Peter Th W


    Gaucher disease (GD), a lysosomal storage disorder, may result in end-stage lung disease. We report successful bilateral lung transplantation in a 49-year-old woman with GD complicated by severe pulmonary hypertension and fibrotic changes in the lungs. Before receiving the lung transplant, the patient was undergoing both enzyme replacement therapy (imiglucerase) and triple pulmonary hypertension treatment (epoprostenol, bosentan, and sildenafil). She had a history of splenectomy, severe bone disease, and renal involvement, all of which were related to GD and considered as relative contraindications for a lung transplantation. In the literature, lung transplantation has been suggested for severe pulmonary involvement in GD but has been reported only once in a child. To our knowledge, until now, no successful procedure has been reported in adults, and no reports deal with the severe potential posttransplantation complications specifically related to GD.

  19. Lobar lung transplantation from deceased donors: A systematic review (United States)

    Eberlein, Michael; Reed, Robert M; Chahla, Mayy; Bolukbas, Servet; Blevins, Amy; Van Raemdonck, Dirk; Stanzi, Alessia; Inci, Ilhan; Marasco, Silvana; Shigemura, Norihisa; Aigner, Clemens; Deuse, Tobias


    AIM To systematically review reports on deceased-donor-lobar lung transplantation (ddLLTx) and uniformly describe size matching using the donor-to-recipient predicted-total lung-capacity (pTLC) ratio. METHODS We set out to systematically review reports on ddLLTx and uniformly describe size matching using the donor-to-recipient pTLC ratio and to summarize reported one-year survival data of ddLLTx and conventional-LTx. We searched in PubMed, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley (CDSR), Database of Abstracts of Reviews of Effects via Wiley (DARE), Cochrane Central Register of Controlled Trials via Wiley (CENTRAL), Scopus (which includes EMBASE abstracts), and Web of Science for original reports on ddLLTx. RESULTS Nine observational cohort studies reporting on 301 ddLLTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The ddLLTx-group was often characterized by high acuity; however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pTLC ratio was available for 242 ddLLTx (80%). The mean pTLCratio before lobar resection was 1.25 ± 0.3 and the transplanted pTLCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddLLTx-group ranged from 50%-100%, compared to 72%-88% in the conventional-LTx group. In the largest study ddLLTx (n = 138) was associated with a lower one-year-survival compared to conventional-LTx (n = 539) (65.1% vs 84.1%, P < 0.001). CONCLUSION Further investigations of optimal donor-to-recipient size matching parameters for ddLLTx could improve outcomes of this important surgical option. PMID:28280698

  20. Impact of nutritional state on lung transplant outcomes: the weight of the evidence. (United States)

    Shah, Pali; Orens, Jonathan B


    Despite advances in perioperative and post-operative management, lung transplant recipients with select pre transplant risk factors have been shown to experience worse post-transplant outcomes in comparison to those without such risk factors. Among these variables, previous studies have shown that select markers of poor nutritional status prior to transplant, such as low body mass index (BMI) and hypoalbuminemia, have been associated with increased post-transplant mortality. In a past issue of the journal, Chamogeorgakis el al. examine a comprehensive battery markers previously associated with malnutrition to determine their impact on outcomes after lung transplantation. The authors find that hypoalbuminemia is associated with worse survival, but does not appear to affect the risk of post-transplant infections. This article reviews the study presented by Chamogeorgakis et al. to discuss how it furthers our understanding of the impact of nutritional status on transplant-related outcomes and consider areas for future investigation.

  1. A Concise Review of Hepatitis C in Heart and Lung Transplantation

    Directory of Open Access Journals (Sweden)

    Edward Kim


    Full Text Available Hepatitis C (HCV infection is prevalent in recipients of, and candidates for, solid organ transplants. The outcomes of HCV infection in cardiac and lung transplant recipients have yet to be clearly established, and future prospective studies are needed. In the absence of safe and effective antiviral treatment for HCV infection in heart and lung transplant recipients, the management of these patients remains a challenge and must be considered on an individual basis. Interferon therapy for HCV before transplantation appears to improve outcomes; however, post-transplant interferon therapy in the cardiac and pulmonary transplant setting may be associated with an increased risk of graft rejection. Given the paucity of information regarding HCV treatment in these transplant recipients, and with appropriate concerns that graft loss from rejection may not be amenable to a second transplant (given the scarcity of suitable cadaveric organs, multicentre, randomized controlled trials are needed to determine the optimal approach for treatment of HCV infection in this population.

  2. Scintigraphy at 3 months after single lung transplantation and observations of primary graft dysfunction and lung function

    DEFF Research Database (Denmark)

    Belmaati, Esther Okeke; Iversen, Martin; Kofoed, Klaus F;


    procedure 3 months after single lung transplantation (SLTX). A total of 41 patients were included in the study: 20 women and 21 men with the age span of patients at transplantation being 38-66 years (mean ± SD: 54.2 ± 6.0). Patient records also included lung function tests and chest X-ray images. We found......, and to investigate whether scintigraphic findings at 3 months were predictive for the outcome at 12 months in relation to primary graft dysfunction (PGD) and lung function. A retrospective study was carried out on all patients who prospectively and consecutively were referred for a routine lung scintigraphy...... no significant correlation between lung function distribution at 3 months and PGD at 72 h. There was also no significant correlation between PGD scores at 72 h and lung function at 6 and 12 months. The same applied to scintigraphic scores for heterogeneity at 3 months compared with lung function at 6 and 12...

  3. Psychological criteria for contraindication in lung transplant candidates: a five-year study* (United States)

    Hojaij, Elaine Marques; Romano, Bellkiss Wilma; Costa, André Nathan; Afonso, Jose Eduardo; de Camargo, Priscila Cilene Leon Bueno; Carraro, Rafael Medeiros; Campos, Silvia Vidal; Samano, Marcos Naoyuki; Teixeira, Ricardo Henrique de Oliveira Braga


    Lung transplantation presents a wide range of challenges for multidisciplinary teams that manage the care of the recipients. Transplant teams should perform a thorough evaluation of transplant candidates, in order to ensure the best possible post-transplant outcomes. That is especially true for the psychologist, because psychological issues can arise at any point during the perioperative period. The objective of our study was to evaluate the psychological causes of contraindication to waiting list inclusion in a referral program for lung transplantation. We retrospectively analyzed data on psychological issues presented by lung transplant candidates, in order to understand these matters in our population and to reflect upon ways to improve the selection process. PMID:26176522

  4. Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation (United States)

    Shepherd, Edward G.; Gee, Samantha W.


    Pediatric lung transplantation is a life-saving intervention for children with irreversible end-stage lung disease. Access to transplant can be limited by geographic isolation from a center or the presence of comorbidities affecting transplant eligibility. Extracorporeal membrane oxygenation (ECMO)-supported patients are an uncommon but historically high-risk cohort of patients considered for lung transplant. We report the development of a service at our center to provide transport services to our hospital for patients unable to wean from ECMO support at their local institution for the purpose of evaluation for lung transplantation by our program. We developed a process for pre-transport consultation by the lung transplant physician team, standardized hand-off tools and equipment lists, and procedures for transitioning patients to transport ECMO machinery. Four patients have been transported to date including fixed wing (FW) and helicopter transports. All patients were successfully transported with either none or minor complications. Transport of ECMO-supported patients is a feasible method to increase access of patients with irreversible lung injured patients to evaluation for lung transplant. PMID:28275613

  5. Iatrogenic “buffalo chest” bilateral pneumothoraces following unilateral transbronchial lung biopsies in a bilateral lung transplant recipient

    Directory of Open Access Journals (Sweden)

    Leith Sawalha


    Full Text Available We present a 54 year old male patient who had a bilateral lung transplant sixteen years ago for Alpha-1 Antitrypsin Deficiency-related emphysema. He was referred for flexible bronchoscopy with transbronchial biopsies to evaluate new mild exertional dyspnea and worsening of his FEV1. Eight transbronchial biopsies were done from the right middle lobe and the right lower lobe. Post procedure he developed bilateral pneumothoces that required emergent bilateral pleural ‘pigtail’ catheters. To our knowledge, this is the first reported case of bilateral pneumothoraces that developed after a unilateral procedure in a bilateral lung transplant recipient relatively late after the transplant.

  6. Soluble CD59 is a Novel Biomarker for the Prediction of Obstructive Chronic Lung Allograft Dysfunction after Lung Transplantation

    NARCIS (Netherlands)

    Budding, Kevin; Van De Graaf, Eduard A.; Kardol-Hoefnagel, Tineke; Kwakkel-van Erp, Johanna M.; Luijk, Bart D.; Oudijk, Erik Jan D; Van Kessel, Diana A.; Grutters, Jan C.; Hack, C. Erik; Otten, Henderikus G.


    CD59 is a complement regulatory protein that inhibits membrane attack complex formation. A soluble form of CD59 (sCD59) is present in various body fluids and is associated with cellular damage after acute myocardial infarction. Lung transplantation (LTx) is the final treatment for end-stage lung dis

  7. Periostitis secondary to prolonged voriconazole therapy in lung transplant recipients. (United States)

    Wang, T F; Wang, T; Altman, R; Eshaghian, P; Lynch, J P; Ross, D J; Belperio, J A; Weigt, S S; Saggar, R; Gregson, A; Kubak, B; Saggar, R


    We report five cases of possible drug-induced periostitis associated with long-term use of voriconazole therapy after lung transplantation (LT). The diagnosis of periostitis was made by the documentation of bone pain, elevation of serum alkaline phosphatase and characteristic findings on radionuclide bone imaging in the absence of any identifiable rheumatologic disease. This periostitis appears similar to hypertrophic osteoarthopathy (HOA) but does not meet all criteria for HOA. In all patients, the symptoms resolved rapidly after discontinuation of voriconazole therapy. Awareness of this potential syndrome, which manifests as bone pain, elevated serum alkaline phosphatase and a bone scan suggestive of periostitis, is necessary in LT recipients on long-term voriconazole.

  8. Extracorporeal membrane oxygenation in the pre and post lung transplant period (United States)

    Hartwig, Mathew G.; Hayes, Don


    Evolution in technology has resulted in rapid increase in utilization of extracorporeal membrane oxygenation (ECMO) as a bridge to recovery and/or transplantation. Although there is limited evidence for the use of ECMO, recent improvements in ECMO technology, personnel training, ambulatory practices on ECMO and lung protective strategies have resulted in improved outcomes in patients bridged to lung transplantation. This review provides an insight into the current outcomes and best practices for utilization of ECMO in the pre- and post-lung transplantation period. PMID:28275619

  9. A novel dual ex vivo lung perfusion technique improves immediate outcomes in an experimental model of lung transplantation. (United States)

    Tanaka, Y; Noda, K; Isse, K; Tobita, K; Maniwa, Y; Bhama, J K; D'Cunha, J; Bermudez, C A; Luketich, J D; Shigemura, N


    The lungs are dually perfused by the pulmonary artery and the bronchial arteries. This study aimed to test the feasibility of dual-perfusion techniques with the bronchial artery circulation and pulmonary artery circulation synchronously perfused using ex vivo lung perfusion (EVLP) and evaluate the effects of dual-perfusion on posttransplant lung graft function. Using rat heart-lung blocks, we developed a dual-perfusion EVLP circuit (dual-EVLP), and compared cellular metabolism, expression of inflammatory mediators, and posttransplant graft function in lung allografts maintained with dual-EVLP, standard-EVLP, or cold static preservation. The microvasculature in lung grafts after transplant was objectively evaluated using microcomputed tomography angiography. Lung grafts subjected to dual-EVLP exhibited significantly better lung graft function with reduced proinflammatory profiles and more mitochondrial biogenesis, leading to better posttransplant function and compliance, as compared with standard-EVLP or static cold preservation. Interestingly, lung grafts maintained on dual-EVLP exhibited remarkably increased microvasculature and perfusion as compared with lungs maintained on standard-EVLP. Our results suggest that lung grafts can be perfused and preserved using dual-perfusion EVLP techniques that contribute to better graft function by reducing proinflammatory profiles and activating mitochondrial respiration. Dual-EVLP also yields better posttransplant graft function through increased microvasculature and better perfusion of the lung grafts after transplantation.

  10. The First Successful Heart-Lung Transplant in a Korean Child with Humidifier Disinfectant-Associated Interstitial Lung Disease. (United States)

    Jhang, Won Kyoung; Park, Seong Jong; Lee, Eun; Yang, Song I; Hong, Soo Jong; Seo, Ju-Hee; Kim, Hyung-Young; Park, Jeong-Jun; Yun, Tae-Jin; Kim, Hyeong Ryul; Kim, Yong-Hee; Kim, Dong Kwan; Park, Seung-Il; Lee, Sang-Oh; Hong, Sang-Bum; Shim, Tae-Sun; Choi, In-Cheol; Yu, Jinho


    From 2006 to 2011, an outbreak of a particular type of childhood interstitial lung disease occurred in Korea. The condition was intractable and progressed to severe respiratory failure, with a high mortality rate. Moreover, in several familial cases, the disease affected young women and children simultaneously. Epidemiologic, animal, and post-interventional studies identified the cause as inhalation of humidifier disinfectants. Here, we report a 4-year-old girl who suffered from severe progressive respiratory failure. She could survive by 100 days of extracorporeal membrane oxygenation support and finally, underwent heart-lung transplantation. This is the first successful pediatric heart-lung transplantation carried out in Korea.

  11. Pulmonary Rehabilitation in Lung Transplant Candidates: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Stefanie Tonguino Rosero


    Full Text Available Pulmonary rehabilitation (PR aims to improve physical fitness and to decrease symptoms in patients with chronic lung disease; however there is not clear evidence regarding the benefits of PR in candidates for lung transplantation (LT. Objective. To determine the effectiveness of PR in LT candidates and also to find out how quality of life and exercise tolerance affects the survival of these patients. Methodology. Electronic databases (Medline, Cochrane, PEDro, Scient Direct and SciELO Search of articles in spanish, english or portuguese; controlled clinical trials and cohort studies published between 2000-2011 regarding PR in candidates for LT, the model of Cochrane systematic reviews was used. Results. The papers included were four cohort, two of which regarded of survival pre LT using the six minutes walking test (6MWT; a study of quality of life related to post LT survival and an exercise tolerance study. Controlled clinical trial was not found. Conclusions. The information found in the included studies had clinical and methodological heterogeneity therefore a meta-analysis could not been undertaken. The PR should be considered as an essential part to maintain the exercise tolerance and the patient’s survival. Research regarding this subject is important and should be carried out.

  12. Lung transplantation in chronic obstructive pulmonary disease: patient selection and special considerations

    Directory of Open Access Journals (Sweden)

    Lane CR


    Full Text Available C Randall Lane, Adriano R Tonelli Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA Abstract: Chronic obstructive pulmonary disease (COPD is a leading cause of mortality and morbidity. Lung transplantation is one of the few treatments available for end-stage COPD with the potential to improve survival and quality of life. The selection of candidates and timing of listing present challenges, as COPD tends to progress fairly slowly, and survival after lung transplantation remains limited. Though the natural course of COPD is difficult to predict, the use of assessments of functional status and multivariable indices such as the BODE index can help identify which patients with COPD are at increased risk for mortality, and hence which are more likely to benefit from lung transplantation. Patients with COPD can undergo either single or bilateral lung transplantation. Although many studies suggest better long-term survival with bilateral lung transplant, especially in younger patients, this continues to be debated, and definitive recommendations about this cannot be made. Patients may be more susceptible to particular complications of transplant for COPD, including native lung hyperinflation, and development of lung cancer. Keywords: emphysema, pulmonary hypertension, mortality, prognosis, outcomes, alpha-1 antitrypsin deficiency

  13. Clinical usefulness of oral immunoglobulins in lung transplant recipients with norovirus gastroenteritis: a case series. (United States)

    Gairard-Dory, A-C; Dégot, T; Hirschi, S; Schuller, A; Leclercq, A; Renaud-Picard, B; Gourieux, B; Kessler, R


    Viral gastroenteritis causing diarrhea is a common complication observed in lung transplant recipients. Differently from the mild and typically self-limited disease seen in immunocompetent subjects, immunocompromised patients frequently have a more severe course. Norovirus and rotavirus are among the leading causes of severe gastroenteritis in transplant recipients. Specific treatment is unavailable, although good supportive treatment can significantly reduce morbidity. Previous studies have suggested that oral immunoglobulins may be used for the treatment of acute viral gastroenteritis after solid-organ transplantation. Herein, we conducted a retrospective chart review of 12 lung transplant recipients with norovirus-induced gastroenteritis who were treated with oral immunoglobulins for 2 days. Eleven patients were successfully treated, whereas 1 subject was only mildly improved. Four patients had at least 1 recurrence. No significant adverse effects were observed. We conclude that oral immunoglobulins may be clinically useful for lung transplant recipients with norovirus-induced gastroenteritis.

  14. A Peptide to Reduce Pulmonary Edema in a Rat Model of Lung Transplantation (United States)

    Finsterwalder, Richard; Friedl, Heinz P.; Rauscher, Sabine; Gröger, Marion; Kocher, Alfred; Wagner, Christine; Wagner, Stephan N.; Fischer, Gottfried; Schultz, Marcus J.; Wiedemann, Dominik; Petzelbauer, Peter


    Background Despite significant advances in organ preservation, surgical techniques and perioperative care, primary graft dysfunction is a serious medical problem in transplantation medicine in general and a specific problem in patients undergoing lung transplantation. As a result, patients develop lung edema, causing reduced tissue oxygenation capacity, reduced lung compliance and increased requirements for mechanical ventilatory support. Yet, there is no effective strategy available to protect the grafted organ from stress reactions induced by ischemia/reperfusion and by the surgical procedure itself. Methods We assessed the effect of a cingulin-derived peptide, XIB13 or a random peptide in an established rat model of allogeneic lung transplantation. Donor lungs and recipients received therapeutic peptide at the time of transplantation and outcome was analyzed 100min and 28 days post grafting. Results XIB13 improved blood oxygenation and reduced vascular leak 100min post grafting. Even after 28 days, lung edema was significantly reduced by XIB13 and lungs had reduced fibrotic or necrotic zones. Moreover, the induction of an allogeneic T cell response was delayed indicating a reduced antigen exchange between the donor and the host. Conclusions In summary, we provide a new tool to strengthen endothelial barrier function thereby improving outcomes in lung transplantation. PMID:26536466

  15. A Peptide to Reduce Pulmonary Edema in a Rat Model of Lung Transplantation.

    Directory of Open Access Journals (Sweden)

    Klaudia Schossleitner

    Full Text Available Despite significant advances in organ preservation, surgical techniques and perioperative care, primary graft dysfunction is a serious medical problem in transplantation medicine in general and a specific problem in patients undergoing lung transplantation. As a result, patients develop lung edema, causing reduced tissue oxygenation capacity, reduced lung compliance and increased requirements for mechanical ventilatory support. Yet, there is no effective strategy available to protect the grafted organ from stress reactions induced by ischemia/reperfusion and by the surgical procedure itself.We assessed the effect of a cingulin-derived peptide, XIB13 or a random peptide in an established rat model of allogeneic lung transplantation. Donor lungs and recipients received therapeutic peptide at the time of transplantation and outcome was analyzed 100min and 28 days post grafting.XIB13 improved blood oxygenation and reduced vascular leak 100min post grafting. Even after 28 days, lung edema was significantly reduced by XIB13 and lungs had reduced fibrotic or necrotic zones. Moreover, the induction of an allogeneic T cell response was delayed indicating a reduced antigen exchange between the donor and the host.In summary, we provide a new tool to strengthen endothelial barrier function thereby improving outcomes in lung transplantation.

  16. Acute Demyelinating Polyneuropathy after Lung Transplantation: Guillain-Barré Syndrome or Tacrolimus Toxicity?

    Directory of Open Access Journals (Sweden)

    Nirmal S. Sharma


    Full Text Available Guillain-Barré syndrome (GBS has been described after solid organ and bone marrow transplantation mostly due to viral infections and possibly calcineurin inhibitors. Incidence after bone marrow transplant is 0.3–0.7%, though incidence in other transplants is not well known. We present the first description of tacrolimus associated GBS in lung transplant recipients in the English language literature. The pathophysiology of tacrolimus-induced polyneuropathy is not known, but some have hypothesized that tacrolimus induces an inflammatory phenomenon by differential effects on T cell subsets. Diagnosis of association may be challenging and requires high index of suspicion. The optimal treatment of GBS-associated with tacrolimus after lung transplantation is unknown, although drug discontinuation may result in improvement in some patients, while some reports suggest that the use of IVIG and/or plasmapheresis may be helpful and safe in organ transplant recipients with severe symptoms.

  17. Tsukamurella tyrosinosolvens - An unusual case report of bacteremic pneumonia after lung transplantation

    Directory of Open Access Journals (Sweden)

    Dromer Claire


    Full Text Available Abstract Background Lung transplant recipients have an increased risk for actinomycetales infection secondary to immunosuppressive regimen. Case presentation A case of pulmonary infection with bacteremia due to Tsukamurella tyrosinosolvens in a 54-year old man who underwent a double lung transplantation four years previously is presented. Conclusion The identification by conventional biochemical assays was unsuccessful and hsp gene sequencing was used to identify Tsukamurella tyrosinosolvens.

  18. Intravenous Immunoglobulin for Hypogammaglobulinemia after Lung Transplantation: A Randomized Crossover Trial


    Lederer, David J.; Nisha Philip; Debbie Rybak; Arcasoy, Selim M.; Kawut, Steven M.


    BACKGROUND: We aimed to determine the effects of treatment with intravenous immunoglobulin on bacterial infections in patients with hypogammaglobulinemia (HGG) after lung transplantation. METHODS: We performed a randomized, double-blind, placebo-controlled two-period crossover trial of immune globulin intravenous (IVIG), 10% Purified (Gamunex, Bayer, Elkhart, IN) monthly in eleven adults who had undergone lung transplantation more than three months previously. We randomized study participants...

  19. Pulmonary artery dissection in a patient with Eisenmenger syndrome treated with heart and lung transplantation

    DEFF Research Database (Denmark)

    Tønder, Niels; Køber, Lars; Hassager, Christian


    We report the case of a patient with known Eisenmenger syndrome due to congenital ventricular septal defect, who developed pulmonary artery dissection. The patient was successfully treated with heart and lung transplantation.......We report the case of a patient with known Eisenmenger syndrome due to congenital ventricular septal defect, who developed pulmonary artery dissection. The patient was successfully treated with heart and lung transplantation....

  20. First Report of Lung Transplantation in a Patient With Active Pulmonary Mycobacterium simiae Infection

    DEFF Research Database (Denmark)

    Qvist, T; Katzenstein, Terese Lea; Lillebaek, T


    Mycobacterium simiae is a slow-growing mycobacteria that in rare cases can cause chronic pulmonary infection. We report the first case of lung transplantation in a patient with active M simiae infection at the time of transplantation. A 56-year-old immunocompetent nonsmoking woman underwent...

  1. Improved quality of life after lung transplantation in individuals with cystic fibrosis

    NARCIS (Netherlands)

    Vermeulen, KM; van der Bij, W; Erasmus, ME; Duiverman, EJ; Koeter, GH; TenVergert, EM


    The aim of the present study was to assess the effect of lung transplantation (LgTX) on health-related quality of life (HRQL) in a group of patients with cystic fibrosis (CF), compared to patients with other diagnoses (non-CF). HRQL was assessed before transplantation in a group of 32 CIF patients a

  2. Airway cellular response to two different immunosuppressive regimens in lung transplant recipients

    NARCIS (Netherlands)

    Slebos, DJ; Kauffman, HF; Koeter, GH; Verschuuren, EAM; van der Bij, W; Postma, DS


    A number of new immunosuppressive drugs have become available in transplant medicine. We investigated the effects of two different immunosuppressive protocols on bronchoalveolar lavage fluid cellular characteristics in 34 lung transplant recipients who were treated with anti-thymocyte globulin induc

  3. Donor surfactant protein D (SP-D) polymorphisms are associated with lung transplant outcome. (United States)

    Aramini, B; Kim, C; Diangelo, S; Petersen, E; Lederer, D J; Shah, L; Robbins, H; Floros, J; Arcasoy, S M; Sonett, J R; D'Ovidio, F


    Chronic lung allograft dysfunction (CLAD) is the major factor limiting long-term success of lung transplantation. Polymorphisms of surfactant protein D (SP-D), an important molecule within lung innate immunity, have been associated with various lung diseases. We investigated the association between donor lung SP-D polymorphisms and posttransplant CLAD and survival in 191 lung transplant recipients consecutively transplanted. Recipients were prospectively followed with routine pulmonary function tests. Donor DNA was assayed by pyrosequencing for SP-D polymorphisms of two single-nucleotide variations altering amino acids in the mature protein N-terminal domain codon 11 (Met(11) Thr), and in codon 160 (Ala(160) Thr) of the C-terminal domain. CLAD was diagnosed in 88/191 patients, and 60/191 patients have died. Recipients of allografts that expressed the homozygous Met(11) Met variant of aa11 had significantly greater freedom from CLAD development and better survival compared to those with the homozygous Thr(11) Th variant of aa11. No significant association was noted for SP-D variants of aa160. Lung allografts with the SP-D polymorphic variant Thr(11) Th of aa11 are associated with development of CLAD and reduced survival. The observed genetic differences of the donor lung, potentially with their effects on innate immunity, may influence the clinical outcomes after lung transplantation.

  4. Long-term health-related quality of life after lung transplantation : Different predictors for different dimensions

    NARCIS (Netherlands)

    Vermeulen, Karin M.; van der Bij, Wim; Erasmus, Michiel E.; TenVergert, Elisabeth M.


    Background: Lung transplantation has proven to be an effective treatment option for patients with end-stage lung disease with profound effects on both survival and health-related quality of life (HRQL). Generally, studies have reported improved HRQL after lung transplantation. When assessing HRQL, p

  5. Catheter fragmentation and local lysis in two lung transplant patients with pulmonary embolism. (United States)

    Suhling, H; Westerkamp, V; Dinh, Q T; Greer, M; Kempf, T; Simon, A; Gottlieb, J; Welte, T; Schieffer, B


    In conjunction with the rising number of lung transplant operations in the past decade, an increased predisposition to venous thrombosis (VT), particularly within the first year posttransplantation has been observed. Previous studies have revealed that between 8.6% and 12% of patients develop VT, which can ultimately result in pulmonary emboli (PE).Transplanted lungs pose a much greater infarction risk due to their lack of collateral vascularisation, relying entirely on the vasa publica--the pulmonary artery--in the absence of vasa privata. Such losses in viable lung parenchyma are always serious, but carry still greater risks for single-lung transplant recipients, an early diagnosis and treatment remain critical. Here we report on two cases of PE after lung transplantation, both of whom were managed with catheter fragmentation and local thrombolysis. In our opinion, this approach represents a viable treatment for symptomatic PE in lung transplant recipients. The benefits and risks of the alternative treatment options in these special cases will be reviewed and the definitive therapy was described. In the patients treated, catheter fragmentation with localized thrombolysis resulted in short term improvements in graft function, but could not prevent later lung infarction in one case.

  6. Pneumonia relevant to lung transplantation and pathogen distribution

    Institute of Scientific and Technical Information of China (English)

    HE Xuan; DAI Hua-ping; CHEN Qi-rui; MIAO Jin-bai; SUN Bing; BAO Na; HU Bin


    Background Pneumonia is the most common cause of morbidity and mortality in lung transplant (LT) recipients.The aim of the present study was to evaluate the incidence,etiology,risk factors and prognosis of pneumonia in LT recipients.Methods The LT cohort consisted of 28 recipients receiving LT in Beijing Chao-Yang Hospital from August 2005 to April 2011.Data collected included demographic data,underlying disorders,time and type of transplant,follow-up information,date of last follow-up,and patient status.A retrospective analysis was made of observational data that were prospectively collected.Results Twenty-two patients of 28 LT recipients had 47 episodes of pneumonia throughout the study period.Thirtyeight episodes of pneumonia in 19 recipients occurred post-LT with a median follow-up of 257.5 days (1-2104 days),the incidence of pneumonia was 192.4 episodes per 100 LT/year and its median time of onset was 100.5 days (0-946 days) post-transplantation.Bacteria,virus and fungi accounted for 62%,16% and 15% of the microbial pathogens,respectively.The most frequent were Pseudomonas aeruginosa (20%),cytomegalovirus (CMV) (15%),and Aspergillus fumigatus (10%).A total of 29% (11/38) of pneumonias occurred in the first month post-LT,and then the incidence decreased gradually.The incidence of CMV pneumonia was 25% (7/28) with a median time of 97 days (10-971 days).More than one bacterial infection and CMV infection were independent risk factors for aspergillus infection.The incidence of pulmonary tuberculosis (TB) was 18% (5/28),and the history of TB was a risk factor for TB relapse.There were 58% (7/12) of recipients who died of infection,and 71% (5/7) of these died in the first year after LT.Conclusions Pneumonia is still a major cause of morbidity and mortality in LT recipients.The most frequent microorganisms were Pseudomonas aeruginosa,CMV,and Aspergillus fumigates.The incidence of CMV pneumonia decreases with a delayed median time of onset

  7. [The transplantation of revascularized thyroid-trachea-lung complex: the experimental study]. (United States)

    Parshin, V D; Zhidkov, I L; Bazarov, D V; Parshin, V V; Chernyĭ, S S


    The osteoplastic tracheobronchopathy affects the trachea, main, lobar and smaller bronchi, causing their stenosis. Nowadays the mainstay of the treatment of such patients is the cryodestruction, laser destruction and the endoscopic buginage of the trachea and bronchi. The palliative nature and low efficacy of these procedures forces to search new ways of treatment. The traditional lung transplantation or separate trachea and lung transplantation is inappropriate because of the complex affection of both trachea and bronchi. The experimental study aimed the possibility of thyreotracheolung revascularized donor complex transplantation.

  8. Endobronchial mucosal blanching due to a post-lung transplantation pulmonary artery stenosis. (United States)

    Slebos, Dirk-Jan; Wolff, Rienhart F E; van der Bij, Wim


    A 45-year-old woman underwent a bronchoscopy shortly after lung transplantation. The airway mucosal appearance significantly differed between both lungs, with a pale aspect of the left bronchial tree. Computed tomography (CT) and perfusion scan confirmed a left pulmonary artery stenosis, improving with conservative treatment.

  9. Ten-Year Survival in Patients with Idiopathic Pulmonary Fibrosis After Lung Transplantation

    NARCIS (Netherlands)

    ten Klooster, Liesbeth; Nossent, George D.; Kwakkel-van Erp, Johanna M.; van Kessel, Diana A.; Oudijk, Erik J.; van de Graaf, Ed A.; Luijk, Bart; Hoek, Rogier A.; van den Blink, Bernt; van Hal, Peter Th.; Verschuuren, Erik A.; van der Bij, Wim; van Moorsel, Coline H.; Grutters, Jan C.


    Introduction Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal fibrosing lung disease with a median survival of approximately 3 years after diagnosis. The only medical option to improve survival in IPF is lung transplantation (LTX). The purpose of this study was to evaluate trajectory

  10. Median sternotomy for double lung transplantation with cardiopulmonary bypass in seven consecutive patients

    DEFF Research Database (Denmark)

    Kohno, Mitsutomo; Steinbrüchel, Daniel A


    We describe our technique of using median sternotomy to perform double lung transplantations with cardiopulmonary bypass. By sparing the respiratory muscles, median sternotomy is probably less invasive and preserves lung function. Furthermore, it causes less long-term discomfort than intercostal...

  11. Extracorporeal membrane oxygenation during double-lung transplantation: single center experience

    Institute of Scientific and Technical Information of China (English)

    XU Ling-feng; LI Xin; GUO Zhen; XU Mei-yin; GAO Cheng-xin; ZHU Jin-hong; JI Bing-yang


    Background For patients with end-stage lung diseases, lung transplantation is the final therapeutic option. Sequential double-lung transplantation is recognized as an established procedure to avoid cardiopulmonary bypass (CPB). But some of the sequential double-lung transplantations require CPB support during the surgical procedure for various reasons. However, conventional CPB may increase the risk of bleeding and early allograft dysfunction. Extracorporeal membrane oxygenation (ECMO) is more advantageous than conventional CPB during the perioperative period of transplantation. Replacing traditional CPB with ECMO is promising for those patients needing cardiopulmonary support during a sequential double-lung transplantation procedure. This study aimed to summarize the preliminary experience of ECMO practice in lung transplantation.Methods Between November 2002 and October 2008, twelve patients with end-stage lung diseases undergoing sequential double-lung transplantation were subjected to ECMO during the surgical procedure. Eleven patients were prepared were prepared for the procedure via transverse thoracostomy (clamshell) and cannulated through the ascending aorta and right atrium for ECMO. The first patient who underwent bilateral thoracotomy for bilateral sequential lung transplantation required emergency ECMO via the femoral artery and vein during the second lung implantation. The Medtronic centrifugal pump and ECMO package (CB1V97R1, Medtronic, Inc., USA) were used for all of the patients.Results During ECMO,the blood flow rate was set between 1.88-2.0 L·m~(-2)·min~(-1) to keep hemodynamic and oxyhgen saturation stable; colloid oncotic pressure was maintained at more than 18 mmHg with albumin and hematocrit (HCT) kept at 28% or more. Two patients died early in this series and the other 10 patients were weaned from ECMO successfully. The duration of ECMO was 1.38-67.00 hours, and postoperative intubation was 10.5-67.0 hours.Conclusions As an established

  12. Substantial Increases Occur in Serum Activins and Follistatin during Lung Transplantation.

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    David M de Kretser

    Full Text Available Lung transplantation exposes the donated lung to a period of anoxia. Re-establishing the circulation after ischemia stimulates inflammation causing organ damage. Since our published data established that activin A is a key pro-inflammatory cytokine, we assessed the roles of activin A and B, and their binding protein, follistatin, in patients undergoing lung transplantation.Sera from 46 patients participating in a published study of remote ischemia conditioning in lung transplantation were used. Serum activin A and B, follistatin and 11 other cytokines were measured in samples taken immediately after anaesthesia induction, after remote ischemia conditioning or sham treatment undertaken just prior to allograft reperfusion and during the subsequent 24 hours.Substantial increases in serum activin A, B and follistatin occurred after the baseline sample, taken before anaesthesia induction and peaked immediately after the remote ischemia conditioning/sham treatment. The levels remained elevated 15 minutes after lung transplantation declining thereafter reaching baseline 2 hours post-transplant. Activin B and follistatin concentrations were lower in patients receiving remote ischemia conditioning compared to sham treated patients but the magnitude of the decrease did not correlate with early transplant outcomes.We propose that the increases in the serum activin A, B and follistatin result from a combination of factors; the acute phase response, the reperfusion response and the use of heparin-based anti-coagulants.

  13. Carbon Monoxide Induces Cytoprotection in Rat Orthotopic Lung Transplantation via Anti-Inflammatory and Anti-Apoptotic Effects


    Song, Ruiping; KUBO, Masatoshi; Morse, Danielle; Zhou, Zhihong; Zhang, Xuchen; Dauber, James H.; Fabisiak, James; Alber, Sean M.; Watkins, Simon C.; Zuckerbraun, Brian S.; Otterbein, Leo E.; Ning, Wen; Oury, Tim D; Patty J. Lee; McCurry, Kenneth R.


    Successful lung transplantation has been limited by the high incidence of acute graft rejection. There is mounting evidence that the stress response gene heme oxygenase-1 (HO-1) and/or its catalytic by-product carbon monoxide (CO) confers cytoprotection against tissue and cellular injury. This led us to hypothesize that CO may protect against lung transplant rejection via its anti-inflammatory and antiapoptotic effects. Orthotopic left lung transplantation was performed in Lewis rat recipient...

  14. Ex vivo lung perfusion to improve donor lung function and increase the number of organs available for transplantation. (United States)

    Valenza, Franco; Rosso, Lorenzo; Coppola, Silvia; Froio, Sara; Palleschi, Alessandro; Tosi, Davide; Mendogni, Paolo; Salice, Valentina; Ruggeri, Giulia M; Fumagalli, Jacopo; Villa, Alessandro; Nosotti, Mario; Santambrogio, Luigi; Gattinoni, Luciano


    This paper describes the initial clinical experience of ex vivo lung perfusion (EVLP) at the Fondazione Ca' Granda in Milan between January 2011 and May 2013. EVLP was considered if donor PaO2 /FiO2 was below 300 mmHg or if lung function was doubtful. Donors with massive lung contusion, aspiration, purulent secretions, pneumonia, or sepsis were excluded. EVLP was run with a low-flow, open atrium and low hematocrit technique. Thirty-five lung transplants from brain death donors were performed, seven of which after EVLP. EVLP donors were older (54 ± 9 years vs. 40 ± 15 years, EVLP versus Standard, P transplantation was higher (79 [40-84] vs. 39 [36-46], P transplantation, primary graft dysfunction (PGD72 grade 3, 32% vs. 28%, EVLP versus Standard, P = 1), mortality at 30 days (0% vs. 0%, P = 1), and overall survival (71% vs. 86%, EVLP versus Standard P = 0.27) were not different between groups. EVLP enabled a 20% increase in available donor organs and resulted in successful transplants with lungs that would have otherwise been rejected ( number: NCT01967953).

  15. Computed tomography findings of postoperative complications in lung transplantation; Achados tomograficos nas complicacoes pos-operatorias do transplante pulmonar

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    Hochhegger, Bruno; Irion, Klaus Loureiro; Marchiori, Edson; Bello, Rodrigo; Moreira, Jose; Camargo, Jose Jesus [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil). Postgraduate Program in Respiratory Sciences; Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Postgraduate Program in Radiological Sciences], e-mail:


    Due to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, post transplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis. (author)

  16. Respiratory Failure due to Possible Donor-Derived Sporothrix schenckii Infection in a Lung Transplant Recipient

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    Nathan C. Bahr


    Full Text Available Background. De novo and donor-derived invasive fungal infections (IFIs contribute to morbidity and mortality in solid organ transplant (SOT recipients. Reporting of donor-derived IFIs (DDIFIs to the Organ Procurement Transplant Network has been mandated since 2005. Prior to that time no systematic monitoring of DDIFIs occurred in the United States. Case Presentation. We report a case of primary graft dysfunction in a 49-year-old male lung transplant recipient with diffuse patchy bilateral infiltrates likely related to pulmonary Sporothrix schenckii infection. The organism was isolated from a bronchoalveolar lavage on the second day after transplantation. Clinical and radiographic responses occurred after initiation of amphotericin B lipid formulation. Conclusion. We believe that this was likely a donor-derived infection given the early timing of the Sporothrix isolation after transplant in a bilateral single lung transplant recipient. This is the first case report of sporotrichosis in a lung transplant recipient. Our patient responded well to amphotericin induction therapy followed by maintenance therapy with itraconazole. The implications of donor-derived fungal infections and Sporothrix in transplant recipients are reviewed. Early recognition and management of these fungi are essential in improving outcomes.

  17. Respiratory Failure due to Possible Donor-Derived Sporothrix schenckii Infection in a Lung Transplant Recipient. (United States)

    Bahr, Nathan C; Janssen, Katherine; Billings, Joanne; Loor, Gabriel; Green, Jaime S


    Background. De novo and donor-derived invasive fungal infections (IFIs) contribute to morbidity and mortality in solid organ transplant (SOT) recipients. Reporting of donor-derived IFIs (DDIFIs) to the Organ Procurement Transplant Network has been mandated since 2005. Prior to that time no systematic monitoring of DDIFIs occurred in the United States. Case Presentation. We report a case of primary graft dysfunction in a 49-year-old male lung transplant recipient with diffuse patchy bilateral infiltrates likely related to pulmonary Sporothrix schenckii infection. The organism was isolated from a bronchoalveolar lavage on the second day after transplantation. Clinical and radiographic responses occurred after initiation of amphotericin B lipid formulation. Conclusion. We believe that this was likely a donor-derived infection given the early timing of the Sporothrix isolation after transplant in a bilateral single lung transplant recipient. This is the first case report of sporotrichosis in a lung transplant recipient. Our patient responded well to amphotericin induction therapy followed by maintenance therapy with itraconazole. The implications of donor-derived fungal infections and Sporothrix in transplant recipients are reviewed. Early recognition and management of these fungi are essential in improving outcomes.

  18. Impact of Single Nucleotide Polymorphisms (SNPs) on Immunosuppressive Therapy in Lung Transplantation (United States)

    Ruiz, Jesus; Herrero, María José; Bosó, Virginia; Megías, Juan Eduardo; Hervás, David; Poveda, Jose Luis; Escrivá, Juan; Pastor, Amparo; Solé, Amparo; Aliño, Salvador Francisco


    Lung transplant patients present important variability in immunosuppressant blood concentrations during the first months after transplantation. Pharmacogenetics could explain part of this interindividual variability. We evaluated SNPs in genes that have previously shown correlations in other kinds of solid organ transplantation, namely ABCB1 and CYP3A5 genes with tacrolimus (Tac) and ABCC2, UGT1A9 and SLCO1B1 genes with mycophenolic acid (MPA), during the first six months after lung transplantation (51 patients). The genotype was correlated to the trough blood drug concentrations corrected for dose and body weight (C0/Dc). The ABCB1 variant in rs1045642 was associated with significantly higher Tac concentration, at six months post-transplantation (CT vs. CC). In the MPA analysis, CT patients in ABCC2 rs3740066 presented significantly lower blood concentrations than CC or TT, three months after transplantation. Other tendencies, confirming previously expected results, were found associated with the rest of studied SNPs. An interesting trend was recorded for the incidence of acute rejection according to NOD2/CARD15 rs2066844 (CT: 27.9%; CC: 12.5%). Relevant SNPs related to Tac and MPA in other solid organ transplants also seem to be related to the efficacy and safety of treatment in the complex setting of lung transplantation. PMID:26307985

  19. Impact of Single Nucleotide Polymorphisms (SNPs on Immunosuppressive Therapy in Lung Transplantation

    Directory of Open Access Journals (Sweden)

    Jesus Ruiz


    Full Text Available Lung transplant patients present important variability in immunosuppressant blood concentrations during the first months after transplantation. Pharmacogenetics could explain part of this interindividual variability. We evaluated SNPs in genes that have previously shown correlations in other kinds of solid organ transplantation, namely ABCB1 and CYP3A5 genes with tacrolimus (Tac and ABCC2, UGT1A9 and SLCO1B1 genes with mycophenolic acid (MPA, during the first six months after lung transplantation (51 patients. The genotype was correlated to the trough blood drug concentrations corrected for dose and body weight (C0/Dc. The ABCB1 variant in rs1045642 was associated with significantly higher Tac concentration, at six months post-transplantation (CT vs. CC. In the MPA analysis, CT patients in ABCC2 rs3740066 presented significantly lower blood concentrations than CC or TT, three months after transplantation. Other tendencies, confirming previously expected results, were found associated with the rest of studied SNPs. An interesting trend was recorded for the incidence of acute rejection according to NOD2/CARD15 rs2066844 (CT: 27.9%; CC: 12.5%. Relevant SNPs related to Tac and MPA in other solid organ transplants also seem to be related to the efficacy and safety of treatment in the complex setting of lung transplantation.

  20. Overweight-mortality paradox and impact of six-minute walk distance in lung transplantation

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    Kongkiat Chaikriangkrai


    Full Text Available Overweight-mortality paradox and impact of six-minute walk distance (SMWD in lung transplantation Background: The objective of this study was to examine combined prognostic influence of body mass index (BMI and SMWD on mortality in lung transplant recipients. Methods: Consecutive isolated lung transplant recipients were identified. Preoperative BMI and SMWD data were collected. The cohort was followed for all-cause mortality. Results: The study included 324 lung transplant recipients with mean age of 57 ± 13 years and 58% were male (27% obstructive, 3% vascular, 6% cystic fibrosis, and 64% with restrictive lung diseases. In the total cohort; 37% had normal BMI, 10% were underweight, 33% were overweight, and 20% were obese. The median SMWD was 700 feet. The lower SMWDgroup was defined as the patients who had SMWD <237 feet as determined by receiver operating characteristic (ROC. Based on this definition, 66 patients (20% had lower SMWD. There were 71 deaths during a median follow-up of 2.3 years. In multivariate analysis, both BMI and SMWD were independently associated with death. Being overweight was associated with reduced mortality risk (hazard ratio (HR 0.50, P = 0.042 compared to the normal BMI group, and this was primarily driven by early mortality posttransplant. This paradoxical overweight-mortality relationship remained significant in the lower SMWD group (HR 0.075, P = 0.018, but not in the higher SMWD group (P = 0.552. Conclusion: In lung transplant recipients under lung allocation score (LAS era, pretransplant BMI and SMWD were independent predictors for mortality after the transplant. The lowest mortality risk was noted in a group of transplant recipients identified as overweight; whereas, being underweight or obese was associated with increased mortality.

  1. How to Recondition Ex Vivo Initially Rejected Donor Lungs for Clinical Transplantation: Clinical Experience from Lund University Hospital

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    Sandra Lindstedt


    Full Text Available A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. We have recently reported the results of the first six double lung transplantations performed with donor lungs reconditioned ex vivo that had been deemed unsuitable for transplantation by the Scandiatransplant, Eurotransplant, and UK Transplant organizations because the arterial oxygen pressure was less than 40 kPa. The three-month survival of patients undergoing transplant with these lungs was 100%. One patient died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are still alive and well 24 months after transplantation, with no signs of bronchiolitis obliterans syndrome. The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation circuit using STEEN solution mixed with erythrocytes, to dehydrate edematous lung tissue. Functional evaluation was performed with deoxygenated perfusate at different inspired fractions of oxygen. The arterial oxygen pressure was significantly improved in this model. This ex vivo evaluation model is thus a valuable addition to the armamentarium in increasing the number of acceptable lungs in a donor population with inferior arterial oxygen pressure values, thereby, increasing the lung donor pool for transplantation. In the following paper we present our clinical experience from the first six patients in the world. We also present the technique we used in detail with flowchart.

  2. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis. (United States)

    Santacruz, Jose Fernando; Mehta, Atul C


    Overall survival rates of lung transplantation have improved since the first human lung transplantation was performed. A decline in the incidence of airway complications (AC) had been a key feature to achieve the current outcomes. Several proposed risk factors to the development of airway complications have been identified, ranging from the surgical technique to the immunosuppressive regimen. There are essentially six different airway complications post-lung transplantation. The most frequently reported complication is bronchial stenosis. Other complications include bronchial dehiscence, exophytic excessive granulation tissue formation, tracheo-bronchomalacia, bronchial fistulas, and endobronchial infections. The management of post-transplant bronchial complications needs a multispecialty team approach. Prevention of some complications may be possible by early and aggressive medical management as well as by using certain surgical techniques for transplantation. Interventional bronchoscopic procedures, including balloon bronchoplasty, cryotherapy, laser photoresection, electrocautery, high-dose endobronchial brachytherapy, and bronchial stents are among the armamentarium. Also, medical management, like antibiotic prophylaxis and therapy for endobronchial infections, or noninvasive positive-pressure ventilation in case of bronchomalacia, are used to treat an AC. In some cases, different surgical approaches are occasionally required. In this article we review the risk factors, the clinical presentation, the diagnostic methods, as well as the management options of the most common AC after lung transplantation.

  3. Preoperative cardiac variables of diastolic dysfunction and clinical outcomes in lung transplant recipients. (United States)

    Yadlapati, Ajay; Lynch, Joseph P; Saggar, Rajan; Ross, David; Belperio, John A; Weigt, Stephen; Ardehali, Abbas; Grogan, Tristan; Yang, Eric H; Aboulhosn, Jamil


    Background. Orthotopic lung transplantation is now widely performed in patients with advanced lung disease. Patients with moderate or severe ventricular systolic dysfunction are typically excluded from lung transplantation; however, there is a paucity of data regarding the prognostic significance of abnormal left ventricular diastolic function and elevated pretransplant pulmonary pressures. Methods. We reviewed the characteristics of 111 patients who underwent bilateral and unilateral lung transplants from 200 to 2009 in order to evaluate the prognostic significance of preoperative markers of diastolic function, including invasively measured pulmonary capillary wedge pressure (PCWP) and echocardiographic variables of diastolic dysfunction including mitral A > E and A' > E'. Results. Out of 111 patients, 62 were male (56%) and average age was 54.0 ± 10.5 years. Traditional echocardiographic Doppler variables of abnormal diastolic function, including A' > E' and A > E, did not predict adverse events (P = 0.49). Mildly elevated pretransplant PCWP (16-20 mmHg) and moderately/severely elevated PCWP (>20 mmHg) were not associated with adverse clinical events after transplant (P = 0.30). Additionally, all clinical endpoints did not show any statistical significance between the two groups. Conclusions. Pre-lung transplant invasive and echocardiographic findings of elevated pulmonary pressures and abnormal left ventricular diastolic function are not predictive of adverse posttransplant clinical events.

  4. Preoperative Cardiac Variables of Diastolic Dysfunction and Clinical Outcomes in Lung Transplant Recipients

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    Ajay Yadlapati


    Full Text Available Background. Orthotopic lung transplantation is now widely performed in patients with advanced lung disease. Patients with moderate or severe ventricular systolic dysfunction are typically excluded from lung transplantation; however, there is a paucity of data regarding the prognostic significance of abnormal left ventricular diastolic function and elevated pretransplant pulmonary pressures. Methods. We reviewed the characteristics of 111 patients who underwent bilateral and unilateral lung transplants from 200 to 2009 in order to evaluate the prognostic significance of preoperative markers of diastolic function, including invasively measured pulmonary capillary wedge pressure (PCWP and echocardiographic variables of diastolic dysfunction including mitral A>E and A′>E′. Results. Out of 111 patients, 62 were male (56% and average age was 54.0 ± 10.5 years. Traditional echocardiographic Doppler variables of abnormal diastolic function, including A′>E′ and A>E, did not predict adverse events (P=0.49. Mildly elevated pretransplant PCWP (16–20 mmHg and moderately/severely elevated PCWP (>20 mmHg were not associated with adverse clinical events after transplant (P=0.30. Additionally, all clinical endpoints did not show any statistical significance between the two groups. Conclusions. Pre-lung transplant invasive and echocardiographic findings of elevated pulmonary pressures and abnormal left ventricular diastolic function are not predictive of adverse posttransplant clinical events.

  5. Direct thrombolysis of multiple thrombi in both right and left heart atrium in a patient on extracorporeal membrane oxygenation support following urgent double-lung transplantation: a case report

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    Pollert L


    Full Text Available Lukas Pollert,1 Zuzana Prikrylova,1 Jan Berousek,1 Frantisek Mosna,1 Robert Lischke2 1Department of Anaesthesiology and Intensive Care, 2nd Faculty of Medicine, 23rd Surgical Department, 1st Faculty of Medicine, Charles University in Prague and Motol University Hospital, Praha, Czech Republic Background: Lung transplantation is considered an established treatment for patients with end-stage chronic respiratory failure. Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at high risk of death. Extracorporeal membrane oxygenation (ECMO has been proposed as an alternative bridging strategy to mechanical ventilation. The shear stress created by the mechanical pumps causes changes in the hematological system in almost all patients treated with ECMO. An antithrombotic strategy to mitigate ECMO bleeding and thrombotic complications is necessary. The use of thrombolytic therapy is recommended for patients with acute symptomatic embolism with associated hypotension or shock. In this setting, the hemodynamic benefits of thrombolytic treatment far outweigh its bleeding risk.Case presentation: This case report describes a 32-year-old woman suffering from lymphangioleiomyomatosis, who underwent urgent double-lung transplantation. This patient was maintained on ECMO preoperatively, perioperatively, and postoperatively due to life-threatening hypoxemia caused by the progression of her pulmonary tissue damage. Multiple thrombi developed in the early postoperative period, in both right and left heart atria. Direct thrombolysis was successfully performed on the first postoperative day.Conclusion: According to the current published literature, direct thrombolysis of thrombi in both right and left atria in a patient supported on ECMO following urgent double-lung transplantation is an extremely rare treatment method. Even when taking into account all of the risks

  6. CNE article: pain after lung transplant: high-frequency chest wall oscillation vs chest physiotherapy. (United States)

    Esguerra-Gonzalez, Angeli; Ilagan-Honorio, Monina; Fraschilla, Stephanie; Kehoe, Priscilla; Lee, Ai Jin; Marcarian, Taline; Mayol-Ngo, Kristina; Miller, Pamela S; Onga, Jay; Rodman, Betty; Ross, David; Sommer, Susan; Takayanagi, Sumiko; Toyama, Joy; Villamor, Filma; Weigt, S Samuel; Gawlinski, Anna


    Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ(2) and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115-125).

  7. Combined laser phototherapy and growth factor treatment of bronchial obstruction after lung transplantation. (United States)

    Hertz, M I; Harmon, K R; Knighton, D R; Cahill, B C; Duvall, A J; Shumway, S J; Bolman, R M


    Lung transplantation has resulted in dramatic functional improvement in patients with end-stage pulmonary diseases. Among the complications of lung transplantation are dehiscence and stenosis at the site of the bronchial or tracheal anastomosis. In this case report, we describe a single lung transplant recipient in whom partial bronchial dehiscence, followed by exuberant growth of granulation tissue, resulted in obstruction of the bronchial lumen. After mechanical dilation failed to produce lasting relief of bronchial obstruction, a novel approach to this problem was successfully employed: YAG laser phototherapy was used to remove obstructing granulation tissue, followed by application of a preparation derived from autologous blood platelets to promote epithelialization of the bronchial anastomosis. The bronchus remains patent and fully epithelialized six months after therapy.

  8. SP-A-enriched surfactant for treatment of rat lung transplants with SP-A deficiency after storage and reperfusion

    NARCIS (Netherlands)

    Erasmus, ME; Hofstede, GJH; Petersen, AH; Batenburg, JJ; Haagsman, HP; Oetomo, SB; Prop, J


    Background. The function of pulmonary surfactant is affected by lung transplantation, contributing to impaired lung transplant function. A decreased amount of surfactant protein-A (SP-A) after reperfusion is believed to contribute to the impaired surfactant function. Surfactant treatment has been sh

  9. Creatinine-based estimation of rate of long term renal function loss in lung transplant recipients. Which method is preferable?

    NARCIS (Netherlands)

    Broekroelofs, J; Stegeman, CA; Navis, GJ; de Haan, J; van der Bij, W; de Zeeuw, D; de Jong, PE


    Background: Progressive renal function loss during long-term follow up is common after lung transplantation and close monitoring is warranted, Since changes in creatinine generation and excretion may occur after lung transplantation, the reliability of creatinine-based methods of renal function asse

  10. Effects of pulmonary rehabilitation in lung transplant candidates: a systematic review (United States)

    Hoffman, Mariana; Chaves, Gabriela; Ribeiro-Samora, Giane Amorim; Britto, Raquel Rodrigues


    Objectives The aim of this systematic review of randomised controlled trials (RCTs), and quasi-experimental and retrospective studies is to investigate the effects of pulmonary rehabilitation (PR) in patients with advanced chronic disease on the waiting list for lung transplantation. Setting PR performed for inpatient or outpatient lung transplant candidates. Intervention PR programme including aerobic exercise training and/or resistance exercise training. Primary and secondary outcomes Quality of life and exercise capacity (primary outcomes). Survival rate after transplant surgery; pulmonary function; respiratory muscle strength; psychological aspects; upper and lower extremity muscle strength and adverse effects (secondary outcomes). Two review authors independently selected the studies, assessed study quality and extracted data. Studies in any language were included. Results This was a systematic review and studies were searched on the Cochrane Library, MEDLINE, EMBASE, CINAHL and PEDro. Experimental and retrospective studies evaluating the effects of PR in candidates for lung transplantation (>18 years old) with any lung diseases were included. 2 RCTs, and two quasi-experimental and two retrospectives studies, involving 1305 participants were included in the review. 5 studies included an enhancement reported in quality of life using the Short Form 36 questionnaire and showed improvements in some domains. All studies included exercise capacity evaluated through 6 min walk test and in five of them, there were improvements in this outcome after PR. Owing to the different characteristics of the studies, it was not possible to perform a meta-analysis. Conclusions Studies included in this review showed that PR is an effective treatment option for patients on the waiting list for lung transplantation and can improve quality of life and exercise capacity in those patients. Although individual studies reported positive effects of PR, this review shows that there is

  11. Treatment of bronchus intermedius stenosis in lung transplantation with Montgomery T-tube stent. A novel technique. (United States)

    Pinillos Robles, Javier; García Luján, Ricardo; de Pablo Gafas, Alicia; de Miguel Poch, Eduardo


    Airway complications after lung transplant are relatively common although the rates vary according to the different studies. Pathogenesis is diverse but the principal mechanism is usually bronchus intermedius ischemia in the post-transplant period. One major complication is bronchial stenosis, with relatively frequent involvement of the bronchus intermedius in the case of right lung transplantation. Various treatments have been proposed for bronchus intermedius stenosis, such as endobronchial balloon dilation, laser, cryosurgery and bronchial stents. We present two cases of lung transplant recipients with bronchus intermedius stenosis treated with a Montgomery stent or T-stent, commonly used for tracheal stenosis, who showed positive clinical and functional response.

  12. Use of CT densitometry to predict lung toxicity in bone marrow transplant patients

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    el-Khatib, E.E.; Freeman, C.R.; Rybka, W.B.; Lehnert, S.; Podgorsak, E.B.


    Total body irradiation (TBI) is considered an integral part of the preparation of patients with hematological malignancies for marrow transplantation. One of the major causes of death following bone marrow transplantation is interstitial pneumonia. Its pathogenesis is complex but radiation may play a major role in its development. Computed tomography (CT) has been used in animal and human studies as a sensitive non-invasive method for detecting changes in the lung following radiotherapy. In the present study CT scans are studied before and up to 1 year after TBI. Average lung densities measured before TBI showed large variations among the individual patients. On follow-up scans, lung density decreases were measured for patients who did not develop lung complications. Significant lung density increases were measured in patients who subsequently had lung complications. These lung density increases were observed prior to the onset of respiratory complications and could be correlated with the clinical course of the patients, suggesting the possibility for the usage of CT lung densitometry to predict lung complications before the onset of clinical symptoms.

  13. Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

    Institute of Scientific and Technical Information of China (English)

    Haridimos Markogiannakis; Manousos Konstadoulakis; Dimitrios Tzertzemelis; Pantelis Antonakis; Ilias Gomatos; Constantinos Bramis; Andreas Manouras


    Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and end colostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigation of even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.

  14. Lung function after allogeneic bone marrow transplantation for leukaemia or lymphoma. (United States)

    Nysom, K; Holm, K; Hesse, B; Ulrik, C S; Jacobsen, N; Bisgaard, H; Hertz, H


    Longitudinal data were analysed on the lung function of 25 of 29 survivors of childhood leukaemia or lymphoma, who had been conditioned with cyclophosphamide and total body irradiation before allogeneic bone marrow transplantation, to test whether children are particularly vulnerable to pulmonary damage after transplantation. None developed chronic graft-versus-host disease. Transfer factor and lung volumes were reduced immediately after bone marrow transplantation, but increased during the following years. However, at the last follow up, 4-13 years (median 8) after transplantation, patients had significantly reduced transfer factor, total lung capacity, and forced vital capacity (-1.0, -1.2, and -0.8 SD score, respectively), and increased ratio of forced expiratory volume in one second to forced vital capacity (+0.9 SD score). None of the patients had pulmonary symptoms, and changes were unrelated to their age at bone marrow transplantation. In conclusion, patients had subclinical restrictive pulmonary disease at a median of eight years after total body irradiation and allogeneic bone marrow transplantation.

  15. Pulmonary nodules and masses in lung transplant recipients: clinical and CT findings

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    Morla, Olivier; Liberge, Renan; Arrigoni, Pierre Paul; Frampas, Eric [Service de Radiologie Centrale, C.H.U. Hotel Dieu, Nantes (France)


    The purpose of this study was to review the clinical and CT findings of pulmonary nodules and masses in lung transplant recipients and to determine distinguishing features among the various aetiologies. This retrospective study included 106 lung transplant recipients who had a chest CT performed over a 7-year period in a single institution. Twenty-four cases of pulmonary nodules and masses were observed on CT. Among the single lesions, three (50 %) were due to infections, one (17 %) to organizing pneumonia, and two (33 %) remained of undetermined origin. Among the multiple lesions, 14 (78 %) were due to infection, three to post-transplant lymphoproliferative disorder (17 %), and one to bronchogenic carcinoma (5 %). The two main microorganisms were P. aeruginosa and Aspergillus spp. Among 12 solid nodules > 1 cm, four (33 %) were due to malignancy: three post-transplant lymphoproliferative disorders (25 %), and one bronchogenic carcinoma (8 %). Among five cavitary nodules four (80 %) were due to aspergillosis. Infection is the most frequent aetiology of pulmonary nodules and masses in lung transplant recipients, but other causes such as post-transplant lymphoproliferative disorder, bronchogenic carcinoma, or organizing pneumonia should be considered. (orig.)

  16. Pseudomembranous colitis in four patients with cystic fibrosis following lung transplantation. (United States)

    Yates, B; Murphy, D M; Fisher, A J; Gould, F K; Lordan, J L; Dark, J H; Corris, P A


    Pseudomembranous colitis is an uncommon complication in patients with cystic fibrosis, despite the use of multiple high-dose antibiotic regimens and the frequency of hospital admissions. Four patients from a total of 137 patients with cystic fibrosis undergoing lung transplantation are described who developed fulminant pseudomembranous colitis. Initial presentation was variable and the mortality rate was 50% despite urgent colectomy. In one case the presenting abdominal distension was thought to be due to meconium ileus equivalent. It is concluded that Clostridium difficile colitis may be a difficult diagnosis in patients with cystic fibrosis and follows a fulminant course after lung transplantation.

  17. Cytokine levels in pleural fluid as markers of acute rejection after lung transplantation

    Directory of Open Access Journals (Sweden)

    Priscila Cilene León Bueno de Camargo


    Full Text Available Our objective was to determine the levels of lactate dehydrogenase, IL-6, IL-8, and VEGF, as well as the total and differential cell counts, in the pleural fluid of lung transplant recipients, correlating those levels with the occurrence and severity of rejection. We analyzed pleural fluid samples collected from 18 patients at various time points (up to postoperative day 4. The levels of IL-6, IL-8, and VEGF tended to elevate in parallel with increases in the severity of rejection. Our results suggest that these levels are markers of acute graft rejection in lung transplant recipients.

  18. Medication-induced periostitis in lung transplant patients: periostitis deformans revisited. (United States)

    Chen, Lina; Mulligan, Michael E


    We report five cases of diffuse periostitis resembling hypertrophic osteoarthropathy and perostitis deformans in lung transplantation patients on chronic voriconazole, a fluoride-containing compound. Although drug-related periostitis has long been known, the association of lung transplant medication with periostitis was only recently introduced in the literature. To our knowledge, imaging findings have not been fully characterized in the radiology literature. Imaging features along with clinical history help to distinguish this benign condition from other disease entities. In this article, we review the current literature and illustrate the variety of imaging characteristics of this entity so that interpreting radiologists can make accurate diagnoses and avoid unnecessary work up.

  19. Methylene Blue for Vasoplegia When on Cardiopulmonary Bypass During Double-Lung Transplantation. (United States)

    Carley, Michelle; Schaff, Jacob; Lai, Terrance; Poppers, Jeremy


    Vasoplegia syndrome, characterized by hypotension refractory to fluid resuscitation or high-dose vasopressors, low systemic vascular resistance, and normal-to-increased cardiac index, is associated with increased morbidity and mortality after cardiothoracic surgery. Methylene blue inhibits inducible nitric oxide synthase and guanylyl cyclase, and has been used to treat vasoplegia during cardiopulmonary bypass. However, because methylene blue is associated with increased pulmonary vascular resistance, its use in patients undergoing lung transplantion has been limited. Herein, we report the use of methylene blue to treat refractory vasoplegia during cardiopulmonary bypass in a patient undergoing double-lung transplantation.

  20. Cytokine levels in pleural fluid as markers of acute rejection after lung transplantation* (United States)

    de Camargo, Priscila Cilene León Bueno; Afonso, José Eduardo; Samano, Marcos Naoyuki; Acencio, Milena Marques Pagliarelli; Antonangelo, Leila; Teixeira, Ricardo Henrique de Oliveira Braga


    Our objective was to determine the levels of lactate dehydrogenase, IL-6, IL-8, and VEGF, as well as the total and differential cell counts, in the pleural fluid of lung transplant recipients, correlating those levels with the occurrence and severity of rejection. We analyzed pleural fluid samples collected from 18 patients at various time points (up to postoperative day 4). The levels of IL-6, IL-8, and VEGF tended to elevate in parallel with increases in the severity of rejection. Our results suggest that these levels are markers of acute graft rejection in lung transplant recipients. PMID:25210966

  1. Multifocal periostitis as a complication of chronic use of voriconazole in a lung transplant recipient. (United States)

    Tedja, R; El-Sherief, A; Olbrych, T; Gordon, S


    Fungal infections are common in solid organ transplantation. An increasing number of transplant recipients receive antifungal therapy for prolonged duration owing to invasive fungal infections. Herein, we describe a diagnosis of periostitis as a complication of chronic use of voriconazole in a lung transplant recipient. The patient was diagnosed with probable pulmonary aspergillosis and was treated with oral voriconazole for a total of 9 months. Evidence of multifocal periostitis was observed in the axial and appendicular skeleton. Early recognition of this phenomenon is important to prevent unnecessary tests and procedures. Prompt discontinuation of voriconazole should result in improvement of symptoms.

  2. Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia

    Directory of Open Access Journals (Sweden)

    Youjin Chang


    Full Text Available Severe acute respiratory distress syndrome (ARDS is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO made it possible to consider lung transplantation (LTPL in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.

  3. Allotransplantation of the lung without immunosuppression after transplantation. II. Combined autotransplantation of bone marrow and allotransplantation of lung. [Gamma radiation, beagles

    Energy Technology Data Exchange (ETDEWEB)

    Blumenstock, D.A.; Cannon, F.D.; Franck, W.A.; Hales, C.A.; Kazemi, H.; Ferrebee, J.W.


    A series of seven animals underwent allotransplantation of a lung from a donor matched for the recognition of serologically defined (SD) antigens by the use of alloantisera followed by autotransplantation of bone marrow without further immunosuppression. In two animals, the lung was transplanted into the recipient immediately before the administration of total-body irradiation and in five, the lung was transplanted after completion of total-body irradiation. In the first group, one animal is living at 46 months with good function of the transplant. The other was killed at 6 months with chronic rejection. In the second group, three of five animals are alive 46 to 47 months after transplantation. Two others died early, one of cardiac tamponade and the other of diffuse hemorrhage before engraftment of marrow could be accomplished. Significant function of the transplant was demonstrated in all long-term survivors. Four control animals, subjected to marrow harvest and reimplantation of the left lung followed by total-body irradiation and marrow reinfusion, were studied to determine the possible deleterious effects of the total-body irradiation and marrow transplant procedure. Pulmonary function studies showed some reduction in ventilation and perfusion to the upper lobe areas, which was probably related to technical factors but did demonstrate no severe adverse effects to the procedures. Autologous bone marrow reconstitution after total-body irradiation combined withallotransplantation of the lung has allowed long-term survival and function of lung transplants without the necessity for administration of immunosuppressive drugs after the transplantation procedure.

  4. Rapid adaptation drives invasion of airway donor microbiota by Pseudomonas after lung transplantation


    M. Beaume; Köhler, T; Greub, G; Manuel, O; J-D. Aubert; Baerlocher, L.; Farinelli, L.; Buckling, A.; van Delden, C.


    In cystic fibrosis (CF) patients, chronic airway infection by Pseudomonas leads to progressive lung destruction ultimately requiring lung transplantation (LT). Following LT, CF-adapted Pseudomonas strains, potentially originating from the sinuses, may seed the allograft leading to infections and reduced allograft survival. We investigated whether CF-adapted Pseudomonas populations invade the donor microbiota and adapt to the non-CF allograft. We collected sequential Pseudomonas isolates and a...

  5. Lessons learned from extracorporeal membrane oxygenation as a bridge to lung transplantation

    Directory of Open Access Journals (Sweden)

    Vladimir Shumaster


    Full Text Available Extracorporeal membrane oxygenation (ECMO has been used infrequently as a bridge to lung transplantation due to lack of consensus and data regarding the benefits of such a strategy. We present data from the United Network of Organ Sharing (UNOS database on the outcomes of patients bridged to lung transplantation with ECMO. We used the UNOS database to analyze data between January 1, 2000 and December 31, 2011. During this time 14,263 lung transplants were performed, of which 143 (1.0% were bridged using ECMO. Patients on ECMO as a bridge to lung transplantation were compared to those transplanted without prior ECMO support. Demographics, survival rates, complications, and rejection episodes were compared between the two groups. The 30-day, 6-month, 1-year, 3-year, and 5-year survival rates were 69%, 56%, 48%, 26%, and 11%, respectively, for the ECMO bridge group and 95%, 88%, 81%, 58%, and 38% respectively, for the control group (p ≤ 0.01. The ECMO group incurred higher rate of postoperative complications, including airway dehiscence (4% vs. 1%, p ≤ 0.01, stroke (3% vs. 2%, p ≤ 0.01, infection (56% vs. 42%, p ≤ 0.01, and pulmonary embolism (10% vs. 0.6%, p ≤ 0.01. The length of hospital stay was longer for the ECMO group (41 vs. 25 days, p ≤ 0.01, and they were treated for rejection more often (49% vs. 36%, p = 0.02. The use of ECMO as a bridge to lung transplantation is associated with significantly worse survival and more frequent postoperative complications. Therefore, we advocate very careful patient selection and cautious use of ECMO.

  6. Nosocomial legionellosis in three heart-lung transplant patients

    DEFF Research Database (Denmark)

    Bangsborg, Jette Marie; Uldum, S; Jensen, J S


    Organ transplant recipients are at high risk of contracting Legionnaires' disease in a hospital environment contaminated with legionellae. This study describes the first cases of culture-verified Legionella infections with an established link to potable hospital water in Denmark; three patients...... operated on at the Cardiopulmonary Transplant Unit, Rigshospitalet, Copenhagen, became infected with legionellae. Environmental and clinical isolates of Legionella pneumophila serogroups 1 and 6 were investigated by restriction enzyme analysis and ribotyping. An ice machine located in the kitchen...

  7. The immediate post-operative period following lung transplantation: mapping of nursing interventions

    Directory of Open Access Journals (Sweden)

    Rayssa Thompson Duarte


    Full Text Available OBJECTIVES: to investigate the principle nursing interventions/actions, prescribed in the immediate post-operative period for patients who receive lung transplantation, recorded in the medical records, and to map these using the Nursing Interventions Classification (NIC taxonomy.METHOD: retrospective documental research using 183 medical records of patients who received lung transplantation (2007/2012. The data of the patients' profile were grouped in accordance with the variables investigated, and submitted to descriptive analysis. The nursing interventions prescribed were analyzed using the method of cross-mapping with the related interventions in the NIC. Medical records which did not contain nursing prescriptions were excluded.RESULTS: the majority of the patients were male, with medical diagnoses of pulmonary fibrosis, and underwent lung transplantation from a deceased donor. A total of 26 most frequently-cited interventions/actions were found. The majority (91.6% were in the complex and basic physiological domains of the NIC. It was not possible to map two actions prescribed by the nurses.CONCLUSIONS: it was identified that the main prescriptions contained general care for the postoperative period of major surgery, rather than prescriptions individualized to the patient in the postoperative period following lung transplantation. Care measures related to pain were underestimated in the prescriptions. The mapping with the taxonomy can contribute to the elaboration of the care plan and to the use of computerized systems in this complex mode of therapy.

  8. Lung function after allogeneic bone marrow transplantation for leukaemia or lymphoma

    DEFF Research Database (Denmark)

    Nysom, K; Holm, K; Hesse, B;


    Longitudinal data were analysed on the lung function of 25 of 29 survivors of childhood leukaemia or lymphoma, who had been conditioned with cyclophosphamide and total body irradiation before allogeneic bone marrow transplantation, to test whether children are particularly vulnerable to pulmonary...

  9. Chronic rejection of a lung transplant is characterized by a profile of specific autoantibodies

    DEFF Research Database (Denmark)

    Hagedorn, Peter; Burton, Christopher Malcolm; Carlsen, Jørn


    SUMMARY: Obliterative bronchiolitis (OB) continues to be the major limitation to long-term survival after lung transplantation. The specific aetiology and pathogenesis of OB are not well understood. To explore the role of autoreactivity in OB, we spotted 751 different self molecules onto glass sl...

  10. Refractory Pulmonary Edema Caused by Late Pulmonary Vein Thrombosis After Lung Transplantation: A Rare Adverse Event. (United States)

    Denton, Eve J; Rischin, Adam; McGiffin, David; Williams, Trevor J; Paraskeva, Miranda A; Westall, Glen P; Snell, Greg


    After lung transplantation, pulmonary vein thrombosis is a rare, potentially life-threatening adverse event arising at the pulmonary venous anastomosis that typically occurs early and presents as graft failure and hemodynamic compromise with an associated mortality of up to 40%. The incidence, presentation, outcomes, and treatment of late pulmonary vein thrombosis remain poorly defined. Management options include anticoagulant agents for asymptomatic clots, and thrombolytic agents or surgical thrombectomy for hemodynamically significant clots. We present a rare case highlighting a delayed presentation of pulmonary vein thrombosis occurring longer than 2 weeks after lung transplantation and manifesting clinically as graft failure secondary to refractory pulmonary edema. The patient was treated successfully with surgical thrombectomy and remains well. We recommend a high index of suspicion of pulmonary vein thrombosis when graft failure after lung transplantation occurs and is not responsive to conventional therapy, and consideration of investigation with transesophageal echocardiography or computed tomography with venous phase contrast in such patients even more than 2 weeks after lung transplantation.

  11. Multifocal nodular periostitis associated with prolonged voriconazole therapy in a lung transplant recipient. (United States)

    Ayub, Asad; Kenney, Charles V; McKiernan, Fergus E


    We report a case of painful, nodular periostitis in a lung transplant recipient on long-term voriconazole therapy. Symptoms, signs, and laboratory abnormalities resolved quickly after drug withdrawal. The presentation more closely resembles periostitis deformans than hypertrophic osteoarthropathy, suggesting that the fluoride moiety of voriconazole may be pathogenic for this condition. Clinicians should be aware of this association.

  12. Severe hemolysis caused by graft-derived anti-B production after lung transplantation

    DEFF Research Database (Denmark)

    Taaning, E; Morling, N; Mortensen, S A


    Anti-B antibody causing sever hemolytic anemia and renal failure was found in the serum of a blood group B patient who had received a bilateral lung transplant from a blood group O donor. Although the donor origin of the antibody was not confirmed, it is likely that the anti-B antibody was produced...

  13. Former Smoking Is a Risk Factor for Chronic Kidney Disease After Lung Transplantation

    NARCIS (Netherlands)

    Hellemons, M. E.; Agarwal, P. K.; van der Bij, W.; Verschuuren, E. A. M.; Postmus, D.; Erasmus, M. E.; Navis, G. J.; Bakker, S. J. L.


    Chronic kidney disease (CKD) is a common complication after lung transplantation (LTx). Smoking is a risk factor for many diseases, including CKD. Smoking cessation for >6 months is required for LTx enlistment. However, the impact of smoking history on CKD development after LTx remains unclear. We i


    NARCIS (Netherlands)



    Spontaneous pneumopericardium occurred in a patient almost 4 weeks after bilateral lung transplantation for cystic fibrosis. The patient had no specific complaints and was in stable haemodynamic condition. We suggest that this pneumopericardium was related to a concomitant active cytomegalovirus (CM

  15. Quantitative Epstein-Barr virus (EBV) serology in lung transplant recipients with primary EBV infection and/or post-transplant lymphoproliferative disease

    NARCIS (Netherlands)

    Verschuuren, E; van der Bij, W; de Boer, W; Timens, W; Middeldorp, J; The, TH


    The Epstein-Barr virus (EBV)-specific antibody response was studied in lung transplant patients to assess their value in the diagnosis and prognosis of post-transplant lymphoproliferative disease. Recently developed synthetic peptides representing Epstein-Barr nuclear antigen-1 (EBNA-1), diffuse ear

  16. Pitfalls and Challenges of Lung Transplant in a Patient With Kartagener Syndrome and Scoliosis. (United States)

    Yazicioglu, Alkin; Alici, Ibrahim Onur; Karaoglanoglu, Nurettin; Yekeler, Erdal


    We present a 22-year-old woman with Kartagener syndrome and scoliosis who died 112 days after single lung transplant. The classic thoracic involvement of situs inversus totalis and the asymmetric arrangement of the thoracic vascular structures might be a pitfall for surgeon. Anatomic obstacles have forced the surgeon to perform a single transplant. The period of primary graft dysfunction in a single transplanted lung patient was a challenge; supporting the patient with a high flow and long period of extracorporeal membrane oxygenation might lead to a vanishing bronchus. Immotile cilia, a feature of Kartagener syndrome, were another challenge and patient needed several daily aspiration bronchoscopies. Vanishing bronchus is a gradual process with high mortality rates; commonly, stenosis is at the non anastomotic bronchial tree because of insufficient nourishment of the bronchial cartilages. Several repeat bronchoscopic balloon dilatations accompanied with medical treatment were unsuccessful.

  17. Pilot study exploring lung allograft surfactant protein A (SP-A) expression in association with lung transplant outcome. (United States)

    D'Ovidio, F; Kaneda, H; Chaparro, C; Mura, M; Lederer, D; Di Angelo, S; Takahashi, H; Gutierrez, C; Hutcheon, M; Singer, L G; Waddell, T K; Floros, J; Liu, M; Keshavjee, S


    Primary graft failure and chronic lung allograft dysfunction (CLAD) limit lung transplant long-term outcomes. Various lung diseases have been correlated with surfactant protein (SP) expression and polymorphisms. We sought to investigate the role of SP expression in lung allografts prior to implantation, in relation to posttransplant outcomes. The expression of SP-(A, B, C, D) mRNA was assayed in 42 allografts. Posttransplant assessments include pulmonary function tests, bronchoscopy, broncho-alveolar lavage fluid (BALF) and biopsies to determine allograft rejection. BALF was assayed for SP-A, SP-D in addition to cytokines IL-8, IL-12 and IL-2. The diagnosis of CLAD was evaluated 6 months after transplantation. Lung allografts with low SP-A mRNA expression prior to implantation reduced survival (Log-rank p < 0.0001). No association was noted for the other SPs. Allografts with low SP-A mRNA had greater IL-2 (p = 0.03) and IL-12 (p < 0.0001) in the BALF and a greater incidence of rejection episodes (p = 0.003). Levels of SP-A mRNA expression were associated with the SP-A2 polymorphisms (p = 0.015). Specifically, genotype 1A1A(0) was associated with lower SP-A mRNA expression (p < 0.05). Lung allografts with low levels of SP-A mRNA expression are associated with reduced survival. Lung allograft SP-A mRNA expression appears to be associated with SP-A gene polymorphisms.

  18. Postoperative complications necessitating right lower lobectomy in a heart-lung transplant recipient with previous sternotomy. (United States)

    Diethrich, E B; Bahadir, I; Gordon, M; Maki, P; Warner, M G; Clark, R; Siever, J; Silverthorn, A


    Heart-lung transplantation for treatment of end-stage cardiopulmonary disease continues to be plagued by many problems. Three primary ones are the technical difficulties that can be encountered, particularly in those patients who have undergone previous cardiac operations, the additional restriction on donor availability imposed by the lack of satisfactory preservation techniques, and the need for lung size compatibility. Two of these difficulties and others surfaced postoperatively in a heart-lung transplant recipient who presented a series of unique operative and therapeutic challenges. A 42-year-old woman with chronic pulmonary hypertension and previous atrial septal defect repair underwent a heart-lung transplantation in August 1985. The operative procedure was expectedly complicated by bleeding from extensive mediastinal adhesions from the previous sternotomy and bronchial collateralization. Excessive chest tube drainage postoperatively necessitated reoperation to control bleeding from a right bronchial artery tributary. Phrenic nerve paresis, hepatomegaly, and marked abdominal distention caused persistent atelectasis and eventual right lower lobe collapse. Arteriovenous shunting and low oxygen saturation necessitated right lower lobectomy 15 days after transplantation, believed to be the first use of this procedure in a heart-lung graft recipient. Although oxygenation improved dramatically, continued ventilatory support led to tracheostomy. An intensive, psychologically oriented physical therapy program was initiated to access and retrain intercostal and accessory muscles. The tracheostomy cannula was removed after 43 days and gradual weaning from supplemental oxygen was accomplished. During this protracted recovery period, an episode of rejection was also encountered and successfully managed with steroid therapy. The patient continued to progress satisfactorily and was discharged 83 days after transplantation. She is well and active 20 months after discharge.

  19. Intravenous transplantation of mesenchymal stem cells attenuates oleic acid induced acute lung injury in rats

    Institute of Scientific and Technical Information of China (English)

    XU Yu-lin; LIU Ying-long; WANG Qiang; LI Gang; L(U) Xiao-dong; KONG Bo


    Background Acute lung injury (ALI) and end-stage acute respiratory distress syndrome (ARDS) were among the most common causes of death in intensive care units.The activation of an inflammatory response and the damage of pulmonary epithelium and endotheliumwerethe hallmark of ALI/ARDS.Recent studies had demonstrated the importance of mesenchymal stem cells (MSCs) in maintaining the normal pulmonary endothelial and epithelial function as well as participating in modulating the inflammatory response and they are involved in epithelial and endothelial repair after injury.Here,our study demonstrates MSCs therapeutic potential in a rat model of ALI/ARDS.Methods Bone marrow derived MSCs were obtained from Sprague-Dawley (SD) rats and their differential potential was verified.ALl was induced in rats byoleic acid (OA),and MSCs were transplanted intravenously.The lung injury and the concentration of cytokines in plasma and lung tissue extracts were assessed at 8 hours,24 hours and 48 hours after OA-injection.Results The histological appearance and water content in rat lung tissue were significantly improved at different time points in rats treated with MSCs.The concentration of tumor necrosis factor-α and intercellular adhesion molecular-1 in rats plasma and lung tissue extracts were significantly inhibited after intravenous transplantation of MSCs,whereas interleukin-10 was significantly higher after MSCs transplantation at 8 hours,24 hours and 48 hours after OA-challenge.Conclusions Intravenous transplantation of MSCs could maintain the integrity of the pulmonary alveolar-capillary barrier and modulate the inflammatory response to attenuate the experimental ALI/ARDS.Transplantation of MSCs could be a novel cell-based therapeutic strategy for prevention and treatment of ALI/ARDS.

  20. Combined Lung-Kidney Transplantation: An Analysis of the UNOS/OPTN Database. (United States)

    Reich, Heidi J; Chan, Joshua L; Czer, Lawrence S C; Mirocha, James; Annamalai, Alagappan A; Cheng, Wen; Jordan, Stanley C; Chaux, George; Ramzy, Danny


    Poor outcomes after thoracic transplantation with concurrent renal dysfunction are well described: without transplantation or with thoracic-only transplantation, patients face unacceptably high mortality. Outcomes after combined lung-kidney transplantation (LKT) remain largely uninvestigated. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database was queried to identify all LKTs, lung transplantations (LTs), and kidney transplantations (KTs) performed in the United States from 1995 to 2013. Survival was calculated using the Kaplan-Meier method and compared using log-rank tests or Cox regression models. Thirty-one LKTs were performed. Mean recipient age was 45.4 ± 13.5 years; 48.3 per cent were male. Retransplantation for graft failure was the leading indication for LT (n = 13) and the most common renal indication was calcineurin inhibitor nephrotoxicity (n = 11). Mean lung allocation score was 46.6 ± 14.4, mean creatinine was 3.7 ± 2.8 g/dL, and glomerular filtration rate was 23.1 (interquartile range 11.9, 38.3) mL/min/1.7 m(2), and 11 (35.5%) were dialysis dependent. Patient survival after LKT was 92.9 per cent, 71.0 per cent, and 71.0 per cent at one month, six months, and one year, with a median survival of 95.2 months. One- and five-year survival after LKT, 71.0 per cent and 59.9 per cent, were similar to LT (n = 23,913), 81.7 per cent and 51.4 per cent (P = 0.061 and 0.55), and inferior to KT (n = 175,269), 94.9 per cent and 82.8 per cent (P < 0.0001), respectively. Patient survival after LKT was similar to isolated LT, and these results suggest that LKT is a feasible therapeutic option for LT candidates with significant renal dysfunction.

  1. Ex Vivo Lung Perfusion and Transplant: State of the Art and View to the Future. (United States)

    Mohamed, Mohamed S A


    After the first clinical application of ex vivo lung perfusion in 2001, the technique has been used in many lung transplant centers worldwide. In addition, many modifications have been tested, leading to the development of various ex vivo lung perfusion systems and application protocols. Currently, the Lund protocol, the Toronto protocol, and Organ Care System Lung protocol are the clinically applied ex vivo lung perfusion protocols, based on the favorable results of the safety studies. Accordingly, the comparison among these EVLP systems and protocols should be an important research target, in order to provide the evidence based medical data that would recommend one protocol over the others. In this manuscript, the current experience with EVLP is reviewed and some molecular and clinical targets, that could be used to compare the various protocols of the technique, are introduced.

  2. Biopsy-verified bronchiolitis obliterans and other noninfectious lung pathologies after allogeneic hematopoietic stem cell transplantation

    DEFF Research Database (Denmark)

    Uhlving, Hilde Hylland; Andersen, Claus B; Christensen, Ib Jarle


    Bronchiolitis obliterans (BO) is a serious complication of allogeneic hematopoietic stem cell transplantation (HSCT). Lung biopsy is the gold standard for diagnosis. This study describes the course of BO and assesses the congruity between biopsy-verified BO and a modified version of the National...... Institutes of Health's consensus criteria for BO syndrome (BOS) based exclusively on noninvasive measures. We included 44 patients transplanted between 2000 and 2010 who underwent lung biopsy for suspected BO. Of those, 23 were diagnosed with BO and 21 presented other noninfectious pulmonary pathologies......, and maximal mid-expiratory flow throughout follow-up, but there was no difference in the change in pulmonary function from the time of lung biopsy. The BO diagnosis was not associated with poorer overall survival. Fifty-two percent of patients with biopsy-verified BO and 24% of patients with other...

  3. Complications related to lobectomy in living lobar lung transplant donors


    Spencer Marcantônio Camargo; José de Jesus Peixoto Camargo; Sadi Marcelo Schio; Leticia Beatriz Sánchez; José Carlos Felicetti; José da Silva Moreira; Cristiano Feijó Andrade


    OBJETIVO: Avaliar as complicações pós-operatórias imediatas de doadores vivos de lobos pulmonares para transplante. MÉTODOS: Entre setembro de 1999 e maio de 2005 foram realizadas lobectomias em 32 doadores saudáveis para transplante pulmonar em 16 receptores. Os prontuários médicos destes doadores foram analisados retrospectivamente para verificar a incidência de complicações pós-operatórias e as alterações da função pulmonar após a lobectomia. RESULTADOS: Vinte e dois doadores (68,75%) não ...

  4. Patient-reported outcome 2 years after lung transplantation: does the underlying diagnosis matter?

    Directory of Open Access Journals (Sweden)

    Ghosh S


    Full Text Available Maria Jose Santana,1 David Feeny,2 Sunita Ghosh,3 Dale C Lien41Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; 2Kaiser Permanente Center for Health Research, Portland, OR, USA; 3Cross Cancer Center, University of Alberta, Edmonton, Alberta, Canada; 4University of Alberta Hospital, Edmonton, Alberta, CanadaPurpose: Transplantation has the potential to produce profound effects on survival and health-related quality of life (HRQL. The inclusion of the patient’s perspective may play an important role in the assessment of the effectiveness of lung transplantation. Patient perspectives are assessed by patient-reported outcome measures, including HRQL measures. We describe how patients’ HRQL among different diagnosis groups can be used by clinicians to monitor and evaluate the outcomes associated with transplantation.Methods: Consecutive lung transplant recipients attending the lung transplant outpatient clinic in a tertiary institution completed the 15-item Health Utilities Index (HUI questionnaire on a touchscreen computer. The results were available to clinicians at every patient visit. The HUI3 covers a range of severity and comorbidities in eight dimensions of health status. Overall HUI3 scores are on a scale in which dead = 0.00 and perfect health = 1.00; disability categories range from no disability = 1 to severe disability <0.70. Single-attribute and overall HUI3 scores were used to compare patients’ HRQL among different diagnosis groups. Random-effect models with time since transplant as a random variable and age, gender, underlying diagnoses, infections, and broncholitis obliterans syndrome as fixed variables were built to identify determinants of health status at 2-years posttransplantation.Results: Two hundred and fourteen lung transplant recipients of whom 61% were male with a mean age of 52 (19–75 years were included in the study. Chronic obstructive pulmonary disease and cystic fibrosis patients displayed

  5. Graft downsizing during ex vivo lung perfusion: case report and technical notes. (United States)

    Nosotti, M; Rosso, L; Mendogni, P; Tosi, D; Palleschi, A; Righi, I; Froio, S; Valenza, F; Santambrogio, L


    Among patients with respiratory insufficiency awaiting lung transplantation, small adult patients have a lower opportunity of receiving size-matched pulmonary grafts, because of the shortage of donors, particularly those of small size. Reducing the size of an oversized graft is one of the methods to increase the donor pool; similarly, ex vivo lung perfusion is an emerging technique aimed toward the same purpose. We describe how we combined the 2 techniques (lobar transplantation plus contralateral nonanatomic graft reduction during ex vivo lung perfusion) to overcome graft shortage in a clinical case. For the 1st time, this case report demonstrates that surgical manipulation during ex vivo lung perfusion does not affect the functional improvement in a lung previously judged to be not suitable for transplantation. The 6-month follow-up results are similar to those of standard bilateral lung transplantation.

  6. A pharmacokinetic analysis of posaconazole oral suspension in the serum and alveolar compartment of lung transplant recipients. (United States)

    Thakuria, L; Packwood, K; Firouzi, A; Rogers, P; Soresi, S; Habibi-Parker, K; Lyster, H; Zych, B; Garcia-Saez, D; Mohite, P; Patil, N; Sabashnikov, A; Capoccia, M; Chibvuri, M; Lamba, H; Tate, H; Carby, M; Simon, A; Leaver, N; Reed, A


    Invasive fungal infections cause significant morbidity and mortality after lung transplantation. Fungal prophylaxis following lung transplantation is not standardised, with transplant centres utilising a variety of regimens. Posaconazole is a broad-spectrum antifungal triazole that requires further investigation within the setting of lung transplantation. This prospective, single-centre, observational study explored the pharmacokinetics of posaconazole oral suspension (POS) in the early perioperative period following lung transplantation in 26 patients. Organ recipients were scheduled to receive 400mg POS twice daily for 6 weeks as primary antifungal prophylaxis. Therapeutic drug monitoring (TDM) of serum posaconazole levels was performed in accordance with local clinical protocols. Bronchoalveolar lavage fluid (BALF) was sampled during routine bronchoscopies. Posaconazole levels were measured both in serum and BALF using mass spectrometry. Posaconazole levels were highly variable within lung transplant recipients during the perioperative period and did not achieve 'steady-state'. Serum posaconazole concentrations positively correlated with levels within the BALF (r=0.5527; P=0.0105). Of the 26 patients, 10 failed to complete the study for multiple reasons and so the trial was terminated early. Unlike study findings in stable recipients, serum posaconazole levels rarely achieved steady-state in the perioperative period; however, they do reflect the concentrations within the airways of newly transplanted lungs. The role of POS as primary prophylaxis in the perioperative period is uncertain, but if used TDM may be helpful for determining attainment of therapeutic levels.

  7. Elevated plasma angiopoietin-2 levels and primary graft dysfunction after lung transplantation.

    Directory of Open Access Journals (Sweden)

    Joshua M Diamond

    Full Text Available INTRODUCTION: Primary graft dysfunction (PGD is a significant contributor to early morbidity and mortality after lung transplantation. Increased vascular permeability in the allograft has been identified as a possible mechanism leading to PGD. Angiopoietin-2 serves as a partial antagonist to the Tie-2 receptor and induces increased endothelial permeability. We hypothesized that elevated Ang2 levels would be associated with development of PGD. METHODS: We performed a case-control study, nested within the multi-center Lung Transplant Outcomes Group cohort. Plasma angiopoietin-2 levels were measured pre-transplant and 6 and 24 hours post-reperfusion. The primary outcome was development of grade 3 PGD in the first 72 hours. The association of angiopoietin-2 plasma levels and PGD was evaluated using generalized estimating equations (GEE. RESULTS: There were 40 PGD subjects and 79 non-PGD subjects included for analysis. Twenty-four PGD subjects (40% and 47 non-PGD subjects (59% received a transplant for the diagnosis of idiopathic pulmonary fibrosis (IPF. Among all subjects, GEE modeling identified a significant change in angiopoietin-2 level over time in cases compared to controls (p = 0.03. The association between change in angiopoietin-2 level over the perioperative time period was most significant in patients with a pre-operative diagnosis of IPF (p = 0.02; there was no statistically significant correlation between angiopoietin-2 plasma levels and the development of PGD in the subset of patients transplanted for chronic obstructive pulmonary disease (COPD (p = 0.9. CONCLUSIONS: Angiopoietin-2 levels were significantly associated with the development of PGD after lung transplantation. Further studies examining the regulation of endothelial cell permeability in the pathogenesis of PGD are indicated.

  8. Endobronchial Perfluorocarbon Reduces Inflammatory Activity before and after Lung Transplantation in an Animal Experimental Model

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    Luiz Alberto Forgiarini Junior


    Full Text Available Background. The aim of this study was to evaluate the use of liquid perfluorocarbon (PFC as an adjuvant substance for lung preservation and assess its role in pulmonary protection after transplantation. Methods. Seventy-two rat lungs were flushed with low-potassium dextran (LPD solution and randomized into three main groups: control with LPD alone and experimental with 3 (PFC3 and 7 mL/kg (PFC7 of endobronchial PFC instilled just after harvest. Each group was divided into four subgroups according to preservation time (3, 6, 12, and 24 hours. Afterwards, we performed lung transplantation using rat lungs preserved for 12 hours with LPD alone or with 7 mL/kg of endobronchial PFC. Results. There was a significant increase in oxidative stress in the control group at 6 h of cold ischemic time compared with the PFC3 and PFC7 groups. The apoptotic activity and NF-κB expression were significantly higher in the control group compared with the PFC groups at 3, 12, and 24 h of cold preservation. After transplantation, the NF-κB, iNOS, and nitrotyrosine expression as well as caspase 3 activity were significantly lower in the PFC groups. Conclusion. The use of endobronchial PFC as an adjuvant to the current preservation strategy improved graft viability.

  9. Acute fibrinous and organising pneumonia following lung transplantation is associated with severe allograft dysfunction and poor outcome: a case series

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    Keith Meyer


    Full Text Available   Acute fibrinous and organising pneumonia (AFOP is a histopathologic variant of acute lung injury that has been associated with infection and inflammatory disorders and has been reported as a complication of lung transplantation. A retrospective chart review was performed for all patients transplanted at the University of Wisconsin Hospital and Clinics from January 1995 to December 2013 (n = 561. We identified 6 recipients whose clinical course was complicated by AFOP. All recipients were found to have AFOP on lung biopsy or at post-mortem examination, and 5 of the 6 patients suffered progressive allograft dysfunction that led to fatal outcome. Only 1 of the 6 patients stabilised with augmented immunosuppression and had subsequent improvement and stabilisation of allograft function. We could not clearly identify any specific cause of AFOP, such as drug toxicity or infection. Lung transplantation can be complicated by lung injury with an AFOP pattern on histopathologic examination of lung biopsy specimens. The presence of an AFOP pattern was associated with irreversible decline in lung function that was refractory to therapeutic interventions in 5 of our 6 cases and was associated with severe allograft dysfunction and death in these 5 individuals. AFOP should be considered as a potential diagnosis when lung transplant recipients develop progressive decline in lung function that is consistent with a clinical diagnosis of chronic lung allograft dysfunction.  

  10. Intravenous immunoglobulin for hypogammaglobulinemia after lung transplantation: a randomized crossover trial.

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    David J Lederer

    Full Text Available BACKGROUND: We aimed to determine the effects of treatment with intravenous immunoglobulin on bacterial infections in patients with hypogammaglobulinemia (HGG after lung transplantation. METHODS: We performed a randomized, double-blind, placebo-controlled two-period crossover trial of immune globulin intravenous (IVIG, 10% Purified (Gamunex, Bayer, Elkhart, IN monthly in eleven adults who had undergone lung transplantation more than three months previously. We randomized study participants to three doses of IVIG (or 0.1% albumin solution (placebo given four weeks apart followed by a twelve week washout and then three doses of placebo (or IVIG. The primary outcome was the number of bacterial infections within each treatment period. RESULTS: IVIG had no effect on the number of bacterial infections during the treatment period (3 during IVIG and 1 during placebo; odds ratio 3.5, 95% confidence interval 0.4 to 27.6, p = 0.24. There were no effects on other infections, use of antibiotics, or lung function. IVIG significantly increased trough IgG levels at all time points (least square means, 765.3 mg/dl during IVIG and 486.3 mg/dl during placebo, p<0.001. Four serious adverse events (resulting in hospitalization occurred during the treatment periods (3 during active treatment and 1 during the placebo period, p = 0.37. Chills, flushing, and nausea occurred during one infusion of IVIG. CONCLUSIONS: Treatment with IVIG did not reduce the short-term risk of bacterial infection in patients with HGG after lung transplantation. The clinical efficacy of immunoglobulin supplementation in HGG related to lung transplantation over the long term or with recurrent infections is unknown. TRIAL REGISTRATION: NCT00115778.

  11. Non-invasive diagnosis of acute heart- or lung-transplant rejection using radiolabeled annexin V

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    Blankenberg, F.G. [Stanford Univ., CA (United States). Dept. of Radiology; Strauss, H.W. [Stanford Univ., CA (United States). Nuclear Medicine Div.


    Background. Apoptosis is a ubiquitous set of cellular processes by which superfluous or unwanted cells are eliminated in the body without harming adjacent healthy tissues. When apoptosis is inappropriate (too little or too much), a variety of human diseases can occur, including acute heart or lung transplant rejection. Objective. Our group has developed a new radiopharmaceutical, radiolabeled annexin V, which can image apoptosis. Results and conclusion. Here we briefly review the biomolecular basis of apoptosis and its role in acute rejection. We also describe the possible use of radiolabeled annexin V to screen children noninvasively for acute rejection following organ transplantation. (orig.) With 6 figs., 53 refs.

  12. Successful management of bilateral refractory chylothorax after double lung transplantation for lymphangioleiomyomatosis

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    Mohammed Hussein


    Full Text Available Lymphangioleiomyomatosis (LAM is a rare disease that leads to airways and lymphatic channels obstruction due to abnormal smooth muscle proliferation. It presents with dyspnea, pneumothorax or chylothorax. Lung transplantation (LT has emerged as a valuable therapeutic option with limited reports. We report a case of LAM that underwent double LT and complicated by refractory bilateral chylothorax which was managed successfully by povidone-iodine pleurodesis and the addition of sirolimus to the post-transplantation immunosuppressive therapy. The patient has no recurrence with 24 months follow-up.

  13. Long-term leukopenia in a lung transplanted patient with cystic fibrosis treated with zoledronic acid

    DEFF Research Database (Denmark)

    Karahasanovic, A; Thorsteinsson, A-L; Bjarnason, N H


    , albeit with long-term consequences of the disease, such as osteoporosis, becoming of increasing significance. The medical treatment of osteoporosis in patients with CF or after organ transplantation is still being explored, and no clear guidelines regarding the best choice of bisphosphonate exist. We...... report a case of a young woman with CF, lung transplantation and low bone mass developing long-term leukopenia after treatment with zoledronic acid. The leukopenia, with a strong affection of the neutrocytes, lasted for 4 months and the condition only went into remission after granulocyte...

  14. Edaravone attenuates ischemia-reperfusion injury by inhibiting oxidative stress in a canine lung transplantation model

    Institute of Scientific and Technical Information of China (English)

    XU Jin-zhi; SHEN Bao-zhong; LI Ye; ZHANG Tong; XU Wan-hai; LIU Xiao-wei; LU Hong-guang


    Background Previous reports have confirmed that edaravone has protective effects against ischemia-reperfusion(IR) injury of many organs.In this study,we investigated the effect of edaravone on preventing IR injury of the lung in a canine lung transplantation model. Methods Twelve weight-matched pairs of random-bred dogs were randomized into two groups.Within each pair,one dog served as donor and the other as recipient.In the study group,prostaglandin EI(PGEl)(8 μg/kg)was injected into the donor pulmonary artery(PA)before occlusion and the donor lungs were flushed with 1.0L of LPD solution containing edaravone(10mg/kg)and stored in the same LPD solution at a temperature of 1.C for 8 hours.The left single lung transplantation was then performed and recipients received intravenous injection with edaravone l 1 0 mg/kg)at the onset of reperfusion.In the control group,edaravone was substituted by the same volume of sterile saline solution.Another six dogs were obtained as normal control group in which left lungs were dissected after thoracotomy without an IR injury.One hour after repeffusion.or after dissection of the left lung,the right lung was excluded from peffusion and ventilation after which,cardiopulmonary parameters were measured.Wet/dry ratios,malondiaIdehyde(MDA)and myeloperoxidase (MPO)levels were assessed and histological analysis of lung tissue performed at the same time.Results All animals survived until the end of the experiment.The study group showed significantly decreased wet/dry ratios(treated:(74.1±4.2)%vs control:(86.8±5.2)%,P<0.01),MDA levels(treated:0.50±0.08 vs control:0.88±0.15,P <0.01)and MPO activity(treated:0.23±0.05 vs control:0.43±0.07,P

  15. Comparison of an advanced minimally invasive cardiac output monitoring with a continuous invasive cardiac output monitoring during lung transplantation. (United States)

    Tomasi, Roland; Prueckner, Stephan; Czerner, Stephan; Schramm, Renè; Preissler, Gerhard; Zwißler, Bernhard; von Dossow-Hanfstingl, Vera


    The aim of this study was to compare a continuous non-calibrated left heart cardiac index (CI) measurement by arterial waveform analysis (FloTrac(®)/Vigileo(®)) with a continuous calibrated right heart CI measurement by pulmonary artery thermodilution (CCOmbo-PAC(®)/Vigilance II(®)) for hemodynamic monitoring during lung transplantation. CI was measured simultaneously by both techniques in 13 consecutive lung transplants (n = 4 single-lung transplants, n = 9 sequential double-lung transplants) at distinct time points perioperatively. Linear regression analysis and Bland-Altman analysis with percentage error calculation were used for statistical comparison of CI measurements by both techniques. In this study the FloTrac(®) system underestimated the CI in comparison with the continuous pulmonary arterial thermodilution (p waveform and continuous pulmonary artery thermodilution are, therefore, not interchangeable during these complex operations.

  16. Successful Recanalization of a Complete Lobar Bronchial Stenosis in a Lung Transplant Patient Using a Combined Percutaneous and Bronchoscopic Approach

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    Miraglia, Roberto, E-mail: [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); Vitulo, Patrizio, E-mail: [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation (Italy); Maruzzelli, Luigi, E-mail: [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); Burgio, Gaetano, E-mail: [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Operating Room Service, Department of Anesthesia and Intensive Care (Italy); Caruso, Settimo, E-mail: [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy); Bertani, Alessandro, E-mail: [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Thoracic Surgery and Lung Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation (Italy); Callari, Adriana, E-mail: [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Pulmonology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation (Italy); Luca, Angelo, E-mail: [Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Radiology Service, Department of Diagnostic and Therapeutic Services (Italy)


    Airway stenosis is a major complication after lung transplantation that is usually managed with a combination of interventional endoscopic techniques, including endobronchial debridement, balloon dilation, and stent placement. Herein, we report a successful case of recanalization of a complete stenosis of the right middle lobe bronchus in a lung transplant patient, by using a combined percutaneous–bronchoscopic approach after the failure of endobronchial debridement.

  17. Lung Transplantation and the Routine Use of Cardiopulmonary Bypass and Median Sternotomy: Experience at the Ochsner Multi-Organ Transplant Institute (United States)

    Bates, Michael; Factor, Matthew; Parrino, P. Eugene; Bansal, Aditya; Rampolla, Reinaldo; Seoane, Leonardo; Mena, Jose; Gaudet, Matthew; Smith, William; McFadden, P. Michael


    Background: From 1990-2005 at Ochsner Medical Center in New Orleans, LA, cardiopulmonary bypass (CPB) was used only when necessary during lung transplantation surgeries. Ochsner's lung transplant program was closed for more than 4 years after Hurricane Katrina, and since the program's reestablishment in 2010, the majority of lung transplantation surgeries have been performed with the patient on CPB and with a median sternotomy incision. The purpose of this study was to compare the outcomes of the CPB and non-CPB groups. Methods: After institutional review board approval, we conducted a retrospective review of the entire program using the Ochsner lung transplant database to identify patients in the non-CPB group from 1990-2005 and in the CPB group from 2010-2014. We calculated 1- and 3-year survival rates for each patient and reviewed medical records for evidence of stroke, the need for operative reexploration, and venous stenosis. We also performed a subgroup analysis of the first 20 consecutive patients undergoing lung transplantation on CPB with median sternotomy from February 2010 through April 2011 to examine intraoperative blood product use, the quantity of blood products administered, CPB cannulation and pump complications, ischemic time, and primary graft dysfunction. Results: Of the 208 patients in the non-CPB group, 74% had 1-year graft survival and 55% had 3-year survival following transplantation. After February 2010, 79 patients underwent lung transplantation on CPB with median sternotomy, and 90% of those patients had 1-year graft survival. Of the 46 patients available for 3-year follow-up, 59% were alive with functional grafts. The difference in 1-year survival rates between the 2 cohorts was statistically significant. Two deaths, 3 strokes, and 5 reexplorations of the chest for bleeding occurred during the perioperative time period in the CPB group, but no mortality was associated with these perioperative events. One patient who had perioperative

  18. Oxygen-sensitive {sup 3}He-MRI in bronchiolitis obliterans after lung transplantation

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    Gast, Klaus K. [Klinikum der Johannes Gutenberg-Universitaet, Klinik und Poliklinik fuer diagnostische und interventionelle Radiologie, Mainz (Germany); Biedermann, Alexander [Klinikum der Johannes Gutenberg-Universitaet, 3. Medizinische Klinik, Pulmonologie, Mainz (Germany); Herweling, Annette [Klinikum der Johannes Gutenberg-Universitaet, Klinik fuer Anaesthesiologie, Mainz (Germany); Schreiber, Wolfgang G. [Klinikum der Johannes Gutenberg-Universitaet, Klinik und Poliklinik fuer diagnostische und interventionelle Radiologie, MR-Physik, Mainz (Germany); Schmiedeskamp, Joerg [Max-Planck-Institut fuer Polymerforschung, Mainz (Germany); Mayer, Eckhard [Klinikum der Johannes Gutenberg-Universitaet, Klinik fuer Herz-, Thorax- und Gefaesschirurgie, Mainz (Germany); Heussel, Claus P. [Abteilung fuer Radiologie, Thoraxklinik Heidelberg, Heidelberg (Germany); Markstaller, Klaus; Eberle, Balthasar [Inselspital/Universitaetsspital, Klinik fuer Anaesthesiologie, Bern (Switzerland); Kauczor, Hans-Ulrich [Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany)


    Oxygen-sensitive {sup 3}He-MRI was studied for the detection of differences in intrapulmonary oxygen partial pressure (pO{sub 2}) between patients with normal lung transplants and those with bronchiolitis obliterans syndrome (BOS). Using software developed in-house, oxygen-sensitive {sup 3}He-MRI datasets from patients with normal lung grafts (n = 8) and with BOS (n = 6) were evaluated quantitatively. Datasets were acquired on a 1.5-T system using a spoiled gradient echo pulse sequence. Underlying diseases were pulmonary emphysema (n = 10 datasets) and fibrosis (n = 4). BOS status was verified by pulmonary function tests. Additionally, {sup 3}He-MRI was assessed blindedly for ventilation defects. Median intrapulmonary pO{sub 2} in patients with normal lung grafts was 146 mbar compared with 108 mbar in patients with BOS. Homogeneity of pO2 distribution was greater in normal grafts (standard deviation pO2 34 versus 43 mbar). Median oxygen decrease rate during breath hold was higher in unaffected patients (-1.75 mbar/s versus -0.38 mbar/s). Normal grafts showed fewer ventilation defects (5% versus 28%, medians). Oxygen-sensitive {sup 3}He-MRI appears capable of demonstrating differences of intrapulmonary pO2 between normal lung grafts and grafts affected by BOS. Oxygen-sensitive {sup 3}He-MRI may add helpful regional information to other diagnostic techniques for the assessment and follow-up of lung transplant recipients. (orig.)

  19. Biopsy-verified bronchiolitis obliterans and other noninfectious lung pathologies after allogeneic hematopoietic stem cell transplantation. (United States)

    Uhlving, Hilde Hylland; Andersen, Claus B; Christensen, Ib Jarle; Gormsen, Magdalena; Pedersen, Karen Damgaard; Buchvald, Frederik; Heilmann, Carsten; Nielsen, Kim Gjerum; Mortensen, Jann; Moser, Claus; Sengeløv, Henrik; Müller, Klaus Gottlob


    Bronchiolitis obliterans (BO) is a serious complication of allogeneic hematopoietic stem cell transplantation (HSCT). Lung biopsy is the gold standard for diagnosis. This study describes the course of BO and assesses the congruity between biopsy-verified BO and a modified version of the National Institutes of Health's consensus criteria for BO syndrome (BOS) based exclusively on noninvasive measures. We included 44 patients transplanted between 2000 and 2010 who underwent lung biopsy for suspected BO. Of those, 23 were diagnosed with BO and 21 presented other noninfectious pulmonary pathologies, such as cryptogenic organizing pneumonia, diffuse alveolar damage, interstitial pneumonia, and nonspecific interstitial fibrosis. Compared with patients with other noninfectious pulmonary pathologies, BO patients had significantly lower values of forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and maximal mid-expiratory flow throughout follow-up, but there was no difference in the change in pulmonary function from the time of lung biopsy. The BO diagnosis was not associated with poorer overall survival. Fifty-two percent of patients with biopsy-verified BO and 24% of patients with other noninfectious pulmonary pathology fulfilled the BOS criteria. Pathological BO diagnosis was not superior to BOS criteria in predicting decrease in pulmonary function beyond the time of biopsy. A lung biopsy may provide a characterization of pathological patterns that can extend our knowledge on the pathophysiology of HSCT-related lung diseases.

  20. Treatment of Severe Post-kidney-transplant Lung Infection by Integrative Chinese and Western Medicine

    Institute of Scientific and Technical Information of China (English)


    Objective: To explore treatments of severe post-kidney-transplant lung infection by integrative Chinese and Western medicine (ICWM), in order to elevate the curing rate as well as to lower the death rate. Methods: Based on conventional ways of Western medical treatments of 18 cases of severe post-kidney-transplant lung infection, such as putting the patients in single individual ward, antibiotics to prevent infection, respiratory machines, blood filtration, nutritional support, steroids, and maintaining electrolytes balance, we applied integrated Chinese medicinal treatments, like altering conventional prescription "pneumonia Ⅲ ", and conducted clinical observation of effectiveness, and indexes including white blood cell (WBC), neutrophilic granulocyte, blood urea nitrogen (BUN), blood creatinine (Cr), etc. Results: Of the 18cases studied, 7 were already cured, 8 proved the treatment effective, 3 died. All clinical indexes had statistically significant changes compared with those of before treatment (P<0.01). Conclusion: ICWM can increase curing rate and lower death rate.

  1. Bronchial fistula after lobar size reduction for bilateral lung transplantation in Kartagener's syndrome: a surgical challenge. (United States)

    Brioude, Geoffrey; D'journo, Xavier Benoit; Reynaud-Gaubert, Martine; Thomas, Pascal Alexandre


    Bilateral lung transplantation was performed in a 52-year old man with end-stage Kartagener's syndrome. A postimplantation right lower lobectomy was required for volume reduction and dextrocardia. A bronchial fistula developed with an intractable colonized residual pleural cavity. Closure was obtained successfully with multiple-stage procedures including decortication, muscle flap and an open-window thoracostomy without modification of the immunosuppressive protocol.

  2. National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis. (United States)

    Merlo, C A; Clark, S C; Arnaoutakis, G J; Yonan, N; Thomas, D; Simon, A; Thompson, R; Thomas, H; Orens, J; Shah, A S


    Successful lung transplantation (LTx) depends on multiple components of healthcare delivery and performance. Therefore, we conducted an international registry analysis to compare post-LTx outcomes for cystic fibrosis (CF) patients using the UNOS registry in the United States and the National Health Service (NHS) Transplant Registry in the United Kingdom. Patients with CF who underwent lung or heart-lung transplantation in the United States or United Kingdom between January 1, 2000 and December 31, 2011 were included. The primary outcome was all-cause mortality. Kaplan-Meier analysis and Cox proportional hazards regression evaluated the effect of healthcare system and insurance on mortality after LTx. 2,307 US LTx recipients and 451 individuals in the United Kingdom were included. 894 (38.8%) US LTx recipients had publically funded Medicare/Medicaid insurance. US private insurance and UK patients had improved median predicted survival compared with US Medicare/Medicaid recipients (p insurance was associated with worse survival after LTx (US private: HR0.78,0.68-0.90,p = 0.001 and UK: HR0.63,0.41-0.97, p = 0.03). This study in CF patients is the largest comparison of LTx in two unique health systems. Both the United States and United Kingdom have similar early survival outcomes, suggesting important dissemination of best practices internationally. However, the performance of US public insurance is significantly worse and may put patients at risk.

  3. Pulmonary acceleration time to optimize the timing of lung transplant in cystic fibrosis. (United States)

    Damy, Thibaud; Burgel, Pierre-Régis; Pepin, Jean-Louis; Boelle, Pierre-Yves; Cracowski, Claire; Murris-Espin, Marlène; Nove-Josserand, Raphaele; Stremler, Nathalie; Simon, Tabassome; Adnot, Serge; Fauroux, Brigitte


    Pulmonary hypertension (PH) may affect survival in cystic fibrosis (CF) and can be assessed on echocardiographic measurement of the pulmonary acceleration time (PAT). The study aimed at evaluating PAT as a tool to optimize timing of lung transplant in CF patients. Prospective multicenter longitudinal study of patients with forced expiratory volume in 1 second (FEV1) ≤60% predicted. Echocardiography, spirometry and nocturnal oximetry were obtained as part of the routine evaluation. We included 67 patients (mean FEV1 42±12% predicted), among whom 8 underwent lung transplantation during the mean follow-up of 19±6 months. No patients died. PAT was determined in all patients and correlated negatively with systolic pulmonary artery pressure (sPAP, r=-0.36, P=0.01). Patients in the lowest PAT tertile (35 mmHg. By multivariate analysis, FEV(1)and nocturnal desaturation were the main determinants of reduced PAT. A PAT<101 ms reduction is a promising tool for timing of lung transplantation in CF.

  4. Dangerous drug interactions leading to hemolytic uremic syndrome following lung transplantation

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    Parissis Haralabos


    Full Text Available Abstract Background To report our experience of a rather uncommon drug interaction, resulting in hemolytic uremic syndrome (HUS. Methods Two consecutive cases of hemolytic uremic syndrome were diagnosed in our service. In both patients the use of macrolides in patients taking Tacrolimus, resulted in high levels of Tacrolimus. Results The first patient was a 48 years old female with Bilateral emphysema. She underwent Single Sequential Lung Transplantation. She developed reperfusion injury requiring prolonged stay. Tacrolimus introduced (Day 51. The patient remained well up till 5 months later; Erythromycin commenced for chest infection. High Tacrolimus levels and a clinical diagnosis of HUS were made. She was treated with plasmapheresis successfully. The second case was a 57 years old female with Emphysema & A1 Antithrypsin deficiency. She underwent Right Single Lung Transplantation. A2 rejection with mild Obliterative Bronchiolitis diagnosed 1 year later and she switched to Tacrolimus. She was admitted to her local Hospital two and a half years later with right middle lobe consolidation. The patient commenced on amoxicillin and clarithromycin. Worsening renal indices, high Tacrolimus levels, hemolytic anemia & low Platelets were detected. HUS diagnosed & treated with plasmapheresis. Conclusions There are 21 cases of HUS following lung transplantation in the literature that may have been induced by high tacrolimus levels. Macrolides in patients taking Cyclosporin or Tacrolimus lead to high levels. Mechanism of action could be glomeruloconstrictor effect with reduced GFR increased production of Endothelin-1 and increased Platelet aggregation.

  5. The feasibility of CT lung volume as a surrogate marker of donor-recipient size matching in lung transplantation. (United States)

    Jung, Woo Sang; Haam, Seokjin; Shin, Jae Min; Han, Kyunghwa; Park, Chul Hwan; Byun, Min Kwang; Chang, Yoon Soo; Kim, Hyung Jung; Kim, Tae Hoon


    Donor-recipient size matching in lung transplantation (LTx) by computed tomography lung volume (CTvol) may be a reasonable approach because size matching is an anatomical issue. The purpose of this study is to evaluate the feasibility of CTvol as a surrogate marker of size matching in LTx by comparing CTvol and predicted total lung capacity (pTLC) to reference total lung capacity (TLC) values.From January to December 2014, data from 400 patients who underwent plethysmography, pulmonary function testing (PFT), and chest computed tomography scans were reviewed retrospectively. Enrolled 264 patients were divided into 3 groups according to PFT results: Group I, obstructive pattern; Group II, restrictive pattern; Group III, normal range. The correlations between pTLC and TLC and between CTvol and TLC were analyzed, and the linear correlation coefficients were compared. The percentage error rates of pTLC and CTvol were calculated and absolute error rates were compared.The correlation coefficient between CTvol and TLC in Group I was larger than that of pTLC and TLC (0.701 vs 0.432, P = 0.002). The absolute percentage error rate between CTvol and pTLC was lower than that of pTLC in Group II (15.3% ± 11.9% vs 42.2% ± 28.1%, P matching in LTx.

  6. Heart-lung transplantation for end-stage heart disease with Eisenmenger's syndrome: report of two cases

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xi; XIONG Mai; WANG Zhi-ping; YIN Sheng-li; WU Zhong-kai; XU Ying-qi; TANG Bai-yun; YAO Jian-ping; CHEN Guang-xian


    @@ From September 2006 to January 2007, 2 patients with end-staged heart and lung disease (congenital disease, Eisenmenger's syndrome, severe pulmonary artery hypertension and heart failure) underwent heart and lung transplantation (HLT) at the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

  7. Successful lung transplantation for talcosis secondary to intravenous abuse of oral drug

    Directory of Open Access Journals (Sweden)

    Dekel Shlomi


    Full Text Available Dekel Shlomi1, David Shitrit1, Daniele Bendayan1, Gidon Sahar2, Yitshak Shechtman3, Mordechai R Kramer11Pulmonary Institute, Departments of 2Cardiothoracic Surgery and 3Pathology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelAbstract: Talcosis due to intravenous injection of oral drugs can cause severe pulmonary disease with progressive dyspnea even when drug use is discontinued. We describe a 54-yearold woman with severe emphysema who underwent left lung transplantation. The patient had a remote history of intravenous injection of crushed methylphenidate (Ritalin tablets. Chest computed tomography showed severe emphysematous changes, more prominent in the lower lobes. Microscopic examination of the extracted lung demonstrated multinucleated giant cells with birefringent crystals, compatible with talcosis. At follow-up, daily symptoms were completely alleviated and lung function was good. We recommend that lung transplantation be considered as a viable option in the treatment of talcosis.Keywords: methylphenidate (Ritalin, emphysema

  8. Rapid adaptation drives invasion of airway donor microbiota by Pseudomonas after lung transplantation (United States)

    Beaume, M.; Köhler, T.; Greub, G.; Manuel, O.; Aubert, J-D.; Baerlocher, L.; Farinelli, L.; Buckling, A.; van Delden, C.; Achermann, Rita; Amico, Patrizia; Baumann, Philippe; Beldi, Guido; Benden, Christian; Berger, Christoph; Binet, Isabelle; Bochud, Pierre-Yves; Boely, Elsa; Bucher, Heiner; Bühler, Leo; Carell, Thierry; Catana, Emmanuelle; Chalandon, Yves; Geest, Sabina de; Rougemont, Olivier de; Dickenmann, Michael; Duchosal, Michel; Fehr, Thomas; Ferrari-Lacraz, Sylvie; Garzoni, Christian; Soccal, Paola Gasche; Giostra, Emiliano; Golshayan, Déla; Good, Daniel; Hadaya, Karine; Halter, Jörg; Heim, Dominik; Hess, Christoph; Hillinger, Sven; Hirsch, Hans H.; Hofbauer, Günther; Huynh-Do, Uyen; Immer, Franz; Klaghofer, Richard; Koller, Michael; Laesser, Bettina; Lehmann, Roger; Lovis, Christian; Marti, Hans-Peter; Martin, Pierre Yves; Martinolli, Luca; Meylan, Pascal; Mohacsi, Paul; Morard, Isabelle; Morel, Philippe; Mueller, Ulrike; Mueller, Nicolas J; Mueller-McKenna, Helen; Müller, Antonia; Müller, Thomas; Müllhaupt, Beat; Nadal, David; Pascual, Manuel; Passweg, Jakob; Ziegler, Chantal Piot; Rick, Juliane; Roosnek, Eddy; Rosselet, Anne; Rothlin, Silvia; Ruschitzka, Frank; Schanz, Urs; Schaub, Stefan; Seiler, Christian; Stampf, Susanne; Steiger, Jürg; Stirnimann, Guido; Toso, Christian; Tsinalis, Dimitri; Venetz, Jean-Pierre; Villard, Jean; Wick, Madeleine; Wilhelm, Markus; Yerly, Patrick


    In cystic fibrosis (CF) patients, chronic airway infection by Pseudomonas leads to progressive lung destruction ultimately requiring lung transplantation (LT). Following LT, CF-adapted Pseudomonas strains, potentially originating from the sinuses, may seed the allograft leading to infections and reduced allograft survival. We investigated whether CF-adapted Pseudomonas populations invade the donor microbiota and adapt to the non-CF allograft. We collected sequential Pseudomonas isolates and airway samples from a CF-lung transplant recipient during two years, and followed the dynamics of the microbiota and Pseudomonas populations. We show that Pseudomonas invaded the host microbiota within three days post-LT, in association with a reduction in richness and diversity. A dominant mucoid and hypermutator mutL lineage was replaced after 11 days by non-mucoid strains. Despite antibiotic therapy, Pseudomonas dominated the allograft microbiota until day 95. We observed positive selection of pre-LT variants and the appearance of novel mutations. Phenotypic adaptation resulted in increased biofilm formation and swimming motility capacities. Pseudomonas was replaced after 95 days by a microbiota dominated by Actinobacillus. In conclusion, mucoid Pseudomonas adapted to the CF-lung remained able to invade the allograft. Selection of both pre-existing non-mucoid subpopulations and of novel phenotypic traits suggests rapid adaptation of Pseudomonas to the non-CF allograft. PMID:28094327

  9. {sup 3}He-MRI in follow-up of lung transplant recipients

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    Gast, Klaus Kurt; Zaporozhan, Julia; Ley, Sebastian; Biedermann, Alexander; Knitz, Frank; Eberle, Balthasar; Schmiedeskamp, Joerg; Heussel, Claus-Peter; Mayer, Eckhard; Schreiber, Wolfgang Guenter; Thelen, Manfred; Kauczor, Hans-Ulrich [Department of Radiology, Johannes Gutenberg University Hospital, Langenbeckstrasse 1, 55131, Mainz (Germany)


    The aim of this study was to evaluate the possible contribution of {sup 3}He-MRI to detect obliterative bronchiolitis (OB) in the follow-up of lung transplant recipients. Nine single- and double-lung transplanted patients were studied by an initial and a follow-up {sup 3}He-MRI study. Images were evaluated subjectively by estimation of ventilation defect area and quantitatively by individually adapted threshold segmentation and subsequent calculation of ventilated lung volume. Bronchiolitis obliterans syndrome (BOS) was diagnosed using pulmonary function tests. At {sup 3}He-MRI, OB was suspected if ventilated lung volume had decreased by 10% or more at the follow-up MRI study compared with the initial study. General accordance between pulmonary function testing and {sup 3}He-MRI was good, although subjective evaluation of {sup 3}He-MRI underestimated improvement in ventilation as obtained by pulmonary function tests. The {sup 3}He-MRI indicated OB in 6 cases. According to pulmonary function tests, BOS was diagnosed in 5 cases. All diagnoses of BOS were also detected by {sup 3}He-MRI. In 2 of these 5 cases, {sup 3}He-MRI indicated OB earlier than pulmonary function tests. The results support the hypothesis that {sup 3}He-MRI may be sensitive for early detection of OB and emphasize the need for larger prospective follow-up studies. (orig.)

  10. Rapid adaptation drives invasion of airway donor microbiota by Pseudomonas after lung transplantation. (United States)

    Beaume, M; Köhler, T; Greub, G; Manuel, O; Aubert, J-D; Baerlocher, L; Farinelli, L; Buckling, A; van Delden, C


    In cystic fibrosis (CF) patients, chronic airway infection by Pseudomonas leads to progressive lung destruction ultimately requiring lung transplantation (LT). Following LT, CF-adapted Pseudomonas strains, potentially originating from the sinuses, may seed the allograft leading to infections and reduced allograft survival. We investigated whether CF-adapted Pseudomonas populations invade the donor microbiota and adapt to the non-CF allograft. We collected sequential Pseudomonas isolates and airway samples from a CF-lung transplant recipient during two years, and followed the dynamics of the microbiota and Pseudomonas populations. We show that Pseudomonas invaded the host microbiota within three days post-LT, in association with a reduction in richness and diversity. A dominant mucoid and hypermutator mutL lineage was replaced after 11 days by non-mucoid strains. Despite antibiotic therapy, Pseudomonas dominated the allograft microbiota until day 95. We observed positive selection of pre-LT variants and the appearance of novel mutations. Phenotypic adaptation resulted in increased biofilm formation and swimming motility capacities. Pseudomonas was replaced after 95 days by a microbiota dominated by Actinobacillus. In conclusion, mucoid Pseudomonas adapted to the CF-lung remained able to invade the allograft. Selection of both pre-existing non-mucoid subpopulations and of novel phenotypic traits suggests rapid adaptation of Pseudomonas to the non-CF allograft.

  11. IDPs from Kosovo still awaiting durable solutions

    Directory of Open Access Journals (Sweden)

    Anika Krstic


    Full Text Available As the Balkans anxiously await delayed UN recommendations on the final status of the Serbian province of Kosovo, displaced persons from Kosovo remain torn between uncertain return prospects and denial of local integration.

  12. Perfil nutricional de pacientes candidatos ao transplante de pulmão Nutritional profile of lung transplant candidates

    Directory of Open Access Journals (Sweden)

    Sabrina Monteiro Pereira de Souza


    Full Text Available OBJETIVO: Verificar o perfil nutricional dos pacientes candidatos ao transplante de pulmão. MÉTODOS: Estudo transversal, retrospectivo com pacientes candidatos ao transplante de pulmão em um hospital público da cidade de São Paulo. O gênero, a idade e a doença pulmonar de base dos participantes foram compilados. Para a avaliação do perfil nutricional dos pacientes, o índice de massa corporal (IMC, a circunferência muscular do braço (CMB, a circunferência da cintura (CC e a prega cutânea tricipital (PCT foram determinados durante o primeiro atendimento ambulatorial. RESULTADOS: Foram incluídos 117 pacientes, sendo 69 (59% do gênero masculino. A média de idade dos participantes foi de 42,5 ± 15,2 anos. A doença de base de maior prevalência foi o enfisema pulmonar, em 29 pacientes (24,8%. O perfil nutricional de 48,3% dos pacientes com enfisema pulmonar, de 55% dos com fibrose cística, 56% dos com bronquiectasias e de 50% dos com outras doenças pulmonares foi considerado normal. A maior parte dos pacientes com fibrose pulmonar (51,7% foi classificada com excesso de peso. A PCT indicou que os pacientes com fibrose cística apresentaram um elevado risco de depleção (64,7%, seguidos pelos pacientes com bronquiectasias (52,6%. CONCLUSÕES: Os pacientes com fibrose pulmonar foram os que obtiveram maiores valores de IMC, mas com PCT e CMB correspondentes a eutrofia. Pacientes com fibrose cística e bronquiectasias apresentaram maior prevalência de depleção nutricional, baseado na PCT e CMB.OBJECTIVE: To determine the nutritional profile of lung transplant candidates. METHODS: A retrospective cross-sectional study involving lung transplant candidates at a public hospital in the city of São Paulo, Brazil. Data related to gender, age and underlying lung disease were compiled for the participants. For the assessment of the nutritional profile of the patients, body mass index (BMI, mid-arm muscle circumference (MAMC, waist

  13. Lung transplantation in a Chinese single center:7 years of experience

    Institute of Scientific and Technical Information of China (English)

    HE Wen-xin; ZHANG Peng; LIU Ming; JIANG Ge-ning; DING Jia-an; GAO Wen; ZHU Yu-ming; ZHOU Xiao; CHEN Chang; WANG Hao; FAN Jiang


    Background Lung transplantation (LT) is a viable option for patients with end-stage lung diseases,but in China,the supply is limited,and the experience with LT is rare too. This study aimed to evaluate the survival and postoperative complications of recipients undergone LT.Methods From January 2003 to May 2010,all patients who underwent LT were included. The clinical data of recipients were analyzed retrospectively,including demographic characteristics,survival rate,and the occurrences of postoperative complications,acute rejection and bronchiolitis obliterans syndrome. Results In total,37 patients underwent LT. The early mortality (<30 days) was 14% (5/37). Cumulative survival rate was 78%,70%,70% and 42% at 1,3,5 and 6 years,respectively. In 37 patients,5 (14%) developed fungal infections,9 (24%)pulmonary bacterial infections,and 6 (16%) had bronchial anastomosis complications after LT. At three months posttransplantation,a significant improvement was observed in lung function (P <0.05). Fifteen recipients (41%) developed acute rejection within the first year. Freedom from bronchiolitis obliterans syndrome was 89%,85% and 80% at 1,2 and 3years after transplantation.Conclusions Despite the limited number of cases,the survival and occurrences of complications after LT were comparable to the international experience. Single LT may be a reasonable option for some patients with end-stage pulmonary diseases.

  14. Determinants of 6-minute walk distance in patients with idiopathic pulmonary fibrosis undergoing lung transplant evaluation. (United States)

    Porteous, Mary K; Rivera-Lebron, Belinda N; Kreider, Maryl; Lee, James; Kawut, Steven M


    Little is known about the physiologic determinants of 6-minute walk distance in idiopathic pulmonary fibrosis. We investigated the demographic, pulmonary function, echocardiographic, and hemodynamic determinants of 6-minute walk distance in patients with idiopathic pulmonary fibrosis evaluated for lung transplantation. We performed a cross-sectional analysis of 130 patients with idiopathic pulmonary fibrosis who completed a lung transplantation evaluation at the Hospital of the University of Pennsylvania between 2005 and 2010. Multivariable linear regression analysis was used to generate an explanatory model for 6-minute walk distance. After adjustment for age, sex, race, height, and weight, the presence of right ventricular dilation was associated with a decrease of 50.9 m (95% confidence interval [CI], 8.4-93.3) in 6-minute walk distance ([Formula: see text]). For each 200-mL reduction in forced vital capacity, the walk distance decreased by 15.0 m (95% CI, 9.0-21.1; [Formula: see text]). For every increase of 1 Wood unit in pulmonary vascular resistance, the walk distance decreased by 17.3 m (95% CI, 5.1-29.5; [Formula: see text]). Six-minute walk distance in idiopathic pulmonary fibrosis depends in part on circulatory impairment and the degree of restrictive lung disease. Future trials that target right ventricular morphology, pulmonary vascular resistance, and forced vital capacity may potentially improve exercise capacity in patients with idiopathic pulmonary fibrosis.

  15. Performance of long-term CT monitoring in diagnosing bronchiolitis obliterans after lung transplantation

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    Berstad, Audun E. [Department of Radiology, Rikshospitalet University Hospital, Sognsvannsveien 20, N-0027 Oslo (Norway)]. E-mail:; Aalokken, Trond Mogens [Department of Radiology, Rikshospitalet University Hospital, Sognsvannsveien 20, N-0027 Oslo (Norway); Kolbenstvedt, Alf [Department of Radiology, Rikshospitalet University Hospital, Sognsvannsveien 20, N-0027 Oslo (Norway); Bjortuft, Oystein [Department of Thoracic Medicine, Rikshospitalet University Hospital, Sognsvannsveien 20, N-0027 Oslo (Norway)


    Aim: The purpose of the study was to evaluate the ability of CT, including expiratory scans with minimum intensity projection in predicting the development of bronchiolitis obliterans syndrome after lung transplantation. Materials and methods: Forty consecutive patients, 29 bilateral and 11 single lung transplanted, were followed-up with regular scans for a median of 36 months. Air trapping was evaluated on expiratory scans constructed from two short spiral scans with minimum intensity projection-technique, one at the level of the carina and the other midway between the right diaphragm and the carina. Air trapping was scored on a 16-point scale. Bronchiolitis obliterans syndrome was diagnosed according to established clinical criteria and quantified spirometrically. Results: Bronchiolitis obliterans syndrome developed in 17 patients (43%) after a median of 12 months. Air trapping and bronchiectasis was seen before the diagnosis of bronchiolitis obliterans syndrome in only two and one patient, respectively. Interobserver agreement for air trapping score was good (kappa = 0.65). Air trapping scores performed significantly better than that achieved by chance alone in determining the presence of bronchiolitis obliterans syndrome (P = 0.0025). An air trapping score of 4 or more provided the best results with regard to sensitivity and specificity in diagnosing bronchiolitis obliterans syndrome. The sensitivity, specificity, positive and negative predictive values of an air trapping of 4 or more in the diagnosis of bronchiolitis obliterans syndrome were 77, 74, 68 and 81%, respectively. Conclusion: Expiratory CT scans with minimum intensity projection-reconstruction did not predict the development of bronchiolitis obliterans syndrome in most patients. The findings seriously limit the clinical usefulness of long-term CT monitoring for diagnosing bronchiolitis obliterans syndrome after lung transplantation.

  16. [Diagnosis, therapy and prevention of respiratory virus infections in lung transplant recipients]. (United States)

    Huber, Lars C; Isenring, Bruno D; Schuurmans, Macé M


    Lung transplant recipients have a life-long profound immunosuppression which makes them prone to respiratory tract infections, in particular viral infections during the winter season. Since the respiratory tract infections may have potentially severe consequences, we recommend early diagnosis and treatment. We obtain nasopharyngeal swabs for viral and bacteriological examination and then treat pre-emptively with antivirals, broad-band antibiotics and often also with intravenous immunoglobulins. Treatment duration is often longer than in immunocompetent patients. As preventive measures we provide vaccination against seasonal influenza and recommend specific daily hygiene measures.

  17. Chronic rejection of a lung transplant is characterized by a profile of specific autoantibodies

    DEFF Research Database (Denmark)

    Hagedorn, Peter; Burton, Christopher M.; Carlsen, Jørn;


    Obliterative bronchiolitis (OB) continues to be the major limitation to long-term survival after lung transplantation. The specific aetiology and pathogenesis of OB are not well understood. To explore the role of autoreactivity in OB, we spotted 751 different self molecules onto glass slides......, and used these antigen microarrays to profile 48 human serum samples for immunoglobulin G (IgG) and IgM autoantibodies; 27 patients showed no or mild bronchiolitis obliterans syndrome (BOS; a clinical correlate of OB) and 15 patients showed medium to severe BOS. We now report that these BOS grades could...

  18. Candida albicans pancreatitis in a child with cystic fibrosis post lung transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Hammer, Mark M.; Sheybani, Elizabeth F. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO (United States); Zhang, Lingxin [Washington University School of Medicine, Department of Pathology, St. Louis, MO (United States); Stoll, Janis M. [Washington University School of Medicine, Division of Gastroenterology, Hepatology and Nutrition, St. Louis, MO (United States)


    We present a case of Candida albicans infection of a previously intact pancreas in a child with cystic fibrosis status post lung transplantation. Although Candida superinfection in necrotizing pancreatitis is not uncommon, this is a unique case of Candida infection of non-necrotic pancreatic parenchyma. This case presented a diagnostic dilemma for radiologists because it appeared virtually identical to acute interstitial edematous pancreatitis on imaging. Ultimately, endoscopic US-based biopsy was pursued for diagnosis. Although difficult to treat and compounded by the immunocompromised status of the child, the pancreatic infection improved with antifungal therapy. (orig.)

  19. Doença coronária obstrutiva em hepatopatas crônicos que aguardam transplante hepático Enfermedad coronaria obstructiva en hepatópatas crónicos que aguardan trasplante hepático Obstructive coronary disease in patients with chronic liver disease awaiting liver transplantation

    Directory of Open Access Journals (Sweden)

    Moacir Fernandes de Godoy


    with ALF with and without obstructive coronary disease. METHODS: Evaluation of risk factors for CAD in 119 patients in a referral center for liver transplantation, with the following characteristics: patients older than 40 years of age with ALV who underwent coronary angiography. RESULTS: Obstructive coronary disease was detected in 21 (17.6% of the cases. These patients had really low cholesterol levels, of which 129.0 ± 53.5 mg/dl averaging 117.0 mg/dl in liver disease patients with normal coronary arteries and 135.4 ± 51.7 mg/dl averaging 122.0 mg/dl in liver disease patients with obstructive coronary artery disease (P = 0.8215. In multivariate logistic regression, age, sex, body mass index and the presence of diabetes, smoking and alcohol consumption were not statistically significant in distinguishing groups. Nor was there an association with the etiology of the ALF. In turn, hypertension was proven to be relevant in association with CAD (P = 0.0474. CONCLUSION: Only hypertension was a risk factor with statistical significance for the development of CAD in patients with ALF awaiting liver transplantation. Because it is a modifiable risk factor, this finding guides the practice of therapeutic attitudes in an attempt to prevent or delay the development of CAD in these patients.

  20. A functional assessment of patients two years after lung transplantation in Poland (United States)

    Gumola, Anna; Wojarski, Jacek; Żegleń, Sławomir; Ochman, Marek; Czyżewski, Damian; Ziora, Dariusz; Zembala, Marian; Kozielski, Jerzy


    The aim of the study The aim of the study was to assess the long-term results of lung transplantation (LT) in Poland two years after the procedure. Material and methods The study included patients who underwent LT between December 2004 and December 2009 in the Silesian Center for Heart Diseases in Zabrze. Various lung functions (forced vital capacity – FVC; forced expiratory volume in 1 second – FEV1), the quality of life (SF-36 questionnaire), the level of perceived dyspnea (Medical Research Council – MRC; basic dyspnea index – BDI), and the patient's mobility (the 6-minute walking test – 6MWT) were assessed before and approximately 24 months after LT. Among 35 patients who underwent LT, 20 patients were referred to our study (mean age: 46.6 ± 9.03 years). Results After LT, a statistically significant increase was observed in the distance achieved in the 6MWT (323.8 vs. 505.8 m), FVC (1.64 vs. 2.88 L), and FEV1 (1.37 vs. 2.09 L). An improvement in perceived dyspnea in MRC and BDI questionnaires was observed in patients with chronic obstructive pulmonary disease (COPD) after LT. The assessment of the quality of life, excluding perceived pain, showed the most significant improvement in the physical cumulative score (PCS; 25 vs. 45 points), especially in patients with idiopathic pulmonary fibrosis. Conclusions Lung transplantation in Poland, in patients who live longer than 2 years after the procedure, significantly improves the mobility, lung function, perceived dyspnea, and the quality of life. PMID:26336415

  1. Neisseria lactamica Causing a Lung Cavity and Skin Rash in a Renal Transplant Patient: First Report from India

    Directory of Open Access Journals (Sweden)

    Khalid Hamid Changal


    Full Text Available Neisseria lactamica, a commensal, has been very rarely reported to cause diseases in immunocompromised hosts. In medical literature, there is only one report of a cavitatory lung lesion caused by it. The patient was a kidney transplant recipient. Neisseria lactamica was found to be the cause of his pulmonary cavity and a desquamating rash on feet. With the rapidly spreading medical advance, more and more patients are getting organ transplants, so the population of immunocompromised people is on the rise. We expect more sinister and less expected organisms to cause diseases in patients who have organ transplants.

  2. Soluble CD59 is a Novel Biomarker for the Prediction of Obstructive Chronic Lung Allograft Dysfunction After Lung Transplantation. (United States)

    Budding, Kevin; van de Graaf, Eduard A; Kardol-Hoefnagel, Tineke; Kwakkel-van Erp, Johanna M; Luijk, Bart D; Oudijk, Erik-Jan D; van Kessel, Diana A; Grutters, Jan C; Hack, C Erik; Otten, Henderikus G


    CD59 is a complement regulatory protein that inhibits membrane attack complex formation. A soluble form of CD59 (sCD59) is present in various body fluids and is associated with cellular damage after acute myocardial infarction. Lung transplantation (LTx) is the final treatment for end-stage lung diseases, however overall survival is hampered by chronic lung allograft dysfunction development, which presents itself obstructively as the bronchiolitis obliterans syndrome (BOS). We hypothesized that, due to cellular damage and activation during chronic inflammation, sCD59 serum levels can be used as biomarker preceding BOS development. We analyzed sCD59 serum concentrations in 90 LTx patients, of whom 20 developed BOS. We observed that BOS patients exhibited higher sCD59 serum concentrations at the time of diagnosis compared to clinically matched non-BOS patients (p = 0.018). Furthermore, sCD59 titers were elevated at 6 months post-LTx (p = 0.0020), when patients had no BOS-related symptoms. Survival-analysis showed that LTx patients with sCD59 titers ≥400 pg/ml 6 months post-LTx have a significant (p < 0.0001) lower chance of BOS-free survival than patients with titers ≤400 pg/ml, 32% vs. 80% respectively, which was confirmed by multivariate analysis (hazard ratio 6.2, p < 0.0001). We propose that circulating sCD59 levels constitute a novel biomarker to identify patients at risk for BOS following LTx.

  3. The construct validity of the health utilities index mark 3 in assessing health status in lung transplantation

    Directory of Open Access Journals (Sweden)

    Zuk Dalyce


    Full Text Available Abstract Purpose To assess the cross-sectional construct validity of the Health Utilities Index Mark 3 (HUI3 in lung transplantation. Methods Two hundred and thirteen patients (103 pre-transplant and 110 post-transplant with mean age 53 years old (SD 13 were recruited during a randomized controlled clinical trial at the out-patient clinic in a tertiary institution. At baseline, patients self-completed measures that included the HUI3, EuroQol EQ-5D, Hospital Anxiety and Depression Scale (HADS and socio-demographic questionnaire. Six-minute walk test scores and forced expiratory volume in 1 second data were collected from patient's medical records. A priori hypotheses were formulated by members of the transplant team about the expected degree of association between the measures. Correlation coefficients of Results Of the ninety predictions made, forty three were correct but in 31 the correlation was slightly lower than predicted and in 7 the correlations were much higher than predicted. In 48% of the cases, predicted and observed associations were in agreement. Predictions of associations were off by one category in 42% of the cases; in 10% of the cases the predictions were off by two categories. Conclusions This is the first study providing evidence of cross-sectional construct validity of HUI3 in lung transplantation. Results indicate that the HUI3 was able to capture the burden of lung disease before transplantation and that post-transplant patients enjoyed higher health-related quality of life than pre-transplant patients.

  4. The Interplay of "Big Five" Personality Factors and Metaphorical Schemas: A Pilot Study with 20 Lung Transplant Recipients (United States)

    Goetzmann, Lutz; Moser, Karin S.; Vetsch, Esther; Grieder, Erhard; Klaghofer, Richard; Naef, Rahel; Russi, Erich W.; Boehler, Annette; Buddeberg, Claus


    The aim of the present study was to investigate the interplay between personality factors and metaphorical schemas. The "Big Five" personality factors of 20 patients after lung transplantation were examined with the NEO-FFI. Patients were questioned about their social network, and self- and body-image. The interviews were assessed with metaphor…

  5. Stress, psychological distress, and coping in patients on the waiting list for lung transplantation : an exploratory study

    NARCIS (Netherlands)

    Vermeulen, KM; Bosma, OH; van der Bij, W; Koeter, GH; TenVergert, EM


    Little information is available in literature on quality of life, stress and coping during the period patients are waiting for lung transplantation. This study explored potential stressful events that patients experience during the waiting period assessed the level of anxiety and depression and expl

  6. Incomplete quality of life data in lung transplant research : comparing cross sectional, repeated measures ANOVA, and multi-level analysis

    NARCIS (Netherlands)

    Vermeulen, KM; Post, WJ; Span, MM; van der Bij, W; Koeter, GH; TenVergert, EM


    Background: In longitudinal studies on Health Related Quality of Life (HRQL) it frequently occurs that patients have one or more missing forms, which may cause bias, and reduce the sample size. Aims of the present study were to address the problem of missing data in the field of lung transplantation

  7. Long-term survival despite early loss of graft function after single lung transplantation for pulmonary fibrosis

    NARCIS (Netherlands)

    Ouwens, JP; van den Berg, JWK; van der Bij, W; Koeter, GH


    We report a patient who received a single, left lung transplantation for idiopathic pulmonary fibrosis. The effect of the graft on pulmonary improvement was only temporary, because the patient developed obliterative bronchiolitis (OB), resulting in complete destruction of the graft. The patient, how

  8. Rapid decline in 51Cr-EDTA measured renal function during the first weeks following lung transplantation

    DEFF Research Database (Denmark)

    Hornum, M.; Iversen, M.; Steffensen, I.;


    We previously described a 54% decline in renal function at 6 months after lung transplantation (LTx). We hypothesized that this decline is a very early event following LTx. Thirty-one consecutive patients (16 females/15 males), mean age 49 (+/-13) years, with emphysema, cystic fibrosis/bronchiect...

  9. Antitumor effect of recombinant human endostatin combined with cisplatin on rats with transplanted Lewis lung cancer

    Institute of Scientific and Technical Information of China (English)

    Zhan-Wu Yu; Ying-Hua Ju; Cheng-Liang Yang; Han-Bing Yu; Quan Luo; Ye-Gang Ma; Yong-Yu Liu


    Objective:To observe the antitumor effect and mechanism of recombinant human endostatin (Endostar) injection in tumor combined with intraperitoneal injection of cisplatin on subcutaneous transplanted Lewis lung cancer in rats.Methods:A total of 30 C57 rats were selected, and the monoplast suspension of Lewis lung cancer was injected into the left axilla to prepare the subcutaneous transplanted tumor models in the axilla of right upper limb. The models were randomly divided into Groups A, B, and C. Medication was conducted when the tumor grew to 400 mm3. Group A was the control group without any interventional treatment. Group B was injected with Endostar 5 for 10 d. Group C was given the injection of Endostar 5 combined with intraperitoneal injection of cisplatin 5 for 10 d. All the rats in three groups were executed the day after the 10-d medication and the tumor was taken off for measurement of volume and mass changes and calculation of antitumor rate, after which the vascular endothelial growth factor (VEGF) concentration in rats’plasma was determined by ELISA. The tumor tissues were cut for the preparation of conventional biopsies. After hematoxylin-eosin staining, the pathologic histology was examined to observe the structures of tumor tissues, VEGF score and microvessel density (MVD) in each group. Results:The volume and mass of tumor in Groups B and C were significantly lower than Group A (P< 0.05) while the tumor volume and mass in Group C were significantly lower than Group B (P < 0.05). The antitumor rate in Group C was significantly higher than Group B (P < 0.05), but the tumor VEGF score, MVD and plasma VEGF level in Group C were significantly lower than Groups A and B (P < 0.05). In Group B, the tumor VEGF score, MVD and plasma VEGF level were significantly lower than Group A (P < 0.05). The microscopic image of Group C showed that its number of active tumor cells and the blood capillary around tumor was significantly

  10. Relationship between Fungal Colonisation of the Respiratory Tract in Lung Transplant Recipients and Fungal Contamination of the Hospital Environment.

    Directory of Open Access Journals (Sweden)

    Christine Bonnal

    Full Text Available Aspergillus colonisation is frequently reported after lung transplantation. The question of whether aspergillus colonisation is related to the hospital environment is crucial to prevention.To elucidate this question, a prospective study of aspergillus colonisation after lung transplantation, along with a mycological survey of the patient environment, was performed.Forty-four consecutive patients were included from the day of lung transplantation and then examined weekly for aspergillus colonisation until hospital discharge. Environmental fungal contamination of each patient was followed weekly via air and surface sampling. Twelve patients (27% had transient aspergillus colonisation, occurring 1-13 weeks after lung transplantation, without associated manifestation of aspergillosis. Responsible Aspergillus species were A. fumigatus (6, A. niger (3, A. sydowii (1, A. calidoustus (1 and Aspergillus sp. (1. In the environment, contamination by Penicillium and Aspergillus was predominant. Multivariate analysis showed a significant association between occurrence of aspergillus colonisation and fungal contamination of the patient's room, either by Aspergillus spp. in the air or by A.fumigatus on the floor. Related clinical and environmental isolates were genotyped in 9 cases of aspergillus colonisation. For A. fumigatus (4 cases, two identical microsatellite profiles were found between clinical and environmental isolates collected on distant dates or locations. For other Aspergillus species, isolates were different in 2 cases; in 3 cases of aspergillus colonisation by A. sydowii, A. niger and A. calidoustus, similarity between clinical and environmental internal transcribed spacer and tubulin sequences was >99%.Taken together, these results support the hypothesis of environmental risk of hospital acquisition of aspergillus colonisation in lung transplant recipients.

  11. Nocardia kroppenstedtii sp. nov., an actinomycete isolated from a lung transplant patient with a pulmonary infection.

    LENUS (Irish Health Repository)

    Jones, Amanda L


    A novel actinomycete, strain N1286(T), isolated from a lung transplant patient with a pulmonary infection, was provisionally assigned to the genus Nocardia. The strain had chemotaxonomic and morphological properties typical of members of the genus Nocardia and formed a distinct phyletic line in the Nocardia 16S rRNA gene tree. Isolate N1286(T) was most closely related to Nocardia farcinica DSM 43665(T) (99.8% gene sequence similarity) but could be distinguished from the latter by the low level of DNA-DNA relatedness. These strains were also distinguishable on the basis of a broad range of phenotypic properties. It is concluded that strain N1286(T) represents a novel species of the genus Nocardia for which the name Nocardia kroppenstedtii sp. nov. is proposed. The type strain is N1286(T) ( = DSM 45810(T) = NCTC 13617(T)).

  12. [Video-assisted thoracic surgery, lung transplantation and mediastinitis: major issues in thoracic surgery in 2010]. (United States)

    Borro, José M; Moreno, Ramón; Gómez, Ana; Duque, José Luis


    We reviewed the major issues in thoracic surgery relating to the advances made in our specialty in 2010. To do this, the 43(rd) Congress of the Spanish Society of Pneumology and Thoracic Surgery held in La Coruña and the articles published in the Society's journal, Archivos de Bronconeumología, were reviewed. The main areas of interest were related to the development of video-assisted thoracic surgery, lung transplantation and descending mediastinitis. The new tumor-node-metastasis (TNM) classification (7(th) edition), presented last year, was still a topical issue this year. The First Forum of Thoracic Surgeons and the Update in Thoracic Surgery together with the Nurses' Area have constituted an excellent teaching program.

  13. Trip to immunity: resistant cytomegalovirus infection in a lung transplant recipient

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    Nikolaus Kneidinger


    Full Text Available We report the case of a young female lung transplant recipient with difficult-to-treat cytomegalovirus (CMV disease. While treatment with intravenous (IV ganciclovir failed due to antiviral drug resistance, a trial with foscarnet resulted in severe side effects. In addition, the patient received IV CMV-specific immune globulins as adjunctive therapy and leflunomide as experimental therapy. In this context, CMV-specific immune monitoring was performed and was successfully implemented in management decisions. The patient was screened for acquisition of an adaptive immune response, and antiviral prophylaxis and therapy was tailored according to results. This report highlights the impact of CMV-specific immune monitoring on individualized therapy for appropriate prophylaxis and management of CMV infection and diseases.

  14. High-resolution computed tomographic findings of Aspergillus infection in lung transplant patients

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    Gazzoni, Fernando Ferreira, E-mail: [Hospital de Clínicas de Porto Alegre, Av. Cristovão Colombo 4105, ap.603-C, Post Code: 90560-005, Porto Alegre, RS (Brazil); Hochhegger, Bruno, E-mail: [Santa Casa de Porto Alegre, Rua 24 de outubro 925/903, Post Code: 90510-002, Porto Alegre, RS (Brazil); Severo, Luiz Carlos, E-mail: [Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 2° andar, Post Code: 90035-003, Porto Alegre, RS (Brazil); Marchiori, Edson, E-mail: [Federal University of Rio de Janeiro, Radiology Department, Av. Pedro Calmon, n° 550 – Cidade Universitária, Post Code: 21941-901, Rio de Janeiro, RJ (Brazil); Pasqualotto, Alessandro, E-mail: [Santa Casa de Porto Alegre, Rua 24 de outubro 925/903, Post Code: 90510-002, Porto Alegre, RS (Brazil); Sartori, Ana Paula Garcia, E-mail: [Santa Casa de Porto Alegre, Rua 24 de outubro 925/903, Post Code: 90510-002, Porto Alegre, RS (Brazil); Schio, Sadi, E-mail: [Santa Casa de Porto Alegre, Rua 24 de outubro 925/903, Post Code: 90510-002, Porto Alegre, RS (Brazil); Camargo, José, E-mail: [Santa Casa de Porto Alegre, Rua 24 de outubro 925/903, Post Code: 90510-002, Porto Alegre, RS (Brazil)


    Objective: The aim of this study was to assess high-resolution computed tomographic (HRCT) findings at presentation in lung transplant patients diagnosed with pulmonary Aspergillus infection. Materials and methods: We retrospectively reviewed HRCT findings from 23 patients diagnosed with pulmonary aspergillosis. Imaging studies were performed 2–5 days after the onset of symptoms. The patient sample comprised 12 men and 11 women aged 22–59 years (mean age, 43.6 years). All patients had dyspnea, tachypnea, and cough. Diagnoses were established with Platelia Aspergillus enzyme immunoassays for galactomannan antigen detection in bronchoalveolar lavage and recovery of symptoms, and HRCT findings after voriconazole treatment. The HRCT scans were reviewed independently by two observers who reached a consensus decision. Results: The main HRCT pattern, found in 65% (n = 15) of patients, was centrilobular tree-in-bud nodules associated with bronchial thickening. This pattern was described in association with areas of consolidation and ground-glass opacities in 13% (n = 3) of patients. Consolidation and ground-glass opacities were the main pattern in 22% (n = 5) of patients. The pattern of large nodules with and without the halo sign was observed in 13% (n = 3) of patients, and were associated with consolidation and ground-glass opacities in one case. Conclusion: The predominant HRCT findings in lung transplant patients with pulmonary aspergillosis were bilateral bronchial wall thickening and centrilobular opacities with the tree-in-bud pattern. Ground-glass opacities and/or bilateral areas of consolidation were also common findings. Pulmonary nodules with the halo sign were found in only 13% of patients.

  15. Propionibacterium acnes as a cause of lung abscess in a cardiac transplant recipient. (United States)

    Veitch, David; Abioye, Abu; Morris-Jones, Stephen; McGregor, Alastair


    A 29-year-old man was admitted with fevers, cough, left-sided chest pain and lethargy for 1 week. He had a cardiac transplant 10 years prior and was on immunosuppressive drugs. He was found to have a pulmonary lesion and went on to develop a lung abscess. Propionibacterium acnes was identified on matrix-assisted laser desorption ionisation mass spectrometry-time of flight and 16s rRNA gene sequencing after drainage. He was curatively treated with co-trimoxazole and co-amoxiclav. He divulged a longstanding history of seborrhoeic dermatitis with frequent flares leading to large volumes of squames collecting on his bed sheets. We hypothesise this was a possible route of entry: inhalation of the Propionibacterium. This case highlights how a common commensal bacterium, P. acnes, was able to cause pathology in an immunosuppressed patient. This is the only case of a patient with transplantation developing a P. acnes pulmonary infection and the only case of P. acnes causing these clinical features to be reported in the literature.

  16. Alemtuzumab in lung transplantation: an open-label, randomized, prospective single center study. (United States)

    Jaksch, P; Ankersmit, J; Scheed, A; Kocher, A; Muraközy, G; Klepetko, W; Lang, G


    Induction therapy with alemtuzumab followed by lower maintenance immunosuppression (IS) has been associated with reduced morbidity and mortality in abdominal and heart transplantation (TX). In the current study, alemtuzumab, in combination with reduced levels of maintenance IS, was compared to thymoglobulin in combination with standard IS. Sixty consecutive patients who underwent lung transplantation (LUTX) at a single center were prospectively randomized in two groups: group A received alemtuzumab in conjunction with reduced doses of tacrolimus, steroids and mycophenolate mofetil. Group B received thymoglobulin in association with standard dose IS. Patient and graft survival, freedom from acute cellular rejection (ACR), lymphocytic bronchiolitis, bronchiolitis obliterans syndrome, kidney function, infectious complications and posttransplant lymphoproliferative disorder were analyzed. Alemtuzumab induction therapy resulted in complete the absence of ACR episodes ≥ A2 within the first year post-TX. The difference to thymoglobulin was significant (alemtuzumab 0 vs. ATG 0.33; p = 0.019). All other factors studied did not show any differences between the two groups. Alemtuzumab induction therapy after LUTX in combination with reduced maintenance IS significantly reduces higher-grade rejection rates. This novel therapeutic agent had no impact on survival, infections rates, kidney function and incidence of malignancies.

  17. Treatment of Cytomegalovirus Infection with Cidofovir and CMV Immune Globulin in a Lung Transplant Recipient

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    Heinrike Wilkens


    Full Text Available Cytomegalovirus (CMV infection after lung transplantation is associated with increased risk for pneumonitis and bronchiolitis obliterans as well as allograft rejection and opportunistic infections. Ganciclovir is the mainstay of prophylaxis and treatment but CMV infections can be unresponsive. Apart from direct antiviral drugs, CMV immunoglobulin (CMVIG preparations may be considered but are only licensed for prophylaxis. A CMV-seronegative 42-year-old man with cystic fibrosis received a lung from a CMV-seropositive donor. Intravenous ganciclovir prophylaxis was delayed until day 12 due to acute postoperative renal failure and was accompanied by five doses of CMVIG (10 g. By day 16, CMV-DNA was detectable and rising; CMV-specific T-cells were undetectable. Switch from ganciclovir to foscarnet prompted a transient decrease in CMV viral load, but after increasing again to reach 3600 copies/mL foscarnet was changed to intravenous cidofovir and CMVIG was restarted. CMV load continued to fluctuate and declined slowly, whereas CMV-specific T-cells were detected five months later and increased thereafter. At last follow-up, the patient was in very good clinical condition with no evidence of bronchiolitis obliterans. No side effects of this treatment were observed. In this hard-to-treat case, the combination of cidofovir with off-label use of CMVIG contributed to a successful outcome.


    Directory of Open Access Journals (Sweden)

    O.A. Kurilova


    Full Text Available The most reliable intraoperative mechanical extracorporeal support is conventional сardiopulmonary bypass (CPB. However, CPB increases a risk of intraoperative bleeding and primary graft dysfunction. ECMO is more benefi cial method of intraoperative cardiopulmonary support than CPB in LTx.Aim. 10 LTx were retrospectively analyzed in the period from 01.2012 till 01.2014.Methods. Indications for ECMO were acute grafts edema after reperfusion (n = 4, group I. In group II (n = 6 indications for ECMO were severe hypoxia (РаО2 and FiO2 ratio < 1,0 and/or acidosis (pH < 7,2 during one lung ventilation. We used central type of veno-arterial ECMO: right atrium to ascending aorta.Results. Intraoperative ECMO lasted 4,1 ± 1,0 hours in group I and 8,5 ± 0,7 hours in group II. ECMO was prolonged into postoperative period in all patients from group I due to primary graft dysfunction. Application of ECMO in group II enabled to stabilize gas exchange and circulation as well as to decrease pulmonary arterial pressure in the time of reperfusion. ECMO was fi nished just after transplantation in group II. The 1-year survival in group I and II was 75,0 and 83,3%, respectively.Conclusion. Central veno-arterial ECMO is an adequate method of intraoperative cardiopulmonary support in LTx. It prevents postreperfusion edema of the lung grafts.

  19. Review of the International Society for Heart and Lung Transplantation Practice guidelines for management of heart failure in children. (United States)

    Colan, Steven D


    In 2004, practice guidelines for the management of heart failure in children by Rosenthal and colleagues were published in conjunction with the International Society for Heart and Lung Transplantation. These guidelines have not been updated or reviewed since that time. In general, there has been considerable controversy as to the utility and purpose of clinical practice guidelines, but there is general recognition that the relentless progress of medicine leads to the progressive irrelevance of clinical practice guidelines that do not undergo periodic review and updating. Paediatrics and paediatric cardiology, in particular, have had comparatively minimal participation in the clinical practice guidelines realm. As a result, most clinical practice guidelines either specifically exclude paediatrics from consideration, as has been the case for the guidelines related to cardiac failure in adults, or else involve clinical practice guidelines committees that include one or two paediatric cardiologists and produce guidelines that cannot reasonably be considered a consensus paediatric opinion. These circumstances raise a legitimate question as to whether the International Society for Heart and Lung Transplantation paediatric heart failure guidelines should be re-reviewed. The time, effort, and expense involved in producing clinical practice guidelines should be considered before recommending an update to the International Society for Heart and Lung Transplantation Paediatric Heart Failure guidelines. There are specific areas of rapid change in the evaluation and management of heart failure in children that are undoubtedly worthy of updating. These domains include areas such as use of serum and imaging biomarkers, wearable and implantable monitoring devices, and acute heart failure management and mechanical circulatory support. At the time the International Society for Heart and Lung Transplantation guidelines were published, echocardiographic tissue Doppler, 3 dimensional

  20. Chest Fat Quantification via CT Based on Standardized Anatomy Space in Adult Lung Transplant Candidates (United States)

    Tong, Yubing; Udupa, Jayaram K.; Torigian, Drew A.; Odhner, Dewey; Wu, Caiyun; Pednekar, Gargi; Palmer, Scott; Rozenshtein, Anna; Shirk, Melissa A.; Newell, John D.; Porteous, Mary; Diamond, Joshua M.


    Purpose Overweight and underweight conditions are considered relative contraindications to lung transplantation due to their association with excess mortality. Yet, recent work suggests that body mass index (BMI) does not accurately reflect adipose tissue mass in adults with advanced lung diseases. Alternative and more accurate measures of adiposity are needed. Chest fat estimation by routine computed tomography (CT) imaging may therefore be important for identifying high-risk lung transplant candidates. In this paper, an approach to chest fat quantification and quality assessment based on a recently formulated concept of standardized anatomic space (SAS) is presented. The goal of the paper is to seek answers to several key questions related to chest fat quantity and quality assessment based on a single slice CT (whether in the chest, abdomen, or thigh) versus a volumetric CT, which have not been addressed in the literature. Methods Unenhanced chest CT image data sets from 40 adult lung transplant candidates (age 58 ± 12 yrs and BMI 26.4 ± 4.3 kg/m2), 16 with chronic obstructive pulmonary disease (COPD), 16 with idiopathic pulmonary fibrosis (IPF), and the remainder with other conditions were analyzed together with a single slice acquired for each patient at the L5 vertebral level and mid-thigh level. The thoracic body region and the interface between subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in the chest were consistently defined in all patients and delineated using Live Wire tools. The SAT and VAT components of chest were then segmented guided by this interface. The SAS approach was used to identify the corresponding anatomic slices in each chest CT study, and SAT and VAT areas in each slice as well as their whole volumes were quantified. Similarly, the SAT and VAT components were segmented in the abdomen and thigh slices. Key parameters of the attenuation (Hounsfield unit (HU) distributions) were determined from each chest slice and

  1. Strong association between respiratory viral infection early after hematopoietic stem cell transplantation and the development of life-threatening acute and chronic alloimmune lung syndromes

    NARCIS (Netherlands)

    Versluys, A. Birgitta; Rossen, John W. A.; van Ewijk, Bart; Schuurman, Rob; Bierings, Marc B.; Boelens, Jaap J.


    Alloimmune lung syndromes (allo-LS), including idiopathic pneumonia syndrome, bronchiolitis obliterans syndrome, and bronchiolitis obliterans organizing pneumonia, are severe complications after hematopoietic stem cell transplantation (HSCT). In our cohort of 110 pediatric patients, 30 had allo-LS (

  2. Functional CT imaging of the lung in the axial and coronal plane after single-lung transplantation; Computertomographische Funktionsuntersuchung der Lunge nach einseitiger Lungentransplantation mit axialer und koronarer Akquisition

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    Kauczor, H.U. [Mainz Univ. (Germany). Klinik fuer Radiologie; Buchenroth, M. [Mainz Univ. (Germany). 3. Medizinische Klinik - Pneumologie; Heussel, C.P. [Mainz Univ. (Germany). Klinik fuer Radiologie; Mayer, E. [Mainz Univ. (Germany). Klinik fuer Herz-, Thorax-, Gefaesschirurgie


    After single-lung transplantation in a patient suffering from obstructive emphysema lung function parameters worsened during follow-up. To conplement the routine high-resolution CT (HRCT) scans acquired in inspiration, additional scans were obtained to evaluate regional lung function. The comparison of HRCT scans acquired in inspiration and in expiration revealed different ventilation conditions of both lungs, continuous acquisition in a single slice (dynamic multiscan acquisition) in the axial and coronal plane demonstrated mediastinal shifting and the movement of the diaphragm during the whole breathing cycle. Both modalities can provide important information concerning regional differences of ventilation after single-lung transplantation. Expiratory HRCT should be applied on a regular basis in the follow-up of patients after single-lung transplantation. Expiratory HRCT should be applied on a regular basis in the follow-up of patients after single-lung transplantation. The application of axial and coronal dynamic multiscan acquisitions will be helpful in particular clinical conditions, like increasing hyperinflation, mediastinal shifting or bronchial collapse within the region of the anastomosis. (orig.) [Deutsch] Nach Einzellungentransplantation wegen eines obstruktiven Emphysems wurden bei einem Patienten in der Nachsorge zur Abklaerung einer Verschlechterung der Lungenfunktionsparameter neben einer hochaufloesenden CT (HRCT) in Inspiration zusaetzliche Aufnahmen zur Funktionsbeurteilung durchgefuehrt. Der Vergleich von HRCT-Aufnahmen in In- und Exspiration zeigte die unterschiedlichen Ventilationsverhaeltnisse bei beiden Lungen; kontinuierliche Aufnahmen in einer Schicht (Multirotationsaufnahmen) stellten bei axialer und insbesondere bei direkter koronarer Akquisition die Mediastinal- und Zwerchfellbewegung waehrend des gesamten Atemzyklus dar. Beide Verfahren koennen wichtige Zusatzinformationen ueber regionale Ventilationsdifferenzen nach einseitiger

  3. A Promoter Polymorphism in the CD59 Complement Regulatory Protein Gene in Donor Lungs Correlates With a Higher Risk for Chronic Rejection After Lung Transplantation. (United States)

    Budding, K; van de Graaf, E A; Kardol-Hoefnagel, T; Broen, J C A; Kwakkel-van Erp, J M; Oudijk, E-J D; van Kessel, D A; Hack, C E; Otten, H G


    Complement activation leads primarily to membrane attack complex formation and subsequent target cell lysis. Protection against self-damage is regulated by complement regulatory proteins, including CD46, CD55, and CD59. Within their promoter regions, single-nucleotide polymorphisms (SNPs) are present that could influence transcription. We analyzed these SNPs and investigated their influence on protein expression levels. A single SNP configuration in the promoter region of CD59 was found correlating with lower CD59 expression on lung endothelial cells (p = 0.016) and monocytes (p = 0.013). Lung endothelial cells with this SNP configuration secreted more profibrotic cytokine IL-6 (p = 0.047) and fibroblast growth factor β (p = 0.036) on exposure to sublytic complement activation than cells with the opposing configuration, whereas monocytes were more susceptible to antibody-mediated complement lysis (p < 0.0001). Analysis of 137 lung transplant donors indicated that this CD59 SNP configuration correlates with impaired long-term survival (p = 0.094) and a significantly higher incidence of bronchiolitis obliterans syndrome (p = 0.046) in the recipient. These findings support a role for complement in the pathogenesis of this posttransplant complication and are the first to show a deleterious association of a donor CD59 promoter polymorphism in lung transplantation.

  4. Beyond cancer treatment – a review of total lymphoid irradiation for heart and lung transplant recipients

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    McKay, Clare, E-mail:; Knight, Kellie A; Wright, Caroline [Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria (Australia)


    Immunosuppressive drugs used in the management of heart and lung transplants have a large monetary and quality of life cost due to their side effects. Total lymphoid irradiation (TLI) is one method of minimising the need for or replacing post-operative immunosuppressive drugs. A literature review was conducted on electronic databases using defined search terms. The aim was to establish the indications for the use of TLI, its advantages and disadvantages and the weaknesses associated with the methods used in related research. Eight articles were located that focused on TLI usage in combating organ rejection. These studies identified that the use of TLI resulted in a reduction in early rejection. One study reported a drop in rejection episodes from 0.46 to 0.14 episodes per patient per month once the TLI was complete. While the short-term prognosis is excellent, the long-term outlook is less positive with an increased risk of organ rejection and myelodysplasia 3.5 years post-TLI. This review reminds us that radiation therapy (RT) is not exclusively indicated for cancer treatment. While TLI cannot replace immunosuppressive drug therapy, it can offer a treatment option for people that cannot tolerate immunosuppressive drugs, or when conventional anti-rejection treatment is no longer viable. Reported long-term complications suggest that TLI should be used with caution. However, this modality should not be overlooked in cases of chronic rejection. Further research is required to establish the efficacy of RT in the treatment of transplant patients who are unsuitable for drug-based anti-rejection therapies.

  5. Quality of Recipient-Caregiver Relationship and Psychological Distress are Correlates of Self-Care Agency after Lung Transplantation


    Dabbs, Annette DeVito; Terhorst, Lauren; Song, Mi-Kyung; Shellmer, Diana A.; Aubrecht, Jill; Connolly, Mary; Dew, Mary Amanda


    Self-care behaviors are crucial for following the complex regimen after lung transplantation, yet little is known about recipients’ levels of self-care agency (the capability and willingness to engage in self-care behaviors) and its correlates. We examined levels of self-care agency and recipient characteristics (socio-demographics, psychological distress, quality of relationship with primary lay caregiver, and health locus of control) in 111 recipients. Based on Perceived Self-Care Agency sc...

  6. A genetic polymorphism in the CAV1 gene associates with the development of bronchiolitis obliterans syndrome after lung transplantation

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    Kastelijn Elisabeth A


    Full Text Available Abstract Background Caveolin 1 (Cav-1 is the primary structural component of cell membrane invaginations called 'caveolae'. Expression of Cav-1 is implicated in the pathogenesis of pulmonary fibrosis. Genetic polymorphisms in the CAV1 gene influence the function of Cav-1 in malignancies and associate with renal allograft fibrosis. Chronic allograft rejection after lung transplantation, called 'bronchiolitis obliterans syndrome' (BOS, is also characterised by the development of fibrosis. In this study, we investigated whether CAV1 genotypes associate with BOS and whether Cav-1 serum levels are influenced by the CAV1 genotype and can be used as a biomarker to predict the development of BOS. Methods Twenty lung transplant recipients with BOS (BOSpos, ninety without BOS (BOSneg and four hundred twenty-two healthy individuals donated DNA samples. Four SNPs in CAV1 were genotyped. Serial Cav-1 serum levels were measured in a matched cohort of 10 BOSpos patients and 10 BOSneg patients. Furthermore, single-time point Cav-1 serum levels were measured in 33 unmatched BOSneg patients and 60 healthy controls. Results Homozygosity of the minor allele of rs3807989 was associated with an increased risk for BOS (odds ratio: 6.13; P = 0.0013. The median Cav-1 serum level was significantly higher in the BOSpos patients than in the matched BOSneg patients (P = 0.026. Longitudinal analysis did not show changes in Cav-1 serum levels over time in both groups. The median Cav-1 serum level in the group of 43 BOSneg patients was lower than that in the healthy control group (P = 0.046. In lung transplant recipients, homozygosity of the minor allele of rs3807989 and rs3807994 was associated with increased Cav-1 serum levels. Conclusion In lung transplant recipients, the CAV1 SNP rs3807989 was associated with the development of BOS and Cav-1 serum levels were influenced by the CAV1 genotype.

  7. Effect and mechanism of acute graft versus host disease on early diffuse murine lung injury following allogeneic stem cell transplantation

    Institute of Scientific and Technical Information of China (English)


    To explore the effect and pathogenssis of acute graft-versus-host disease (aGVHD) on early diffuse lung injury in allogeneic hematopoietic stem cell transplantation (allo-HSCT), we established an aGVHD model of C57BL/6→BALB/c mice. Chest computed tomography (CT) scans, histopathology and the levels of cytokines including tumor necrosis factor α (TNFα) and Interferon (IFNγ) in lungs were dynamically detected in recipient mice after transplantation. The incidence of aGVHD was respectively 0%, 0% and 100% in simple irradiation group (A), syngeneic transplant group(B) and allogeneic transplant group (C). Chest CT scans of recipient mice were normal in 3 groups on days +3 and +7 after transplantation. CT showed that two of ten mice had bilateral lung diffuse infiltrate on day +12 (on the brink of death) in group A and 6 of 10 mice had bilateral lung diffuse infiltrate on day +14 (3 d after aGVHD occurring) in group C, and were normal on days +12 and +14 in group B after transplantation. Histopathology of lungs in the 3 groups was similar, consisting of minor interstitial pneumonitis on day +3. Group A showed edema, hyperplasia of epithelial cells and widened alveolar interval on day +7, and epithelial cell necrosis, lymphocyte infiltration, hemorrhage, protein leakage, and local consolidation on day +12. The histopathology of group B showed slight edema of epithelial cells on +7 day, which were slighter than that on day +3, and virtually normal on day +14. The histopathology in group C was characterized by the significant expansion and congestion of capillaries, and lymphocyte infiltration on day +7, the acute pneumonitis was present involving tissue edema, lymphocyte and macrophage infiltration, protein leakage and perivascular inflammation on day +14. In group A, the levels of TNFα were lower on day +7 than on day +3. In group B, the levels of TNFα attained a peak on day +3, which decreased on days +7 and +14. In group C, the levels of TNFα were highest on day

  8. Acceleration of lung metastasis by up-regulation of CD44 expression in osteosarcoma-derived cell transplanted mice. (United States)

    Shiratori, H; Koshino, T; Uesugi, M; Nitto, H; Saito, T


    The effect of CD44-phenotypic expression on metastasis to the lung was studied using a spontaneous murine osteosarcoma-derived cell line, POS-1, stimulated with lipopolysaccharide (LPS). POS-1 cells were inoculated into the hind paws of 20 C3H/HeJ mice and produced a visible mass in all mice in 5 weeks, and these transplanted tumors resulted in lung metastasis in all mice. The number of metastatic foci in the lungs was 12.0+/-2.1 (mean+/-SD) with LPS-stimulated cells, which was significantly higher than that of unstimulated cells (5.8+/-1.4; N=10 for each; P<0.05). Hyaluronate (HA), a ligand of CD44, inhibited a number of lung metastases in a dose-dependent manner (0.5% HA, 3.0+/-1.1; 0.005% HA, 5.1+/-1.5; without HA, 8.6+/-1.7; N=10 for each; P<0.05, each group with HA versus the group without HA). Adhesion assay by coculturing POS-1 cells and lung microvascular endothelial cells on culture plate showed that the adhesion was significantly lower in HA treated POS-1 than those without HA (1.18+/-0.12 and 2.74+/-0.17, respectively, P<0.05). These results suggest that lung metastasis was accelerated by up-regulation of CD44.

  9. Prednisolone as preservation additive prevents from ischemia reperfusion injury in a rat model of orthotopic lung transplantation.

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    Patrick Paulus

    Full Text Available The lung is, more than other solid organs, susceptible for ischemia reperfusion injury after orthotopic transplantation. Corticosteroids are known to potently suppress pro-inflammatory processes when given in the post-operative setting or during rejection episodes. Whereas their use has been approved for these clinical indications, there is no study investigating its potential as a preservation additive in preventing vascular damage already in the phase of ischemia. To investigate these effects we performed orthotopic lung transplantations (LTX in the rat. Prednisolone was either added to the perfusion solution for lung preservation or omitted and rats were followed for 48 hours after LTX. Prednisolone preconditioning significantly increased survival and diminished reperfusion edema. Hypoxia induced vasoactive cytokines such as VEGF were reduced. Markers of leukocyte invasiveness like matrix metalloprotease (MMP-2, or common pro-inflammatory molecules like the CXCR4 receptor or the chemokine (C-C motif ligand (CCL-2 were downregulated by prednisolone. Neutrophil recruitment to the grafts was only increased in Perfadex treated lungs. Together with this, prednisolone treated animals displayed significantly reduced lung protein levels of neutrophil chemoattractants like CINC-1, CINC-2α/β and LIX and upregulated tissue inhibitor of matrix metalloproteinase (TIMP-1. Interestingly, lung macrophage invasion was increased in both, Perfadex and prednisolone treated grafts, as measured by MMP-12 or RM4. Markers of anti-inflammatory macrophage transdifferentiation like MRC-1, IL-13, IL-4 and CD163, significantly correlated with prednisolone treatment. These observations lead to the conclusion that prednisolone as an additive to the perfusion solution protects from hypoxia triggered danger signals already in the phase of ischemia and thus reduces graft edema in the phase of reperfusion. Additionally, prednisolone preconditioning might also lead to

  10. Cross-reactive anti-viral T cells increase prior to an episode of viral reactivation post human lung transplantation.

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    Thi H O Nguyen

    Full Text Available Human Cytomegalovirus (CMV reactivation continues to influence lung transplant outcomes. Cross-reactivity of anti-viral memory T cells against donor human leukocyte antigens (HLA may be a contributing factor. We identified cross-reactive HLA-A*02:01-restricted CMV-specific cytotoxic T lymphocytes (CTL co-recognizing the NLVPMVATV (NLV epitope and HLA-B27. NLV-specific CD8+ T cells were expanded for 13 days from 14 HLA-A*02:01/CMV seropositive healthy donors and 11 lung transplant recipients (LTR then assessed for the production of IFN-γ and CD107a expression in response to 19 cell lines expressing either single HLA-A or -B class I molecules. In one healthy individual, we observed functional and proliferative cross-reactivity in response to B*27:05 alloantigen, representing approximately 5% of the NLV-specific CTL population. Similar patterns were also observed in one LTR receiving a B27 allograft, revealing that the cross-reactive NLV-specific CTL gradually increased (days 13-193 post-transplant before a CMV reactivation event (day 270 and reduced to basal levels following viral clearance (day 909. Lung function remained stable with no acute rejection episodes being reported up to 3 years post-transplant. Individualized immunological monitoring of cross-reactive anti-viral T cells will provide further insights into their effects on the allograft and an opportunity to predict sub-clinical CMV reactivation events and immunopathological complications.

  11. Impact of pulmonary rehabilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation

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    Juliessa Florian


    Full Text Available OBJECTIVE: To investigate the impact of a pulmonary rehabilitation program on the functional capacity and on the quality of life of patients on waiting lists for lung transplantation. METHODS: Patients on lung transplant waiting lists were referred to a pulmonary rehabilitation program consisting of 36 sessions. Before and after the program, participating patients were evaluated with the six-minute walk test and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36. The pulmonary rehabilitation program involved muscle strengthening exercises, aerobic training, clinical evaluation, psychiatric evaluation, nutritional counseling, social assistance, and educational lectures. RESULTS: Of the 112 patients initially referred to the program, 58 completed it. The mean age of the participants was 46 ± 14 years, and females accounted for 52%. Of those 58 patients, 37 (47% had pulmonary fibrosis, 13 (22% had pulmonary emphysema, and 18 (31% had other types of advanced lung disease. The six-minute walk distance was significantly greater after the program than before (439 ± 114 m vs. 367 ± 136 m, p = 0.001, the mean increase being 72 m. There were significant point increases in the scores on the following SF-36 domains: physical functioning, up 22 (p = 0.001, role-physical, up 10 (p = 0.045; vitality, up 10 (p < 0.001; social functioning, up 15 (p = 0.001; and mental health, up 8 (p = 0.001. CONCLUSIONS: Pulmonary rehabilitation had a positive impact on exercise capacity and quality of life in patients on lung transplant waiting lists.

  12. 大鼠肺移植模型的改良*☆%Improvement of a rat lung transplantation model

    Institute of Scientific and Technical Information of China (English)

    强光亮; 鲍彤; 温焕舜; 肖飞; 梁朝阳


    BACKGROUND:Orthotopic lung transplantation model in a rat is the key to investigate the chronic rejection after lung transplantation. However, the precise surgical technique and difficult operation limit the application of the model. OBJECTIVE:To improve the process of anesthesia and lung transplantation, and to establish a rapid, safe and reversible rat lung transplantation model. METHODS:A total of 42 rats were used to establish the model, including 21 donor models and 21 receptor models. The donor lung was excised by median sternotomy with dissection of the left lung and implantation of cuffs (intravenous catheters cut into 1.5 mm sections). The left lung was implanted in the recipient by lateral thoracotomy using the cuffs for anastomoses. The duration of surgery and success rate of transplantation were recorded and calculated. RESULTS AND CONCLUSION:The survival rate of rats after lung transplantation was 100%. The time of left donor lung extraction was (35.3±5.1) minutes in average. The time of placing cuff in donor lung was (12.5±4.6) minutes in average. The surgical procedure time of recipient was (50.2±3.3) minutes. The time of arteriovenous and bronchus casing anastomosis was (27.7±6.2) minutes. After pulmonary artery and vein blood flow was disparked, the whole lung turned red rapidly, blood perfusion was sufficient, venous returned unimpeded;after mechanical ventilation resumed, al graft lungs expanded wel . This improved anesthesia and lung transplantation technique in rats can provide a valid, reliable and reproducible animal model for studying immune responses and rejection in lung transplantation.%  背景:建立大鼠原位肺移植模型是研究肺移植后慢性排异反应的关键,但因其需要精细外科技术,难度较大,限制了这一模型的应用。目的:改良麻醉和肺移植过程,建立快速、安全、具有可重复性的大鼠肺移植模型。方法:共完成42只大鼠

  13. Complicações relacionadas à lobectomia em doadores de transplante pulmonar intervivos Complications related to lobectomy in living lobar lung transplant donors

    Directory of Open Access Journals (Sweden)

    Spencer Marcantônio Camargo


    Full Text Available OBJETIVO: Avaliar as complicações pós-operatórias imediatas de doadores vivos de lobos pulmonares para transplante. MÉTODOS: Entre setembro de 1999 e maio de 2005 foram realizadas lobectomias em 32 doadores saudáveis para transplante pulmonar em 16 receptores. Os prontuários médicos destes doadores foram analisados retrospectivamente para verificar a incidência de complicações pós-operatórias e as alterações da função pulmonar após a lobectomia. RESULTADOS: Vinte e dois doadores (68,75% não apresentaram complicações. Entre os 10 casos que apresentaram alguma complicação o derrame pleural foi a mais freqüente, ocorrendo em 5 deles (15,6% da amostra. Três doadores (9,3% necessitaram de transfusão de hemácias e, em 2 casos, foi necessária nova intervenção cirúrgica devido a hemotórax. Um doador apresentou pneumotórax após a retirada do dreno de tórax e houve um caso de infecção respiratória. Ocorreram duas intercorrências intra-operatórias (6,25%: em um doador foi realizada broncoplastia do lobo médio; em outro, foi necessária a ressecção da língula. Não houve mortalidade cirúrgica nesta série. As provas de função pulmonar do pós-operatório demonstraram uma redução média de 20% no volume expiratório forçado no primeiro segundo (p OBJECTIVE: To evaluate post-operative complications in living lobar lung transplant donors. METHODS: Between September of 1999 and May of 2005, lobectomies were performed in 32 healthy lung transplant donors for 16 recipients. The medical charts of these donors were retrospectively analyzed in order to determine the incidence of postoperative complications and alterations in pulmonary function after lobectomy. RESULTS: Twenty-two donors (68.75% presented no complications. Among the 10 donors presenting complications, the most frequently observed complication was pleural effusion, which occurred in 5 donors (15.6% of the sample. Red blood cell transfusion was


    Institute of Scientific and Technical Information of China (English)


    Objective: To explore the experience ofliver transpfantation in patients with terminalliver failure. Methods: From October 1991 toJuly 1995, 17 adults and 6 children underwentorthotopic liver transplantation. Preoperativediagnosis showed biliary atresia (n=5), Alagillesyndrome (n=1), primary biliary cirrhosis(n=2), cryptogenic cirrhosis (n=2), alcoholic

  15. Nursing of patients received' lung transplantation under the support of extracorporeal membrane oxygenator%体外膜肺支持下肺移植的护理

    Institute of Scientific and Technical Information of China (English)

    王雯; 王永功; 张建余; 徐继伟


    Objective To explore the nursing solutions of of patients received lung transplantation under the support of extracorporeal membrane oxygenator ( ECMO) and improve the success rate of lung transplantation. Methods The nusing experience were summarized for patients received lung transplantation under the support of (ECMO). Results After 2h removing the ECMO, the oxygen among all patients was good. There were no sever complications related to ECMO. 15 patients were removed the ECMO support immediately after the operation. Conclusions The targeted care solutions are helpful to find problem of ECMO supportie treatment of lung transplantation and satisfy the care needs of lung transplantation under ECMO support.%目的 探讨应用体外膜肺氧合(ECMO)支持下肺移植的护理方案,提高肺移植的成功率.方法 总结29 例在ECOM支持下进行肺移植患者护理经验.结果 所有患者ECMO撤除2 h后,供氧良好,没有发生与ECMO有关的严重并发症;15例术后即刻撤除ECMO支持.结论 针对性护理方案能及时发现并处理ECMO支持下肺移植术后出现的问题,可以满足ECMO支持下肺移植术的护理需要.

  16. Mortality associated with Acinetobacter baumannii infections experienced by lung transplant recipients. (United States)

    Nunley, D R; Bauldoff, G S; Mangino, J E; Pope-Harman, A L


    Lung transplantation (LTX) requires continual systemic immunosuppression, which can result in infections that may compromise recipient survival. A recent outbreak of Acinetobacter baumannii at our institution resulted in infections experienced in both LTX recipients and nontransplant patients. A retrospective review was conducted of patients who had A. baumannii recovered from blood, other normally sterile body fluids, and/or respiratory secretions and who had clinical follow-up extending to 1 year postinfection. A. baumannii was considered "multidrug-resistant" when its growth was not inhibited by minimum inhibitory concentrations of multiple antibiotics. Despite the resistance profile, patients were treated with a combination of antibiotics, which included tigecycline, colistimethate, and when susceptible, imipenem. Once infection was diagnosed, immunosuppression was reduced in all LTX recipients. Six LTX recipients became infected with A. baumannii and were contrasted to infections identified in 14 non-LTX, nonimmunosuppressed patients. A. baumannii was persistently recovered in 4 of 6 LTX recipients (66.7%) compared with only 1 of 14 (7.1%) non-LTX patients (χ(2) = 9.9, p = 0.005). LTX recipients received antibiotic therapy for an average of 76 ± 18.4 days compared with 16.0 ± 6.8 days for the non-LTX patients (p = 0.025, Mann-Whitney U test). All 4 of the 6 (66.7%) LTX recipients died as a consequence of their infection compared with 1 of 14 (7.1%) of the non-LTX patients (χ(2) = 9.9, p = 0.005). Despite receiving more antibiotic therapy, LTX recipients who were infected with multidrug-resistant A. baumannii were less likely to clear their infection and experienced greater mortality compared with non-LTX patients.

  17. Periostitis secondary to prolonged voriconazole therapy in a lung transplant recipient. (United States)

    Lustenberger, David P; Granata, Jaymes D; Scharschmidt, Thomas J


    This article reports a case of perostitis deformans in a lung transplantation patient taking the fluoride-containing medication voriconazole, a relatively new and potent anti-fungal. The patient had a normal range of motion in all joints and a normal gait. On radiographs at presentation, multifocal areas of periostitis were visualized involving the left-hand first, second, and third proximal phalanx shafts. Similar periostitis was present on the left-hand third, fourth, and fifth middle phalanx shafts. Plain radiographs of the right hand also demonstrated multifocal periostitis of the third and fourth proximal and middle phalanges. Aggressive periostitis at the level of the right fourth proximal and middle phalanges was also present. Given her long-term treatment with voriconazole and a presentation consistent with periostitis deformans, voriconazole was presumed to be the offending agent and was replaced with itraconazole. The patient's symptoms resolved shortly after withdrawal of voriconazole.Voriconazole-associated periostitis has only recently been reported in the literature. Food and Drug Administration-approved in 2002, voriconazole is efficacious in treating serious, invasive fungal infections that are generally seen in immunocompromised patients. Due to the novel nature of voriconazole and the uncommon indications for its long-term use, the periostitis deformans described in this article may be unfamiliar to the orthopedic surgeon. Consequently, a patient presenting with bone pain and periosteal involvement on plain radiographs may provoke a broad, expensive, and ultimately unnecessary diagnostic evaluation. The clinical case and imaging findings presented here can help to promote understanding of this benign condition and its simple cure: voriconazole discontinuation.

  18. Cadaveric transplantation.

    Directory of Open Access Journals (Sweden)

    Gokal R


    Full Text Available Transplantation is already the optimum treatment for terminal renal failure. Donor organ shortage means that there are large number of patients on dialysis awaiting this treatment. This has in some countries led to unacceptable unscrupulous practices of live non-related graft donation. The outcome of graft and patient after transplantation has improved significantly based on a better understanding of immunopathology, immunosuppression and tissue typing. The future is promising and xenografting may well solve the organ shortage but undoubtedly will raise other issues.

  19. Avaliação do percentual de compatibilidade HLA entre membros da mesma família para pacientes à espera de transplante de medula óssea em Santa Catarina, Brasil Evaluation of the percentage of HLA compatibility between members of the same family for patients awaiting bone marrow transplantation in the state of Santa Catarina, Brazil

    Directory of Open Access Journals (Sweden)

    Carine Meinerz


    Full Text Available O transplante de medula óssea (TMO é uma terapia especial utilizada para tratar pacientes com doenças hematológicas e certas alterações genéticas. Para que um transplante seja bem sucedido, é necessário, entre outros fatores, que haja compatibilidade para moléculas codificadas pelos genes HLA. Em geral, os transplantes de melhor prognóstico são aqueles realizados entre irmãos HLA idênticos. Este trabalho tem por objetivo avaliar o percentual de compatibilidade de doadores de medula óssea (MO nas famílias de pacientes que necessitam de TMO no estado de Santa Catarina. A coleta dos dados foi realizada no arquivo do Laboratório de Imunogenética do Hemocentro de Santa Catarina (Hemosc, compreendendo o período de 2000 a 2007. Foram totalizados 469 casos de pacientes à espera de TMO. Para estes, foram triados 2.463 possíveis doadores aparentados. Destes, 49,8% eram irmãos dos pacientes. Houve compatibilidade com algum membro da família do paciente em 213 (45,4% casos, sendo que 99% das compatibilidades foram estabelecidas entre irmãos, 0,7% com mães e 0,3% com tios dos pacientes. Avaliando-se os doadores, obteve-se um total de 1.230 irmãos tipificados para doação, dos quais 296 (24,06% apresentaram compatibilidade com o paciente para o qual realizaram a tipificação. Os dados encontrados neste estudo mostram que a possibilidade de que seja encontrado um doador compatível para TMO dentro da família do paciente, em Santa Catarina, é bastante promissora, principalmente entre irmãos do paciente.Bone marrow transplantation (BMT is a special therapy used to treat patients with hematological diseases and certain genetic disorders. For a transplant to be successful, it is necessary, among others factors, to have compatibility of the molecules coded by HLA genes. In general, the best prognosis for BMT is obtained with HLA-identical siblings. The aim of this work was to evaluate the percentage of compatibility between patients

  20. Comparison of characteristics of human small cell carcinoma of the lung in patients, in vitro and transplanted into nude mice

    DEFF Research Database (Denmark)

    Engelholm, S A; Spang-Thomsen, M; Vindeløv, L L;


    % of the cases. Fifty-four % of the tumours could be established as serially transplantable tumours in nude mice. The tumours were characterized by histology, electron microscopy, DNA index, and cell cycle distribution. The in vitro cell lines were furthermore characterized by the plating efficiency...... and by doubling time. The macroscopic growth of the heterotransplanted tumours was ascribed to a transformed Gompertz function. The tumour cells preserved their light microscopic constitution of small cell carcinoma of the lung in the model systems. The heterogeneity of the original tumours was reflected in vitro...

  1. Home spirometry: Assessment of patient compliance and satisfaction and its impact on early diagnosis of pulmonary symptoms in post-lung transplantation patients. (United States)

    Fadaizadeh, Lida; Najafizadeh, Katayoun; Shajareh, Elham; Shafaghi, Shadi; Hosseini, Mahsa; Heydari, Gholamreza


    Telemedicine is useful in monitoring patients, and in particular those, such as lung transplant recipients, suffering from chronic illnesses. This prospective cohort study was conducted on 15 lung transplant recipients. The patients provided physicians with data from spirometry as well as their clinical respiratory symptoms via SMS messages. In cases where spirometry results or clinical symptoms required follow-up, the monitoring physician contacted the patient according to guidelines and gave appropriate instructions. Qualitative assessment of satisfaction showed that the sense of increased support from medical staff was rated highest (92.9%). Telespirometry is an efficient method of monitoring lung transplant recipients which leads to patient satisfaction, compliance, adherence to study and sense of security. Nevertheless, for optimal implementation of this method, thorough training of both medical staff and patients is required.

  2. Lichenoid exanthema mimicking graft-versus-host disease associated with obstructive lung disease in a non-transplanted patient. (United States)

    Eberle, Franziska Carola; Holland, Angelique; Hörster, Stefan; Vogelmeier, Claus; Hertl, Michael


    Lichenoid graft-versus-host disease (GVHD) is commonly observed in patients who have received donor lymphocyte infusions or allogeneic bone marrow transplantation (BMT). Here we report a striking case of lichenoid GVH-like exanthema in a young woman without any history of blood transfusions or BMT. A polymorphous, multiforme-like exanthema was observed after systemic antibiotic therapy of bronchitis and was initially diagnosed as drug eruption. Later on, disseminated lichenoid papules were noticed on the trunk and extremities with all histologic and clinical characteristics of lichenoid GVHD. Cutaneous GVH-like disease developed, as did obstructive lung disease. Pulmonary as well as skin disease were both refractory to various immunosuppressive therapies. The immune pathogenesis that caused the skin and lung disease in this patient remains unclear. Multiple pregnancies with two abortions with the potential induction of microchimerism may play a role in the disease pathogenesis.

  3. Influence of MSA on Cell Growth and Spontaneousn Metastasis of L9981-Luc Lung Cancer Transplanted Model in Nude Mice by Bioluminescence Imaging


    Yuanrong REN; Wang, Yuli; Liu, Hongyu; YAN, HUIQIN; Chen, Jun; Hou, Mei; Li, Weimin; Yaguang FAN; Zhou, Qinghua


    Background and objective Methylseleninic acid (MSA) is an artificially developed selenium compound. It has been proven that MSA could inhibit growth and metastasis on many tumor cells. This study investigated whether MSA has an impact on the growth and metastasis of L9981-Luc lung cancer transplanted model in nude mice or not. Methods A transplantated tumor model was established in nude mice. Fifteen nude mice were randomly divided into three groups: the control group treated with normal sali...

  4. [Annual review of Archivos de Neumología in interventional pneumology, interstitial diseases and lung transplantation]. (United States)

    Disdier, Carlos; Bollo, Elena; Morales, Pilar; Montero, Carmen


    A review has been made of original articles on invasive pneumology techniques, interstitial diseases and lung transplantation, published in the Archivos de Bronconeumología during the year 2008. We have selected the publication by Martínez-Olondrins et al on the mediastinal staging of bronchogenic carcinoma by transbronchial needle aspiration to highlight the role of this simple, safe and cost-effective technique at a time when aspiration by ultrasound-guided bronchoscopy is profiled as an alternative to staging by mediastinoscopy. Besides its usefulness in the study of lymph nodes, transbronchial needle aspiration increases the overall performance of bronchoscopy by 20%, which means that it should be considered as a basic tool in the study of lung cancer. We also comment on the work by Galvis-Caravajal et al, who describe percutaneous radiofrequency as an alternative to radiotherapy in small lung or metastasic tumours. In diffuse interstitial disease, Morell et al analysed the diagnostic methods in 500 patients with this clinical-radiological presentation in which a definitive diagnosis was achieved in 85%, with 25% of them being obtained by non-invasively. Baloira et al analysed the characteristics of 19 patients with desquamative interstitial pneumonia and respiratory bronchiolitis associated-interstitial lung disease obtained from the National register of Interstitial Diseases.

  5. Five-year update on the mouse model of orthotopic lung transplantation: Scientific uses, tricks of the trade, and tips for success (United States)

    Lin, Xue; Li, Wenjun; Lai, Jiaming; Okazaki, Mikio; Sugimoto, Seiichiro; Yamamoto, Sumiharu; Wang, Xingan; Gelman, Andrew E.; Kreisel, Daniel


    It has been 5 years since our team reported the first successful model of orthotopic single lung transplantation in the mouse. There has been great demand for this technique due to the obvious experimental advantages the mouse offers over other large and small animal models of lung transplantation. These include the availability of mouse-specific reagents as well as knockout and transgenic technology. Our laboratory has utilized this mouse model to study both immunological and non-immunological mechanisms of lung transplant physiology while others have focused on models of chronic rejection. It is surprising that despite our initial publication in 2007 only few other laboratories have published data using this model. This is likely due to the technical complexity of the surgical technique and perioperative complications, which can limit recipient survival. As two of the authors (XL and WL) have a combined experience of over 2500 left and right single lung transplants, this review will summarize their experience and delineate tips and tricks necessary for successful transplantation. We will also describe technical advances made since the original description of the model. PMID:22754663

  6. Clinical efficacy and tolerability of caspofungin in a renal transplant patient with Aspergillus flavus lung infection: case report. (United States)

    Pasticci, M B; Barchiesi, F; Fallani, S; Palladino, N; Lapalorcia, L M; Gubbiotti, M; Cozzari, M; Novelli, A; Baldelli, F


    Organ transplant recipients are at increased risk for severe invasive aspergillosis, and amphotericin deoxycholate has been the standard treatment for many years. Currently, however, lipid formulations are preferred due to their few side effects. Also, a number of new antifungal drugs have been developed including new azoles and echinocandins. Caspofungin is the first of the echinocandin derivatives patented to treat patients with invasive aspergillosis who are refractory or intolerant to other therapies. A renal transplant patient on immunosuppressive treatment with chronic hepatitis B virus infection was admitted with fever, hemophthisis and lung consolidation, diagnosed to be probably caused by Aspergillus flavus. The patient developed cholestatic hepatitis most likely related to itraconazole. Clinical failure and in vitro itraconazole resistance of the isolate was also documented while the patient was receiving itraconazole at a reduced dosage. Caspofungin was administered once a day as ambulatory treatment and was well tolerated. Clinical improvement was observed after 6 weeks of treatment and no hepatic toxicity was documented. Caspofungin seems to be a potentially useful antifungal agent in renal transplant patients with invasive aspergillosis. Further evaluation of the efficacy of caspofungin is needed.

  7. Extracorporeal membrane oxygenator as a bridge to successful surgical repair of bronchopleural fistula following bilateral sequential lung transplantation: a case report and review of literature



    Abstract Background Lung transplantation (LTx) is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis. However, airway complications remain a major cause of morbidity and mortality in these patients, serious airway complications like bronchopleural fistula (BPF) are rare, and their management is very difficult. Case presentation A 47-year-old man with end-stage respiratory failure due to cystic fibrosis underwent bilateral sequential lung transplantati...

  8. Mortality and functional performance in severe emphysema after lung volume reduction or transplant. (United States)

    Weinstein, Michael S; Martin, Ubaldo J; Crookshank, Aaron D; Chatila, Wissam; Vance, Gwendolyn B; Gaughan, John P; Furukawa, Satoshi; Criner, Gerard J


    The purpose of this endeavor is to compare the morbidity, mortality and costs of LVRS versus transplantation in severe emphysema. This was a retrospective review of severe emphysema patients who received LVRS (n = 70) from 1994-1999, or transplant (n = 87) from 1994-2004. Change in functional status was calculated by the change in modified BODE (mBODE) score. Financial data included physician, hospital and medication costs. Preoperatively, there was no significant difference between the transplant and LVRS groups (mean +/- SD) in age (57.7 +/- 5.7 vs. 59.1 +/- 8.3 years), BMI, Borg dyspnea score, 6-minute walk distance or mBODE (10.4 +/- 2.6 vs. 9.6 +/- 2.7, p = 0.4). Preoperatively, FEV1% (23.6 +/- 8.5 vs. 31.9 +/- 17.7, p = 0.008) was significantly lower in the transplant group. One year post-operatively, transplantation patients had a significantly greater improvement in mBODE (-5.7 vs. -2.0, p = 0.0004), FEV1% (43.4 vs. 2.2%, p = 0.0004) and Borg score (-3.0 vs. -1.4, p = 0.04). Transplantation patients had lower long-term survival compared to LVRS patients (p = 0.01). The only variable that affected survival was type of surgery favoring LVRS (hazard ratio 1.7, 95% confidence limits 1.05-2.77). During a mean follow-up of 2.4 +/- 2.5 years after transplant and 5.0 +/- 3.1 years after LVRS, transplantation mean total costs were greater ($381,732 vs. $140,637, p improvement in airflow obstruction, dyspnea, exercise tolerance, and mBODE score, but costs more and carries greater mortality.

  9. 小鼠左肺原位移植模型的建立%Establishment of a mouse model of orthotopic lung transplantation

    Institute of Scientific and Technical Information of China (English)

    贺仕才; 仇广林; 王泽兴; 车向明; David.S Wilkes; 谯瞧; 卢靖; 樊林


    Objective To investigate the lung transplantation by establishing an orthotopic mouse lung transplanta-tion model by microsurgery.Methods Thirty SPF male C57BL/6 mice served as both recipient and donor.Orthotopic lung transplantation models were established in the mice by three-cuff anastomotic technique.Native and transplanted lung tissue samples were taken at 7, 14, 21 and 28 days after transplantation for pathological evaluation of the outcomes using HE staining.Results After learning curve, 30 mice received transplantation.All mice survived and the success rate of lung transplantation was 89%.The donor operation time was 35.2 ±9.81 min and recipient operation time was 24.6 ± 7.42 min.Mean cold ischemia time was 46.6 ±8.92 min, and warm ischemia time was 17.2 ±3.08 min.No histological alterations were routinely detected in the isograft lungs at all times post-transplantation compared with the native lungs. Conclusions Mouse lung transplantation model can be successfully established by the established technique with a high success rate and excellent reproducibility, and is in accordance with the physiology of clinical orthotopic lung transplanta-tion.It is a good animal model for studying the pathogenesis and treatment of lung transplantation.%目的:通过显微外科技术建立小鼠原位肺移植模型,为肺移植研究提供动物模型。方法采用C57BL/6小鼠作为供、受体,行同基因小鼠原位左肺移植,使用Cuff套管法进行气管及血管吻合。术后7、14、21、28 d取移植肺及原肺,行HE染色,评价肺移植后效果。结果学习曲线后,共30例小鼠移植,手术成功率89%,小鼠成活率100%。供体手术时间:(35.2±9.81)min,受体手术时间:(24.6±7.42) min,冷缺血时间是:(46.6± 8.92)min,热缺血时间是:(17.2±3.08)min。同基因移植物大体及病理无明显改变,病理显示与原肺无差别。结论本技术能够方便快捷建立小

  10. First case of atypical takotsubo cardiomyopathy in a bilateral lung-transplanted patient due to acute respiratory failure. (United States)

    Ghadri, Jelena R; Bataisou, Roxana D; Diekmann, Johanna; Lüscher, Thomas F; Templin, Christian


    Takotsubo cardiomyopathy which is characterised by a transient left ventricular wall motion abnormality was first described in 1990. The disease is still not well known, and as such it is suggested that an emotional trigger is mandatory in this disease. We present the case of a 51-year old female patient seven years after bilateral lung transplantation, who developed acute respiratory distress syndrome and subsequently suffered from atypical takotsubo cardiomyopathy with transient severe reduction of ejection fraction and haemodynamic instability needing acute intensive care treatment. Acute respiratory failure has emerged as an important physical trigger factor in takotsubo cardiomyopathy. Little is known about the association of hypoxia and takotsubo cardiomyopathy which can elicit a life-threatening condition requiring acute intensive care. Therefore, experimental studies are needed to investigate the role of hypoxia in takotsubo cardiomyopathy.

  11. Decline in 51Cr-labelled EDTA measured glomerular filtration rate following lung transplantation

    DEFF Research Database (Denmark)

    Hornum, Mads; Burton, Christopher M; Iversen, Martin;


    -labelled EDTA clearance (mGFR) and the Cockcroft-Gault calculated clearance (cGFR). Trough cyclosporine levels (C0) and demographic and transplant information were also included in the analysis. RESULTS: A total of 66959 C0 and serum creatinine and 1945 mGFR measurements pertaining to 383 patients were included...

  12. Computed tomography findings of postoperative complications in lung transplantation Achados tomográficos nas complicações pós-operatórias do transplante pulmonar

    Directory of Open Access Journals (Sweden)

    Bruno Hochhegger


    Full Text Available Due to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, post-transplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis.Com o número cada vez maior e uma melhor sobrevida dos pacientes submetidos ao transplante pulmonar, os radiologistas devem estar cientes das diversas possibilidades de complicações associadas ao transplante de pulmão. O tratamento precoce das complicações é importante para a sobrevida a longo prazo dos receptores de transplante pulmonar. Com frequência, a TCAR desempenha um papel central na investigação de tais complicações. O reconhecimento precoce dos sinais de complicações proporciona um tratamento rápido e melhora a sobrevida. O objetivo desta revisão pictórica foi proporcionar uma visão sobre as complicações mais prevalentes na TC, tais como edema de reperfusão, rejeição aguda, infecção, tromboembolismo pulmonar, rejeição crônica, síndrome da bronquiolite obliterante, pneumonia em organização criptogênica, doença linfoproliferativa pós-transplante, deiscência brônquica e estenose brônquica.

  13. Lung-Derived Microscaffolds Facilitate Diabetes Reversal after Mouse and Human Intraperitoneal Islet Transplantation.

    Directory of Open Access Journals (Sweden)

    Nasser Abualhassan

    Full Text Available There is a need to develop three-dimensional structures that mimic the natural islet tissue microenvironment. Endocrine micro-pancreata (EMPs made up of acellular organ-derived micro-scaffolds seeded with human islets have been shown to express high levels of key beta-cell specific genes and secrete quantities of insulin per cell similar to freshly isolated human islets in a glucose-regulated manner for more than three months in vitro. The aim of this study was to investigate the capacity of EMPs to restore euglycemia in vivo after transplantation of mouse or human islets in chemically diabetic mice. We proposed that the organ-derived EMPs would restore the extracellular components of the islet microenvironment, generating favorable conditions for islet function and survival. EMPs seeded with 500 mouse islets were implanted intraperitoneally into streptozotocin-induced diabetic mice and reverted diabetes in 67% of mice compared to 13% of controls (p = 0.018, n = 9 per group. Histological analysis of the explanted grafts 60 days post-transplantation stained positive for insulin and exhibited increased vascular density in a collagen-rich background. EMPs were also seeded with human islets and transplanted into the peritoneal cavity of immune-deficient diabetic mice at 250 islet equivalents (IEQ, 500 IEQ and 1000 IEQ. Escalating islet dose increased rates of normoglycemia (50% of the 500 IEQ group and 75% of the 1000 IEQ group, n = 3 per group. Human c-peptide levels were detected 90 days post-transplantation in a dose-response relationship. Herein, we report reversal of diabetes in mice by intraperitoneal transplantation of human islet seeded on EMPs with a human islet dose as low as 500 IEQ.

  14. The number of FoxP3+ cells in transbronchial lung allograft biopsies does not predict bronchiolitis obliterans syndrome within the first five years after transplantation

    DEFF Research Database (Denmark)

    Krustrup, Dorrit; Iversen, Martin; Martinussen, Torben;


    Background: An important limitation to the success of lung transplantation is the development of bronchiolitis obliterans syndrome (BOS). It has been hypothesized that regulatory T lymphocytes (Tregs) are related to the risk of BOS. We aim to evaluate whether the number of forkhead box P3 (FoxP3......+) cells/mm2 in lung allograft biopsies is a predictor of long-term outcome. Materials and Methods: A total of 58 consecutive lung transplant patients were included in the study. For 233 routine surveillance biopsy samples, the numbers of FoxP3+ cells/mm2 were assessed by immunohistochemical staining...... with antibodies against FoxP3. BOS scores were calculated for the first five yr after transplantation. Results: We determined that acute rejection was related to the time elapsed from transplantation to BOS with hazard ratios of 3.18 (p = 0.02) and 3.73 (p = 0.04) when comparing the levels of acute rejection...

  15. Cyclosporine C2 levels have impact on incidence of rejection in de novo lung but not heart transplant recipients: the NOCTURNE study

    DEFF Research Database (Denmark)

    Iversen, Martin; Nilsson, Folke; Sipponen, Jorma


    BACKGROUND: Cyclosporine (CsA) absorption varies early after transplantation and can be accurately assessed by the area under the absorption curve (AUC). The 2-hour post-dose (C2) level of CsA in whole blood is reported to be a useful surrogate marker of CsA AUC in kidney and liver transplant...... monitoring, but should be further explored in thoracic organ recipients. METHODS: In a 12-month study we included de novo lung (n = 95) and heart (n = 96) recipients. All participants received cyclosporine (Sandimmun Neoral) monitored by C0 and blood was collected for analysis of C2 retrospectively...

  16. Inhibition of lung metastasis of osteosarcoma cell line POS-1 transplanted into mice by thigh ligation. (United States)

    Kamijo, Akira; Koshino, Tomihisa; Uesugi, Masaaki; Nitto, Hironori; Saito, Tomoyuki


    Using a model with external ligation of the thigh, the effect of ischemia-reperfusion injury on tumor growth and the activity of lung metastasis was investigated in mice inoculated a spontaneous murine osteosarcoma cell line (POS-1) in vivo. POS-1 cell suspension was inoculated into the right hind footpad of 70 mice. Four weeks after inoculation, the ipsilateral thigh was ligated for 3 h in 15 mice and the contralateral thigh in 15 mice. Another ten mice were inoculated with POS-1 without ligating the thigh. The number of metastatic foci on the lung surface 6 weeks after inoculation was 2.29+/-0.98 (mean+/-SE) foci/lungs in mice with ipsilateral ligation and 6.25+/-2.41 in mice with contralateral ligation, which were significantly lower than control (13.40+/-1.42 in mice no ligation) (P<0.01). The number of metastatic foci on the lung surface in mice with intraperitoneal injection of superoxide dismutase (SOD) and catalase was 3.25+/-0.65 (mean+/-SE) foci/lungs in mice with ligation which was significantly greater than that in mice without SOD and catalase injection 1.29+/-0.97 (P=0.04). Cell viability was 9.12+/-4.07% with 100 microM H(2)O(2) in 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay. It revealed that at concentrations of 100 microM H(2)O(2) or higher was cytotoxic to POS-1. In cell invasion assay, the number of invading cells with 10 microM H(2)O(2) was 2.80+/-0.53 cells/field, which was significantly lower than control (5.93+/-0.18) (mean+/-SE), indicating that low-dose H(2)O(2) suppressed invasion of POS-1. These results suggested that reperfusion injury had selective cytotoxicity to POS-1 through producing reactive oxygen species. Activated oxygen was considered to inhibit the regional growth and the ability of lung metastasis of POS-1 cells.

  17. Immune mechanisms of obliterative bronchiolitis following lung transplantation%肺移植闭塞性细支气管炎免疫机制研究进展

    Institute of Scientific and Technical Information of China (English)

    王光锁; 王正; 孙宗全


    闭塞性细支气管炎是影响肺移植患者长期生存的主要因素.适应性免疫一直是肺移植排斥反应的研究重点.但是越来越多的研究表明,体液免疫、自体免疫、固有免疫等亦是闭塞性细支气管炎发生的重要因素.%Chronic rejection remains the leading cause of chronic allograft dysfunction and late mortality after lung transplantation. Adaptive immune system and its cellular-based rejection has been the focus in the development of obliterative bronchiolitis. Recent research has identified that humoral immunity, autoimmunity, and innate immunity also contribute to obliterative bronchiolitis. This paper presents an updated review of the immune mechanisms for obliterative bronchiolitis following lung transplantation.

  18. Cuba's kidney transplantation program. (United States)

    Mármol, Alexander; Pérez, Alexis; Pérez de Prado, Juan C; Fernández-Vega, Silvia; Gutiérrez, Francisco; Arce, Sergio


    The first kidney transplant in Cuba was performed on 24 February 1970, using a cadaveric donor. In 1979, living donor kidney transplantation began between first-degree relatives. A total of 2775 patients are enrolled in renal replacement therapy in 47 hospitals across the country, 1440 of whom are awaiting kidney transplantation. Organs for the kidney program are procured in 63 accredited hospitals equipped for multidisciplinary management of brain death. Accordingly, over 90% of transplanted kidneys are from cadaveric donors. Identification of potential recipients is carried out through a national, computerized program that affords all patients the same opportunity regardless of distance from a transplant center, and selection of the most suitable candidate is based primarily on HLA compatibility. KEYWORDS Chronic renal failure, kidney transplantation.

  19. Incomplete quality of life data in lung transplant research: comparing cross sectional, repeated measures ANOVA, and multi-level analysis

    Directory of Open Access Journals (Sweden)

    van der Bij Wim


    Full Text Available Abstract Background In longitudinal studies on Health Related Quality of Life (HRQL it frequently occurs that patients have one or more missing forms, which may cause bias, and reduce the sample size. Aims of the present study were to address the problem of missing data in the field of lung transplantation (LgTX and HRQL, to compare results obtained with different methods of analysis, and to show the value of each type of statistical method used to summarize data. Methods Results from cross-sectional analysis, repeated measures on complete cases (ANOVA, and a multi-level analysis were compared. The scores on the dimension 'energy' of the Nottingham Health Profile (NHP after transplantation were used to illustrate the differences between methods. Results Compared to repeated measures ANOVA, the cross-sectional and multi-level analysis included more patients, and allowed for a longer period of follow-up. In contrast to the cross sectional analyses, in the complete case analysis, and the multi-level analysis, the correlation between different time points was taken into account. Patterns over time of the three methods were comparable. In general, results from repeated measures ANOVA showed the most favorable energy scores, and results from the multi-level analysis the least favorable. Due to the separate subgroups per time point in the cross-sectional analysis, and the relatively small number of patients in the repeated measures ANOVA, inclusion of predictors was only possible in the multi-level analysis. Conclusion Results obtained with the various methods of analysis differed, indicating some reduction of bias took place. Multi-level analysis is a useful approach to study changes over time in a data set where missing data, to reduce bias, make efficient use of available data, and to include predictors, in studies concerning the effects of LgTX on HRQL.

  20. The Presence of HLA-E-Restricted, CMV-Specific CD8+ T Cells in the Blood of Lung Transplant Recipients Correlates with Chronic Allograft Rejection.

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    Lucy C Sullivan

    Full Text Available The human cytomegalovirus (CMV immune evasion protein, UL40, shares an identical peptide sequence with that found in the leader sequence of many human leukocyte antigen (HLA-C alleles and when complexed with HLA-E, can modulate NK cell functions via interactions with the CD94-NKG2 receptors. However the UL40-derived sequence can also be immunogenic, eliciting robust CD8+ T cell responses. In the setting of solid organ transplantation these T cells may not only be involved in antiviral immunity but also can potentially contribute to allograft rejection when the UL40 epitope is also present in allograft-encoded HLA. Here we assessed 15 bilateral lung transplant recipients for the presence of HLA-E-restricted UL40 specific T cells by tetramer staining of peripheral blood mononuclear cells (PBMC. UL40-specific T cells were observed in 7 patients post-transplant however the magnitude of the response varied significantly between patients. Moreover, unlike healthy CMV seropositive individuals, longitudinal analyses revealed that proportions of such T cells fluctuated markedly. Nine patients experienced low-grade acute cellular rejection, of which 6 also demonstrated UL40-specific T cells. Furthermore, the presence of UL40-specific CD8+ T cells in the blood was significantly associated with allograft dysfunction, which manifested as Bronchiolitis Obliterans Syndrome (BOS. Therefore, this study suggests that minor histocompatibility antigens presented by HLA-E can represent an additional risk factor following lung transplantation.

  1. Development and Preclinical Application of an Immunocompetent Transplant Model of Basal Breast Cancer with Lung, Liver and Brain Metastases.

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    Olga Aprelikova

    Full Text Available Triple negative breast cancer (TNBC is an aggressive subtype of breast cancer that is associated with a poor prognosis and for which no targeted therapies currently exist. In order to improve preclinical testing for TNBC that relies primarily on using human xenografts in immunodeficient mice, we have developed a novel immunocompetent syngeneic murine tumor transplant model for basal-like triple-negative breast cancer. The C3(1/SV40-T/t-antigen (C3(1/Tag mouse mammary tumor model in the FVB/N background shares important similarities with human basal-like TNBC. However, these tumors or derived cell lines are rejected when transplanted into wt FVB/N mice, likely due to the expression of SV40 T-antigen. We have developed a sub-line of mice (designated REAR mice that carry only one copy of the C3(1/Tag-antigen transgene resulting from a spontaneous transgene rearrangement in the original founder line. Unlike the original C3(1/Tag mice, REAR mice do not develop mammary tumors or other phenotypes observed in the original C3(1/Tag transgenic mice. REAR mice are more immunologically tolerant to SV40 T-antigen driven tumors and cell lines in an FVB/N background (including prostate tumors from TRAMP mice, but are otherwise immunologically intact. This transplant model system offers the ability to synchronously implant the C3(1/Tag tumor-derived M6 cell line or individual C3(1/Tag tumors from various stages of tumor development into the mammary fat pads or tail veins of REAR mice. C3(1/Tag tumors or M6 cells implanted into the mammary fat pads spontaneously metastasize at a high frequency to the lung and liver. M6 cells injected by tail vein can form brain metastases. We demonstrate that irradiated M6 tumor cells or the same cells expressing GM-CSF can act as a vaccine to retard tumor growth of implanted tumor cells in the REAR model. Preclinical studies performed in animals with an intact immune system should more authentically replicate treatment

  2. 10 years of prophylaxis with nebulized liposomal amphotericin B and the changing epidemiology of Aspergillus spp. infection in lung transplantation. (United States)

    Peghin, Maddalena; Monforte, Victor; Martin-Gomez, Maria-Teresa; Ruiz-Camps, Isabel; Berastegui, Cristina; Saez, Berta; Riera, Jordi; Ussetti, Piedad; Solé, Juan; Gavaldá, Joan; Roman, Antonio


    The aim of this study was to assess the outcome and tolerability of prophylactic nebulized liposomal amphotericin B (n-LAB) in lung transplant recipients (LTR) and the changing epidemiology of Aspergillus spp. infection and colonization. We performed an observational study including consecutive LTR recipients (2003-2013) undergoing n-LAB prophylaxis lifetime. A total of 412 patients were included (mean postoperative follow-up 2.56 years; IQR 1.01-4.65). Fifty-three (12.8%) patients developed 59 Aspergillus spp. infections, and 22 invasive aspergillosis (overall incidence 5.3%). Since 2009, person-time incidence rates of Aspergillus spp. colonization and infection decreased (2003-2008, 0.19; 2009-2014, 0.09; P = 0.0007), but species with reduced susceptibility or resistance to amphotericin significantly increased (2003-2008, 38.1% vs 2009-2014, 58.1%; P = 0.039). Chronic lung allograft dysfunction (CLAD) was associated with Aspergillus spp. colonization and infection (HR 24.4, 95% CI 14.28-41.97; P = 0.00). Only 2.9% of patients presented adverse effects, and 1.7% required discontinuation. Long-term administration of prophylaxis with n-LAB has proved to be tolerable and can be used for preventing Aspergillus spp. infection in LTR. Over the last years, the incidence of Aspergillus spp. colonization and infection has decreased, but species with reduced amphotericin susceptibility or resistance are emerging. CLAD is associated with Aspergillus spp. colonization and infection.

  3. Fat quantification and analysis of lung transplant patients on unenhanced chest CT images based on standardized anatomic space (United States)

    Tong, Yubing; Udupa, Jayaram K.; Torigian, Drew A.; Wu, Caiyun; Christie, Jason; Lederer, David J.


    Chest fat estimation is important for identifying high-risk lung transplant candidates. In this paper, an approach to chest fat quantification based on a recently formulated concept of standardized anatomic space (SAS) is presented. The goal of this paper is to seek answers to the following questions related to chest fat quantification on single slice versus whole volume CT, which have not been addressed in the literature. What level of correlation exists between total chest fat volume and fat areas measured on single abdominal and thigh slices? What is the anatomic location in the chest where maximal correlation of fat area with fat volume can be expected? Do the components of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) have the same area-to-volume correlative behavior or do they differ? The SAS approach includes two steps: calibration followed by transformation which will map the patient slice locations non-linearly to SAS. The optimal slice locations found for SAT and VAT based on SAS are different and at the mid-level of the T8 vertebral body for SAT and mid-level of the T7 vertebral body for VAT. Fat volume and area on optimal slices for SAT and VAT are correlated with Pearson correlation coefficients of 0.97 and 0.86, respectively. The correlation of chest fat volume with abdominal and thigh fat areas is weak to modest.

  4. Transplantation Immunity. Contemporary Views. (United States)

    Zaretskaya, Yuliya M.


    "Transplantation immunity in Cyclosporin era" is a special chapter in science under name transplantation immunity. Nowadays, practically all the organs can be grafted: kidney, heart, lung, liver, pancreas both as organ, and as islet cells, bone marrow from relative and unrelative donors. The broad spectrum of grafted organs gave one more surprising peculiarity of transplantation immunity: it operates with different strength after transplantation of various organs. If the decreasing gradient of transplantation immunity could be composed, then it appeared to be approximately in the following order: bone marrow - skin - kidney - heart - lung. The most complicated operating activity of transplantation immunity is occurring after bone marrow transplantation, especially from unrelative donor, because in bone marrow transplantation immunological process develops in both directions. Therefore now, bone marrow is the only organ (tissue), when the complete compatibility between donor and recipient is required after its transplantation; especially in cases with unrelative donors.

  5. Extracorporeal membrane oxygenator as a bridge to successful surgical repair of bronchopleural fistula following bilateral sequential lung transplantation: a case report and review of literature

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    Machaal Ali


    Full Text Available Abstract Background Lung transplantation (LTx is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis. However, airway complications remain a major cause of morbidity and mortality in these patients, serious airway complications like bronchopleural fistula (BPF are rare, and their management is very difficult. Case presentation A 47-year-old man with end-stage respiratory failure due to cystic fibrosis underwent bilateral sequential lung transplantation. Severe post-operative bleeding occurred due to dense intrapleural adhesions of the native lungs. He was re-explored and packed leading to satisfactory haemostasis. He developed a bronchopleural fistula on the 14th post-operative day. The fistula was successfully repaired using pericardial and intercostal vascular flaps with veno-venous extracorporeal membrane oxygenator (VV-ECMO support. Subsequently his recovery was uneventful. Conclusion The combination of pedicled intercostal and pericardial flaps provide adequate vascular tissue for sealing a large BPF following LTx. Veno-venous ECMO allows a feasible bridge to recovery.

  6. The Impact of Alemtuzumab and Basiliximab Induction on Patient Survival and Time to Bronchiolitis Obliterans Syndrome in Double Lung Transplantation Recipients. (United States)

    Furuya, Y; Jayarajan, S N; Taghavi, S; Cordova, F C; Patel, N; Shiose, A; Leotta, E; Criner, G J; Guy, T S; Wheatley, G H; Kaiser, L R; Toyoda, Y


    We examined the effect of alemtuzumab and basiliximab induction therapy on patient survival and freedom from bronchiolitis obliterans syndrome (BOS) in double lung transplantation. The United Network for Organ Sharing database was reviewed for adult double lung transplant recipients from 2006 to 2013. The primary outcome was risk-adjusted all-cause mortality. Secondary outcomes included time to BOS. There were 6117 patients were identified, of whom 738 received alemtuzumab, 2804 received basiliximab, and 2575 received no induction. Alemtuzumab recipients had higher lung allocation scores compared with basiliximab and no-induction recipients (41.4 versus 37.9 versus 40.7, p alemtuzumab and basiliximab recipients compared with patients who received no induction (2321 versus 2352 versus 1967 days, p = 0.001). Alemtuzumab (hazard ratio 0.80, 95% confidence interval 0.67-0.95, p = 0.009) and basiliximab induction (0.88, 0.80-0.98, p = 0.015) were independently associated with survival on multivariate analysis. At 5 years, alemtuzumab recipients had a lower incidence of BOS (22.7% versus 55.4 versus 55.9%), and its use was independently associated with lower risk of developing BOS on multivariate analysis. While both induction therapies were associated with improved survival, patients who received alemtuzumab had greater median freedom from BOS.

  7. Establishment and Improvement of SD Rat Model of Left Lung Transplantation%SD 大鼠左肺移植模型的建立与改进

    Institute of Scientific and Technical Information of China (English)

    戴斌; 唐建; 吴起才; 黄磊; 古亮


    目的:改进大鼠原位左肺移植技术,建立快速、安全、可重复性强的大鼠肺移植动物模型的方法。方法SPF 级健康雄性 SD 大鼠90只,体质量300~350 g。其中60只作为供、受体,受体略大于供体,供、受体间体质量差不超过20 g,运用三袖套法吻合左肺动、静脉及支气管以建立大鼠左肺移植模型,移植成功后的受体在48 h 后取肺静脉血进行血气分析(PO2、PCO2);30只为对照组,肺静脉取血进行血气分析。观察记录大鼠肺移植供肺获取、套管及受体移植时间;移植肺血液循环及膨胀情况;移植肺与对照组血气分析结果比较。结果完成大鼠肺移植手术30例,成功27例,失败3例(肺静脉撕裂1例,脱机失败1例,肺动脉扭转1例)。大鼠供肺获取时间为(13.5±2.0)min,供肺套管时间为(15.5±2.5)min;游离大鼠受体左侧肺门部动、静脉及支气管并套线、结扎时间为(19.2±2.0)min;吻合时间为(18.5±4.0)min。在先开放肺动脉血流,接着开放肺静脉血流后,移植的左侧肺叶颜色均匀一致的红润,左肺血流得到充分的灌注,静脉充盈良好,回流畅通;恢复机械通气后,27例移植肺膨胀良好。左肺移植成功48 h 后,肺移植大鼠右侧肺门夹闭5 min 后 PO2为(7.88±0.84)kPa,PCO2为(6.67±1.09)kPa;对照组大鼠夹闭右侧肺门5 min 后肺静脉 PO2为(8.55±0.97)kPa,PCO2为(6.20±0.88)kPa。2组 PO2比较差异有统计学意义(P <0.05),PCO2比较差异无统计学意义(P >0.05)。结论改进后的肺移植技术可为大鼠肺移植的相关研究提供稳定、可靠及可重复的动物模型。%ABSTRACT:Objective To improve the technique of orthotopic left lung transplantation in rats, and to establish a fast,safe and repeatable method for rat lung transplantation.Methods Ninety healthy male SPF

  8. 大鼠右肺原位移植模型的建立%A model of orthotopic right lung transplantation in rats

    Institute of Scientific and Technical Information of China (English)

    蒋雷; 高文; 陈晓峰; 何文新; 范江; 林洪胜; 宫素岗


    目的 探讨建立大鼠右肺原位移植模型的手术技术,以及该模型应用于缺血再灌注损伤研究的可行性.方法 选用纯种雄性SD大鼠(体重250~270 g)作为肺移植模型的供、受者.供、受者的手术均在手术放大镜下进行,由同一操作者连续完成大鼠右肺原位移植模型12例.供者全身麻醉后行机械通气,正中切开胸腹暴露心脏和双肺,下腔静脉注射肝素,切开右室流出道和左心耳放血后将灌注管插入肺动脉内行肺灌注,灌注完成后切取并保存供肺.右肺移植时,受者全身麻醉和辅助呼气方法同供者.右后外侧第4肋间切口入胸,游离并从远端切断肺血管和支气管,将供肺植入受者胸腔后,分别吻合支气管及肺动、静脉.观察受者术中及术后的情况.结果 供肺平均冷缺血时间为(131.25±20.24)min;平均移植时间为(91.25±15.97)min.开放循环后24 h,共有8只受者存活,手术成功率为66.7%.有6只受者存活时间超过4周.结论 大鼠右肺原位移植模型难度较大,但它是一种新型的适用于肺移植缺血再灌注损伤研究的动物模型.%Objective To report the preliminary experience with the techniques of orthotopic right lung transplantation in rats, and to evaluate an application of the model in the study on ischemia-reperfusion injury after experimental lung transplantation. Methods Pure breed SD rats (weighing 250~270 g) were chosen. Under an operation microscope (10) for both donor and recipient procedures, 12 consecutive orthotopic right lung transplantations in rats were performed. Under the general anes-thesia and mechanical ventilation, middle line laparothoracotomy was used to expose the heart and bi-lateral lungs. Heparin was given through the inferior vena cava. After opening the right ventricular outflow tract and exsanguinating through the left auricle, a perfusion catheter was placed in the pul-monary artery. Following lung perfusion, the donor lung was

  9. Preoperative Strength Training for Elderly Patients Awaiting Total Knee Arthroplasty

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    D. M. van Leeuwen


    Full Text Available Objective. To investigate the feasibility and effects of additional preoperative high intensity strength training for patients awaiting total knee arthroplasty (TKA. Design. Clinical controlled trial. Patients. Twenty-two patients awaiting TKA. Methods. Patients were allocated to a standard training group or a group receiving standard training with additional progressive strength training for 6 weeks. Isometric knee extensor strength, voluntary activation, chair stand, 6-minute walk test (6MWT, and stair climbing were assessed before and after 6 weeks of training and 6 and 12 weeks after TKA. Results. For 3 of the 11 patients in the intensive strength group, training load had to be adjusted because of pain. For both groups combined, improvements in chair stand and 6MWT were observed before surgery, but intensive strength training was not more effective than standard training. Voluntary activation did not change before and after surgery, and postoperative recovery was not different between groups (P>0.05. Knee extensor strength of the affected leg before surgery was significantly associated with 6-minute walk (r=0.50 and the stair climb (r−=0.58, P<0.05. Conclusion. Intensive strength training was feasible for the majority of patients, but there were no indications that it is more effective than standard training to increase preoperative physical performance. This trial was registered with NTR2278.

  10. Trasplante pulmonar: Evolución y complicaciones. Experiencia de Clínica Las Condes LUNG TRANSPLANTATION: EVOLUTION AND COMPLICATIONS. CLINICAL EXPERIENCE

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    Full Text Available El trasplante pulmonar es una alternativa terapéutica para pacientes con enfermedad pulmonar severa sin respuesta a tratamiento. Objetivos: Evaluar los resultados y complicaciones de los pacientes trasplantados en Clínica Las Condes. Material y método: 21 pacientes trasplantados entre abril 1999 a mayo de 2003: 10 trasplantes simples y 11 bipulmonares, edad x 48 años (13-70;13 hombres; patología predominante fibrosis pulmonar idiopática: 10 (48%. Espirometría basal en patología restrictiva CVF: x 1.827 ml (43 % (1.170 - 2.430 ml y obstructiva: VEF1 x 818 ml (24% (352 - 1.756 ml, todos dependientes de oxígeno. Inmunosupresión triasociada: prednisona, azatioprina y ciclosporina o tacrolimus. Resultados: 3 pacientes fallecen a los 30 días por hemorragia cerebral, hemoptisis masiva y sepsis respectivamente. Seguimiento de 2 a 45 meses. Evolución espirométrica (VEF1: 1 año 2.107 ml (67% , 2 años 2.012 ml (65% y 3 años 2.440 ml (74%. Todos suspenden oxígeno y realizan actividad física. Complicaciones: Disfunción primaria de injerto 2, rechazo agudo 4, lesión vía aérea 2, neumonia por Citomegalovirus 2, síndrome de bronquiolitis obliterante (SBO 3 y fallecen dos. Conclusiones: El trasplante pulmonar mejora calidad de vida en pacientes con enfermedad pulmonar terminal y nuestros resultados confirman que es una alternativa posible en nuestro paísBackground: Lung transplantation is a valid treatment for some patients with severe lung disease who have a poor prognosis with medical treatment. Objective: to evaluate the results and complications of lung transplantation in a series of patients at Clinica Las Condes. Patients and methods: 21 lung transplanted patients from April 1999 to May 2003; 10 single and 11 bilateral; mean age 48 years, range 13 to 70 years; 13 men (62%. The most frequent diagnosis was idiopathic pulmonary fibrosis (10 patients; 48%. Mean FVC for restrictive disorders was 1 827 ml (43% predicted and mean FEV1 for

  11. The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation

    DEFF Research Database (Denmark)

    Berry, Gerald J; Burke, Margaret M; Andersen, Claus Yding


    During the last 25 years, antibody-mediated rejection of the cardiac allograft has evolved from a relatively obscure concept to a recognized clinical complication in the management of heart transplant patients. Herein we report the consensus findings from a series of meetings held between 2010-20...

  12. Prolonged Negative Pressure Wound Therapy Followed by Split-Thickness Skin Graft Placement for Wide Dehiscence of Clamshell Incision After Bilateral Lung Transplantation: A Case Report. (United States)

    Suzuki, H; Watanabe, T; Okazaki, T; Notsuda, H; Niikawa, H; Matsuda, Y; Noda, M; Sakurada, A; Hoshikawa, Y; Aizawa, T; Miura, T; Okada, Y


    Clamshell incision is a standard approach for bilateral lung transplantation, providing a good operative field; however, once wide dehiscence occurs, its management is sometimes difficult because of intense immunosuppression and malnutrition of the recipient. A 22-year-old man with idiopathic pulmonary arterial hypertension underwent cadaveric bilateral lung transplantation through a clamshell incision using standard cardiopulmonary bypass. He developed wound dehiscence on postoperative day (POD) 20 that resulted in exposure of the bilateral fifth ribs and open pneumothorax. Considering the extreme malnutrition and emaciation of the recipient, we avoided initial closure of the dehiscence. After the debridement of necrotic tissue, negative pressure wound therapy was initiated on POD 25 and was continued for approximately 6 months with trafermin spray application. Eventually, the wound, including the fifth ribs, was completely covered with granulation tissue except for the wire tying the sternum. On POD 217, the patient underwent removal of the sternal wire followed by split-thickness skin grafting. His wound was successfully closed and he was discharged without activity limitation on POD 265.

  13. Optimal Route for Human Umbilical Cord Blood-Derived Mesenchymal Stem Cell Transplantation to Protect Against Neonatal Hyperoxic Lung Injury: Gene Expression Profiles and Histopathology.

    Directory of Open Access Journals (Sweden)

    Dong Kyung Sung

    Full Text Available The aim of this study was to determine the optimal route of mesenchymal stem cell (MSC transplantation. To this end, gene expression profiling was performed to compare the effects of intratracheal (i.t. versus intravenous (i.v. MSC administration. Furthermore, the therapeutic efficacy of each route to protect against neonatal hyperoxic lung injury was also determined. Newborn Sprague-Dawley rats were exposed to hyperoxia (90% oxygen from birth for 14 days. Human umbilical cord blood-derived MSCs labeling with PKH26 were transplanted through either the i.t. (5×10(5 or i.v. (2×10(6 route at postnatal day (P 5. At P14, lungs were harvested for histological, biochemical and microarray analyses. Hyperoxic conditions induced an increase in the mean linear intercept and mean alveolar volume (MAV, indicative of impaired alveolarization. The number of ED-1 positive cells was significantly decreased by both i.t. and i.v. transplantations. However, i.t. administration of MSCs resulted in a greater decrease in MAV and ED-1 positive cells compared to i.v. administration. Moreover, the number of TUNEL-positive cells was significantly decreased in the i.t. group, but not in the i.v. group. Although the i.t. group received only one fourth of the number of MSCs that the i.v. group did, a significantly higher number of donor cell-derived red PKH 26 positivity were recovered in the i.t. group. Hyperoxic conditions induced the up regulation of genes associated with the inflammatory response, such as macrophage inflammatory protein-1 α, tumor necrosis factor-α and inter leukin-6; genes associated with cell death, such as p53 and caspases; and genes associated with fibrosis, such as connective tissue growth factor. In contrast, hyperoxic conditions induced the dwon-regulation of vascular endothelial growth factor and hepatocyte growth factor. These hyperoxia-induced changes in gene expression were decreased in the i.t. group, but not in the i.v. group. Thus

  14. Cinacalcet to prevent parathyrotoxic crises in hypercalcaemic patients awaiting parathyroidectomy (United States)

    Rostoker, Guy; Bellamy, Jean; Janklewicz, Philippe


    Primary hyperparathyroidism is the third most common endocrine disorder. Hypercalcaemia exceeding 3 mmol/l is a major risk factor for parathyrotoxic crises, and management of patients at risk remains a medical challenge. The authors recently managed three such patients referred for severe nephrolithiasis. All had severe hypercalcaemia (at least 3 mmol/l). Instead of the usual management, which involves hospitalisation in an intensive care environment (for about 5–7 days) for rehydration and infusion of intravenous bisphosphonates, followed by emergency parathyroidectomy, the three patients received ambulatory cinacalcet (not an approved indication), 30 mg twice a day. The serum calcium normalised in two cases and declined to a safe level in the third case, allowing minimally invasive parathyroidectomy to be performed at a date chosen according to the patients’ and surgeon’s respective schedules. The authors consider that cinacalcet may benefit severely hypercalcaemic patients awaiting surgery for primary hyperparathyroidism. PMID:22696718

  15. Morte encefálica, cuidados ao doador de órgãos e transplante de pulmão Brain death, multiorgan donor and lung transplantation

    Directory of Open Access Journals (Sweden)

    Fernando D'Império


    Full Text Available JUSTIFICATIVA E OBJETIVOS: O transplante de órgãos é aceito como uma opção para doença orgânica terminal, em pacientes bem selecionados. Este é o resultado de grandes avanços nos campos da Imunologia, da Tecnologia da Terapia Intensiva e da Farmacologia. Entretanto, os sistemas de transplantes são, atualmente, vítimas de seu próprio sucesso, à medida que as listas de espera se alongam, em contraste com a disponibilidade de órgãos, que permanece estável, acarretando crescente número de mortes nestas filas de espera. A comunidade de transplante respondeu a esta situação revendo os critérios de aceitabilidade de doadores e desenvolvendo novas estratégias na obtenção de órgãos (como nos casos de captação após a parada circulatória. CONTEÚDO: Entretanto muito se evoluiu na compreensão da fisiopatologia da morte encefálica e suas conseqüências visando a melhor manutenção do doador potencial de múltiplos órgãos e utilização destes. Este artigo procurou discutir os pontos de maior interesse na manutenção clínica do paciente com morte encefálica, correlacionando com a sua fisiopatologia e apontando os pontos considerados de maior relevância específica como a depleção de aminas vasoativas e a manutenção dos sistemas cardiorrespiratório, distúrbios endócrinos e hidroeletrolítcos. Observam-se também algumas recomendações quanto ao aproveitamento e de órgãos específicos (coração, pulmão, rim e fígado. CONCLUSÕES: Com o aumento significativo das listas de espera por órgãos e a escassez de órgãos disponíveis leva-nos a um esforço para aprimorar as técnicas existentes de captação e preservação, assim como desenvolver novas medidas para seu aproveitamento de forma a reduzir a mortalidade nas filas de espera que são sempre uma sombra nos programas de transplantes.BACKGROUND AND OBJECTIVES: Organ transplantation is now an accepted option for end stage organ disease in well selected

  16. The attitude toward xenocorneal transplantation in wait-listed subjects for corneal transplantation in Korea. (United States)

    Lee, Jong Joo; Kim, Dong Hyun; Jang, Young Eun; Choi, Hyuk Jin; Kim, Mee Kum; Wee, Won Ryang


    Shortage of donor cornea is a significant problem in Asia, and xenocorneal transplantation is being actively studied to alleviate this problem. However, the attitudes of subjects who await corneal transplants toward xenocorneal transplantation are not known at all. Thus, this study aimed to investigate the attitudes of subjects on the waiting lists for corneal transplants, toward corneal xenotransplantation. A telephone questionnaire survey comprising six items was conducted in 132 subjects among the wait-listed individuals (n = 590) who were awaiting corneal transplantation or had undergone corneal transplantation at Seoul National University Hospital from July, 2003 to August, 2012. Among six inquiries, four questions were used to analyze attitudes toward corneal xenotransplantation. Each question pertained to (1) the acceptance of xenocorneal transplantation, (2) willingness to participate in clinical trials, (3) worries in xenocorneal transplantation, and (4) the concern of self-identity or social life after xenocorneal transplantation. To analyze demographic factors influencing the question, the subjects were arbitrarily divided into two groups: the young (age xenotransplantation. Younger subjects expressed more worry about xenotransplantation than elderly subjects. The well-educated expressed less concern over self-identity and social life than the less-educated. This survey among subjects who are wait-listed for corneal transplant or who have received a corneal transplant demonstrates that there is an interest in xenocorneal transplantation as an alternate procedure, although there are worries about the procedure that should be further explored in educational campaigns and future studies of the general population.

  17. Lung transplantation from donor of cardiac death in China (report of 3 cases)%心脏死亡供者供肺移植三例报告

    Institute of Scientific and Technical Information of China (English)

    叶书高; 刘东; 陈静瑜; 毛文君; 刘峰; 陆荣国; 陈若


    目的 总结心脏死亡供者供肺获取以及应用于临床肺移植的经验.方法 共进行3例心脏死亡供者供肺获取及肺移植.3例供者平素健康,因发生严重颅脑外伤或脑肿瘤,经严格医学检查后均被明确判定为脑死亡,并被确定为潜在心脏死亡供者.供者的近亲亲属均知情同意心脏死亡器官捐献,临床评估供肺良好,供者在停止呼吸机,心脏停跳5 min后,确定为心脏死亡,并在全身麻醉下切取供肺.3例受者术前淋巴细胞毒交叉配合试验均为阴性,供、受者ABO血型相同,身高相近,体重相差均在20%以内,胸腔大小匹配.结果 利用3例心脏死亡供者供肺成功进行了2例双肺移植和1例单肺移植,3例供肺的热缺血时间分别为23、27和32 min.3例受者手术顺利,在ICU的监护时间分别为31、18和26 d,术后肺功能得到极大改善,例1和例2分别于术后30和19d发生急性排斥反应,经皮质激素冲击治疗后好转,3例受者均未发生感染等并发症,随访期间生活质量良好.结论 在现有条件下,严格按《中国心脏死亡器官捐献工作指南》开展心脏死亡器官捐献应用于临床肺移植的工作,正确维护好潜在心脏死亡供者,在全面评估供肺质量的前提下,心脏死亡供肺可作为肺移植的主要供肺之一.%Objective To summarize the clinical experience of harvesting and using the lungs of cardiac death donor.Methods The lungs from donation after cardiac death (DCD) were harvested and used for lung transplantation.The donors suffered from severe craniocerebral trauma or brain neoplasms and were identified after cardiac death post declaration of brain death.Written consent about DCD was obtained from the consanguinities.The donor lungs were harvested after clinical evaluation of donors with considerable function and after the determination of DCD.The preoperative lymphocytotoxic cross match test was negative,ABO blood type was compatible,and the

  18. 77 FR 28607 - Advisory Committee on Organ Transplantation; Request for Nominations for Voting Members (United States)


    ... organ donation, health care public policy, transplantation medicine and surgery, critical care medicine... transplant professions, nursing, epidemiology, immunology, law and bioethics, behavioral sciences, economics...; transplantation medicine and surgery, including pediatric and heart/lung transplantation; critical care...

  19. Regression of Hypervascular Nodules in a Patient with Wilson's Disease Awaiting Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Alcindo Pissaia


    Full Text Available This paper describes the regressive course over one year of hypervascular nodules in a patient with Wilson's disease. CT revealed multiple, enhancing nodules (up to 3 cm in diameter detected in the liver in the early arterial phase after the administration of intravenous contrast material. Most of these nodules became isodense in the portal venous phase. After one year of efficient therapy combining d-penicillamine and zinc acetate, most of the nodules had disappeared, while the liver contours had become more regular. To our knowledge, the regression of large hypervascular nodules has not previously been reported in patients with Wilson's disease.

  20. 单肺移植术后受者对侧自体肺并发症的分析%Complications in the native lung after single lung transplantation

    Institute of Scientific and Technical Information of China (English)

    陈乾坤; 姜格宁; 丁嘉安; 周晓; 汪浩; 陈昶; 朱余明; 王海峰; 何文新


    Objective We retrospectively reviewed 48 single lung transplants to evaluate the prognostic factors by incidence of complications arising in the native lung.Method Between 2003 and 2012,48 single lung transplants were proformed for emphysema (29 cases),pulmonary fibrosis (14 cases),lymphangioleiomyomatosis (1 case),bronchiolitis obliterans (2 cases) and pneumoconiosis (2 cases).The clinical records of the complications related to the native lung were reviewed.Result Complications in the native lung occurred in 21 patients (43.7%),leading to 17 deaths (14.6%),including pneumothorax in 2 cases (4.2%),long-term air leak after lung volume reduction surgery in 1 case (2.1%),hyperinflation in 4 cases (8.3%),chylothorax in 1 case (2.1%),lung cancer in 2 case (4.2 %),bacteria infection in 6 cases (12.5 %),and fungal infection in 5 cases (10.4%).The 1-,3-and 5-year suvival rate in recipients without or with complications in the native lung was 85%,55%,48%,and 63%,42%,21%,respectively (P<0.05).Multivariate analysis showed that infectious complications in the native lung was the independent prognostic factor (P <0.05).Conclusion After single lung transplantation,the native lung can be the source of serious problems.Infectious complications generally result in a fatal outcome,and other complications can be successfully treated in most cases,even if surgery is required.%目的 探讨单肺移植术后自体肺并发症对移植疗效和受者预后的影响.方法 回顾性分析自2003年1月至2012年8月间单中心施行的48例单肺移植的临床资料.患者的原发疾病分别为慢性阻塞性肺病29例(61%),特发性肺间质纤维化14例(29%),闭塞性细支气管炎2例(4%),尘肺2例(4%),肺淋巴管肌瘤1例(2%).分析术后对侧自体肺并发症发生情况及其预防和处理,并探讨其对受者预后的影响.结果 48例单肺移植受者中,21例(43.7%)出现了对侧自体肺并发症,其中7例(14.6

  1. Lipid raft facilitated ligation of K-{alpha}1-tubulin by specific antibodies on epithelial cells: Role in pathogenesis of chronic rejection following human lung transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Tiriveedhi, Venkataswarup; Angaswamy, Nataraju [Department of Surgery, Pathology and Immunology, Washington University School of Medicine, St. Louis, MO (United States); Weber, Joseph [Department of Medicine, Washington University School of Medicine, St. Louis, MO (United States); Mohanakumar, T., E-mail: [Department of Surgery, Pathology and Immunology, Washington University School of Medicine, St. Louis, MO (United States)


    Research highlights: {yields} Addition of KAT Abs (+) sera to NHBE culture causes upregulation of growth factors. {yields} Cholesterol depletion causes down regulation of growth factor expression. {yields} Cholesterol depletion is accompanied by loss of membrane bound caveolin. {yields} Thus, we demonstrate lipid raft are critical for efficient ligation of the KAT Abs. -- Abstract: Long term function of human lung allografts is hindered by development of chronic rejection manifested as Bronchiolitis Obliterans Syndrome (BOS). We have previously identified the development of antibodies (Abs) following lung transplantation to K-{alpha}1-tubulin (KAT), an epithelial surface gap junction cytoskeletal protein, in patients who develop BOS. However, the biochemical and molecular basis of the interactions and signaling cascades mediated by KAT Abs are yet to be defined. In this report, we investigated the biophysical basis of the epithelial cell membrane surface interaction between KAT and its specific Abs. Towards this, we analyzed the role of the lipid raft-domains in the membrane interactions which lead to cell signaling and ultimately increased growth factor expression. Normal human bronchial epithelial (NHBE) cells, upon specific ligation with Abs to KAT obtained either from the serum of BOS(+) patients or monoclonal KAT Abs, resulted in upregulation of growth factors VEGF, PDGF, and bFGF (6.4 {+-} 1.1-, 3.2 {+-} 0.9-, and 3.4 {+-} 1.1-fold increase, respectively) all of which are important in the pathogenesis of BOS. To define the role for lipid raft in augmenting surface interactions, we analyzed the changes in the growth factor expression pattern upon depletion and enrichment with lipid raft following the ligation of the epithelial cell membranes with Abs specific for KAT. NHBE cells cultured in the presence of {beta}-methyl cyclodextran ({beta}MCD) had significantly reduced growth factor expression (1.3 {+-} 0.3, vs {beta}MCD untreated being 6.4 {+-} 1.1-fold

  2. 24例体外膜肺氧合辅助下序贯式双肺移植术的配合%24 Cases in Vitro Membrane Lung Oxygenation Auxiliary Next Sequential Type Double Lung Transplantation to Cooperate

    Institute of Scientific and Technical Information of China (English)

    周丽萍; 盛玲; 王凤珠


      目的 总结24例体外膜肺氧合(ECMO)辅助下序贯式双肺移植的手术配合体会。方法 回顾性分析体外膜肺氧合辅助下序贯式双肺移植术中各小组环节配合要点。结果 24例ECMO辅助下完成的序贯式双肺移植患者,ECMO转流后氧合改善,手术全程生命体征平稳,手术经过顺利。结论 ECMO辅助下序贯式双肺移植的手术配合中,充分的术前准备、迅速安全的体位安置、合理分工密切的手术配合、防感染措施的有效落实、严密的巡视与观察是护理配合的关键所在。%Objective To summarize 24 cases the in vitro membrane oxygenation and help oxygen sequential type double lung transplant surgery with experience. Methods Retrospective analysis in vitro membrane lung and auxiliary oxygen sequential type double lung transplantation in each group link cooperates points. Result 24 cases under ECMO’s help finish of sequential type double lung transplant patients,after ECMO’s help oxygen and improved, the stable operation life signs, Operation process smoothly. Conclusion The ECMO auxiliary sequential type double lung transplant surgery in the cooperation, sufficient preoperative preparation, rapid safety posture resettlement, rational division of work closely with surgery, the effective implementation of the measures to prevent infection, strict patrol and observation is the key to cooperate with care. cooperate with care to the key is strict patrol and observation.

  3. Primary mesenchymal stem cells in human transplanted lungs are CD90/CD105 perivascularly located tissue-resident cells

    DEFF Research Database (Denmark)

    Rolandsson, Sara; Andersson Sjöland, Annika; Brune, Jan C


    in vitro MSC properties; however, xenotransplantation into non-obese diabetic/severe combined immunodeficient (NOD/SCID) mice showed that lung MSC readily differentiated into adipocytes and stromal tissues, but lacked significant in vivo bone formation. CONCLUSIONS: These data clearly demonstrate...

  4. Strategies to eradicate minimal residual disease in small cell lung cancer: high-dose chemotherapy with autologous bone marrow transplantation, matrix metalloproteinase inhibitors, and BEC2 plus BCG vaccination. (United States)

    Krug, L M; Grant, S C; Miller, V A; Ng, K K; Kris, M G


    In the last 25 years, treatment for small cell lung cancer (SCLC) has improved with advances in chemotherapy and radiotherapy. Standard chemotherapy regimens can yield 80% to 90% response rates and some cures when combined with thoracic irradiation in limited-stage patients. Nonetheless, small cell lung cancer has a high relapse rate due to drug resistance; this has resulted in poor survival for most patients. Attacking this problem requires a unique approach to eliminate resistant disease remaining after induction therapy. This review will focus on three potential strategies: high-dose chemotherapy with autologous bone marrow transplantation, matrix metalloproteinase inhibitors, and BEC2 plus BCG vaccination.

  5. Developing Optimal Parameters for Hyperpolarized Noble Gas and Inert Fluorinated Gas MRI of Lung Disorders (United States)


    Lung Transplant; Lung Resection; Lung Cancer; Asthma; Cystic Fibrosis; Chronic Obstructive Pulmonary Disease; Emphysema; Mesothelioma; Asbestosis; Pulmonary Embolism; Interstitial Lung Disease; Pulmonary Fibrosis; Bronchiectasis; Seasonal Allergies; Cold Virus; Lung Infection; Pulmonary Hypertension; Pulmonary Dysplasia; Obstructive Sleep Apnea

  6. Bronchogenic Carcinoma after Lung Transplantation: A Case Report and Literature Review%肺移植术后肺癌1例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    王烨铭; 陈静瑜


    Background and objective Lung transplantation is an efficient therapeutic option for patients with end-stage pulmonary diseases, but less is known about lung cancer after lung transplantation.The aim of this study is to improve the awareness, diagnosis and treatment of bronchogenic carcinoma after lung transplantation with a case report and related literatures.Methods We reported a 65-year-old male with idiopathic pulmonary fibrosis (IPF) who underwent right lung transplantation under extracorporeal membrane oxygenation (ECMO) support in May 2007 in our hospital.The patient recovered smoothly and discharged from the hospital 46 days after the procedure with regular follow-up.Immunosuppression therapy was triple drug maintenance regimen including tacrolimus (Tac), mycophenolate mofetil (MMF) and steroids.Results Small cell lung cancer in the left lung with multiple osseous metastases was found 13 months after the lung transplantation.Symptoms were relieved a bit by administering chemotherapeutics (etoposide and cisplatin) for 4 cycles.However, the patient was succumbed to his illness within 11 months after the diagnosis of lung cancer.Conclusion Lung cancer after lung transplantation has been suggested as one of causes of late mortality with the risk factors such as chronic obstructive pulmonary disease (COPD), IPF, cigarette smoking history and imrnunosuppression etc.Early diagnosis and treatment are very important to improve the prognosis.%背景与目的 肺移植是治疗终末期肺部疾病的有效手段,然而对肺移植术后肺癌却缺乏了解.我们通过对1例肺移植术后肺癌患者临床资料的报道,并结合相关文献复习,以提高对肺移植术后肺癌的认识、诊断及治疗水平.方法 2007年5月我院为一例65岁、术前诊断为两肺特发性肺间质纤维化(idiopathic pulmonary fibrosis,IPF)的男性患者在体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)辅助下成功进行了

  7. Improvement of rat model of orthotopic left lung transplantation%改良三袖套吻合法建立大鼠左肺原位移植模型及其鉴定

    Institute of Scientific and Technical Information of China (English)

    朱宏伟; 吴镜湘; 徐美英


    Objective To improve the cuff-like vessel anastomosis technique-based rat model of lung transplantation, and establish a simple and stable rat model of orthotopic left lung transplantation. Methods Based on preliminary experiments,improvement was made from cuff-like vessel anastomosis technique-based rat model of lung transplantation on the following aspects: lungs were extracted from donors through median sternotomy, and were perfused through cut at the cone of the pulmonary artery with low pressure; blood vessel clamps were used to fix the rear part of pipe; micro left auricular clamps were used to clamp lung hilum instead of removing “sick lung” to complete tallies; respiratory tract management was enhanced. The new model was evaluated by successful rate of operation, time of operation, transplanted lung function and pathological changes. Results Ten consecutive rat models of orthotopic left lung transplantation were completed, with the successful rate of 80%. The time of donor lung perfusion-harvest, donor lung vessel anastomosis and recipient vessel anastomosis was (12±2) min, (18 ± 3) min and (31 ± 3) min, respectively. The oxygenation index 15 min after reperfusion was significantly higher than that 30 min after single lung ventilation (P <0.05). The typical pathological changes of ischemiareperfusion injury were confirmed by pathological examinations 2 h after reperfusion. Conclusion The improved rat model of orthotopic left lung transplantation has been successfully established, which is simple and effective.%目的 对三袖套吻合法建立的大鼠肺移植模型进行改进,建立操作简便和稳定有效的大鼠左肺原位移植模型.方法 在预实验的基础上,对三袖套吻合法建立的大鼠肺移植模型进行以下改进:供体采用胸骨正中切口,经肺动脉圆锥处进行低压肺灌注;制作"袖套"时用无损伤血管夹固定套管尾部;套入"袖套"时用无创显微心耳钳钳夹住左肺门,在不离

  8. Ultrastructural and Immunohistochemical Studies of Transplanted Canine Lung Carcinoma Cell to Severe Combined Immunodeficiency Mice (STUDI ULTRASTRUKTUR DAN IMUNOHISTOKIMIA TRANSPLANTASI SEL KANKER PARU-PARU ANJING PADA MENCIT SEVERE COMBINED IMMUNODEFF

    Directory of Open Access Journals (Sweden)

    Dwi Kesuma Sari


    Full Text Available Primary lung cancers, or tumors originating in the lung, are relatively uncommon in dogs. The objectiveof this study was to describe the canine lung carcinoma that serially transplanted into severe combinedimmunodeficiency (SCID mice, in order to established cell line from this tumor cell.  Morphology andcharacteristic of this canine lung carcinoma in SCID mice by histopathological and ultrastructuralexaminations with metastatic lesion in lung were also examined.  Histopathologically, the tumor masswere consisted of cuboidal to columnar cells with papillary pattern, uniform in size, the nuclei were oftenvariable in size, and some cells have vacuole on their cytoplasms.  Glandular forms were predominant withlobulated pattern, ductal pattern with papillary injected into tube-like structure were also encountered.Mitotic figures commonly found with inflammatory reaction were sometimes present in the interstitiumand lumen gland.  Ultrastructural analysis of the tumor cells showed round to oval cells with one or moreprominent nucleoli.  The cells possessed numerous mitochondria, smooth endoplasmic reticulum, andindividual cells which were interconnected via desmosomes.  Tonofilament characterize by long cytoplasmicmaterial was encountered.  Positive reaction of the round to oval tumor cells to anti keratin antibodyconfirmed that their epithelial cell nature.  Lung metastatic lesions were found in SCID mice aftertransplantation and this phenomenon indicated that canine lung carcinoma is tumorigenic to SCID mice.

  9. Organ transplantation in Bulgaria. (United States)

    Naumova, Elissaveta; Panchev, Petar; Simeonov, Pencho J; Mihaylova, Anastassia; Penkova, Kalina; Boneva, Petia; Marinova, Daniela; Paskalev, Emil; Simeonov, Petar L; Zlatev, Assen


    The transplantation program in Bulgaria started in 1968 with renal transplantations to a child and adult woman. In 1986 the first heart transplantation was performed. To date a total of 10 heart transplants have been performed, including one combined heart/lung. A liver transplantation program was launched in 2005 with a total number of 16 transplantations-7 from living donors and 9 from deceased donors. The highest transplantation activity is registered in the field of renal transplantation. During the period 1980-2006, 462 Bulgarian recipients of kidney were transplanted in Bulgaria. The ratio between transplantations from deceased and living related donors is approximately 1:0.9. Annual transplantation activity varies among the years from 1 to 12 renal transplantations p.m.p./per year. The 1- (80.7% vs. 63.1%), 5- (57.86% vs. 39.0%) and 10-year (42.65% vs. 23.62%) graft survival rates are higher for recipients of living donor kidneys compared to those of deceased donor. In 1983 a National kidney waiting list was established. Currently the number of the registered patients eligible for renal transplantation is 885. The proportion of sensitized patients in the waiting list is 20.45% and 4.34% of them are hyperimmunized. Recently HLAMatchmaker program has been implemented not only for sensitized patients but also for those with rare alleles and haplotypes. Post-transplant immunological monitoring showed a strong association between alloantibody presence and delayed graft function (Chi-square=10.73, P<0.001), acute rejection (Chi-square=14.504, P<0.001), chronic rejection (Chi-square=12.84, P<0.001) and graft loss (Chi-square=20.283, P<0.001). Based on the experience in our transplant center a strategy for improvement of long-term renal graft survival was developed and implemented.

  10. Liver transplant (United States)

    Hepatic transplant; Transplant - liver; Orthotopic liver transplant; Liver failure - liver transplant; Cirrhosis - liver transplant ... The donated liver may be from: A donor who has recently died and has not had liver injury. This type of ...

  11. A new rabbit model for study of lung preservation

    Institute of Scientific and Technical Information of China (English)

    FU Qing-lin; ZHANG Xin-zhong; HAN Pei-li; SHI Rui-feng; CUI Yu; Zhang Jie


    @@ In 1983,Cooper successfully performed the first case of right lung transplantation for a patient with end stage pulmonary fibrosis and long survival was achieved, which confirmed that lung transplantation is feasible clinically.

  12. Is Waiting the Hardest Part? Comparing the Emotional Experiences of Awaiting and Receiving Bad News. (United States)

    Sweeny, Kate; Falkenstein, Angelica


    Awaiting uncertain news is stressful, but is it more stressful than receiving bad news? We compared these emotional experiences in two studies. Participants in Study 1 reflected on a personal experience awaiting news that ultimately turned out badly, and participants in Study 2 were law graduates awaiting their results on the bar exam who ultimately failed the exam. In Study 1, participants were ambivalent as to whether awaiting or receiving bad news was more difficult, and emotion ratings in both studies confirmed this ambivalence. Anxiety was higher in anticipation of bad news (at least at the moment of truth) than in the face of it, whereas other negative emotions were more intense following the news than during the waiting period. Thus, whether waiting is "the hardest part" depends on whether one prefers to be racked with anxiety or afflicted with other negative emotions such as anger, disappointment, depression, and regret.

  13. 同种异体单肺移植7例报告%Allogeneic single lung transplantation in 7 cases

    Institute of Scientific and Technical Information of China (English)

    刘德若; 张海涛; 梁朝阳; 王在永; 陈京宇; 鲍彤; 张真榕; 辛育龄; 郭永庆; 赵风瑞; 李福田; 葛炳生; 石彬; 田燕雏; 宋之乙; 寿延宁


    总结7例同种异体单肺移植资料的移植方案、肺保存及移植后管理监测情况.7例同种异体单肺移植患者中特发性肺纤维化3例,慢性阻塞性肺病2例,双侧矽肺、肺气肿1例,双肺结核右毁损肺1例.7例供体均为脑死亡者,供肺均采用Euro,Colins液或低钾右旋糖酐液灌注并良好保存.受体与供体血型匹配,5例患者行右侧单肺移植,2例行左侧单肺移植.肺支气管、肺动脉为端端吻合,肺静脉为心房-心房吻合.移植前后均常规应用抗牛素和免疫抑制剂.肺移植后进行全面指标监测,包括心肺功能、抗生素使用及免疫抑制药物的调整.7例患者均未出现支气管、肺动静脉吻合口并发症.5例移植后2个月内死亡,1例存活近1年,另1例存活近2年.死亡者中4例死于肺感染导致多脏器功能衰竭,1例死于多曲霉菌感染致严重肺出血.6例移植后出现排斥反应,其中1例出现3次.肺移植手术适应证的选择、供肺的选择和保存、肺移植操作以及移植前后的管理已逐渐成熟,移植前心肺功能差者、移植后使用免疫抑制药物同时合并严重感染者病死率仍很高.%The present case report was designed to summarize the clinical experience of operative technique. lung preservation, lung perfusion, and perioperative management. Of 7 cases who underwent allogenic single lung transplantation (LT), 3 were idiopathic pulmonary fibrosis, 2 were chronic obstructive pulmonary disease, 1 was silicosis, emphysema, and bulla, and I was tuberculosis in both sides and presented with destroyed lung in one side. All donors were already brain death. Donor lungs were well preserved utilizing Euro-Colins liquid or low-potassium dextran solution. Donors and recipients were matched in blood type. Of 7 cases selected,5 received single right lung transplantation, and 2 received single left LT. End-to-end anastomosis was performed for pulmonary branches and pulmonary arteries. while

  14. 肺移植后OB动物模型的研究进展%Progress on animal model of bronchiolitis obliterans after lung transplantation

    Institute of Scientific and Technical Information of China (English)



    肺移植(lung transplantation,LT)已成为治疗终末期肺疾病患者生命的一个重要手段.细支气管闭塞综合征(bronchiolitis obliterans syndrome,BOS)作为LT术后的一种并发症广泛存在,其特征性病理表现为闭塞性细支气管炎(obliterative bronchiolitis,OB):细支气管周围有淋巴细胞浸润,最终导致纤维瘢痕的形成和细支气管闭塞.理想的动物模型有助于研究的进一步开展.目前,研究肺移植缺少一种理想的动物模型.了解肺移植后闭塞性细支气管炎的发病机制,有助于改善肺移植病人的生活质量,延长肺移植后患者生存率.本研究23将就肺移植后的闭塞性细支气管炎模型做一综述.

  15. 体外膜肺氧合在临床肺移植中的应用%Application of ECMO in lung transplantation

    Institute of Scientific and Technical Information of China (English)

    胡春晓; 郑明峰; 王雁娟; 陈静瑜; 许波; 王志萍


    目的 总结体外膜肺氧合(ECMO)技术在临床肺移植中应用的经验.方法 45例肺移植受者,年龄(50.5±8.6)岁(16~74)岁.原发病为肺纤维化合并肺动脉高压32例,慢性阻塞性肺病4例,矽肺2例,肺结核2例,弥漫性细支气管炎1例,支气管扩张2例,以及原发性肺动脉高压2例.其中3例受者在术前经股动、静脉切开置ECMO管道,分别维持13、19和6d后,在ECMO支持下接受了肺移植手术;40例受者在术中应用了ECMO辅助;2例未在体外循环下接受肺移植的受者,因原发性移植物功能丧失(PGD)于术后行ECMO辅助支持.结果 40例术中应用ECMO者,37例于术毕顺利撤除ECMO,术中辅助流量为(2.8±0.6)L/min,辅助持续时间为(7.7±0.9)h,存活31例;3例术后继续使用ECMO,直至血流动力学稳定,其中2例分别于术后36 h和7d时顺利撤除,另1例术后使用ECMO维持5d后出现急性肾功能衰竭,术后2周时死于多器官功能衰竭.2例术中无体外循环辅助受者和其余3例术中辅助受者因术后发生PGD或急性心力衰竭,而初次或再次使用ECMO,辅助流量分别为(2.5±0.3)L/min和(2.6±0.4)L/min,辅助持续时间分别为(53.5±21.9)h和(88.7±45.9)h,其中3例治愈出院,2例因多器官功能衰竭而死亡.所有受者均未发生明确与ECMO相关的并发症.结论 ECMO是肺移植围手术期支持的重要辅助工具,对于降低等待肺移植过程中的死亡率、稳定术中血流动力学、改善术后严重呼吸功能障碍以及原发性移植物功能不良,可以提供良好的辅助功能.%Objective To summarize the experiences of extracorporeal membrane oxygenation (ECMO) technique in human lung transplantation. Methods ECMO was used in 45 patients undergoing lung transplantation.There were 32 cases of dilated pulmonary fibrosis and pulmonary hypertension,4 cases of chronic obstructive pulmonary disease,2 cases of pneumosilicosis,2 cases of phthisis,one case of diffuse panbronchiolitis,2

  16. Bone marrow transplant (United States)

    Transplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant; Reduced intensity nonmyeloablative transplant; Mini transplant; Allogenic bone marrow transplant; Autologous bone marrow transplant; Umbilical ...

  17. 体外膜肺氧合在肺移植围手术期的应用30例%Perioperative application of extracorporeal membrane oxygenation (ECMO) in lung transplantation

    Institute of Scientific and Technical Information of China (English)

    郑明峰; 陈静瑜; 朱幸沨; 何毅军; 张稷; 叶书高; 刘峰; 陈若; 卫栋


    Objective To explore the perioperative application of extracorporeal membrane oxygenation (ECMO) in lung transplantation. Methods Thirty patients with primary and end-stage pulmonary disease accompanied by pulmonary hypertension were subjected to operation under the accessory of ECMO. Eighteen patients received single-lung transplantation and 12 patients bilateral sequential lung transplantation without sternal division in our hospital from November 2005 to July 2009. In 2 patients ECMO was given before operation and maintained for 19 days and 6 days respectively. In the remaining patients, ECMO pipeline was placed after anesthesia. After lung trarnsplantation,ECMO was removed after the recipients' oxygen saturation and hemodynamics were stable. Results In all recipients lung transplantation was successfully done. ECOM was removed in 27recipients after operation, and the rest 3 recipients were supported by ECMO after operation: the ECMO was removed at 36th h and 7th day after lung transplantation in two patients respectively,and another one was supported by ECMO for 5 days after operation and suffered acute kidney failure, and died of multiple organ failure 2 weeks post-transplantation. Two recipients were infected in thigh arteriovenous cut and one suffered femoral artery thrombosis, but all of them got better and discharged from hospital after treatment. Conclusion ECMO can be used for lung transplantation on patients with primary and secondary pulmonary hypertension. The complications may be associated with patients'serious condition and unstable hemodynamics. Early detection and active and effective treatment can improve patient's prognosis.%目的 总结体外膜肺氧合(ECMO)在肺移植围手术期应用的经验.方法 30例原发性终末期肺病伴继发性肺动脉高压的患者在肺移植术中应用了ECMO,其中单肺移植18例,不横断胸骨序贯式双肺移植12例.在术前使用ECMO维持者2例,分别维持19 d和6 d;其他患者在麻醉


    NARCIS (Netherlands)

    UYAMA, T; Winter, Jobst B.; GROEN, Greetje; WILDEVUUR, Charles R.H.; MONDEN, Y; PROP, J


    Airway disease after lung or heart-lung transplantation is one of late major complications, affecting the prognosis of the transplants. Little is known about the causes of airway changes. We performed rat lung transplantation and investigated the late airway changes of the long-term surviving lung g

  19. EBV-positive mucocutaneous ulcer in organ transplant recipients: a localized indolent posttransplant lymphoproliferative disorder. (United States)

    Hart, Melissa; Thakral, Beenu; Yohe, Sophia; Balfour, Henry H; Singh, Charanjeet; Spears, Michael; McKenna, Robert W


    Epstein-Barr virus (EBV)-positive mucocutaneous ulcer (EBV MCU) is a B-cell lymphoproliferative disorder occurring in elderly or iatrogenic immunocompromised patients. It has not been reported in solid organ transplant recipients. We observed 7 patients with EBV MCU in a cohort of 70 transplant recipients with EBV posttransplant lymphoproliferative disorder (PTLD). Transplants included: 5 renal, 1 heart, and 1 lung. Median patient age was 61; 5 were male. EBV MCU was observed in oral mucosa in 4 and gastrointestinal tract in 3. Duration of immunosuppressive therapy before EBV MCU was 0.6 to 13 years. Ulcers were undermined by inflammatory cells and polymorphic or monomorphic large cell lymphoproliferation. Reed-Sternberg-like cells were present in 5/7. Large B cells were CD20, CD30, and EBV-encoded RNA positive in all cases. Diagnosis in 3 recent patients was EBV MCU; 4 patients diagnosed before familiarity with EBV MCU were classified as monomorphic large cell (n=3) and polymorphic (n=1) PTLD. None of the patients had EBV DNA in their blood (<1000 copies/mL) at diagnosis or follow-up versus 35/44 transplant patients with systemic PTLD (P<0.001). All lesions resolved with reduced immunosuppression (7/7), change in immunosuppression (2/7), and rituximab (3/7). Five patients are living: 4 healthy, 1 awaiting second renal transplant. Two patients died 3 and 5 years after resolution of EBV MCU. No patient recurred with EBV MCU or other PTLDs. EBV MCU mimics more aggressive categories of PTLD but lacks EBV DNA in blood, which may be a useful distinguishing feature. Lesions are likely to resolve with conservative management. Awareness of EBV MCU in the posttransplant setting is necessary for appropriate diagnosis and treatment.

  20. Hair Transplants (United States)

    ... to Choose the Best Skin Care Products Hair Transplants What are hair transplants? In punch transplanting, a plug containing hair follicles ... should first be done before considering a hair transplant? Before the procedure, an ASDS doctor will review ...

  1. Perfusão pulmonar anterógrada "versus" retrógrada na preservação pulmonar para transplante em modelo canino de viabilidade pulmonar pós-morte Antegrade versus retrograde lung perfusion in pulmonary preservation for transplantation in a canine model of post-mortem lung viability

    Directory of Open Access Journals (Sweden)

    Jean Carlo Kohmann


    reperfusão (p = 0,01 e ao término do período de avaliação (p = 0,01. Os autores concluem que, neste modelo experimental, a perfusão retrógrada hipotérmica resulta em função superior do enxerto após 3 horas de isquemia normotérmica sob ventilação mecânica.Lung retrieval following cardio-circulatory arrest has been studied experimentally, however severe ischemia/reperfusion injury requires improved methods of graft preservation. Allograft perfusion with crystalloid solution delivered via pulmonary artery (antegrade perfusion remains the standard procedure, however it does not provide adequate washout of the blood retained within the bronchial circulation which may trigger reperfusion injury. This has led the authors to test the impact of antegrade versus retrograde (via left atrium perfusion of lung grafts submitted to 3 hours of warm ischemia after cardio-circulatory arrest in a dog model of left lung allotransplantation. Twelve donor dogs were sacrificed with thiopental sodium and kept under mechanical ventilation at room temperature for 3 hours. They were randomized and the heart-lung blocks harvested after being perfused in a retrograde (group I, n = 6 or antegrade (group II, n = 6 fashion with modified Euro-Collins solution. Twelve recipient animals were submitted to a left lung transplant receiving the grafts from both groups and the assessment was performed during 6 hours. Hemodynamic parameters were similar for animals in both groups. The gas exchange (arterial PaO2 and PaCO2 in recipients of group I (retrograde perfusion was significantly better when compared to recipients of grafts perfused via pulmonary artery. Intracellular ATP did not show difference between the groups, however there was a measurable drop in its values when samples obtained upon extraction were compared to those measured after reperfusion and at the end of the assessment. The authors concluded that retrograde perfusion yields better pulmonary function after 6 hours of reperfusion

  2. Effect of heart cooling on hemodynamics during one lung transplantation%单肺移植术中心脏局部低温对血流动力学的影响

    Institute of Scientific and Technical Information of China (English)

    李颖芬; 陈德坚; 陈剑锋; 董庆龙


    目的:观察非体外循环下行单肺移植术,术中供肺吻合时局部心脏低温对血流动力学的影响。方法26例终末期肺疾病患者,气管插管全身麻醉下行肺移植术。取第一侧患肺切除术后供肺吻合前(T0)、供肺吻合中心脏局部低温30min(T1)、供肺吻合中心脏局部低温60min(T2)作为观察时点,比较各时点的血流动力学数据。结果与T0比较,T1、T2的食管温和血温明显降低,T1、T2的心输出量(CO)和心脏指数(CI)明显降低。结果与T0比较,T1、T2的TE和TB明显降低,T1、T2的心输出量(CO)和心脏指数(CI)明显降低。结论单肺移植术中供肺吻合时,单侧肺通气、全身常温、心脏局部低温这一特殊麻醉状态下,尽管已对患者做了相应的保温及药物干预措施,对血流动力学的影响不大,但仍会出现心泵功能下降。%Objective To observe the hemodynamics during lung transplantation without cardiopulmonary bypass, when the donor lung was implantated and local heart cooling was performed. Methods Twenty-six patients with end-stage lung disease, undergone single or bilateral sequential lung transplantation with tracheal intubation general anesthesia. During the first lung transplantation, the temperature of esophagus(TE) and of blood(TB), the hemodynamic dates such as PAP, PCWP, CCO, CI, SVI were recorded at sick lung resection(T0), 30 minutes after the beginning of lung implantation(T1), and 30 minutes after T1 (T2). Results Compared with T0,TE and TB decreased at T1(P<0.05) and at T2(P < 0.05). CO and CI decreased significantly at T1 and T2 compared with T0(P < 0.05). Conclusion During the implantation of lung transplantation, in the status of one-lung ventilation, ordinary temperature all over the body but heart cooling, even though have administrated with incubation and vasoactive drug, hemodynamic dates seem stable, but cardiac pump function is decrease.

  3. Feasibility and Effectiveness of a Home-Based Exercise Training Program Before Lung Resection Surgery

    Directory of Open Access Journals (Sweden)

    Valérie Coats


    Full Text Available BACKGROUND: Patients with lung cancer often experience a reduction in exercise tolerance, muscle weakness and decreased quality of life. Although the effectiveness of pulmonary rehabilitation programs is well recognized in other forms of cancers and in many pulmonary diseases, few researchers have studied its impact in patients with lung cancer, particularly in those awaiting lung resection surgery (LRS.

  4. Multidrug-resistant tuberculosis in transplant recipients: Case report and review of the literature. (United States)

    Huaman, Moises A; Brawley, Robert; Ashkin, David


    Transplant recipients are at increased risk of tuberculosis (TB). We describe a case of pulmonary and vertebral multidrug-resistant TB (MDR-TB) in a kidney transplant patient who required neurosurgical intervention and unfortunately developed fatal nosocomial complications. Thirteen transplant recipients with MDR-TB were previously reported in the literature (one hematopoietic cell transplant, one heart transplant, one lung transplant, one heart-lung transplant, and nine kidney transplant recipients). Extrapulmonary disease, severe treatment complications, and deaths were observed in patients who developed MDR-TB after transplantation.

  5. Influence of ischemic post-conditioning on the lipid peroxidation after lung transplantation in canis%缺血后处理对供体犬肺再灌注损伤的影响

    Institute of Scientific and Technical Information of China (English)

    鲁建军; 张伟; 姚达; 秦存伟; 罗红鹤; 钟佛添; 巫国勇


    目的 观察供体犬肺再灌注后早期脂质过氧化反应的变化,了解缺血后处理对供体犬肺植入后功能的影响.方法 随机选取12对比咯犬,组成供、受体,随机分成2组.对照组:6对犬,按常规进行供受体左侧异体单肺移植,不予缺血后处理的干预.缺血后处理组:6对犬,进行供受体常规左侧异体单肺移植,再灌注早期实施3个周期的10 s再灌-10 s再阻断、总时程1 min的缺血后处理.于供肺再灌注后1、2 h两个时间点采集供肺标本检测超氧化物歧化酶(SOD)的活性、丙二醛(MDA)的含量.光镜下观察供肺植入后1、2 h两个时间点肺组织的病理变化.结果 术后实验犬均存活.植入供体肺平均用时(35.92±1.73)min.缺血后处理组在1、2h时间点的供肺组织SOD活性水平较对照组升高、MDA含量较对照组减低,差异有统计学意义(P<0.05).缺血后处理组肺组织光镜下观察在各时间点的炎症反应均较对照组的变化轻微.结论 缺血后处理可以抑制再灌注时氧自由基的堆积,从而减少供肺的缺血冉灌注损伤,改善供肺植入后的功能.%Objective Ischemia-reperfusion injury may occur in the donor lung during lung transplantation. As a response to ischemia-reperfusion injury, ischemic post-conditioning provides an intrinsic protection. The study was aimed at identifying the influ-ence of ischemic post-conditioning on the function of donor lung in dogs by measuring the changes of lipid peroxidation during early reperfusion. Methods Twelve orthotopic left lung transplantations were performed by using 24 paired dogs. The animals were divided randomly into the ischemic post-conditioning group and the control group. For dogs (6 pairs) in the control group, no intervention of ischemic post-conditioning was performed during routine left lung transplantation, for the rest dogs in the ischemic post-conditioning group, 3 cycles of iscbemic post-conditioning with reperfusion(for 10

  6. Utilização de endoprótese metálica no tratamento de estenose brônquica após transplante pulmonar Treatment of bronchial stenosis after lung transplantation using a self-expanding metal endobronchial stent

    Directory of Open Access Journals (Sweden)

    Marcos Naoyuki Samano


    Full Text Available As complicações decorrentes da anastomose brônquica nos transplantes pulmonares, embora tenham diminuído ao longo do tempo, ainda figuram como um dos principais fatores de morbi-mortalidade nesses pacientes. As formas de tratamento dessas complicações incluem dilatação por balão, fotocoagulação por laser, endopróteses de silicone e metálicas, e reoperação. Relata-se o caso de um paciente que apresentou estenose brônquica após transplante pulmonar unilateral esquerdo, cujo tratamento foi realizado com endoprótese metálica auto-expansível de nitinol (Ultraflex®. Embora seja um caso pioneiro no Brasil, a boa resposta clínica, concordante com os dados da literatura, sugere que esse tratamento seja uma boa alternativa nesses casos.Although the incidence of bronchial anastomosis as a complication of lung transplantation has decreased in recent years, it remains a significant cause of morbidity and mortality in these patients. Treatment options include balloon dilatation, laser photocoagulation, placement of a stent (silicone or metal, and performing a second operation. We report the case of a patient who presented bronchial stenosis after left lung transplantation and was treated with a self-expanding metal alloy (nitinol stent (Ultraflex®. Despite the fact that this was the first case of stenosis treated in this fashion in Brazil, the positive clinical response, in agreement with results reported in the literature, indicates that this treatment is a viable alternative in such cases.

  7. Relationship between the expression of Toll-like receptor 2 and 4 in mononuclear cells and postoperative acute lung injury in orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    CHI Xin-jin; CAI Jun; LUO Chen-fang; CHENG Nan; HEI Zi-qing; LI Shang-rong; LUO Gang-jian


    Background The aim of this study was to investigate the potential relationship between the dynamic expression of Toll-like receptor 2 and 4 (TLR2/4) in peripheral blood mononuclear cells as well as changes in serum concentration of inflammatory factors and acute lung injury (ALl) in patients after orthotopic liver transplantation (OLT).Methods The peripheral blood samples of 27 patients (23 men and 4 women with ASA Ⅲ to Ⅳ) who received OLT were collected for measurement of TLR2/4 at T1 (after induction of anesthesia), T2 (25 minutes after anhepatic phase), T3 (3 hours after graft reperfusion) and T4 (24 hours after graft reperfusion). The expression of TLR2/4 in mononuclear cells was measured by flow cytometry. The serum concentrations of tumor necrosis factor (TNF)-a, intedeukin (IL)-113 and IL-8 were measured by enzyme-linked irnmunosorbent assay (ELISA). Twenty-seven patients were assigned to ALI group (n=9) and non-ALI group (n=18) according to the diagnostic criteria of ALI. The expression of TLR2/4 in the ALl group or non-ALI group was analyzed.Results Compared to the non-ALI group, the volumes of blood loss, ascites, total output and transfused red blood cells were higher in the ALI group, and the anhepallc phase lasted longer (P0.05). The expression of TLR2/4 in mononuclear cells increased significantly at T3 and 14 in the ALI group (P<0.05, P<0.01). A positive correlation was noted between the expression of TLR4 in mononuclear cells and the serum concentrations of TNF-α, IL-1β (P=0.041, P=0.046) in the ALl group. In the non-ALI group, statistical results showed that the expression level of TLR2/4 in mononuclear cells was not significantly different during the peri-operative period of OLT (besides TLR4 expression at T4). Compared to the non-ALI group, the increasing amplitude of TLR2/4 expression in mononuclear cells was more significant in the ALI group. The patients whose TLR2/4 expression in mononuclear cells exceeded that at T1 by one time were

  8. Imaging in transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Bankier, A.A. (ed.) [Harvard Medical School, Boston, MA (United States). Beth Israel Deaconess Medical Center


    This book covers all topics related to the imaging of organ transplantation. An introductory section addresses such issues as organ procurement, patient selection, immune responses, and ethical and economic considerations. The main part of the book then offers in-depth coverage of heart, renal, liver, lung, bone marrow and pancreatic and intestinal transplantation. Each of these topics is discussed firstly in a clinical chapter and then in a radiological chapter. The clinical chapters detail the epidemiology, clinical background, and surgical procedures, as well as any clinically relevant issues of which the radiologist should be aware. The radiological chapters describe and depict the imaging manifestations of specific organ transplantations, document the normal radiological appearance of transplanted organs and consider both early and late complications. This is a unique, superbly illustrated volume that will be of great assistance to all who work in this field. (orig.)

  9. Matching the Market for Heart Transplantation. (United States)

    Hsich, Eileen M


    Heart transplantation is the most effective therapy for patients with Stage D heart failure with a median life expectancy of ≈10 to 15 years. Unfortunately, many patients die on the waiting list hoping for a chance of survival. The life boat cannot rescue everyone. Over a decade, the donor pool has remained relatively stable, whereas the number of heart transplant candidates has risen. Potential recipients often have many comorbidities and are older because the criteria for heart transplantation has few absolute contraindications. Women, Hispanics, and patients with restrictive heart disease and congenital heart disease are more likely to die while awaiting heart transplantation than men, white patients, and those with either ischemic or dilated cardiomyopathy. To better match the market, we need to (1) increase the donor pool, (2) reduce the waitlist, and (3) improve the allocation system. This review article addresses all 3 options and compares strategies in the United States to those in other countries.

  10. Cornea Transplant (United States)

    ... died from an unknown cause. During your cornea transplant On the day of your cornea transplant, you' ... when you see your eye doctor. Procedures to transplant a portion of the cornea With some types ...

  11. Transplant rejection (United States)

    ... this page: // Transplant rejection To use the sharing features on this page, please enable JavaScript. Transplant rejection is a process in which a transplant ...

  12. Pulmonary surfactant and lung transplantation

    NARCIS (Netherlands)

    Erasmus, Michiel Elardus


    Pulmonary surfactant lowers the surface tension at the air-water interface inside the alveolus. This is achieved by adsorption of surfactant phospholipids at the air-water interface, a process controlled by surfactant-associated proteins, such as SP-A. In this way, surfactant prevents collapse of th

  13. The impact of kidney transplantation on insulin sensitivity

    DEFF Research Database (Denmark)

    Jørgensen, Morten B; Hornum, Mads; van Hall, Gerrit


    OBJECTIVE: To investigate the impact of kidney transplantation (KTx) on insulin sensitivity affecting glucose metabolism. METHODS: Nine non-diabetic patients awaiting living donor KTx were examined prior to transplantation with an oral glucose tolerance test and a 3h hyperinsulinaemic euglycaemic...... as mean [range]. RESULTS: Two patients had pre-transplant prediabetes whereas all others had normal glucose tolerance. After KTx, average glucose infusion rate to maintain euglycaemia during clamp declined significantly from 15.1 [9.1 - 23.7] to 9.8 [2.8 - 14.6] μmol kg(-1) min(-1) (P

  14. Breast Cancer Worry among Women Awaiting Mammography: Is It Unfounded? Does Prior Counseling Help?


    Steinemann, Susan K; Chun, Maria BJ; Huynh, Dustin H; Loui, Katherine


    The purpose of this study was to explore the prevalence of breast cancer anxiety and risk counseling in women undergoing mammography, and the association with known risk factors for cancer. Women awaiting mammography were surveyed regarding anxiety, prior breast cancer risk counseling, demographic and risk factors. Anxiety was assessed via 7-point Likert-type scale (LS). Risk was defined by Gail model or prior breast cancer. Data were analyzed by nonparametric methods; significance determined...


    NARCIS (Netherlands)



    Lung transplant recipients suffer from a high number of viral infections. It has been suggested that the defense against viral infections is impaired in lung transplants, Therefore, we investigated in rat lung transplants whether antibody responses against an intrapulmonary viral infection were impa

  16. The analysis of the whole body gamma knife treatment for lung metastasis after liver transplantation%肝癌移植术后肺内转移的体部伽玛刀应用分析

    Institute of Scientific and Technical Information of China (English)

    赵品婷; 卢少平; 梁昉; 邵秋菊; 梁军


    Objective : To evaluate the effects of radiation therapy for lung metastasis after liver transplantation. Methods : From November 2004 to October 2009 , 12 cases of lung metastasis after liver transplantation were treated with OUR -QCD whole body gamma knife. The target volumes were surrounded with 50% - 80% isodose curve, and the doses were 18 - 42Gy/3 -8f,3f/w. The max doses were 12 - 14Gy in the center of tumor,and the doses of the normal tissue were lower 2 Gy per time outside PTV. The volume of normal tissue exposed was controled with dose volume histogram ( DVH) . Results : After 3 months , the total local control rate was 91. 7% , which were evaluated by CT images. The median survival time was 10 months. No radiation pneumonitis above gradeⅢ occurred. Conclusion : Three - dimensional conformal radiation therapy for liver transplantation in patients with lung metastasis was effective. Three - dimensional conformal radiation therapy of more lesions and/or multiple times was still effective.%目的:探讨肝癌移植术后肺内转移的体部伽玛刀治疗方法及其效果.方法:2004年11月-2009年10月,应用体部伽玛刀治疗肝癌移植术后肺内转移患者12例.应用50%-80%等剂量曲线包绕靶区,剂量18-42Gy/3-8次,3次/周.肿瘤中心最大剂量12-14Gy、PTV外的正常组织在2 Gy/次以下;应用剂量体积直方图(DVH)减少正常组织受照体积.结果:治疗后3月复查CT,总局部控制率91.7%(11/12).中位生存时间10个月.无Ⅲ级以上放射性肺炎.结论: 三维适形放射治疗对于肝癌移植术后肺内转移患者有较好的疗效,多病灶、多次治疗仍具较好疗效.

  17. Pancreatic transplantation

    Directory of Open Access Journals (Sweden)

    Åke Andrén-Sandberg


    Full Text Available A pancreas transplant is a surgical procedure to place a healthy pancreas from a donor into a patient whose pancreas no longer functions properly. Exocrine pancreas transplantation remains the standard treatment of choice for patients with diabetes mellitus complicated by end-stage renal disease. The use of pancreas transplantation for type 2 diabetes mellitus is an emerging concept. A pancreas transplant is often done in conjunction with a kidney transplant. Even if pancreas transplantation provides the best glycemic control option for diabetes mellitus, it is associated with significant morbidities related to infectious disease. The present article provides with a review of pancreatic transplantation.

  18. Treatment of addictive behaviors in liver transplant patients. (United States)

    Weinrieb, Robert M; Lucey, Michael R


    Very little addiction treatment research has been done concerning smoking cessation, illicit drugs, or even alcohol abuse in liver transplant patients. Our data suggest that a surprising number of patients who are awaiting a liver transplant for alcohol-related end-stage liver disease will return to drinking before transplantation. We found that motivational enhancement therapy afforded no marked benefit over treatment as usual for drinking, smoking, mood, or general health outcomes in alcoholics awaiting liver transplantation. Stably abstinent methadone-maintained opiate-dependent patients should not be tapered off methadone; are generally good candidates for liver transplant; show low relapse rates into illicit use of opiates; and may be at risk for more medical complications than their counterparts. Pre- and posttransplantation smoking rates are high and cause marked morbidity and mortality. Transplant teams should encourage smoking cessation treatments.Marijuana use in liver transplant recipients is not uncommon, and apart from the risk of developing aspergillosis, additional health risks have not yet been identified.

  19. 肾移植术后受者肺部感染的病原菌分布及耐药性分析%Analysis of distribution and drug resistance of pathogens causing lung infecions in patients after renal transplantation

    Institute of Scientific and Technical Information of China (English)

    瞿亚红; 宋文慧; 周程程; 范明亮


    Objective :To investigate the distribution of pathogens and drug resistance in patients with lung infe-tions after renal transplantation. Methods; 538 sputum specimens, which were taken from patients with lung infection after renal transplantation in our hospital from October 2006 to September 2010, were conducted routine micro-culture and susceptibility test, then the test results were analyzed in statistics. Results; A total of 197strains of pathogens were isolated from the 538 cases. Among them, 85 Gram - negative bacilli(43.15% ) , 59 Cram -positive cocci (29.95% ) , 46 fungus(23. 35% ) and 7(3.55% ) other strains were identified. Of all, Klebsiella pneu-moniae, Candida albicans and coagulase-negative staphylococci were the primary pathogens. The drug resistance of Klebsiella pneumoniae was the lowest to IMP, the drug resistance rates of Candida albicans to fluconazole was 6. 72% , and most of them were multi-drug resistant. Conclusion; Gram-negative bacilli were the major pathogens causing lung infecions in patients after renal transplantation. But the fungus was still an important factor in causing lung infecions in patients after renal transplantation.%目的:了解我院肾移植术后受者肺部感染的病原菌分布及其耐药现状,为临床合理使用抗生素提供依据.方法:对我院2006年10月-2011年9月移植科送检的来自538例肾移植术后受者的痰标本进行常规微生物培养及药敏试验,对检测结果进行统计分析.结果:共检出病原菌197株,其中革兰阴性菌杆菌85株(43.15%),革兰阳性球菌59株(29.95%),真菌46株,其它7株.肺炎克雷伯菌占首位,其次分别为白假丝酵母菌及血浆凝固酶阴性葡萄球菌.药敏结果显示肺炎克雷伯菌对亚胺培南最为敏感(耐药率为0%),居第二位的白假丝酵母菌对氟康唑的耐药率为6.72%.感染菌多重耐药现象严重.结论:我院肾移植术后受者肺部感染的病原菌以革兰阴性菌杆菌为主,但

  20. The history of organ donation and transplantation in Iran. (United States)

    Ghods, Ahad J


    The first kidney transplant in Iran was performed in 1967, and this was the first organ transplant in countries that are current members of the Middle East Society for Organ Transplantation. In 1988, in response to the long waiting list at the Iranian Ministry of Health for kidney transplant, a state-regulated living-unrelated donor kidney transplant program was adopted. By 1999, the kidney transplant waiting list in Iran was eliminated. In 1989, a fatwa (religious approval) from the Supreme Religious Leader was obtained that recognized brain death and allowed deceased-donor organ transplant. Subsequently, transplant centers began performing deceased-donor kidney, liver, and heart transplants. In 2000, the Brain Death and Organ Transplantation Act was passed by the Iranian parliament, legalizing deceased-donor organ transplant. The transplant team at Shiraz began performing more deceased-donor kidney and liver transplants and became a successful deceased-donor organ transplant model in the country. By the end of 2012, there were 34166 kidney (including 4436 deceased-donor) and 2021 liver (including 1788 deceased-donor), 482 heart, 147 pancreas, 63 lung, and several intestine and multiorgan transplants performed in Iran. In 2011, there were 2771 solid-organ transplants performed in Iran (37 transplants per million population), and Iran ranked as number 33 among the 50 most active countries worldwide. In 2011 and 2012, Iran was ahead of all country members of the Middle East Society for Organ Transplantation in performing deceased-donor kidney and liver transplants.

  1. HLA polymorphisms as incidence factor in the progression to end-stage renal disease in Brazilian patients awaiting kidney transplant. (United States)

    Crispim, J C; Mendes-Júnior, C T; Wastowski, I J; Palomino, G Martelli; Saber, L T; Rassi, D M; Donadi, E A


    Chronic renal failure (CRF) leads in the majority of instances to end-stage renal disease (ESRD) requiring renal replacement therapy. Age, gender, genetics, race, hypertension, and smoking among others are factors associated with ESRD. Our interest was to evaluate the possible associations of class I and II HLA antigens with ESRD renal disease independent of other factors, among patients with CRF, having various diagnoses in the Brazilian population of the São Paulo state. So 21 HLA-A, 31 HLA-B, and 13 HLA-DR were detected in 105 patients who were compared with 160 healthy controls of both sexes who were not related to the patients evaluated until 2005. We calculated allelic frequencies, haplotypes frequencies, etiological fractions (EF), preventive fractions, and relative risks (RR). We compared demographic data of patients and controls. The antigens positively associated with ESRD were: HLA-A78 (RR = 30.31 and EF = 0.96) and HLA-DR11 (RR = 18.87 and EF = 0.65). The antigens HLAB14 (RR = 29.90 and EF = 0.75) was present at a significantly lower frequency among patients compared with controls. In contrast, no haplotype frequency showed statically significant associations. Further molecular studies may clarify types and subtypes of alleles involved with ESRD progression.

  2. Kidney transplant in diabetic patients: modalities, indications and results

    Directory of Open Access Journals (Sweden)

    Rangel Érika B


    Full Text Available Abstract Background Diabetes is a disease of increasing worldwide prevalence and is the main cause of chronic renal failure. Type 1 diabetic patients with chronic renal failure have the following therapy options: kidney transplant from a living donor, pancreas after kidney transplant, simultaneous pancreas-kidney transplant, or awaiting a deceased donor kidney transplant. For type 2 diabetic patients, only kidney transplant from deceased or living donors are recommended. Patient survival after kidney transplant has been improving for all age ranges in comparison to the dialysis therapy. The main causes of mortality after transplant are cardiovascular and cerebrovascular events, infections and neoplasias. Five-year patient survival for type 2 diabetic patients is lower than the non-diabetics' because they are older and have higher body mass index on the occasion of the transplant and both pre- and posttransplant cardiovascular diseases prevalences. The increased postransplant cardiovascular mortality in these patients is attributed to the presence of well-known risk factors, such as insulin resistance, higher triglycerides values, lower HDL-cholesterol values, abnormalities in fibrinolysis and coagulation and endothelial dysfunction. In type 1 diabetic patients, simultaneous pancreas-kidney transplant is associated with lower prevalence of vascular diseases, including acute myocardial infarction, stroke and amputation in comparison to isolated kidney transplant and dialysis therapy. Conclusion Type 1 and 2 diabetic patients present higher survival rates after transplant in comparison to the dialysis therapy, although the prevalence of cardiovascular events and infectious complications remain higher than in the general population.

  3. The impact of ICU nurses' preoperative visit on treatment compliance of patients after lung transplantation%ICU护士术前访视对肺移植患者术后遵医行为的影响

    Institute of Scientific and Technical Information of China (English)

    王芳; 黄云娟; 许正红; 朱亭立; 黄琴红; 陈静瑜; 王俏英; 王玲秀


    Objective:To investigate the effects of preoperative visit on treatment compliance of patients after lung transplantation. Methods:Forty-two cases of lung transplant patients were enrolled and randomly divided into observation group and control group. And the observation group were interviewed before operation in ICU, the control group underwent routine preoperative preparation and education. Compliance was measured after operation. Results:Treatment compliance of observation group in the ifrst day and third day were 94.1%and 88.2%, and that in the control group was 88.0%and 84.0%, which showed a signiifcant difference between the two groups (P<0.05). Conclusion:ICU nurses' preoperative visits can effectively enhance the compliance of patients.%目的:探讨术前访视对肺移植患者术后遵医行为的影响。方法:将42例肺移植患者随机分为观察组和对照组,观察组接受ICU护士术前访视,对照组行常规术前准备及宣教,测评并比较患者术后遵医行为。结果:观察组术后第1天及第3天遵医率分别为94.1%、88.2%,对照组术后第1天及第3天遵医率分别为88.0%、84.0%,观察组遵医率高于对照组,差异有统计学意义(P<0.05)。结论:ICU护士术前访视能有效改善肺移植患者术后遵医行为。

  4. Optical Coherence Tomography in Kidney Transplantation (United States)

    Andrews, Peter M.; Wierwille, Jeremiah; Chen, Yu

    End-stage renal disease (ESRD) is associated with both high mortality rates and an enormous economic burden [1]. The preferred treatment option for ESRD that can extend patients' lives and improve their quality of life is kidney transplantation. However, organ shortages continue to pose a major problem in kidney transplantation. Most kidneys for transplantation come from heart-beating cadavers. Although non-heart-beating cadavers represent a potentially large pool of donor kidneys, these kidneys are not often used due to the unknown extent of damage to the renal tubules (i.e., acute tubular necrosis or "ATN") induced by ischemia (i.e., lack of blood flow). Also, ischemic insult suffered by kidneys awaiting transplantation frequently causes ATN that leads to varying degrees of delayed graft function (DGF) after transplantation. Finally, ATN represents a significant risk for eventual graft and patient survival [2, 3] and can be difficult to discern from rejection. In present clinical practice, there is no reliable real-time test to determine the viability of donor kidneys and whether or not donor kidneys might exhibit ATN. Therefore, there is a critical need for an objective and reliable real-time test to predict ATN to use these organs safely and utilize the donor pool optimally. In this review, we provided preliminary data indicating that OCT can be used to predict the post-transplant function of kidneys used in transplantation.

  5. Effects of an educational intervention on the anxiety of women awaiting mastectomies. (United States)

    Belleau, F P; Hagan, L; Mâsse, B


    The purpose of this experimental study was to assess the effects of an individualized psychocognitive educational intervention on preoperative anxiety in women awaiting mastectomies. A total of 60 women aged between 27 and 65 years were randomly distributed to two groups of 30 participants. Using the Situational Anxiety Inventory (IAS) along with repeated-measures variance analysis, it was noted that, immediately following the educational interventions (both experimental and control) there was a significant reduction (p Lazarus and Folkman's stress, appraisal and coping theory which states that direct action on cognitive perception can influence a feeling of threat as assessed through the level of anxiety.

  6. Discussion of CT Image Features of Specific Lung Infection after Renal Transplantation%肾移植患者术后特异性肺部感染的 CT 影像特点

    Institute of Scientific and Technical Information of China (English)

    赵鹤亮; 陈昕; 洪波; 张惠英


    OBJECTIVE To observe the CT image features of specific lung infection after renal transplantation so as to provide references for clinical treatments .METHODS Totally 70 patients with specific lung infections after renal transplantation were chosen from Jan .2009 to Dec .2013 and their lungs were scanned by Light Speed 64 VCT scanner .In addition ,all patients were given blood cultures to find infectious pathogens .RESULTS Bacterial pneu‐monia accounted for 42 .86% ,cytomegalovirus pneumonia accounted for 12 .86% ,pneumocystis carinii pneumonia accounted for 5 .71% , pulmonary tuberculosis accounted for 17 .14% , and mycotic pneumonia accounted for 21 .43% .Among them ,there were 17 cases with CT manifestation as diffuse patch and grinding glassy spots or net‐shaped shadow including 18 .57% of cytomegalovirus pneumonia and 5 .71% of pneumocystis carinii pneumoni‐a .CONCLUSION Specific lung infections after renal transplantation were mainly bacterial pneumonias ,and differ‐ent infection types have distinctive CT features .Bacterial and mycotic pneumonias mainly feature with lung paren‐chyma seepage ,cytomegalovirus and pneumocystis carinii pneumonia mainly feature with pulmonary interstitial thickening ,and pulmonary tuberculosis mainly features with uneven millets .%目的:观察肾移植术后特异性肺部感染的C T影像特点,为临床治疗提供参考依据。方法临床纳入2009年1月-2013年12月70例肾移植术后发生特异性肺部感染的患者,采用飞利浦256层螺旋C T 机进行肺部扫描;此外,所有患者进行血液培养,查找感染病原体。结果细菌感染性肺炎、巨细胞病毒性肺炎、卡氏肺囊虫肺炎、肺结核、真菌性肺炎分别占42.86%、12.86%、5.71%、21.43%;其中,C T表现为弥漫性斑片与磨玻璃状斑点状或网状阴影患者17例,巨细胞病毒性肺炎18.57%、卡氏肺囊虫肺炎5.71%。结论肾移植术后特异性肺感染以

  7. Interventions in a heart transplant recipient with a histrionic personality disorder. (United States)

    Smith, C; Chakraburtty, A; Nelson, D; Paradis, I; Kesinger, S; Bak, K; Litsey, A; Paris, W


    Organ transplantation is a psychosocially demanding process. Patients must undergo a comprehensive evaluation to await a donor organ that may never become available. After transplantation, recipients must deal with the acceptance of a new organ and comply with a medical regimen that includes numerous medications, follow-up exams, and procedures. Emotional well-being is monitored throughout the transplant process. However, despite the best of efforts and thorough pretransplant bio-psycho-social evaluations, it is possible for patients to have significant psychopathology that remains undetected. Following the stress of transplantation, such patients may present with exacerbation of symptomatology, which has the potential to negatively affect compliance and long-term outcome.

  8. Ethical considerations related to organ transplantation and Islamic Law. (United States)

    Mousavi, Seyed R


    With the increasing number of transplantable organs and tissues, as well as improvements in transplantation results, has come a severe shortage of organ donors. Organs for transplantation are usually obtained from living genetically related donors or from heart-beating cadavers. Unfortunately, these sources have so far been unable to keep up with demand. As a result, there is a large and steadily increasing number of potential recipients awaiting transplantation, some of who will die before an organ can be found. These trends have raised many ethical, moral, societal and in particular religious (Islamic Law) issues regarding supply, the methods of organ allocation, and use of living donors. Several ethical dilemmas regarding case selection, allocation within the law, medical problems, and economic sources have now to be confronted. Despite this, the legal framework regulating transplantation in Iran was recently enhanced in comparison to other Islamic countries.

  9. Hair transplant (United States)

    ... page: // Hair transplant To use the sharing features on this page, please enable JavaScript. A hair transplant is a surgical procedure to improve baldness. Description ...

  10. Transplant services (United States)

    ... this page: // Transplant services To use the sharing features on this ... are comfortable before, during, and after surgery. Information Transplant surgery is typically done to replace a diseased ...

  11. 器官捐赠供肺移植受者术后早期肺部感染17例临床分析%Early respiratory infections in lung transplantation recipients from donation after cardiac death donors

    Institute of Scientific and Technical Information of China (English)

    吴波; 张稷; 卫栋; 陈静瑜


    Objective To explore the epidemiology,etiology and prevention strategy of early respiratory infections (≤1 month) in lung transplantation recipients with donation after cardiac death donors.Method The clinical data of donors and recipients,particularly on early respiratory infections,were retrospectively analyzed in 17 lung transplantations.Result From Jan.2015 to Apr.2015,12 episodes of early respiratory infections (≤ 1 month) in 17 lung transplantation recipients occurred (12/17,70.6%).The organisms most frequently involved were bacteria:Pseudomonas aeruginosa (4/26,15.4%),Klebsiella pneumoniae (4/26,15.4%),Staphylococcus aureus (3/26,11.5%),and Acinetobacter baumannii (3/26,11.5%).Of 26 bacterial strains,3 were Methecillin resistant Staphlococcus aureus,3 were carbapenem resistant Acinetobacter baumanni,2 were carbapenem resistant Pseudomonas cepacia,2 were extended spectrum b-lactamase-producing Klebsiella pneumoniae,and one was carbapenem and quinolone resistant Pseudomonas aeruginosa.Conclusion The morbidity of early infections is high in lung transplantation recipients.In our experience,bacterial respiratory infections are most common in the early post-transplant period (≤ 1 month).Incidence of Aspergillus spp.and Cytomegalovirus pneumonia is lower than before lung transplantation,probably due to the spread of universal prophylaxis.%目的 旨在探讨心脏死亡供者器官捐赠供肺移植术后早期(≤1个月)受者呼吸道感染的发病率、病原体及防治策略.方法 回顾分析2015年1月至2015年4月间心脏死亡供者器官捐赠供肺移植17例的供、受者资料,特别是受者术后早期呼吸道感染的临床资料.结果 17例受者术后早期共发生呼吸道感染12例次,术后呼吸道分泌物培养共得致病细菌26株,包括铜绿假单胞菌4株(15.4%,4/26),肺炎克雷伯菌4株(15.4%,4/26),鲍曼不动杆菌3株(11.5%,3/26),金黄色葡萄球菌3株(11.5%,3/26),嗜麦芽窄食单胞菌2

  12. Study on effect of survivin antioligonucleotide on subcutaneous transplanted Xunwei lung adenocarcinoma nude mice model%Survivin反义核苷酸对宣威肺腺癌移植瘤裸鼠模型作用的研究

    Institute of Scientific and Technical Information of China (English)

    王巍炜; 洪志鹏; 李高峰; 王绍佳; 陈瑞彬; 张继朋


    目的 选用宣威肺腺癌细胞裸鼠移植瘤模型,采用survivinmRNA的反义寡核苷酸(ASODN)抑制宣威肺腺癌细胞,观察其疗效,为进一步临床研究提供实验依据.方法 建立宣威肺腺癌细胞XWLC-05裸鼠皮下移植瘤模型,选取48只成瘤裸鼠,随机分为:对照组、单纯脂质体转染(LIP)组、survivin正义寡核苷酸(SODN)组、survivinASODN组,通过皮下移植瘤内多点注射后,观察裸鼠一般情况、移植瘤体积,计算抑瘤率等.病理学检测各组肿瘤的变化以及对心脏、肝脏、肾脏的影响.结果 survivinASODN组注射survivinASODN后,裸小鼠表现为生长速度较为缓慢,质量低于其他3组(P>0.05),其生长抑制率高于其他3组(P>0.05).而对照组、LIP组、survivinSODN组在肿瘤质量及生长抑制率方面均无明显差异.病理检查见瘤组织中有大量的细胞坏死灶.各组裸鼠均未出现死亡,病理检查重要脏器未见明显损害.结论 survivinASODN能够抑制裸鼠皮下移植瘤的生长,未对其他脏器产生明显损害.%Objective By selecting transplanted Xunwei lung adenocarcinoma nude mice model, to adopt survivinnmRNA anti-sense oligonucleotide to inhibit Xunwei lung adenocarcinoma cells and to observe its effects to provide the experiment evidence for further clinical study be offered in clinical treatment. Methods After modeling subcutaneous transplanted Xunwei lung adenocarcinoma cell XWLC-05 nude mice,48 nude mice were selected and devided into 4 groups randomly: control group (blank) , Lip group (simple liposome) , survivin-SODN group (injecting sense oligonucleotide) and survivin-ASODN group (injecting antisense oligonucleotide). We injected different drugs according to different groups. Then the general activity of nude mice in different groups was observed and the tumor size was measured. Also,the antineoplastic rates in different groups were calculated. The pathological methods were used to analyse the effects of 4

  13. Hericium erinaceus (Lion’s Mane) mushroom extracts inhibit metastasis of cancer cells to the lung in CT-26 colon cancer-transplanted mice (United States)

    We investigated the anti-metastatic activity of four Hericium erinaceus edible mushroom extracts using CT-26 murine colon carcinoma cells as an indicator of inhibition of cell migration to the lung. Hot water (HWE) and microwaved 50% ethanol (MWE) extracts of Hericium erinaceus strongly elicited ca...

  14. 78 FR 49276 - Advisory Committee on Organ Transplantation; Request for Nominations for Voting Members (United States)


    ... donation, health care public policy, transplantation medicine and surgery, critical care medicine and other... professions, nursing, epidemiology, immunology, law and bioethics, behavioral sciences, economics and... and surgery, including pediatric and heart/lung transplantation; critical care medicine;...

  15. 75 FR 57807 - Advisory Committee on Organ Transplantation; Request for Nominations for Voting Members (United States)


    ... donation, health care public policy, transplantation medicine and surgery, critical care medicine and other... professions, nursing, epidemiology, immunology, law and bioethics, behavioral sciences, economics and... and surgery, including pediatric and heart/lung transplantation; critical care medicine;...

  16. Effect of anesthetic methods on respiratory and lung functions of patients after sequential double lung transplantation%麻醉方式对序贯式双肺移植患者呼吸功能及肺功能的影响

    Institute of Scientific and Technical Information of China (English)



    背景:在非体外循环的条件下,保证患者在麻醉效果良好的情况下完成序贯式双肺移植,胸段硬膜外复合全静脉麻醉和全静脉麻醉的选择上尚存在争议。  目的:观察序贯式双肺移植过程中两种不同的麻醉方式对患者呼吸功能及肺生物学功能的影响。  方法:将24例序贯式双肺移植患者分为全静脉麻醉组及硬膜外复合全静脉麻醉组。对两组患者麻醉后单、双肺通气10 min后的氧耗量、二氧化碳排出量、呼吸商和能量消耗进行测定。同时,对比分析两组患者移植过程中去甲肾上腺素、肾上腺素、皮质醇以及血糖水平参数变化。  结果与结论:两组患者在移植后6个月、1年及3年的随访调查中,肺功能均得到明显的改善,血气分析状况良好,两组差异无显著性意义。两组患者的并发症发生率、急性排斥反应及死亡率差异均无显著性意义(P>0.05)。麻醉后硬膜外复合全静脉麻醉组单、双肺通气患者的氧耗量、二氧化碳排出量和能量消耗指标均明显高于全静脉麻醉组相同时段对应指标(P0.05)。硬膜外复合全静脉麻醉组单、双肺通气患者的去甲肾上腺素、肾上腺素、皮质醇以及血糖水平均明显低于全静脉麻醉组相同时段对应水平(P0.05)。提示在双肺移植过程中,胸段硬膜外复合全静脉麻醉与全静脉麻醉相比,患者氧耗量、二氧化碳排出量和能量代谢明显增强,可减轻应激反应,且麻醉后代谢、应激情况不受通气方式影响。%BACKGROUND:In the non-extracorporeal circulation conditions, the choice of thoracic general-epidural anesthesia plus intravenous anesthesia and intravenous anesthesia alone is stil controversial for sequential double lung transplantation. OBJECTIVE:To investigate the influence of two different anesthetic methods on the respiratory function and lung biological function of the

  17. Alternative Awaiting and Broadcast for Two-Way Relay Fading Channels

    CERN Document Server

    Liu, Jianquan; Tao, Meixia


    We investigate a two-way relay (TWR) fading channel based on store-and-forward (SF), where two source nodes wish to exchange information with the help of a relay node. A new upper bound on the ergodic sum-capacity for the TWR fading system is derived when delay tends to infinity.We further propose two alternative awaiting and broadcast (AAB) schemes: pure partial decoding (PPD) with SF-I and combinatorial decoding (CBD) with SF-II, which approach the new upper bound at high SNR with unbounded and bounded delay respectively. Numerical results show that the proposed AAB schemes significantly outperform the traditional physical layer network coding (PLNC) methods without delay. Compared to the traditional TWR schemes without delay, the proposed CBD with SF-II method significantly improves the maximum sum-rate with an average delay of only some dozen seconds in the relay buffer.

  18. Sequential unilateral lung volume reduction for emphysema - Stretching the benefit. (United States)

    Khorramnia, Sadie; Holsworth, Lynda; Mestitz, Hugh; Westall, Glen P; Williams, Trevor J; Gooi, Julian H; Snell, Gregory I


    Bronchoscopic Lung Volume Reduction (BLVR) and Surgical Lung Volume Reduction (SLVR) and are two different approaches used to remodel severely emphysematous lungs to improve lung function and quality-of-life. We present a case initially referred for lung transplantation, where sequential left upper lobe BLVR and 7 years later right upper lobe SLVR, providing enduring physiological and functional improvement. The potential for sustained benefit via sequential unilateral lung volume reduction is under-appreciated.

  19. Food allergies developing after solid organ transplant. (United States)

    Needham, J M; Nicholas, S K; Davis, C M


    The development of food allergy is an increasingly recognized form of morbidity after solid organ transplant. It occurs more commonly in liver transplant recipients, although it has also been reported in heart, lung, kidney, and intestinal transplants. Pediatric transplant recipients are more likely to develop symptoms compared to adults, and reports of frequency vary widely from 5% to 38% in pediatric liver transplant recipients. Multiple mechanisms have been proposed in the literature, although no single mechanism can yet account for all reported observations. As food allergy can have at worst potentially fatal consequences, and at best require lifestyle adjustment through food avoidance, it is important for recipients to be aware of the donor's food allergies and particularly in pediatrics, the possibility of completely de novo allergies. This review explores the recent reports surrounding food allergy after solid organ transplant, including epidemiology, proposed mechanisms, and implications for practice.

  20. Lung cancer screening: the European perspective. (United States)

    Veronesi, Giulia


    European studies have contributed significantly to the understanding of lung cancer screening. Smoking within screening, quality of life, nodule management, minimally invasive treatments, cancer prevention programs, and risk models have been extensively investigated by European groups. Mortality data from European screening studies have not been encouraging so far, but long-term results of the NELSON study are eagerly awaited. Investigations on molecular markers of lung cancer are ongoing in Europe; preliminary results suggest they may become an important screening tool in the future.

  1. Association between preoperative magnetic resonance imaging, pain intensity and quantitative sensory testing in patients awaiting lumbar diskectomy.

    LENUS (Irish Health Repository)

    Hegarty, Dominic


    Magnetic resonance imaging (MRI) offers important information regarding the morphology, location and size of a herniated disc, which influences the decision to offer lumbar diskectomy (LD). This study aims to examine the association between clinical neurophysiologic indices including pain intensity and quantitative sensory testing (QST), and the degree of lumbar nerve root compromise depicted on magnetic resonance (MR) in patients awaiting LD.

  2. Cytomegalovirus Immunoglobulin After Thoracic Transplantation (United States)

    Grossi, Paolo; Mohacsi, Paul; Szabolcs, Zoltán; Potena, Luciano


    Abstract Cytomegalovirus (CMV) is a highly complex pathogen which, despite modern prophylactic regimens, continues to affect a high proportion of thoracic organ transplant recipients. The symptomatic manifestations of CMV infection are compounded by adverse indirect effects induced by the multiple immunomodulatory actions of CMV. These include a higher risk of acute rejection, cardiac allograft vasculopathy after heart transplantation, and potentially bronchiolitis obliterans syndrome in lung transplant recipients, with a greater propensity for opportunistic secondary infections. Prophylaxis for CMV using antiviral agents (typically oral valganciclovir or intravenous ganciclovir) is now almost universal, at least in high-risk transplants (D+/R−). Even with extended prophylactic regimens, however, challenges remain. The CMV events can still occur despite antiviral prophylaxis, including late-onset infection or recurrent disease, and patients with ganciclovir-resistant CMV infection or who are intolerant to antiviral therapy require alternative strategies. The CMV immunoglobulin (CMVIG) and antiviral agents have complementary modes of action. High-titer CMVIG preparations provide passive CMV-specific immunity but also exert complex immunomodulatory properties which augment the antiviral effect of antiviral agents and offer the potential to suppress the indirect effects of CMV infection. This supplement discusses the available data concerning the immunological and clinical effects of CMVIG after heart or lung transplantation. PMID:26900989

  3. Islet Transplantation (United States)

    ... transplanted islet cells failed. But in recent years, scientists have begun to make rapid advances in transplant technology, and some of the most exciting new research comes to us from researchers at the University of ... Canada. These scientists have used a new procedure called the Edmonton ...

  4. Corneal Transplantation

    DEFF Research Database (Denmark)

    Hjortdal, Jesper Østergaard

    Corneal transplantation has been performed for more than 100 years. Until 15 years ago the state-of-the art type of transplantation was penetrating keratoplasty, but since the start of this millennium, newly designed surgical techniques have developed considerably. Today, the vast majority of ker...

  5. Regulating Transplants

    Institute of Scientific and Technical Information of China (English)


    Legislation to determine brain death is viewed as essential in controlling the organ transplant industry Organ transplant represents a very sensitive and complicated issue. Experts say the temporary administrative regulations recently promulgated by the Central Government are an important step, but relevant laws and regulations must follow. Among these, the


    Institute of Scientific and Technical Information of China (English)

    邢天宇; 夏强; 张建军


    目的 系统评价肝移植术后新发肺癌、乳腺癌以及胰腺癌的风险性.方法 计算机检索Cochrane图书馆、MEDLINE、EMbase数据库中肝移植术后患肺癌、乳腺癌及胰腺癌随机对照试验,检索时间为1980年1月至2011年9月.按照纳入与排除标准选择文献、评价文献质量和提取资料,而后采用RevMan 5.0软件进行Meta分析.结果 共纳入9个RCT,包括8162例肝移植术后患者,Meta分析结果显示:肝移植术后患肺癌的风险率相比于未移植组提高3.73倍(95%可信区间:2.73 ~5.10,P<0.001),而肝移植术后乳腺癌以及胰腺癌风险率相比1于未移植组未见明显提高发生比率分别为1.27倍(95%可信区间:0.97 - 1.65,P=0.08)以及1.32倍(95%可信区间:0.96 - 1.80,P=0.08),肝移植后诊断出新生肺癌的平均时间为4.2年.结论 肝移植后肺癌发生率明显上升,术后低剂量的CT检查有助于肝移植后新发肺癌的早期诊断及治疗从而提高远期生存率.%Objective To evaluate the risk of the new onset of lung cancer、breast cancer and pancreatic cancer after the Liver transplantation. Methods Databases such as The Cochrane Library, MEDLINE, Embase were searched from January of 1980 to September of 2011 to collect randomized controlled trials (RCTs) of the risk of lung cancer、breast cancer and pancreatic cancer after the Liver transplantation. The quality of RCTs was appraised and the data were extracted. Meta-analysis were conducted with Rev-Man5. 0 software for the standard RCTs. Results A total of nine RCTs were included. The meta-analysis was performed on data of 8162 patients and identified that standard incidence ratio of lung cancei\\breast cancer and pancreatic cancer of post liver transplantation is 3.73-fold higher (95% confidence interval 2.73 ~ 5. 10, P < 0. 001) ,1. 27-fold higher (95% confidence interval 0.97-1.65, P=0.08), 1. 32-fold higher (95% confidence interval 0. 96 ~ 1. 80, P =0. 08) than the non-transplant

  7. Solid organ transplantation after allogeneic hematopoietic stem cell transplantation: a retrospective, multicenter study of the EBMT

    DEFF Research Database (Denmark)

    Koenecke, C; Hertenstein, B; Schetelig, J


    To analyze the outcome of solid organ transplantation (SOT) in patients who had undergone allogeneic hematopoietic stem cell transplantation (HSCT), a questionnaire survey was carried out within 107 European Group of Blood and Marrow Transplantation centers. This study covered HSCT between 1984...... and 2007 in Europe. Forty-five SOT in 40 patients were reported. Fifteen liver, 15 renal, 13 lung, 1 heart and 1 skin transplantations were performed in 28 centers. Overall survival (OS) of patients after SOT was 78% at 5 years (95% confidence interval [CI], 64% to 92%). OS at 5 years was 100% for renal......, 71% (95% CI, 46% to 96%) for liver and 63% (95% CI, 23% to 100%) for lung transplant recipients. The 2-year-incidence of SOT failure was 20% (95% CI, 4% to 36%) in patients with graft-versus-host disease (GvHD) and 7% (95% CI, 0% to 21%) in patients without GvHD before SOT. The relapse incidence...

  8. Unity with PMA-2 attached awaits further processing in the SSPF (United States)


    The International Space Station's (ISS) Unity node, with Pressurized Mating Adapter (PMA)-2 attached, awaits further processing by Boeing technicians in its workstand in the Space Station Processing Facility (SSPF). The Unity node is the first element of the ISS to be manufactured in the United States and is currently scheduled to lift off aboard the Space Shuttle Endeavour on STS-88 later this year. Unity has two PMAs attached to it now that this mate is completed. PMAs are conical docking adapters which will allow the docking systems used by the Space Shuttle and by Russian modules to attach to the node's hatches and berthing mechanisms. Once in orbit, Unity, which has six hatches, will be mated with the already orbiting Control Module and will eventually provide attachment points for the U.S. laboratory module; Node 3; an early exterior framework or truss for the station; an airlock; and a multi-windowed cupola. The Control Module, or Functional Cargo Block, is a U.S.-funded and Russian-built component that will be launched aboard a Russian rocket from Kazakstan.

  9. Unity with PMA-2 attached awaits further processing in the SSPF (United States)


    The International Space Station's (ISS) Unity node, with Pressurized Mating Adapter (PMA)-2 attached, awaits further processing in the Space Station Processing Facility (SSPF). The Unity node is the first element of the ISS to be manufactured in the United States and is currently scheduled to lift off aboard the Space Shuttle Endeavour on STS-88 later this year. Unity has two PMAs attached to it now that this mate is completed. PMAs are conical docking adapters which will allow the docking systems used by the Space Shuttle and by Russian modules to attach to the node's hatches and berthing mechanisms. Once in orbit, Unity, which has six hatches, will be mated with the already orbiting Control Module and will eventually provide attachment points for the U.S. laboratory module; Node 3; an early exterior framework or truss for the station; an airlock; and a multi-windowed cupola. The Control Module, or Functional Cargo Block, is a U.S.- funded and Russian-built component that will be launched aboard a Russian rocket from Kazakstan.

  10. 脑死亡供体鼠吸入一氧化碳对受体鼠移植肺损伤的影响%Effects of carbon monoxide inhalation by brain death donor on the transplanted lung Injury in recipient of rats

    Institute of Scientific and Technical Information of China (English)

    周华成; 李文志; 潘鹏; 吕湘琪; 金笛; 丁文刚


    Objective To investigate the effects of carbon monoxide (CO) inhalation by brain death (BD) donor on transplanted lung injury in recipient of rats. Methods Twenty-four male Wistar rats weighing 250-300 g were randomly divided into 3 groups ( n = 8 each) : group Ⅰ donor without brain death (NBD) ; group Ⅱ brain death donor inhaling O2 (BDO2) and group Ⅲ brain death donor inhaling CO (BDCO). The donor rats were anesthetized with intraperitoneal pentobarbital sodium 60 mg/kg, trachoostomized and mechanically ventilated (VT 10 ml/kg, RR 50 bpm, PEEP 2 cm H2O). BD was induced by inserting a Fogarty catheter into the skull and brain was compressed by inflating the balloon according to Avlonitis VS. After BD was confirmed, 40% O2 was inhaled for 2 h in group Ⅱ and a mixture of 40% O2 + 0.025% CO was inhaled for 2 h in group Ⅲ . MAP was maintained at 80-100 mm Hg. Cuff technique was used for orthotopic left lung transplantation according to Mizobuchi T.Arterial blood samples were obtained every 30 min in recipient for blood gas analysis. The recipients were killed by exsangmnation at 2 h after lung transplantation and blood was collected for determination of SOD activity and MDA, IL-6, IL-10 and TNF-α concentrations. The transplant lung was removed for determination of W/D lung weight ratio, MPO activity in the lung tissue and microscopic examination. Lung injury scores were calculated. Results PaO2/FiO2, BE, pH, plasma SOD activity and IL-10 concentrations were significantly lower while W/D lung weight ratio, MPO activity in the lung tissue and lung injury scores of the transplant lung were significantly higher in group BDO2 and BDCO than in group (NBD). PaO2/FiO2, BE, pH, plasma SOD activity and IL-10 concentration were significantly higher and W/D ratio, MPO activity in the lung tissue, lung injury scores of the transplant lung and plasma concentrations of MDA, IL-6 and TNF-α were significantly lower in group BDCO than in group BDO2. Conclusion Inhalation of

  11. Outcomes after singleversus bilateral lung transplantation for idiopathic pulmonary fibrosis%单肺与双肺移植治疗特发性肺间质纤维化的临床研究

    Institute of Scientific and Technical Information of China (English)

    孙敏; 李慧星; 谢于峰; 徐辉; 刘峰; 陈静瑜


    Objective To compare outcomes after single and bilateral lung transplantation in patients with idiopathic pulmonary fibrosis (IPF).Methods 104 patients with IPF who underwent lung transplantation at Wuxi People' s Hospital from January 2008 to February 2015 were evaluated.Recipients were divided into single lung transplantation (STL)group(41 cases)and bilateral lung transplantation(BLT) group (63 cases).Preoperative characteristics,postoperative outcomes,postoperative complications,functional outcomes,survival and causes of death between the two groups were analyzed retrospectively.The patients were followed up by letter,call and outpatient visit.Results Preoperative characteristics:The SLT group were significantly older (P < 0.05),and had significantly higher systolic (P < 0.05) pulmonary artery pressures than the BLT group.Postoperative outcomes:The intraoperative blood loss of SLT group as significantly less than BLT group (P < 0.05).The cold ischemic time of SLT group as significantly shorter than BLT group (P < 0.05).The BLT group was significantly more frequently required extracorporeal membrane oxygenation (ECMO) support than SLT group (P < 0.05).There was no statistically significant difference inventilator support,reoperation,reintubation,length of ICU stay and death between the SLT and the BLT group (P > 0.05).Postoperative complications:The BLT group had a higher incidence of primary graft dysfunction than the SLT group (P < 0.05).There was no statistically significant difference in chest complications,acute rejection,airway complications,pulmonary infection between the SLT and the BLT group (P>0.05).Functional outcomes:FVC%,FEV1%,DLCO and 6-MWD,were significantly higher in the BLT group than the SLT group (P <0.05).Survival:The overall survival rates at 1,2 and 3 years were not different between the SLT and the BLT group (75.3%,61.6% and 46.2% vs 79.1%,68.6% and 53.4%,P > 0.05).Conclusions The lung transplantationis

  12. Correlation of lung abnormalities on high-resolution CT with clinical graft-versus-host disease after allogeneic versus autologous bone marrow transplantation in children

    Energy Technology Data Exchange (ETDEWEB)

    Merlini, Laura; Borzani, Irene Maria Olivia; Anooshiravani, Mehrak; Hanquinet, Sylviane [University of Geneva Children' s Hospital, Paediatric Radiology Unit, Geneva (Switzerland); Rochat, Isabelle [University of Geneva Children' s Hospital, Paediatric Pneumology Unit, Geneva (Switzerland); Ozsahin, Ayse Hulya [University of Geneva Children' s Hospital, Paediatric Oncology Unit, Geneva (Switzerland)


    Late-onset noninfectious pulmonary complications (LONIPCs) are life-threatening complications of bone marrow transplantation (BMT). Several pathological patterns are described in the literature with different prognoses, and with different relationships to graft-versus-host disease (GVHD). The role of high-resolution CT (HRCT) is not yet well established. To illustrate different patterns of LONIPCs on HRCT in allogeneic versus autologous BMT in order to investigate the correlation with chronic GVHD (cGVHD). A total of 67 HRCT scans were performed in 24 patients with noninfectious pulmonary disease at least 3 months after BMT (16 allogeneic, 8 autologous). Abnormality patterns and extension on HRCT images were correlated with the clinical outcome and with the severity of cGVHD. Of 24 patients, 9 showed LONIPCs (1 autologous, 8 allogeneic). There was a significant association between abnormalities on HRCT and severe cGVHD (P = 0.038), with no specific pattern. Prognosis seemed to be related to the severity of cGVHD and not to the extent of abnormalities on HRCT. The significant association between abnormalities on HRCT and severe GVHD suggests that LONIPCs can be a pulmonary manifestation of the disease. HRCT is a useful tool when combined with clinical data. (orig.)

  13. Organ transplantation in Malaysia: a social-legal study. (United States)

    Ngah, Anisah Che


    Kidney and corneal transplants have been undertaken since the seventies although other forms of organ transplantation were lesser known. To date more than 1000 kidney transplants, the majority from living related donors have been performed. Nevertheless heart, lung and liver transplant only had an impact in the nineties. The main reason being, the lack of cadaveric donors, which has hampered the development of organ transplantation in Malaysia. It is instructive to note that the Malaysian society has been rather conservative when it comes to organ transplantation. This is compounded by the Asean culture and value system, which are directly derived from our historical background and religious convictions. However attempts had been made by various organisations such as The Malaysian Society of Transplantation, which was set up in 1994 to create greater awareness on organ donation & transplantation amongst both the healthcare professionals and the public.

  14. Pancreas Transplantation (United States)

    The pancreas is a gland behind your stomach and in front of your spine. It produces the juices that ... hormones that help control blood sugar levels. A pancreas transplant is surgery to place a healthy pancreas ...

  15. Extracorporeal membrane oxygenation after living-related liver transplant. (United States)

    Gedik, Ender; Çelik, Muhammet Reha; Otan, Emrah; Dişli, Olcay Murat; Erdil, Nevzat; Bayındır, Yaşar; Kutlu, Ramazan; Yılmaz, Sezai


    Various types of extracorporeal membrane oxygenation methods have been used in liver transplant operations. The main indications are portopulmonary or hepatopulmonary syndromes and other cardiorespiratory failure syndromes that are refractory to conventional therapy. There is little literature available about extracorporeal membrane oxygenation, especially after liver transplant. We describe our experience with 2 patients who had living-related liver transplant. A 69-year-old woman had refractory aspergillosis pneumonia and underwent pumpless extracorporeal lung assist therapy 4 weeks after liver transplant. An 8-month-old boy with biliary atresia underwent urgent liver transplant; he received venoarterial extracorporeal membrane oxygenation therapy on postoperative day 1. Despite our unsuccessful experience with 2 patients, extracorporeal membrane oxygenation and pumpless extracorporeal lung assist therapy for liver transplant patients may improve prognosis in selected cases.

  16. Stem Cell Transplant (United States)

    ... transplant is a procedure that infuses healthy blood stem cells into your body to replace your damaged or ... A bone marrow transplant is also called a stem cell transplant. A bone marrow transplant may be necessary ...

  17. After the Transplant (United States)

    ... Types Risk Factors Prevention & Early Detection After The Transplant After dealing with the effects of long-term ... Lifestyle changes Pregnancy after transplant Cancer after transplant Transplants By Organ - January 1, 1988 - April 30, 2016 ...

  18. Overcoming Challenges: Breathing Hope Through Teamwork and Long-Distance Thoracic Transplantation. (United States)

    Villalon, Ernie


    Lung donation and transplantation is increasing in volume annually, yet there continues to be a shortage of available organs for transplant. Despite this shortage, suitable lungs are occasionally not transplanted due to logistical issues. Issues such as time and distance can be a major barrier in deceased donor organ recovery and transplantation. This single case study serves as an example of the teamwork and cooperation that resulted in the successful transplantation of lungs in spite of long-distance logistical issues between the donor and the recipient. All of the members who contributed to this collaboration recognized the need and urgency to overcome these challenges. The organ procurement organization's collaboration with multiple transplant centers across multiple regions resulted in a successful outcome for the lung recipient.

  19. 二肽酰肽酶Ⅳ酶活性抑制减轻移植肺缺血/再灌注损伤的蛋白质组学研究%The proteomics study of attenuated rat transplanted lung ischemia/reperfusion injury targeted by intragraft dipeptidylpeptidaseⅣcatalytic inhibition

    Institute of Scientific and Technical Information of China (English)

    唐建; 葛晶; 吴东; 余俊杰; 王建军; 翟伟


    Objective To explore the attenuation effect of dipeptidylpeptidaseⅣ(DPPⅣ)enzymatic inhibition on ischemia/reperfusion injury in a rat orthotopic left lung transplantation model by using the proteomics technique.Methods Rats were randanmised divided to two groups,one was control group(doner lung flushed and reserved with LPD for 18 h),another was treated group(doner lung flushed and reserved with LPD+AB192 for 18 h).Then did orthotopic left lung transplantation,the implanted lungs were harvested 3 d after transplantation.The lung tissue then did the proteomics.Differential proteomics was applied to find the discrepancy protein expression in donor lung tissue after DPPⅣenzyme was inhibited,two dimensional gel electrophoresis(2D-PAGE)icons at the 3 d after operation were compared between the two set of lung tissues.Results 87 discrepancy protein spots were obtained.15 discrepancy protein spots were identified after mass spectrum peptide finger print map analysis,9 discrepancy proteins were over-expressed in experimental group while were hypo-expressed or non-expressed in control group,6 were over-expressed in control group.Conclusion Relative protein or peptide may play an important role on the attenuation effect of DPPⅣenzymatic inhibition on ischemia/reperfusion injury in a rat orthotopic left lung transplantation model.%目的 通过蛋白质组学技术探讨二肽酰肽酶Ⅳ(DPPⅣ)酶活性抑制减轻移植肺缺血/再灌注损伤的机制.方法 建立稳定原位大鼠左肺移植模型后,20只大鼠分为实验组和对照组,对照组大鼠供肺用LPD液灌注并保存18 h,实验组供肺用含特异性不可逆DPPⅣ酶抑制剂AB192的LPD液灌注并保留18h,行左肺原位移植,3d后移植肺组织取出,行蛋白质组学研究,即利用双向凝胶电泳(2D-PAGE)分离两组总蛋白,通过图像分析寻找表达差异的蛋白点,对其进行基质辅助激光解析电离飞行时间质谱(MALDI-TOF)分析.结果 运用差异蛋白质

  20. Imaging of Kaposi sarcoma in a transplanted liver: A rare case report

    Directory of Open Access Journals (Sweden)

    Saumya Gupta


    Full Text Available In post-transplant patients, de novo malignancies such as post-transplant lymphoproliferative disease (PTLD, lung carcinoma, renal cell carcinoma, cutaneous malignancies, and Kaposi sarcoma are now seen. The immunotherapy used to prevent graft failure indirectly increases their risk. We present a rare case of visceral Kaposi sarcoma in a patient with orthotopic liver transplant.

  1. Effects of Marijuana on the Lung and Its Defenses against Infection and Cancer. (United States)

    Tashkin, Donald P.


    Examines the many effects of marijuana use on the lungs. States that patients with pre-existing immune deficits are particularly vulnerable to marijuana-related pulmonary infections. However, warns that habitual use of marijuana may lead to respiratory cancer must await epidemiological studies, which are now possible since 30 years have passed…

  2. Protective effects of ulinastatin during non-heart-beating donors lung transplantation%乌司他丁对无心跳兔供肺的保护作用

    Institute of Scientific and Technical Information of China (English)

    倪斌; 马海涛; 谈震东; 祝冒善; 朱逸; 李畅; 宋心雨


    Objective To investigate the protective effects of treatment with ulinastatin (UTD during rabbit non-heart-beating donors lung transplantation, and explore the possible mechanism.Methods Thirty rabbits were divided randomly into three groups: group A as control group, group B as UTI flushing group, and group C as UTI preconditioning plus flushing group.In group A donors were exsanguinated to maintain hypotension for 30 rain before intravenous injection of potassium chloride to make heart arrest.After a period of 1 h warm ischemia in situ, topical cooling was executed.Meanwhile, the donor lungs were antegradely flushed through pulmonary arteries with low-potassium-dextron (LPD) solution at 4℃.After flushing in situ, lung-heart blocks were harvested and store at 4 ℃ for another 5 h, then perfused for 90 min in isolated, ventilated, blood-perfused rabbit lung models.Pulmonary venous blood samples were collected for blood gas analysis at 1st, 30th, 60th, and 90th min after initiation of reperfusion.At the same time, PAwP was recorded respectively.Lung samples were obtained at the end of reperfusion.The pulmonary water index (W/D), tissue myeloperoxidase (MPO) activity, tissue malondialdehyde (MDA) content, and mRNA expression of IL-8 and ICAM-1 were measured.Microscopic examination of donor lungs was conducted.In group B, the same procedures were conducted as in group A except for adding UTI (500 000 U/L) to LPD solution.In group C, except that a bolus of UTI (50 000 U/kg) was given to donors intravenously during hypotension, the same procedures were conducted as in group B.Results (1) In all three groups, there were same tendencies of gradually decreasing of PO2 levels; and as compared with groups B and C, PO2 levels in group A were significantly reduced.Similar results could be observed in PAwP values, but the tendency was increasing.(2) The level of W/D, MPO activity, MDA content, and the mRNA expression of IL-8 and ICAM-1 in groups B and C were decreased as

  3. Mycoses in the transplanted patient. (United States)

    Dictar, M O; Maiolo, E; Alexander, B; Jacob, N; Verón, M T


    The incidence of invasive fungal infection (IFI) has increased considerably over the past 20 years, and transplant recipients are at especially high risk for fungal infections owing to their overall immunosuppressed condition. Organ transplantation procedures were incorporated as a therapeutic option for many patients who lacked the normal functions of organs such as the heart, liver, kidney, lung, pancreas and small bowel. The prevalence of IFI in solid organ transplant (SOTR) patients ranges from 5 to 50% in kidney and liver transplants, respectively. In bone marrow transplant (BMT) patients, IFI are major causes of morbidity and mortality due to the protracted neutropenic period and graft-versus-host disease. Candida spp. and Aspergillus spp. account for >80% of fungal episodes in both SOTR and BMT. The development of new immunosuppressive agents, new prophylaxis strategies (as pre-emptive therapy) and the improvement in surgical techniques led to increase survival of transplant recipients. In this session, a clear and concise update of the recent advances in the laboratory diagnosis of candidiasis and aspergillosis in this kind of patients was presented. However, we still need to establish more rapid, sensitive and specific methods for IFI diagnosis. Representatives of the 'Subcomision de Infecciones en el Paciente Neutropenico y Transplantado (SIPNYT)' de la Sociedad Argentina de Infectologia (SADI), presented the results of an unusual multicenter study both retrospective and descriptive studies of IFI in SOTR and BMT patients in Argentina. In addition, a study of IFI in 1,861 SOTR patients from four centers and the analysis of IFI in 2,066 BMT patients from all 12 BMT centers from Argentina was presented. From these studies it can be concluded that 'all transplant recipients are not the same' and that they should be stratified according to their different risk degrees in order to determine the best prophylaxis and treatment strategies.

  4. Pancreas transplants

    Energy Technology Data Exchange (ETDEWEB)

    Chandra, J.; Phillips, R.R.; Boardman, P.; Gleeson, F.V. [Department of Radiology, Churchill Hospital, Headington, Oxford (United Kingdom); Anderson, E.M. [Department of Radiology, Churchill Hospital, Headington, Oxford (United Kingdom)], E-mail:


    Cadaveric, whole pancreas transplantation has proved an effective therapy in the treatment of long-standing type 1 diabetes mellitus and is capable of achieving an insulin-independent eugyclaemic state. As a result, this procedure is being increasingly performed. However, the surgical procedure is complex and unfamiliar to many radiologists. Imaging with computed tomography (CT) and magnetic resonance imaging (MRI) gives excellent results and can be used confidently to diagnose vascular, enteric, and immune-mediated complications. We present a review of the normal post-transplantation appearance and the features of early and late complications.

  5. Expression of ADAMs ("a disintegrin and metalloprotease") in the human lung

    NARCIS (Netherlands)

    Dijkstra, Antoon; Postma, Dirkje S.; Noordhoek, Jacobien A.; Lodewijk, Monique E.; Kauffman, Henk F.; ten Hacken, Nick H. T.; Timens, Wim


    In view of the associations of "a disintegrin and metalloprotease" (ADAM) with respiratory diseases, we assessed the expression of various ADAMs in human lung tissue. Lung tissue was obtained from nine individuals who underwent surgery for lung cancer or underwent lung transplantation for emphysema.

  6. Kidney transplantation after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Li-Yang Wu; Hang Liu; Wei Liu; Han Li; Xiao-Dong Zhang


    Kidney transplantation after liver transplanta-tion (KALT) offers longer survival and a better quality of life to liver transplantation recipients who develop chronic renal failure. This article aimed to discuss the efifcacy and safety of KALT compared with other treatments. The medical records of 5 patients who had undergone KALT were retrospectively studied, together with a literature review of studies. Three of them developed chronic renal failure after liver transplanta-tion because of calcineurin inhibitor (CNI)-induced neph-rotoxicity, while the others had lupus nephritis or non-CNI drug-induced nephrotoxicity. No mortality was observed in the 5 patients. Three KALT cases showed good prognoses, maintaining a normal serum creatinine level during entire follow-up period. Chronic rejection occurred in the other two patients, and a kidney graft was removed from one of them. Our data suggested that KALT is a good alternative to dialysis for liver transplantation recipients. The cases also indicate that KALT can be performed with good long-term survival.

  7. Neuropathologic findings after organ transplantation. An autopsy study. (United States)

    Schwechheimer, K; Hashemian, A


    Since 1972 organ transplantations of kidney, bone marrow, liver, heart and lung have been performed at the University Hospital of Essen, Germany. Out of 2535 transplantations until September 1993, autopsies were performed in 157 patients In 25 patients (15.9%) neuropathologic findings (n = 26) were found. In 97 autopsies after bone marrow transplantation, 9 patients (9.3%) exhibited a severe neuropathologic alteration. In six patients (6/9; 66.6%), necrotisizing toxoplasmose encephalitis was found. Other cases showed a septic-metastatic mycotic encephalitis with crypto-coccus neoformans and candida albicans (n = 2) and leucemia infiltrates (n = 1). Massive cerebral hemorrhage was the most frequent neuropathologic finding after liver (4/8) and kidney transplantation (3/6). In addition liver-transplanted patients exhibited septic-metastatic encephalitis (3/8) and embolic brain infarct (1/8) as well as cerebral metastases (2/6) and primary malignant cerebral lymphoma in kidney transplantation (1/6). CNS findings in five autopsies after heart-lung-transplantation were diverse. They comprised intracerebral hemorrhage, intravasal lymphoma and septic-metastatic encephalitis, respectively. In summary, neuropathologic autopsy findings after organ transplantation are diverse and preferentially comprise infections, cerebral hemorrhages, and malignant lymphomas. After bone marrow transplantation, the most frequent neuropathologic autopsy finding was toxoplasmose encephalitis and massive cerebral hemorrhages after liver and kidney transplantations.

  8. The department of psychology within a pediatric cardiac transplant unit. (United States)

    Rossi, A; De Ranieri, C; Tabarini, P; Di Ciommo, V; Di Donato, R; Biondi, G; Parisi, F


    In 1979, the department of Psychology started its activity to provide psychological support to patients and their families during the course of treatment and during the follow-up period. Since 1986, a transplantation program was initiated in the cardiology and pediatric cardiac surgery departments, performing 179 cardiac, 3 heart-kidney, 18 heart-lung 14 both lung, 1 heart-lung-liver, and 1 single lung transplantation. From 1993, to September 2010 the kidney transplant program has performed. 218 cases. Since 2008, we performed (32 liver and 1 intestinal transplantations). We examined the quality of life and coping with transplantation attitudes because there is recent evidence of high levels of family anxiety and depression related to a child's poor response to the disease and compliance. Our work associated post-traumatic stress disorder (PTSD) with anxiety and with these clinical variables: gender pathology, rejection, number of drugs frequency of hospital visits, number of hospitalizations, as well as age at and time from transplantation. We examined 56 parents (25 fathers and 31 mothers) of cardiac transplant recipients. Our most relevant data demonstrated the presence of PTSD among 52% of mothers and 40% of fathers. Significant correlations were observed within the trait of anxiety. No correlations were noted between PTSD and other variables. Testing anxiety levels of parents is considered to be basic to provide psychological support to parents, encourage personal skills, and avoid PTSD symptoms.

  9. Transplant production (United States)

    For field pepper (Capsicum spp.) production, plants can be established from direct seed or transplants depending on the location and cultural practices for the specific pepper type grown. Direct seeding can result in slow, variable, and reduced plant stands due to variations in soil temperature, wat...

  10. Heart Transplantation (United States)

    A heart transplant removes a damaged or diseased heart and replaces it with a healthy one. The healthy heart comes from a donor who has died. It is the last resort for people with heart failure when all other treatments have failed. The ...

  11. OPTN/SRTR 2015 Annual Data Report: Lung. (United States)

    Valapour, M; Skeans, M A; Smith, J M; Edwards, L B; Cherikh, W S; Uccellini, K; Israni, A K; Snyder, J J; Kasiske, B L


    In 2015, 2409 active candidates aged 12 years or older were added to the lung transplant waiting list; 2072 transplants were performed, the most of any year. The median waiting time for candidates listed in 2015 was 3.4 months; the shortest waiting time was for diagnosis group D. Despite the highest recorded transplant rate of 157 per 100 waitlist years, waitlist mortality continued a steady decade-long rise to a high of 16.5 deaths per 100 waitlist years. Measures of short- and long-term survival showed no trend toward improved overall survival in the past 5 years, except that 6-month death rates decreased from 9.4% in 2005 to 7.9% in 2014. At 5 years posttransplant, 55.5% of recipients remained alive. In 2015, 23 new child (ages 0-11 years) candidates were added to the list; 17 transplants were performed. Incidence of death was 6.1% at 6 months and 8.2% at 1 year for transplants in 2013-2014. Important policy changes will affect access to transplant. In February 2015, OPTN implemented a comprehensive revision of the lung allocation score to better reflect mortality risk. Broader geographic sharing of donor lungs for pediatric candidates and allowance for selected transplants across blood types for candidates aged younger than 2 years have been approved and are expected to improve pediatric access to transplant. The impact of these changes on lung transplant trends will be observed in the coming years.

  12. U.S. system for organ procurement and transplantation. (United States)

    Schaeffer, M J; Alexander, D C


    The establishment and responsibilities of the organ procurement and transplantation network in the United States are discussed, and the process of receiving an organ transplant through the system is described. The National Organ Transplant Act of 1984 provided for a federally funded network for organ procurement and transplantation, which would function as a private, non-profit organization. This organization is the United Network for Organ Sharing (UNOS). UNOS monitors the activities of and provides service to transplant centers and organ procurement organizations (OPOs). The names of all candidates awaiting cadaveric organ transplants are placed on a central waiting list maintained by UNOS; UNOS also is responsible for maintaining a scientific registry to collect relevant data from transplant centers on the recipients of organ transplants. Although there is a national list of more than 25,000 persons waiting at any given time for a cadaveric organ, there are far fewer actual organ donors (less than 5000 in 1991). The hospital's best resource with respect to the donation process is the local OPO, which provides services related to organ donor referral, evaluation, and surgical recovery. The organ donation process consists of eight components: donor identification, referral, evaluation, consent, management, recovery of organs, allocation, and follow-up. An organ recovery coordinator from the local OPO helps the hospital staff in determining donation potential, seeking consent from the next of kin, and managing the donor after consent has been obtained. The OPO--never the donor's family or their insurer--is billed for charges relating to the donation. The OPO then bills the costs associated with the donation to the transplant centers receiving each organ for implantation.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Pulmonary complications in renal transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jung Bin; Choi, Yo Won; Jeon, Seok Chol; Park, Choong Ki; Lee, Seung Rho; Hahm, Chang Kok; Joo, Kyung Bin [Hanyang University College of Medicine, Seoul (Korea, Republic of)


    To evaluate the radiographic and CT findings of pulmonary complications other than pulmonary edema arising from renal transplantation. Among 393 patients who had undergone renal transplantation at our hospital during a previous ten-year period, 23 with pulmonary complications other than pulmonary edema were included in this study. The complications involved were infection caused by CMV (n=6), bacteria (n=4), fungus (n=4), tuberculosis (n=2), varicella (n=1) or chlamydia (n=1), and malignancy involving lung cancer (n=4) or Kaposi's sarcoma (n=1). Two chest radiologists reviewed all images. The complications manifesting mainly as pulmonary nodules were lung cancer (4/4), tuberculosis (1/2), and Kaposi's sarcoma (1/1). Pulmonary consolidation was a main feature in bacterial infection (4/4), fungal infection (3/4), tuberculosis (1/2), chlamydial infection (1/1), and varicellar pneumonia (1/1). Ground-glass attenuation was a main CT feature in CMV pneumonia (4/6), and increased interstitial making was a predominant radiographic feature in CMV pneumonia (2/6). The main radiologic features described above can be helpful for differential diagnosis of the pulmonary complications of renal transplantation.

  14. The effects of discontinuing cinacalcet at the time of kidney transplantation (United States)

    Jadoul, Michel; Baños, Ana; Zani, Valter J.; Hercz, Gavril


    Background. The calcimimetic, cinacalcet, is approved for treating secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) on dialysis. Biochemical profiles and clinical outcomes in patients discontinuing cinacalcet at kidney transplantation have not been previously described. Methods. We performed a retrospective observational study evaluating post-transplant biochemical profiles and clinical outcomes in patients who had enrolled in phase 2 or 3 randomized, placebo-controlled studies of cinacalcet before receiving a kidney transplant. Results. The study included 28 former cinacalcet and 10 former placebo patients. Post-kidney transplant, there were no obvious differences between the two groups in levels of serum intact parathyroid hormone, calcium or phosphorus. One patient in each group underwent post-transplant parathyroidectomy. Kidney transplant failure was apparent in one former cinacalcet-treated patient (4%) and three former placebo patients (30%). The duration of hospitalization (mean ± standard error) immediately post-transplant in these two groups was 2.3 ± 0.3 and 3.4 ± 0.8 weeks, respectively. Conclusions. Using cinacalcet to treat SHPT in patients with CKD awaiting kidney transplantation does not appear to modify SHPT-related post-transplant biochemical profiles, or clinical outcomes, compared with placebo. PMID:20090879

  15. 缺血再灌注肺损伤对肺移植临床效果的影响%Impact of ischemia-reperfusion injury on outcome following lung transplantation

    Institute of Scientific and Technical Information of China (English)

    葛素娟; 代华平; 何璇; 陈其瑞; 苗静柏; 孙兵; 班承钧; 詹庆元; 胡滨


    Objective Primary graft dysfunction (PGD) is a severe form of ischemia-reperfusion injury (IRI) developing in the early days of post-lung transplantation (LT).We aimed to investigate the incidence and severity grading of PGD,and analyze the impact of PGD on early morbidity and mortality after LT as well as on long-term function and survival.Method Twenty-eight consecutive recipients undergoing LT were collected at Beijing Chao-Yang Hospital between Aug.2005 and Dec.2010,and 24 LT recipients were enrolled in this study.The incidence of PGD was calculated and the recipients were classified by standardized consensus criteria reported by the International Society for Heart and Lung Transplantation (ISHLT) Working Group on PGD.The difference was compared among T0-24,T24-48 and T48-72.The incidence of PGD,PGD grading and impact of PGD on early morbidity and mortality after LT as well as on long-term function and survival were analyzed.Result The incidence of PGD after LT was 66.7% (16/24).The incidence of severe PGD (grading 3) was 54.2% (13/24).There was significant difference among T0-24,T24-48 and T48-72 in the severity grading of PGD (P<0.01).At 30th day and 3rd month post-LT,one and 4 died,respectively,among LT recipients with PGD.There was no death in LT recipients without PGD.The all-cause mortality rate had no statistically significant difference between the two groups (P > 0.05).The median duration of mechanical ventilation in LT recipients with or without PGD was 91.1 h and 19.2 h respectively (P<0.05).The improvements of pulmonary function and 6 Minute Walk Test (6MWT) within one year after LT showed no statistically significant difference between LT recipients with PGD and those without PGD (P > 0.05 ). Conclusion MBL gene single nucleotide polymorphisms may influence CMV infection after HSCT.%目的 分析肺移植受者缺血再灌注肺损伤的发生情况及其对肺移植临床效果的影响.方法 2005年8月至2010年12

  16. Spectrum of fibrosing diffuse parenchymal lung disease. (United States)

    Morgenthau, Adam S; Padilla, Maria L


    The interstitial lung diseases are a heterogeneous group of disorders characterized by inflammation and/or fibrosis of the pulmonary interstitium. In 2002, the American Thoracic Society and the European Respiratory Society revised the classification of interstitial lung diseases and introduced the term diffuse parenchymal lung disease. The idiopathic interstitial pneumonias are a subtype of diffuse parenchymal lung disease. The idiopathic interstitial pneumonias are subdivided into usual interstitial pneumonia (with its clinical counterpart idiopathic interstitial pneumonia), nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, and lymphocytic pneumonia. Sarcoidosis and hypersensitivity pneumonitis are the 2 most common granulomatous diffuse parenchymal lung diseases. Rheumatoid arthritis, systemic sclerosis, and dermatomyositis/polymyositis (causing antisynthetase syndrome) are diffuse parenchymal lung diseases of known association because these conditions are associated with connective tissue disease. Hermansky-Pudlak syndrome is a rare genetic diffuse parenchymal lung disease characterized by the clinical triad of pulmonary disease, oculocutaneous albinism, and bleeding diathesis. This review provides an overview of the chronic fibrosing diffuse parenchymal lung diseases. Its primary objective is to illuminate the clinical challenges encountered by clinicians who manage the diffuse parenchymal lung diseases regularly and to offer potential solutions to those challenges. Treatment for the diffuse parenchymal lung diseases is limited, and for many patients with end-stage disease, lung transplantation remains the best option. Although much has been learned about the diffuse parenchymal lung diseases during the past decade, research in these diseases is urgently needed.

  17. Liver Transplant: Nutrition (United States)

    ... ZIP code here Enter ZIP code here Liver Transplant: Nutrition for Veterans and the Public Nutrition Liver ... apply to transplant and liver disease patients. Pre-Transplant Protein Malnutrition -- Many patients with end stage liver ...

  18. Transplant Center Search Form (United States)

    ... Share Your Story Give Us Feedback - A + A Transplant Center Search Form Welcome to the Blood & Marrow ... transplant centers for patients with a particular disease. Transplant Center login Username: * Password: * Request new password Join ...

  19. A review of abdominal organ transplantation in cystic fibrosis. (United States)

    Lu, Brandy R; Esquivel, Carlos O


    With advances in medical treatments, patients with CF are having improved quality of life and living longer. Although pulmonary disease is still the leading cause of morbidity and mortality, this longevity has allowed for the development of other organ dysfunction, mainly liver and pancreas. This review discusses the abdominal organ complications and the role of abdominal organ transplantation in CF. Liver failure and portal hypertension complications are the most common indicators for liver transplantation in CF, and five-yr survival for isolated liver transplantation is >80%. Deficiency of pancreatic enzymes is almost universal and up to 40% of patients with CF can develop insulin-dependent diabetes, although the role of pancreas transplantation is less clear and needs further research. Finally, the need for lung transplantation should always be assessed and considered in combination with liver transplantation on a case-by-case basis.

  20. Presumed consent for transplantation: a dead issue after Alder Hey? (United States)

    English, V; Sommerville, A


    In the wake of scandals about the unauthorised retention of organs following postmortem examination, the issue of valid consent (or the lack of it) has returned to the forefront. Emphasis is put on obtaining explicit authorisation from the patient or family prior to any medical intervention, including those involving the dead. Although the controversies in the UK arose from the retention of human material for education or research rather than therapy, concern has been expressed that public mistrust could also adversely affect organ donation for transplantation. At the same time, however, the British Medical Association (BMA) continues to call for a shift to a system of presumed consent for organ transplantation. This apparent inconsistency can be justified because valid distinctions exist between the reasons requiring explicit consent for retention and the acceptability of presumed consent for transplantation. This paper argues for introducing a system of presumed consent for organ donation, given the overwhelming expressions of public support for transplantation. Ongoing legislative review in the UK provides an ideal chance to alter the default position to one where potential donors can simply acquiesce or opt out of donation. Combined with consultation with their relatives, this could be a much better method of realising individuals' wishes. It would also achieve a better balance between the duties owed to the deceased and those owed to people awaiting a transplant. PMID:12796433

  1. Cholelithiasis in patients on the kidney transplant waiting list

    Directory of Open Access Journals (Sweden)

    André Thiago Scandiuzzi Brito


    Full Text Available OBJECTIVES: To evaluate the prevalence of cholecystopathy in chronic renal patients awaiting kidney transplants. INTRODUCTION: The prevalence and management of cholelithiasis in renal transplant patients is not well established. METHODS: A total of 342 chronic renal failure patients on the waiting list for a kidney transplant were studied. Patients were evaluated for the presence of cholelithiasis and related symptoms, previous cholecystectomies and other abdominal surgeries, time on dialysis, and general data (gender, age, number of pregnancies, and body mass index. RESULTS: Cholelithiasis was found in 41 out of 342 patients (12%. Twelve of these patients, all symptomatic, had previously undergone cholecystectomies. Five out of 29 patients who had not undergone surgery were symptomatic. Overall, 17 patients (41.5% were symptomatic. Their mean age was 54 (range 32-74 years old; 61% were female, and their mean body mass index was 25.4. Nineteen (76% out of 25 women had previously been pregnant, with an average of 3.6 pregnancies per woman. CONCLUSIONS: The frequency of cholelithiasis was similar to that reported in the literature for the general population. However, the high frequency of symptomatic patients points toward an indication of routine pre-transplant cholecystectomy to avoid serious post-transplant complications.

  2. Improvements of Surgical Technique in Establishment of Rat Orthotopic Pulmonary Transplantation Model Using Cuffs

    Institute of Scientific and Technical Information of China (English)


    In order to establish more simple and effective rat orthotopic lung transplantation models, 20 rats were divided into donor and recipient groups. Rat lung transplantation models were established by using improved cuff technique. All the 10 operations were accomplished successfully.The mean operative time of recipients was 45±4 min. The survival time was over 30 days after lung transplantation. The checks of X-ray were almost ncrmal. There was no significant difference in the blood gas analysis before and after clipping the right hilum (P>. 05). This method is more simple,applicable and requires less time.

  3. Role of reepithelization in the development of obliterative airway disease after lung transplantation%气道上皮再生对肺移植后闭塞性气道疾病的影响

    Institute of Scientific and Technical Information of China (English)

    徐保彬; 陈昶; 高文; 魏宁; 郑卉; 张容轩


    ,从而预防了OAD的发生.%Objective To investigate the role of airway reepithelization in the development of obliterative airway disease (OAD) after lung transplantation. Methods Donor allograft was obtained as Balb/c trachea and its connecting left bronchi, and it was subsequently orthotopically transplanted into recipient C57BL/6 mouse. Both ends of the donor trachea were anastmosed to the recipient in endto-end mode, and the bronchial branch was ligated distally. In the ligated group, the proximal end of the bronchi was ligated; it was otherwise left open in the unligated group. Allografts were harvested on postoperative day 28, and were examined for OAD manifestations, epithelium integrity and differentiation, submucous lymphocyte infiltration, and fibroproliferation. LCR, submucous fibrous tissue area and ciliated epithelium proportion were measured with computerized morphometry. Epithelium phenotype was examined by immunohistochemical stain. Results Tacheal allografts and unligated bronchi maintained luminal patency and integrated epithelium, while ligated bronchial allografts were obliterated with fibrous tissue, which was characteristic of OAD. LCR and lamina propria of the donor trachea and unligated bronchi were significantly higher than normal tracha (P<0. 01 and P < 0. 05 ). However,ciliated epithelium proportion of the tracheal allografts was intermediate between normal trachea and ligated bronchi (P<0. 05 and P<0. 01). Immunohistochernical stain revealed recipient phenotype in both the tracheal and unligated bronchial allografts; no recipient phenotype expression was noted in the ligated bronchial allografts. Conclusion Reepithelization with recipient-drived mucosa prevents OAD development in orthotopic tracheal and unligated bronchial allografts by changing the epithelium phenotype and regulating fibroblasts proliferation in the lamina propria.

  4. Risk of death among those awaiting treatment for HIV infection in Zimbabwe: adolescents are at particular risk

    Directory of Open Access Journals (Sweden)

    Amir Shroufi


    Full Text Available Introduction: Mortality among HIV-positive adults awaiting antiretroviral therapy (ART has previously been found to be high. Here, we compare adolescent pre-ART mortality to that of adults in a public sector HIV care programme in Bulawayo, Zimbabwe. Methods: In this retrospective cohort study, we compared adolescent pre-ART outcomes with those of adults enrolled for HIV care in the same clinic. Adolescents were defined as those aged 10–19 at the time of registration. Comparisons of means and proportions were carried out using two-tailed sample t-tests and chi-square tests respectively, for normally distributed data, and the Mann–Whitney U-tests for non-normally distributed data. Loss to follow-up (LTFU was defined as missing a scheduled appointment by three or more months. Results: Between 2004 and 2010, 1382 of 1628 adolescents and 7557 of 11,106 adults who registered for HIV care met the eligibility criteria for ART. Adolescents registered at a more advanced disease stage than did adults (83% vs. 73% WHO stage III/IV, respectively, p<0.001, and the median time to ART initiation was longer for adolescents than for adults [21 (10–55 days vs. 15 (7–42 days, p<0.001]. Among the 138 adolescents and 942 adults who never commenced ART, 39 (28% of adolescents and 135 (14% of adults died, the remainder being LTFU. Mortality among treatment-eligible adolescents awaiting ART was significantly higher than among adults (3% vs. 1.8%, respectively, p=0.004. Conclusions: Adolescents present to ART services at a later clinical stage than adults and are at an increased risk of death prior to commencing ART. Improved and innovative HIV case-finding approaches and emphasis on prompt ART initiation in adolescents are urgently needed. Following registration, defaulter tracing should be used, whether or not ART has been commenced.

  5. Tobacco smoking and solid organ transplantation. (United States)

    Corbett, Chris; Armstrong, Matthew J; Neuberger, James


    Smoking, both by donors and by recipients, has a major impact on outcomes after organ transplantation. Recipients of smokers' organs are at greater risk of death (lungs hazard ratio [HR], 1.36; heart HR, 1.8; and liver HR, 1.25), extended intensive care stays, and greater need for ventilation. Kidney function is significantly worse at 1 year after transplantation in recipients of grafts from smokers compared with nonsmokers. Clinicians must balance the use of such higher-risk organs with the consequences on waiting list mortality if the donor pool is reduced further by exclusion of such donors. Smoking by kidney transplant recipients significantly increases the risk of cardiovascular events (29.2% vs. 15.4%), renal fibrosis, rejection, and malignancy (HR, 2.56). Furthermore, liver recipients who smoke have higher rates of hepatic artery thrombosis, biliary complications, and malignancy (13% vs. 2%). Heart recipients with a smoking history have increased risk of developing coronary atherosclerosis (21.2% vs. 12.3%), graft dysfunction, and loss after transplantation. Self-reporting of smoking is commonplace but unreliable, which limits its use as a tool for selection of transplant candidates. Despite effective counseling and pharmacotherapy, recidivism rates after transplantation remain high (10-40%). Transplant services need to be more proactive in educating and implementing effective smoking cessation strategies to reduce rates of recidivism and the posttransplantation complications associated with smoking. The adverse impact of smoking by the recipient supports the requirement for a 6-month period of abstinence in lung recipients and cessation before other solid organs.

  6. Effect of preoperative pulmonary artery pressure on early survival after lung transplantation for idiopathic pulmonary fibrosis%术前肺动脉高压对肺纤维化患者肺移植术后早期存活率的影响

    Institute of Scientific and Technical Information of China (English)

    朱艳红; 陈静瑜; 周敏; 郑明峰; 吴波; 张稷


    Objective To estimate the effects of preoperative pulmonary hypertension on early survival (90 days) after lung transplantation for idiopathic pulmonary fibrosis (IPF).Methods We reviewed 30 cases of lung transplant patients which suffered from IPF.According to the pulmonary artery pressure,non-pulmonary hypertension group (n=17) and pulmonary hypertension group (n=13) were set up.Risk factors were assessed individually and adjusted for confounding by a multivariable logistic regression model.The early outcomes (90 days) were compared in two groups by the χ~2 test. Results The early survival rate was 61.5% and 94.1% in pulmonary hypertension group and non-pulmonary hypertension group respectively (P<0.05).Multivariate analysis confirmed that mean pulmonary artery pressure was independent risk factors after adjustment for potential confounders.Recipient age,operating procedure,and use of extracorporeal membrane oxygenation (ECMO) were not independent risk factors for early mortality.Conclusion The increased pulmonary artery pressure is an independent risk factor for death after single-lung transplantation in IPF.Mean pulmonary artery pressure should be included in the overall risk assessment of patients with IPF evaluated for lung transplantation.%目的 探讨术前肺动脉高压对特发性肺纤维化(IPE)患者肺移植术后早期(<90 d)存活率的影响.方法 2002年9月至2009年4月为30例特发性肺纤维化患者进行了肺移植.根据术前肺动脉压的检测结果,将30例患者分为两组.肺动脉高压组:13例,术前平均肺动脉压≥30 mmHg;对照组:17例,术前平均肺动脉压<30 mm Hg.对两组患者的年龄、术式(单、双肺移植)、肺动脉乐力、是否应用体外膜氧合(ECMO)等进行多因素逻辑同归分析比较.结果 肺动脉高压组和对照组患者肺移植术后早期存活率分别为61.5%和94.1%,两组比较,差异有统计学意义(P

  7. Melatonin influence in ovary transplantation: systematic review. (United States)

    Shiroma, M E; Botelho, N M; Damous, L L; Baracat, E C; Soares-Jr, J M


    Melatonin is an indolamine produced by the pineal gland and it can exert a potent antioxidant effect. Its free radical scavenger properties have been used to advantage in different organ transplants in animal experiments. Several concentrations and administration pathways have been tested and melatonin has shown encouraging beneficial results in many transplants of organs such as the liver, lungs, heart, pancreas, and kidneys. The objective of the present study was to review the scientific literature regarding the use of melatonin in ovary transplantation. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was carried out using the Cochrane and Pubmed databases and employing the terms 'melatonin' AND 'ovary' AND 'transplantation.' After analysis, 5 articles were extracted addressing melatonin use in ovary transplants and involving 503 animals. Melatonin enhanced various graft aspects like morphology, apoptosis, immunological reaction, revascularization, oxidative stress, and survival rate. Melatonin's antioxidative and antiapoptotic properties seemingly produce positive effects on ovarian graft activity. Despite the promising results, further studies in humans need to be conducted to consolidate its use, as ovary transplantation for fertility preservation is gradually being moved from the experimental stage to a clinical setting.

  8. Lung function

    Institute of Scientific and Technical Information of China (English)


    2005200 The effect of body position changes on lung function, lung CT imaging and pathology in an oleic acid induced acute lung injury model. JI Xin-ping (戢新平), et al. Dept Emergency, 1st Affili Hosp, China Med Univ, Shenyang 110001. Chin J Tuberc Respir Dis, 2005;28(1) :33-36. Objective: To study the effect of body position changes on lung mechanics, oxygenation, CT images and pathology in an oleic acid-induced acute lung injury (ALl) model. Methods: The study groups con-

  9. Evaluation of pulmonary function in renal transplant recipients and chronic renal failure patients undergoing maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed E. Abdalla


    Conclusion: There is impairment of lung function in patients with CRF undergoing hemodialysis. The main changes are small airway obstruction, reduction in carbon monoxide transfer and diminished 6MWT that were not completely improved in the kidney transplant patients.

  10. Lung transplantation from donor of cardiac death and donation after brain death in one centre Ⅲ: 4 cases report%单中心心脏死亡和脑死亡供肺肺移植临床经验总结

    Institute of Scientific and Technical Information of China (English)

    毛文君; 陈静瑜; 郑明峰; 吴波; 叶书高; 刘峰


    Objective To summarize the clinical experience ot harvesting and using the lungs from donation after brain death (DBD) and donation after cardiac death (DCD,Maastricht category Ⅳ) in China.Methods Eleven potential DBDs and DCDs were evaluated by our transplant group preoperatively,including 6 cases of DCDs and 5 cases of DBDs,and all of them received the tests of sputum culture bedside bronchoscopy,chest X rays,and blood gas analysis.After clear evaluation,1 case of DCD and 2 cases of DBD were discharged from the group for bilateral inflammatory infiltration and poor oxygenation index,and one case of DCD was precluded due to long warm ischemic time (>60min).The donor lungs from remaining 7 cases were harvested successfully after the declaration of brain death or cardiac death.The preoperative lymphocytotoxic cross match test was negative,ABO blood types were compatible,and the donors were all suitable for the transplant procedure.Results Seven lung transplants were performed successfully under ECMO support,including 5 cases of bilateral lung transplantation and 2 cases of single lung transplantation.One patient was complicated with severe infection and died of sepsis on postoperative day (POD) 39,and one was succumbed to multiple organ failure.Two patients suffered of acute rejection on POD 30 and POD 19,respectively,and obtained improvements by bolus steroid therapy.The remaining 3 patients all recovered uneventfully.During a follow up period,all the patients lived an active life style with high quality of life.The mean survival time was 23.3 months (3-51 months).Conclusion The DCD and DBD may be one of the available donor resources for lung transplantation after efficient management of the potential donors and detailed preoperative evaluation in China.%目的 总结单中心脑死亡器官捐赠(DBD)和心脏死亡器官捐赠(DCD)的供肺获取以及肺移植的临床经验.方法 11例潜在器官捐献供者进行了术前评估,所有供者均进行痰

  11. 骨髓间充质干细胞对脂多糖诱导的急性肺损伤小鼠的早期治疗作用%Therapeutic effect of intravenous bone marrow-derived mesenchymal stem cell transplantation on early-stage LPS-induced acute lung injury in mice

    Institute of Scientific and Technical Information of China (English)

    邰文琳; 董昭兴; 张丹丹; 王殿华


    目的 观察经尾静脉输注的骨髓间充质干细胞(MSCs)对脂多糖(LPS)诱导的急性肺损伤小鼠的早期治疗作用.方法 采用密度梯度单个核细胞分离培养法分离纯化骨髓间充质干细胞,传至第4代时观察细胞形态、流式细胞仪检测细胞表面标志,定向诱导检测分化能力后备用.36只小鼠随机分为对照组,PBS治疗组,MSC治疗组.对照组气管内滴注生理盐水50 μl,PBS和MSC治疗组气管内滴注LPS制备急性肺损伤模型.造模后lh后经尾静脉输注MSC5× 106(MSCs治疗组)或PBS 100 μl(PBS治疗组或对照组).24h后处死小鼠,留取标本检测肺组织病理形态学、肺组织湿干重比(W/D)、支气管肺泡灌洗液(BALF)中中性粒细胞数、蛋白含量、细胞因子水平和肺组织中的MPO表达量.结果 与对照组比较,PBS治疗组肺组织病理损伤严重,BALF中中性粒细胞数、蛋白含量、TNF-α、IL-6和IL-10水平、肺组织中的MPO含量及肺组织湿干重比均显著升高.与PBS治疗组比较,MSCs治疗组肺组织病理损伤程度减轻,BALF中中性粒细胞数、蛋白含量、TNF-α、IL-6水平、肺组织中的MPO含量及肺组织湿干重比均显著降低,但仍高于对照组水平,IL-10水平显著高于PBS治疗组和对照组.结论MSCs移植在LPS诱导的急性肺损伤早期阶段可有效改善肺组织病理损伤,减轻肺部炎症反应,降低肺水肿程度,这种治疗作用不依赖于MSCs移植后在肺内的定植数量.%Objective To investigate the effect of intravenous bone marrow-derived mesenchymal stem cell(MSC)transplantation for early intervention of lipopolysaccharide(LPS)-induced acute lung injury(ALI)in mice.Methods Thirty-six mice were randomized into control group,PBS-treated ALI group,and MSC-treated ALI group.In the latter two groups,mouse models of ALI were established by intranasal instillation of LPS,and 1 h later,the 4th passage of MSCs isolated from the bone marrow of mice or PBS were


    NARCIS (Netherlands)



    Lung transplantation interrupts hilar lymphatics. This may have an impact on immune responses to antigens entering the lung because the antigens cannot reach the lung-associated lymph nodes where the immune response is generated. We investigated the interruption and regeneration of lymphatics and th

  13. Heart transplantation in adults with congenital heart disease. (United States)

    Houyel, Lucile; To-Dumortier, Ngoc-Tram; Lepers, Yannick; Petit, Jérôme; Roussin, Régine; Ly, Mohamed; Lebret, Emmanuel; Fadel, Elie; Hörer, Jürgen; Hascoët, Sébastien


    With the advances in congenital cardiac surgery and postoperative care, an increasing number of children with complex congenital heart disease now reach adulthood. There are already more adults than children living with a congenital heart defect, including patients with complex congenital heart defects. Among these adults with congenital heart disease, a significant number will develop ventricular dysfunction over time. Heart failure accounts for 26-42% of deaths in adults with congenital heart defects. Heart transplantation, or heart-lung transplantation in Eisenmenger syndrome, then becomes the ultimate therapeutic possibility for these patients. This population is deemed to be at high risk of mortality after heart transplantation, although their long-term survival is similar to that of patients transplanted for other reasons. Indeed, heart transplantation in adults with congenital heart disease is often challenging, because of several potential problems: complex cardiac and vascular anatomy, multiple previous palliative and corrective surgeries, and effects on other organs (kidney, liver, lungs) of long-standing cardiac dysfunction or cyanosis, with frequent elevation of pulmonary vascular resistance. In this review, we focus on the specific problems relating to heart and heart-lung transplantation in this population, revisit the indications/contraindications, and update the long-term outcomes.

  14. Generic tacrolimus in solid organ transplantation. (United States)

    Taube, D; Jones, G; O'Beirne, J; Wennberg, L; Connor, A; Rasmussen, A; Backman, L


    The availability of a wide range of immunosuppressive therapies has revolutionized the management of patients who have undergone solid organ transplantation (SOT). However, the cost of immunosuppressive drugs remains high. This situation has led to the development of generic equivalents, which are similar in quality, safety, and efficacy to their approved innovator drugs. There are data available for three generic brands, tacrolimus (Intas), tacrolimus (PharOS), and tacrolimus (Sandoz). Bioequivalence has been demonstrated for generic tacrolimus (Sandoz) within a narrow therapeutic range to its innovator tacrolimus drug (Prograf) in both healthy volunteers and kidney transplant patients. Clinical experience with this generic tacrolimus formulation has also been established in both de novo and conversion patients who have undergone kidney and liver transplantation, as well as in conversion of other SOT patients, including lung and heart recipients.

  15. Organ transplantation in Tunisia. (United States)

    El Matri, Aziz; Ben Abdallah, Taieb


    Kidney transplants were first performed in Tunisia in 1986, and transplants soon extended to other organs including the heart, liver, and pancreas. Live-related donor and deceased-donor kidney transplants were both began in the summer of 1986. An organ procurement and transplant law was passed in March 1991, and the National Centre for Advancement of Organ Transplantation was created in 1995. The number of transplantation units has increased to 7 throughout the country, and the yearly transplant number has progressively increased to 139 in 2010, including 20% from deceased kidney donors. Despite these gains, the need continues to grow. Heart transplants began in January 1993, and Tunisia and Jordan are currently the only Arab countries where it is practiced. However, only 16 patients have received a heart transplant as of 2004, and the number of recipients has decreased in the past 10 years. Liver transplants are rare in other Arab countries, but began in Tunisia in January 1998. Over 10 years, 38 patients benefited from this procedure. After a few years of stagnation, the number of liver transplants is increasing. While all types of transplantation are needed, kidney transplantation is a priority in Tunisia. The target is to perform 400 transplants annually, which would require a long-term strategy to provide full financial coverage using the National Health Insurance Funds in both the public and private sectors.

  16. Open lung biopsy (United States)

    ... CT scan Disseminated tuberculosis Granulomatosis with polyangiitis Lung cancer - small cell Lung disease Lung needle biopsy Malignant mesothelioma Pulmonary tuberculosis Rheumatoid lung disease Sarcoidosis Simple pulmonary eosinophilia ...

  17. Approach to a case of multiple irregular red cell antibodies in a liver transplant recipient: Need for developing competence

    Directory of Open Access Journals (Sweden)

    Ravi C Dara


    Full Text Available Liver transplant procedure acts as a challenge for transfusion services in terms of specialized blood components, serologic problems, and immunologic effects of transfusion. Red cell alloimmunization in patients awaiting a liver transplant complicate the process by undue delay or unavailability of compatible red blood cell units. Compatible blood units can be provided by well-equipped immunohematology laboratory, which has expertise in resolving these serological problems. This report illustrates resolution of a case with multiple alloantibodies using standard techniques, particularly rare antisera. Our case re-emphasizes the need for universal antibody screening in all patients as part of pretransfusion testing, which helps to identify atypical antibodies and plan for appropriate transfusion support well in time. We recommend that the centers, especially the ones that perform complex procedures like solid organ transplants and hematological transplants should have the necessary immunohematological reagents including rare antisera to resolve complex cases of multiple antibodies as illustrated in this case.

  18. First-in-man observation of Talaromyces marneffei-transmission by organ transplantation. (United States)

    Hermans, Frederik; Ombelet, Sien; Degezelle, Karlien; Testelmans, Dries; Van Raemdonck, Dirk E; Verleden, Geert M; Verbeken, Eric K; Van Bleyenbergh, Pascal; Lagrou, Katrien; Vos, Robin


    A lung transplant recipient was diagnosed with penicilliosis due to Talaromyces marneffei, a fungus endemic in South-East Asia, which was acquired by donor transmission. This first case of Talaromyces marneffei-transmission by transplantation underscores that current globalisation of travelling necessitates increased vigilance for transmission of unusual pathogens in organ recipients.

  19. Integrity of airway epithelium is essential against obliterative airway disease in transplanted rat tracheas

    NARCIS (Netherlands)

    Qu, N; de Vos, P; Schelfhorst, M; de Haan, A; Timens, W; Prop, J


    Background: The pathogenesis of obliterative bronchiolitis after lung transplantation requires further elucidation. In this study we used rat trachea transplantation to examine the role of epithelium in the progression of obliterative airway disease. Methods: Normal and denuded (i.e., epithelium rem

  20. Improvement in renal function after everolimus introduction and calcineurin inhibitor reduction in maintenance thoracic transplant recipients

    DEFF Research Database (Denmark)

    Arora, Satish; Gude, Einar; Sigurdardottir, Vilborg;


    The NOCTET (NOrdic Certican Trial in HEart and lung Transplantation) trial demonstrated that everolimus improves renal function in maintenance thoracic transplant (TTx) recipients. Nevertheless, introduction of everolimus is not recommended for patients with advanced renal failure. We evaluated...... NOCTET data to assess everolimus introduction amongst TTx recipients with advanced renal failure....

  1. Transmission of Angiosarcomas From a Common Multiorgan Donor to Four Transplant Recipients

    DEFF Research Database (Denmark)

    Thoning, J; Liu, Ying; Bistrup, C


    We describe the donor tumor transmission of metastatic angiosarcomas to four transplant recipients through transplantation of deceased-donor organs, i.e. kidneys, lung and liver, from an apparently unaffected common female multiorgan donor. Fluorescent in situ hybridization of angiosarcoma cells...

  2. Recommendations for use of marginal donors in heart transplantation: Brazilian Association of Organs Transplantation guideline. (United States)

    Fiorelli, A I; Stolf, N A G; Pego-Fernandes, P M; Oliveira Junior, J L; Santos, R H B; Contreras, C A M; Filho, D D L; Dinkhuysen, J J; Moreira, M C V; Mejia, J A C; Castro, M C R


    The high prevalence of heart failure has increased the candidate list for heart transplantation; however, there is a shortage of viable donated organs, which is responsible for the high mortality of patients awaiting a transplantation. Because the marginal donor presents additional risk factors, it is not considered to be an ideal donor. The use of a marginal donor is only justified in situations when the risk of patient death due to heart disease is greater than that offered by the donor. These recommendations sought to expand the supply of donors, consequently increasing the transplant rate. We selected articles based on robust evidence to provide a substratum to develop recommendations for donors who exceed the traditional acceptance criteria. Recipient survival in the immediate postoperative period is intimately linked to allograft quality. Primary allograft failure is responsible for 38% to 40% of immediate deaths after heart transplantation: therefore; marginal donor selection must be more rigorous to not increase the surgical risk. The main donor risk factors with the respective evidence levels are: cancer in the donor (B), female donor (B), donor death due to hemorrhagic stroke (B), donor age above 50 years (relative risk [RR] = 1.5) (B), weight mismatch between donor and recipient 240 minutes (RR = 1.2) (B), left ventricular dysfunction with ejection fraction below 45% (B), and use of high doses of vasoactive drugs (dopamine > 15 mg/kg·min) (B). Factors that impact recipient mortality are: age over 50 years (RR = 1.5); allograft harvest at a distance; adult recipient weighing more than 20% of the donor; high doses of vasoactive drugs (dopamine greater than 15 mg/kg·min) and ischemic time >4 hours. The use of a marginal donor is only justified when it is able to increase life expectancy compared with clinical treatment, albeit the outcomes are interior to those using an ideal donor.

  3. Pérdida de glutatión desde pulmones de conejo en solución de preservación para trasplante: Efectos clínicos y funcionales a corto plazo Loss of glutathione from rabbit lungs in transplant preservation solution

    Directory of Open Access Journals (Sweden)



    Full Text Available El daño por isquemia-reperfusión es causa de morbimortalidad en pacientes con trasplante pulmonar. Se desconoce si la solución de preservación habitual del pulmón puede contribuir a la deficiencia de antioxidantes, favoreciendo el estrés oxidativo en el receptor. Objetivo: Evaluar si existe pérdida de glutatión desde pulmones de conejo a la solución de preservación para trasplante. Resultados: Encontramos una disminución en el contenido de glutatión total del pulmón, sin aumento en el contenido de glutatión oxidado. Esto se asoció a la aparición y aumento sostenido de glutatión en la solución de preservación desde los 30 min. Conclusiones: Existe salida de glutatión desde el pulmón no mediada por oxidación de éste y posiblemente favorecida por el gradiente de concentración de glutatión reducido. Esta pérdida deja al tejido vulnerable frente a las condiciones de estrés oxidativo en el receptor.Introduction: Ischemia-reperfusion injury causes morbidity and mortality in lung transplant patients. It is unknown if the usual lung preservation solution favors antioxidant deficiency and thus, increased oxidative stress in the receptor. Objective: To evaluate if there is any loss of glutathione from rabbit lungs to the preservation solution. Results: We found a decrease in lung total glutathione content, without an increase in the oxidized form of this antioxidant. At the same time, we were able to measure increasing levels of glutathione in the preservation solution from 30 min on. Conclusions: There is loss of glutathione from the lung to the preservation solution that is not mediated by glutathione oxidation and likely due to passage of the reduced form along the concentration gradient, rendering the tissue vulnerable to oxidative stress once in the receptor.

  4. Transplante de intestino delgado Small intestine transplantation

    Directory of Open Access Journals (Sweden)

    Flávio Henrique Ferreira Galvão


    Full Text Available RACIONAL: Avanços da biotecnologia e o desenvolvimento de novas drogas imunossupressoras melhoraram os resultados do transplante de intestino delgado. Esse transplante é atualmente indicado para casos especiais da falência intestinal. OBJETIVO: A presente revisão realça os recentes desenvolvimentos na área do transplante de intestino delgado. MATERIAL E MÉTODO: Mais de 600 publicações de transplante de intestino delgado foram revisadas. O desenvolvimento da pesquisa, novas estratégias de imunossupressão, monitorização do enxerto e do receptor, e avanços na técnica cirúrgica são discutidos. RESULTADOS: Realizaram-se cerca de 700 transplante de intestino delgado em 55 centros: 44% intestino-fígado, 41% enxerto intestinal isolado e 15% transplante multivisceral. Rejeição e infecção são as principais limitações desse transplante. Sobrevida de 5 anos na experiência internacional é de 46% para o transplante de intestino isolado, 43% para o intestino-fígado e de cerca de 30% para o transplante multivisceral. Sobrevidas prolongadas são mais freqüentes nos centros com maior experiência. Em série de 165 transplantes intestinais na Universidade de Pittsburgh, PA, EUA, foi relatada sobrevida do paciente maior do que 75% no primeiro ano, 54% em 5 anos e 42% em 10 anos. Mais de 90% desses pacientes assumem dieta oral irrestrita. CONCLUSÃO: O transplante de intestino delgado evoluiu de estratégia experimental para uma alternativa viável no tratamento da falência intestinal permanente. Promover o refinamento da terapia imunossupressora, do manejo e prevenção de infecções, da técnica cirúrgica e da indicação e seleção adequada dos pacientes é crucial para melhorar a sobrevida desse transplante.BACKGROUND: Significant progress has been made in clinical small bowel transplantation over the last decade mainly due advances in biotechnology and new immunosuppressive regiments. This transplantation has now been indicated

  5. Comparison of lung preservation solutions in human lungs using an ex vivo lung perfusion experimental model

    Directory of Open Access Journals (Sweden)

    Israel L. Medeiros


    Full Text Available OBJECTIVE: Experimental studies on lung preservation have always been performed using animal models. We present ex vivo lung perfusion as a new model for the study of lung preservation. Using human lungs instead of animal models may bring the results of experimental studies closer to what could be expected in clinical practice. METHOD: Brain-dead donors whose lungs had been declined by transplantation teams were used. The cases were randomized into two groups. In Group 1, Perfadex®was used for pulmonary preservation, and in Group 2, LPDnac, a solution manufactured in Brazil, was used. An ex vivo lung perfusion system was used, and the lungs were ventilated and perfused after 10 hours of cold ischemia. The extent of ischemic-reperfusion injury was measured using functional and histological parameters. RESULTS: After reperfusion, the mean oxygenation capacity was 405.3 mmHg in Group 1 and 406.0 mmHg in Group 2 (p = 0.98. The mean pulmonary vascular resistance values were 697.6 and 378.3 dyn·s·cm-5, respectively (p =0.035. The mean pulmonary compliance was 46.8 cm H20 in Group 1 and 49.3 ml/cm H20 in Group 2 (p =0.816. The mean wet/dry weight ratios were 2.06 and 2.02, respectively (p=0.87. The mean Lung Injury Scores for the biopsy performed after reperfusion were 4.37 and 4.37 in Groups 1 and 2, respectively (p = 1.0, and the apoptotic cell counts were 118.75/mm² and 137.50/mm², respectively (p=0.71. CONCLUSION: The locally produced preservation solution proved to be as good as Perfadex®. The clinical use of LPDnac may reduce costs in our centers. Therefore, it is important to develop new models to study lung preservation.

  6. Azole-resistant Aspergillus fumigatus isolate with the TR34/L98H mutation in both a fungicide-sprayed field and the lung of a hematopoietic stem cell transplant recipient with invasive aspergillosis. (United States)

    Rocchi, Steffi; Daguindau, Etienne; Grenouillet, Frédéric; Deconinck, Eric; Bellanger, Anne-Pauline; Garcia-Hermoso, Dea; Bretagne, Stéphane; Reboux, Gabriel; Millon, Laurence


    A French farmer developed invasive aspergillosis with azole-resistant Aspergillus fumigatus with the TR34/L98H mutation following a hematopoietic stem cell transplantation. He had worked in fungicide-sprayed fields where a non-genetically related A. fumigatus TR34/L98H isolate was collected. If azole resistance detection increases, voriconazole as first-line therapy might be questioned in agricultural areas.

  7. How deceased donor transplantation is impacting a decline in commercial transplantation-the Tamil Nadu experience. (United States)

    Abraham, Georgi; Reddy, Yuvaram N V; Amalorpavanathan, Joseph; Daniel, Dolly; Roy-Chaudhury, Prabir; Shroff, Sunil; Reddy, Yogesh


    India with a population of 1.2 billion has a renal transplantation rate of 3.25 per million population. The major cause of chronic kidney disease is hypertension and diabetes. The crude and age-adjusted incidence rates of end-stage renal disease are estimated to be 151 and 232 per million population, respectively, in India. There was a remarkable lack of knowledge in the public about deceased organ donation until a decade ago. However, the role played by the media and nongovernmental organizations in partnership with the government has emphasized and implemented deceased donor transplantation in certain states in India-to mention particularly, the Tamil Nadu model. In the last 2 years, deceased organ donation has reached 1.3 per million population in Tamil Nadu, thereby effectively eliminating commercial transplantation. There is no religious bar for organ donation. A central transplant coordinator appointed by the government oversees legitimate and transparent allocation of deceased organs both in the public and private facilities as per the transplant waiting list. This model also takes care of the poor sections of society by conducting donation and transplantation through government-run public facilities free of cost. In the last 2 years, deceased donor transplantation has been performed through this network procuring organs such as the heart, heart valves, lung, liver, kidneys, cornea, and skin. The infrastructural lack of immunological surveillance-including donor-specific antibody monitoring, human leukocyte antigen typing, and panel reactive antibody except in a few tertiary care centers-prevents allocation according to the immunological status of the recipient. This private-public partnership promoting deceased donor transplantation has effectively eliminated commercialization in transplantation in the state of Tamil Nadu with a population of 72 million which is a model for other regions of South Asia and developing countries.

  8. Current status of pig lung xenotransplantation. (United States)

    Kubicki, Natalia; Laird, Christopher; Burdorf, Lars; Pierson, Richard N; Azimzadeh, Agnes M


    Human organ transplantation has improved duration and quality of life for many people, but its full potential is critically limited by short supply of available organs. One solution is xenotransplantation, although this comes with its own set of challenges. Lungs in particular are highly sensitive to injury, during the transplantation process generally, and to multiple immune rejection mechanisms. Using pig lung donors, our lab has been working on lung transplants into baboons as a surrogate for a human recipient. Several ex vivo human blood perfusion models have also proven useful. The combination of these experiments allows us to test large animal models as well as whole organ or isolated endothelial reactions to perfusion with human blood. We have found that a multi-modality therapeutic approach to prevent various pathogenic cascades - such as antibody-driven complement activation, other immune pathway activation, thrombosis, and tissue ischemia-reperfusion injury - has met with progressively greater success to protect the xeno lung from injury. Pig gene knockout and human gene transfer has been perhaps the greatest contributor. This review will discuss mechanisms of xeno lung injury, relevant experimental models, as well as recent results and future targets for research.

  9. Long-awaited pregnancy

    DEFF Research Database (Denmark)

    Bay, Bjørn; Mortensen, Erik Lykke; Golombok, Susan


    Objective: To study whether fertility treatment, subfertility, or pregnancy planning are related to long-term intellectual development. Design: Cohort study. Setting: Not applicable. Patient(s): A total of 5,032 singletons born from 1990 to 1992 in the Aarhus Birth Cohort were followed up to a me...... pregnancy planning, subfertility, or fertility treatment and cognitive ability or academic performance....... test scores at age 19 years. Result(s): We found no evidence of school difficulties in childhood, impaired school performance in adolescence, or lower intelligence in young adulthood in multivariate analyses adjusted for parental age, educational level, maternal parity, before pregnancy body mass index...

  10. Corneal transplant - discharge (United States)

    ... page: // Corneal transplant - discharge To use the sharing features on this page, please enable JavaScript. You had a corneal transplant. Most of the tissue of your cornea (the ...

  11. International Transplant Nurses Society (United States)

    ... The Mission of ITNS The International Transplant Nurses Society is committed to the promotion of excellence in ... 20-1589538 Copyright © 2006 - 2014 International Transplant Nurses Society (ITNS). No materials, including graphics, may be reused, ...

  12. Cardiac risk stratification with myocardial perfusion imaging in potential renal-pancreas transplant recipients

    Energy Technology Data Exchange (ETDEWEB)

    McCarthy, M.C.; Larcos, G.; Chapman, J. [Westmead Hospital, Westmead, Sydney, NSW (Australia). Departments of Nuclear Medicine and Ultrasound


    Full text: Combined renal/pancreas transplantation is used in patients with severe type-1 diabetes and renal failure. Many patients have asymptomatic coronary artery disease (CAD). Thus, myocardial perfusion imaging (MPI) is widely used for preoperative risk assessment, however, its value has recently been challenged. The purpose of this study was to determine the predictive value of MPI compared to coronary angiography and/or thirty day perioperative cardiac events (cardiac death, myocardial infarction and unstable angina). We reviewed the MPI in 132 patients that were referred for possible renal pancreas transplantation during the period between 1987 - June 1997. Fifty five patients were excluded because of: still awaiting transplantation (n=19) ongoing medical assessment (n=21), received kidney only transplant (n=6) or other factors (n=9). Thus, 77 patients form the basis of this report. Seventy one patients were transplanted, 5 had coronary angiography and one died before transplantation but with coronary anatomy defined at autopsy. All patients (39 male, 38 female; mean age 37 years) had Tl-201 or Tc-99m MIBI SPECT at Westmead (n=54) or elsewhere (n=23). Patients underwent MPI, a mean of 12.1 months before transplantation and a mean of 6 months before coronary angiography or autopsy. MPI was normal in 64 (83%) and abnormal in 13 (17%) patients. Of the abnormal MPI, 7 patients had CAD and one had unstable angina post-operatively (PPV = 8/13; 61%). One patient had a fixed defect post CABG but proceeded to transplant with-out event; the other 4 patients had normal coronary anatomy. Of the normal MPIs there were no transplant related cardiac events, but one patient required CABG >12 months post MPI and a further patient died >12 months post transplant and was shown to have CAD at autopsy (NPV=62/64;97%). In conclusion we have found an excellent NPV and an acceptable PPV for MPI in potential renal pancreas graft recipients

  13. Tetanus after allogeneic bone-marrow transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Kendra, J.R.; Halil, O.; Barrett, A.J.; Selwyn, S. (Westminster Medical School, London (UK))


    A brief report is presented of a case of tetanus after allogeneic bone-marrow transplantation complicated by radiation-induced pneumonitis. A 30-year-old army sergeant received a bone-marrow transplant from his brother for the treatment of a granulocytic sarcoma after local radiotherapy to the tumour. Six years earlier he had sustained an open, compound fracture of the left tibia and fibula while on army exercise. At the time a pin and plate had been inserted and booster anti-tetanus administered. Bone-marrow transplantation was performed after total body irradiation. Cyclosporin A was given against graft-versus-host disease. Fifty four days after transplantation tetanus was diagnosed and death followed 14 days later. Necropsy disclosed radiation-induced pneumonitis, but no organisms were cultured from the lungs or the old fracture site. It is suggested that spores were incorporated into the wound site before surgery and that oxygenation around the plate became compromised after transplantation, permitting germination of dormant spores, immunosuppression allowing development of the disease.

  14. Successful lung salvage by ex vivo reconditioning of neurogenic pulmonary edema: case report. (United States)

    Sanchez, P G; Iacono, A T; Rajagopal, K; Griffith, B P


    Liberalization in donor selection criteria allowed centers to increase the number of lung transplants, yet less than 25% of all donors had lungs utilized for transplantation in the United States in 2013. Less than 5% of all transplanted donors deviate 3 or more criteria from the ideal donor. Ex vivo lung perfusion (EVLP) provides the opportunity to increase the percentage of used donors by acting on modifiable selection criteria such as oxygenation, contusion and pulmonary infiltrates. We report the pre-transplant use of EVLP in the salvage of lungs from a donor that developed neurogenic pulmonary edema -PaO2 188 mmHg-. The recipient had a lung allocation score of 69.3. The post-operative course was excellent and was discharged home after 15 days. He is alive and doing well 780 days after transplant. In this report the pre-transplant use of EVLP led not only to transplanting lungs that otherwise would not have been used by many centers, but also to a very short and typical period of post-operative mechanical ventilation and hospital stay.

  15. Organ Transplants in Kazakhstan. (United States)

    Baigenzhin, Abay; Doskaliyev, Zhaksylyk; Tuganbekova, Saltanat; Zharikov, Serik; Altynova, Sholpan; Gaipov, Abduzhappar


    The Republic of Kazakhstan is one of the fastest developing countries in the world and has a health care system that is unique in Central Asia. Its organ transplant services are also developing rapidly. We aimed to analyze and briefly report on the current status of organ transplant in the Republic of Kazakhstan. We analyzed organ transplant activities in that country for the period 2012 to 2014. All data were collected from the official database of the National Transplant Coordinating Center of the Republic of Kazakhstan. At the end of 2014, the number of transplant centers had increased to 10, three of which could perform multiorgan transplants; during the same period, the number of deceased-donor organ-donating hospitals increased up to 37. By 2013, the transplant activity rate for all centers had reached 9.22 per million population. During the previous 3 years (2012-2014), there was a 3-fold increase in the number of living donors and an 18-fold increase in the number of kidney transplants. Between 2012 and 2014, the number of living-donor liver transplants increased from 17 to 25, and the number of deceased-donor transplants increased from 3 to 7. During the last 3 years (2012-2014), the number of heart transplants increased to 7 cases. During the last 3 years (2012-2014), Kazakhstan achieved a significant improvement in the organization of its transplant services, and a noticeable upward trend in the system continues.

  16. Transplantation of human amnion-derived mesenchymal stem cells alleviates ischemia-reperfusion-induced acute lung injury after cardiopulmonary bypass%人羊膜间充质干细胞移植减轻体外循环再灌注肺损伤

    Institute of Scientific and Technical Information of China (English)

    强勇; 梁贵友; 余丽梅; 齐斌; 高振宇


    BACKGROUND:In recent years, mesenchymal stem cels exhibit a good prospect in organ or tissue repair and therefore, and therefore, cel transplantation based on mesenchymal stem cel plasticity can promote cel regeneration and functional recovery from lung injury after cardiopulmonary bypass. OBJECTIVE:To investigate the effects of human amnion-derived mesenchymal stem cels (hAMSCs) transplantation on ischemia-reperfusion-induced acute lung injury in dogs after cardiopulmonary bypassand its mechanism for regulating inflammatory cytokines. METHODS:Eighteen adult healthy mongrel dogs were randomly divided into three groups (n=6 per group): black group (cardiopulmonary bypass with 1 mL physiological saline injectionvia the femoral vein without blocking the aorta), control group (cardiopulmonary bypass with blocking the aorta for 1 hour and then opening the aorta for 15 minutes plus 1 mL physiological saline injectionvia the femoral vein), experiment group (cardiopulmonary bypass with blocking the aorta for 1 hour and then opening the aorta for 15 minutes plus femoral vein injection of 1 mL physiological saline containing 2×107 hAMSCs). Arterial blood samples of 2 mL were taken to calculate oxygenation index and respiratory index before cardiopulmonary bypass (T1), 15 minutes (T2), 1 hour (T3), 2 hours (T4), 3 hours (T5) after opening the aorta. 8 mL intravenous blood samples were taken to detect the serum tumor necrosis factor α, matrix metaloproteinase-9, interleukin-8 and interleukin-10 by ELISA. Meanwhile, western blot assay was used to detect the expression of nuclear factor-κB in lung tissues, and histopathological changes of lung tissues observed under optical microscope. RESULTS AND CONCLUSION:Compared with the control group, the oxygenation index was significantly increased in the experimental group at 2 and 3 hours after transplantation, and the respiratory index was remarkably decreased at 1, 2, 3 hours after transplantation. Compared with the control group

  17. Lung density

    DEFF Research Database (Denmark)

    Garnett, E S; Webber, C E; Coates, G


    breathing in the sitting position ranged from 0.25 to 0.37 Subnormal values were found in patients with emphsema. In patients with pulmonary congestion and edema, lung density values ranged from 0.33 to 0.93 The lung density measurement correlated well with the findings in chest radiographs...

  18. Lung Cancer (United States)

    Lung cancer is one of the most common cancers in the world. It is a leading cause of cancer death in men and women in the United States. Cigarette smoking causes most lung cancers. The more cigarettes you smoke per day and ...

  19. Usefulness of an accelerated transoesophageal stress echocardiography in the preoperative evaluation of high risk severely obese subjects awaiting bariatric surgery

    Directory of Open Access Journals (Sweden)

    Tessier Michel


    Full Text Available Abstract Background Severe obesity is associated with an increased risk of coronary artery disease (CAD. Bariatric surgery is an effective procedure for long term weight management as well as reduction of comorbidities. Preoperative evaluation of cardiac operative risk may often be necessary but unfortunately standard imaging techniques are often suboptimal in these subjects. The purpose of this study was to demonstrate the feasibility, safety and utility of transesophageal dobutamine stress echocardiography (TE-DSE using an adapted accelerated dobutamine infusion protocol in severely obese subjects with comorbidities being evaluated for bariatric surgery for assessing the presence of myocardial ischemia. Methods Subjects with severe obesity [body mass index (BMI >40 kg/m2] with known or suspected CAD and being evaluated for bariatric surgery were recruited. Results Twenty subjects (9M/11F, aged 50 ± 8 years (mean ± SD, weighing 141 ± 21 kg and with a BMI of 50 ± 5 kg/m2 were enrolled in the study and underwent a TE-DSE. The accelerated dobutamine infusion protocol used was well tolerated. Eighteen (90% subjects reached their target heart rate with a mean intubation time of 13 ± 4 minutes. Mean dobutamine dose was 31.5 ± 9.9 ug/kg/min while mean atropine dose was 0.5 ± 0.3 mg. TE-DSE was well tolerated by all subjects without complications including no significant arrhythmia, hypotension or reduction in blood arterial saturation. Two subjects had abnormal TE-DSE suggestive of myocardial ischemia. All patients underwent bariatric surgery with no documented cardiovascular complications. Conclusions TE-DSE using an accelerated infusion protocol is a safe and well tolerated imaging technique for the evaluation of suspected myocardial ischemia and cardiac operative risk in severely obese patients awaiting bariatric surgery. Moreover, the absence of myocardial ischemia on TE-DSE correlates well with a low operative risk of cardiac event.

  20. Lung Cancer Screening (United States)

    ... Treatment Lung Cancer Prevention Lung Cancer Screening Research Lung Cancer Screening (PDQ®)–Patient Version What is screening? Go ... These are called diagnostic tests . General Information About Lung Cancer Key Points Lung cancer is a disease in ...

  1. Lung Cancer Prevention (United States)

    ... Treatment Lung Cancer Prevention Lung Cancer Screening Research Lung Cancer Prevention (PDQ®)–Patient Version What is prevention? Go ... to keep cancer from starting. General Information About Lung Cancer Key Points Lung cancer is a disease in ...

  2. What Is Lung Cancer? (United States)

    ... Graphics Infographic Stay Informed Cancer Home What Is Lung Cancer? Language: English Español (Spanish) Recommend on Facebook Tweet ... cancer starts in the lungs, it is called lung cancer. Lung cancer begins in the lungs and may ...

  3. Two-stage liver transplantation: an effective procedure in urgent conditions. (United States)

    Montalti, Roberto; Busani, Stefano; Masetti, Michele; Girardis, Massimo; Di Benedetto, Fabrizio; Begliomini, Bruno; Rompianesi, Gianluca; Rinaldi, Laura; Ballarin, Roberto; Pasetto, Alberto; Gerunda, Giorgio E


    Temporary portocaval shunt and total hepatectomy is a technique used in the presence of toxic liver syndrome because of fulminant hepatic failure, hepatic trauma, primary non-function (PNF), and eclampsia. We performed this technique on four patients. An indication for anhepatic state was severe hemodynamic instability in three of them. Etiologies of these three patients were as follows: PNF after liver transplantation, ischemic hepatitis after right hepatic artery embolization, and massive reperfusion syndrome during a liver transplantation. In the fourth patient, during the liver transplantation when hepatic artery was ligated, a kidney carcinoma in the donor graft was discovered. We decided to complete the hepatectomy and to construct a temporary portocaval shunt. Mean anhepatic phases were 19 h and 15 min. All patients survived the two-stage liver transplantation procedure without major complications. Our cases demonstrated that temporary portocaval shunt while awaiting urgent liver transplantation could be an effective "bridge" in selected patients who develop toxic liver syndrome; however, a short time between portocaval shunt and transplantation and careful intensive care managements are mandatory.

  4. Expression of aquaporin-1 and aquaporin-3 in lung tissue of rat model with ischemia-reperfusion injury

    Institute of Scientific and Technical Information of China (English)

    ZHAO Song; LI Xiang-nan


    @@ End-stage lung diseases are common and frequentlyoccurring diseases which are difficult for clinical treatment. In recent years, lung transplantation has become a widely accepted and effective therapeutic option for patients with the end-stage pulmonary diseases. Early pulmonary edema resulting from ischemia-reperfusion injury accounts for the major part of mortality and morbidity after lung transplantation. The water channel proteins in lung injury have been little studied, and their impact on the formation of pulmonary edema remains unclear. In this study, we established a rat lung ischemia-reperfusion model to study its impact on the expressions of water channel proteins in lung tissue and explore a new approach to lung transplantation in pulmonary edema pathogenesis.

  5. [Nosocomial infection in patients receiving a solid organ transplant or haematopoietic stem cell transplant]. (United States)

    Moreno Camacho, Asunción; Ruiz Camps, Isabel


    Bacterial infections are the most common infections in solid organ transplant recipients. These infections occur mainly in the first month after transplantation and are hospital-acquired. Nosocomial infections cause significant morbidity and are the most common cause of mortality in this early period of transplantation. These infections are caused by multi-drug resistant (MDR) microorganisms, mainly Gram-negative enterobacteria, non-fermentative Gram-negative bacilli, enterococci, and staphylococci. The patients at risk of developing nosocomial bacterial infections are those previously colonized with MDR bacteria while on the transplant waiting list. Intravascular catheters, the urinary tract, the lungs, and surgical wounds are the most frequent sources of infection. Preventive measures are the same as those applied in non-immunocompromised, hospitalized patients except in patients at high risk for developing fungal infection. These patients need antifungal therapy during their hospitalization, and for preventing some bacterial infections in the early transplant period, patients need vaccinations on the waiting list according to the current recommendations. Although morbidity and mortality related to infectious diseases have decreased during the last few years in haematopoietic stem cell transplant recipients, they are still one of the most important complications in this population. Furthermore, as occurs in the general population, the incidence of nosocomial infections has increased during the different phases of transplantation. It is difficult to establish general preventive measures in these patients, as there are many risk factors conditioning these infections. Firstly, they undergo multiple antibiotic treatments and interventions; secondly, there is a wide variability in the degree of neutropenia and immunosuppression among patients, and finally they combine hospital and home stay during the transplant process. However, some simple measures could be

  6. Infection Prevention in Transplantation. (United States)

    Pergam, Steven A


    The number of patients undergoing hematopoietic cell and solid organ transplantation are increasing every year, as are the number of centers both transplanting and caring for these patients. Improvements in transplant procedures, immunosuppressive regimens, and prevention of transplant-associated complications have led to marked improvements in survival in both populations. Infections remain one of the most important sources of excess morbidity and mortality in transplant, and therefore, infection prevention strategies are a critical element for avoiding these complications in centers caring for high-risk patients. This manuscript aims to provide an update of recent data on prevention of major healthcare-associated infections unique to transplantation, reviews the emergence of antimicrobial resistant infections, and discusses updated strategies to both identify and prevent transmission of these pathogens in transplant recipients.

  7. Ex vivo lung perfusion in Brazil

    Directory of Open Access Journals (Sweden)

    Luis Gustavo Abdalla


    Full Text Available Objective: To evaluate the use of ex vivo lung perfusion (EVLP clinically to prepare donor lungs for transplantation. Methods: A prospective study involving EVLP for the reconditioning of extended-criteria donor lungs, the criteria for which include aspects such as a PaO2/FiO2 ratio < 300 mmHg. Between February of 2013 and February of 2014, the lungs of five donors were submitted to EVLP for up to 4 h each. During EVLP, respiratory mechanics were continuously evaluated. Once every hour during the procedure, samples of the perfusate were collected and the function of the lungs was evaluated. Results: The mean PaO2 of the recovered lungs was 262.9 ± 119.7 mmHg at baseline, compared with 357.0 ± 108.5 mmHg after 3 h of EVLP. The mean oxygenation capacity of the lungs improved slightly over the first 3 h of EVLP-246.1 ± 35.1, 257.9 ± 48.9, and 288.8 ± 120.5 mmHg after 1, 2, and 3 h, respectively-without significant differences among the time points (p = 0.508. The mean static compliance was 63.0 ± 18.7 mmHg, 75.6 ± 25.4 mmHg, and 70.4 ± 28.0 mmHg after 1, 2, and 3 h, respectively, with a significant improvement from hour 1 to hour 2 (p = 0.029 but not from hour 2 to hour 3 (p = 0.059. Pulmonary vascular resistance remained stable during EVLP, with no differences among time points (p = 0.284. Conclusions: Although the lungs evaluated remained under physiological conditions, the EVLP protocol did not effectively improve lung function, thus precluding transplantation.

  8. 肺积方调节CD4+CD25+Treg细胞及T淋巴细胞增殖与抗Lewis肺癌移植鼠肿瘤生长作用研究%Effects of Feijifang on Levels of CD4+CD25+Treg and T Lymphocytes and Tumor Growth in Mice with Trans-planted Lewis Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    杨国良; 张学进; 胡丹丹


    Objective:To investigate the effect of Feijifang combined with chemotherapy on tumor growth and the levels of CD4+CD25+ regulatory T cells(Treg) and T lymphocytes in mice with transplanted Lewis lung cancer and the underlying mechanism of Feijifang modulating immune evasion. Methods:Sixty-four mice with transplanted Lewis lung cancer were randomly divided into control group,Feiji group,comprehensive treatment group(Feijifang combined with diamminedichloroplatinum),and diamminedichloroplatinum (DDP) group,16 mice in each. The proliferation of T lymphocytes in the spleen and thymus was detected by MTT method and the percentage of CD4+CD25+Treg was assessed by flow cytometry. The volume and weight of tumors were recorded and evaluated. Results:The volume and weight of tumors in the DDP,Feiji,and comprehensive treatment groups were less than those in the control group (P0.05). On day 10 and 21,the percentage of CD4+CD25+Treg was lower in the DDP,Feiji,and comprehensive treatment groups as compared with that in the control group (P0.05)。第10、21天DDP组、肺积方组、综合组荷瘤小鼠胸腺CD4+CD25+Treg细胞比例均较对照组降低(P<0.05);DDP组第21天胸腺CD4+CD25+Treg细胞比例较第10天明显升高(P<0.05);综合组脾脏CD4+CD25+Treg细胞比例较低,与肺积方组、DDP组比较差异有统计学意义(P<0.05)。结论:肺积方联合化疗具有抗Lewis肺癌移植小鼠肿瘤生长的作用,该作用可能与其下调CD4+CD25+Treg细胞含量相关。

  9. Solid organ transplants following hematopoietic stem cell transplant in children. (United States)

    Bunin, Nancy; Guzikowski, Virginia; Rand, Elizabeth R; Goldfarb, Samuel; Baluarte, Jorge; Meyers, Kevin; Olthoff, Kim M


    SOT may be indicated for a select group of pediatric patients who experience permanent organ failure following HSCT. However, there is limited information available about outcomes. We identified eight children at our center who received an SOT following an HSCT. Patients were six months to 18 yr at HSCT. Diseases for which children underwent HSCT included thalassemia, Wiskott-Aldrich syndrome, Shwachman-Diamond/bone marrow failure, sickle cell disease (SCD), erythropoietic porphyria (EP), ALL, chronic granulomatous disease, and neuroblastoma. Time from HSCT to SOT was 13 days to seven yr (median, 27 months. Lung SOT was performed for two patients with BO, kidney transplants for three patients, and liver transplants for three patients (VOD, chronic GVHD). Seven patients are alive with functioning allografts 6-180 months from SOT. Advances in organ procurement, operative technique, immunosuppressant therapy, and infection control may allow SOT for a select group of patients post-HSCT. However, scarcity of donor organs available in a timely fashion continues to be a limiting factor. Children who have undergone HSCT and develop single organ failure should be considered for an SOT if there is a high likelihood of cure of the primary disease.

  10. Distribution of Pneumocystis jirovecii in lungs from colonized COPD patients (United States)

    Sivam, Sheila; Sciurba, Frank C.; Lucht, Lorrie A.; Zhang, Yingze; Duncan, Steven R.; Norris, Karen A.; Morris, Alison


    Pneumocystis jirovecii has been detected in lung tissue from patients with chronic obstructive pulmonary disease (COPD) and is associated with disease severity. The regional distribution of the organism in lungs is unknown, but differences in distribution of Pneumocystis could affect estimates of colonization prevalence. We examined the distribution of Pneumocystis in the lungs of 19 non-HIV-infected patients with COPD who were undergoing lung transplantation. DNA was extracted from explanted lungs. We found Pneumocystis colonization in lung tissue of 42.1% of patients with advanced COPD; however, there was significant regional variation in colonization between lung segments of individual patients. Colonization was detected more commonly in the lower and middle lobes than the upper lobes. These findings suggest that single samples from an individual may underestimate the prevalence of Pneumocystis colonization and future studies may obtain a higher yield of Pneumocystis colonization detection when sampling the lower lobes. PMID:21851870

  11. Association between acute graft versus host disease and lung injury after allogenic hematopoietic stem cell transplantation%异基因造血干细胞移植后急性移植物抗宿主病与肺损伤的关系

    Institute of Scientific and Technical Information of China (English)

    刘启发; 罗晓丹; 范志平; 宁涓; 徐丹; 孙竞; 张钰; 徐兵; 魏永强


    Objective To investigate the characteristics of chest hiigh-resolution computed tomography(HRCT)and pathogenesis of acute graft versus host disease(aGVHD)-induced lung injury after allogenic hematopoietic stem cell transplantation(allo-HSCT).Methods Chest HRCT was performed in 47 patients with aGVHD of grade Ⅱ-Ⅳ after allo-HSCT.Twenty-four of the patients underwent different treatment regimens against aGVHD.Before the treatment peripheral blood samples were collected to detect the serum interferon-γ(IFN-γ)and tumor necrosis factor-α(TNF-α).Transbronchial biopsy was performed in 4 patients that failed to recover completely after treatment.Pulmonary function was examined in the patients who survived more than 6 months in every 3 months.Resuits Twenty of tlle 47 patients showed abnormal images by chest HRCT and 17 of the 20 patients were suspected to be witll aGVHD-induced lung iniury.The HRCT images were characterized by diffused interstitial infiltrate in 5 cases.diflused intemtitial and alveolar infiltrate in 7 cases.and diffused interstitial and segmental lobar alveolar infiltrate in 5 cases.Nine cases had bilateral pleural effusion and hydropericardium,including 4 eases accompanied by myocardial hypertrophy.The levels of serum IFN-γ and TNF-α of the patients with lung injury were(6.9±1.8)μg/L and(400±102)μg/L respectively,both not significantly different from those of the patients without lung injury[(6.3±1.2)μg/L and(428±83)μg/L respectively,P=0.202,0.306].The histopathology of the lung tissue was characterized by disorganization,epithelial cell damage,interstitial fibroplasias,and interstitial T lymphocyte or macrophage infiltrate.The effective rate of treatment for aGVHD-induced lung iniury was positively correlated witll that for aGVHD(r=0.771,P=0.01).Eleven of the 24 patients who survived more than 6 months had abnormal pulmonary function.including 7 out of tlle 9 patients with aGVHD-induced lung injury and 4 out the 15 patients without a

  12. Machine perfusion for improving outcomes following renal transplant: current perspectives

    Directory of Open Access Journals (Sweden)

    Cannon RM


    Full Text Available Robert M Cannon,1 Glen A Franklin1,2 1The Hiram C Polk Jr MD Department of Surgery, University of Louisville, 2Kentucky Organ Donor Affiliates, Louisville, KY, USAAbstract: There is a disparity between the number of kidneys available for transplantation and the number of patients awaiting an organ while on dialysis. The current kidney waiting list in the US contains more than 100,000 patients. This need has led to the inclusion of older donors with worsening renal function, as well as greater utilization of kidneys from non-heartbeating (donation after cardiac death donors. Coinciding with this trend has been a growing interest in technology to improve the function of these more marginal organs, the most important of which currently is machine perfusion (MP of donated kidneys after procurement. While this technology has no standard guidelines currently for comprehensive use, there are many studies that demonstrate higher organ yield and function after a period of MP. Particularly with the older donor and during donation after cardiac death cases, MP may offer some significant benefits. This manuscript reviews all of the current literature regarding MP and its role in renal transplantation. We will discuss both the experience in Europe and the US using machine perfusion for donated kidneys.Keywords: machine perfusion, renal transplantation, kidney pumping, renal failure, organ donation

  13. Future of transplantation medicine. (United States)

    Rowiński, Wojciech


    Organ transplantation has become very successful method of treatment of end stage organ disease. However the waiting lists of patients aiming such treatment are exponentially growing due to insufficient organ supply. Prognosis of the future for transplantation medicine is truly difficult. Prospects from past years, that "soon induction of tolerance will become possible"(1975), wide xenogenic transplant utilization (in 2000), fetal brain cell transplantation to treat some neurologic disease and transplantation of isolated cells instead of whole organs (1998) proved wrong. The research in the nearest future will be focused on tolerance induction, inhibition of alloreaction in blood-group discordant transplants (in immunized patients) and xenografts. In parallel, studies on hybrid and totally artificial, implantable devices (artificial pancreas and liver) will be carried on. 21st century will belong to regeneration medicine, with therapeutic applications of stem cells.

  14. Transplantation psychoneuroimmunology: building hypotheses. (United States)

    Klapheke, M M


    The research findings of psychoneuroimmunology have not yet been fully applied to the field of transplantation psychiatry. Though much study has been devoted to the impact of psychiatric disease on the immunosuppressed state and disease progression in HIV-related illness, little has yet been written on the immunology implications of psychiatric disturbances in the immunosuppressed post-transplant patient. Utilizing Medline literature searches to review relevant research data in psychoneuroimmunology and transplantation immunology, the author formulates and examines four transplantation psychoneuroimmunology hypotheses involving the potential impact of depression on post-transplant organ rejection, cancer, coronary artery disease, and infections. The author concludes that though major questions remain, it appears reasonable to include the impact of depression, and possibly other psychological states, among factors that may affect the net state of immunosuppression in transplant patients.

  15. Highly Sensitive Marker Panel for Guidance in Lung Cancer Rapid Diagnostic Units (United States)

    Blanco-Prieto, Sonia; De Chiara, Loretta; Rodríguez-Girondo, Mar; Vázquez-Iglesias, Lorena; Rodríguez-Berrocal, Francisco Javier; Fernández-Villar, Alberto; Botana-Rial, María Isabel; de la Cadena, María Páez


    While evidence for lung cancer screening implementation in Europe is awaited, Rapid Diagnostic Units have been established in many hospitals to accelerate the early diagnosis of lung cancer. We seek to develop an algorithm to detect lung cancer in a symptomatic population attending such unit, based on a sensitive serum marker panel. Serum concentrations of Epidermal Growth Factor, sCD26, Calprotectin, Matrix Metalloproteinases −1, −7, −9, CEA and CYFRA 21.1 were determined in 140 patients with respiratory symptoms (lung cancer and controls with/without benign pathology). Logistic Lasso regression was performed to derive a lung cancer prediction model, and the resulting algorithm was tested in a validation set. A classification rule based on EGF, sCD26, Calprotectin and CEA was established, able to reasonably discriminate lung cancer with 97% sensitivity and 43% specificity in the training set, and 91.7% sensitivity and 45.4% specificity in the validation set. Overall, the panel identified with high sensitivity stage I non-small cell lung cancer (94.7%) and 100% small-cell lung cancers. Our study provides a sensitive 4-marker classification algorithm for lung cancer detection to aid in the management of suspicious lung cancer patients in the context of Rapid Diagnostic Units. PMID:28117344

  16. Specific immune responses against airway epithelial cells in a transgenic mouse-trachea transplantation model for obliterative airway disease

    NARCIS (Netherlands)

    Qu, N; de Haan, A; Harmsen, MC; Kroese, FGM; de Leij, LFMH; Prop, J


    Background. Immune injury to airway epithelium is suggested to play a central role in the pathogenesis of obliterative bronchiolitis (OB) after clinical lung transplantation. In several studies, a rejection model of murine trachea transplants is used, resulting in obliterative airway disease (OAD) w

  17. Paeoniflorin inhibits macrophage-mediated lung cancer metastasis. (United States)

    Wu, Qi; Chen, Gang-Ling; Li, Ya-Juan; Chen, Yang; Lin, Fang-Zhen


    Alternatively activated macrophages are more frequently involved in tumor growth, angiogenesis, and immunosuppression. A previous study showed that paeoniflorin, the major active constituent of Paeonia lactiflora Pallas, can inhibit tumor growth and lung metastases of Lewis lung tumor-bearing mice. This study tried to investigate whether paeoniflorin inhibited lung cancer metastasis by inhibiting the alternative activation of macrophages (M2 macrophage). Using a viability assay, the cytotoxicity of paeoniflorin on Lewis lung cancer cells and peritoneal macrophages were investigated. In vitro scratch wound and in vivo lung metastasis experiments were used to test the ability to inhibit the migration of paeoniflorin and the function of M2 macrophages. Flow cytometry was performed to test the cell cycle of Lewis lung cancer cells, and to test the M2 macrophages in peritoneal macrophages and subcutaneous transplantable tumor. It was found that paeoniflorin showed no inhibitory effect on the growth of Lewis lung cancer cells and peritoneal macrophages of mouse in vitro. Paeoniflorin could attenuate the migration of LLC stimulated by alternatively activated macrophages (stimulated for 24 h and 48 h, paeoniflorin 1, 3, 10, 30, 100 μmol·L(-1), P lung cancer cells (paeoniflorin 100 μmol·L(-1), P lung metastasis of Lewis lung cancer cells xenograft and decrease the numbers of M2 macrophages in subcutaneous xenograft tumour in vivo (paeoniflorin 20, 40 mg·kg(-1), P lung metastasis of Lewis lung cancer cells xenograft partly through inhibiting the alternative activation of macrophages.

  18. Split liver transplantation. (United States)

    Yersiz, H; Cameron, A M; Carmody, I; Zimmerman, M A; Kelly, B S; Ghobrial, R M; Farmer, D G; Busuttil, R W


    Seventy-five thousand Americans develop organ failure each year. Fifteen percent of those on the list for transplantation die while waiting. Several possible mechanisms to expand the organ pool are being pursued including the use of extended criteria donors, living donation, and split deceased donor transplants. Cadaveric organ splitting results from improved understanding of the surgical anatomy of the liver derived from Couinaud. Early efforts focused on reduced-liver transplantation (RLT) reported by both Bismuth and Broelsch in the mid-1980s. These techniques were soon modified to create both a left lateral segment graft appropriate for a pediatric recipient and a right trisegment for an appropriately sized adult. Techniques of split liver transplantation (SLT) were also modified to create living donor liver transplantation. Pichlmayr and Bismuth reported successful split liver transplantation in 1989 and Emond reported a larger series of nine split procedures in 1990. Broelsch and Busuttil described a technical modification in which the split was performed in situ at the donor institution with surgical division completed in the heart beating cadaveric donor. In situ splitting reduces cold ischemia, simplifies identification of biliary and vascular structures, and reduces reperfusion hemorrhage. However, in situ splits require specialized skills, prolonged operating room time, and increased logistical coordination at the donor institution. At UCLA over 120 in situ splits have been performed and this technique is the default when an optimal donor is available. Split liver transplantation now accounts for 10% of adult transplantations at UCLA and 40% of pediatric transplantations.

  19. Liver transplantation in the management of unresectable hepatoblastoma in children. (United States)

    Meyers, Rebecka L; Tiao, Greg M; Dunn, Stephen P; Langham, Max R


    Complete surgical resection is essential to long-term survival in children with hepatoblastoma. We present the guidelines from the Children's Oncology Group (COG), liver tumor study group of the Societe Internationale Oncologie Pediatrique (SIOPEL), and German Pediatric Oncology Group (GPOH) for early referral of children with potentially unresectable hepatoblastoma to a specialty center with expertise in extreme resection and liver transplantation. Patients who will become candidates for liver transplantation should receive chemotherapy following the same protocols as for children undergoing a partial hepatectomy. The Pediatric Liver Unresectable Tumor Observatory (PLUTO) is an international prospective database established to collect data and make future recommendations on controversial issues regarding the use of transplant in hepatoblastoma including: 1) What is the optimal treatment of multifocal tumors. 2) What is the role of extreme resection vs. liver transplant in patients with major venous involvement. 3) What is the role of transplant in patients who present with lung metastasis. 3) Should patients with tumor relapse be offered a rescue transplant. 4) What is the role of pre- and post- transplant chemotherapy.

  20. Epidemiology and outcome of invasive fungal infections in solid organ transplant recipients. (United States)

    Neofytos, D; Fishman, J A; Horn, D; Anaissie, E; Chang, C-H; Olyaei, A; Pfaller, M; Steinbach, W J; Webster, K M; Marr, K A


    Contemporary epidemiology and outcomes of invasive fungal infections (IFIs) in solid organ transplant (SOT) recipients are not well described. From March 2004 through September 2007, proven and probable IFIs were prospectively identified in 17 transplant centers in the United States. A total 429 adult SOT recipients with 515 IFIs were identified; 362 patients received a single and 67 patients received >or=2 organs. Most IFIs were caused by Candida species (59.0%), followed by Aspergillus species (24.8%), Cryptococcus species (7.0%), and other molds (5.8%). Invasive candidiasis (IC) was the most frequently observed IFI in all groups, except for lung recipients where invasive aspergillosis (IA) was the most common IFI (Ptransplant recipients occurred during the first 100 days post transplant. Over half of IA cases in lung recipients occurred >1 year post transplant. Overall 12-week mortality was 29.6%; liver recipients had the highest mortality (P=0.05). Organ damage, neutropenia, and administration of corticosteroids were predictors of death. These results extend our knowledge on the epidemiology of IFI in SOT recipients, emphasizing the occurrence of IC early after non-lung transplant, and late complications with molds after lung transplant. Overall survival appears to have improved compared with historical reports.


    Directory of Open Access Journals (Sweden)

    M. Sh. Khubutia


    Full Text Available The purpose of this study was to investigate the occurrence of HLA and MICA antibodies in patients from the waiting list for kidney transplantation and their influence on the course of post-transplant period. Determination of HLA antibodies class I and II, and MICA antibodies was performed on a platform of Luminex (xMAP-tech- nology using sets LABScreen ONE LAMBDA (U.S.. A total of 156 patients from the waiting list for kidney transplantation. Revealed the presence of HLA and MICA antibodies in the serum of 31.4% of patients. Regraf- ted patients increased the content of antibodies to the antigens of HLA system was noted in 88.2% of cases, 47% met the combination of antibodies to the I, II classes and MICA. In patients awaiting first kidney transplantation, HLA and MICA antibodies were determined in 23.7% of cases. The presence of pretransplant HLA and MICA antibodies had a significant influence on the course of post-transplant period. Patients with the presence of HLA and MICA in 50% of cases delayed graft function. Sessions of plasmapheresis can reduce the concentration of HLA and MICA antibodies on average by 61.1%. 

  2. Interstitial Lung Diseases (United States)

    Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. The inflammation and ... is responsible for some types of interstitial lung diseases. Specific types include Black lung disease among coal ...

  3. Lung Carcinoid Tumor: Surgery (United States)

    ... Disease Lung Carcinoid Tumor Treating Lung Carcinoid Tumors Surgery to Treat Lung Carcinoid Tumors Surgery is the ... be cured by surgery alone. Types of lung surgery Different operations can be used to treat (and ...

  4. Lung cancer - small cell (United States)

    Cancer - lung - small cell; Small cell lung cancer; SCLC ... About 15% of all lung cancer cases are SCLC. Small cell lung cancer is slightly more common in men than women. Almost all cases of SCLC are ...

  5. Bioethics of organ transplantation. (United States)

    Caplan, Arthur


    As the ability to transplant organs and tissues has grown, the demand for these procedures has increased as well--to the point at which it far exceeds the available supply creating the core ethical challenge for transplantation--rationing. The gap between supply and demand, although large, is worse than it appears to be. There are two key steps to gaining access to a transplant. First, one must gain access to a transplant center. Then, those waiting need to be selected for a transplant. Many potential recipients do not get admitted to a program. They are deemed too old, not of the right nationality, not appropriate for transplant as a result of severe mental impairment, criminal history, drug abuse, or simply because they do not have access to a competent primary care physician who can refer them to a transplant program. There are also financial obstacles to access to transplant waiting lists in the United States and other nations. In many poor nations, those needing transplants simply die because there is no capacity or a very limited capacity to perform transplants. Although the demand for organs now exceeds the supply, resulting in rationing, the size of waiting lists would quickly expand were there to suddenly be an equally large expansion in the number of organs available for transplantation. Still, even with the reality of unavoidable rationing, saving more lives by increasing organ supply is a moral good. Current public policies for obtaining organs from cadavers are not adequate in that they do not produce the number of organs that public polls of persons in the United States indicate people are willing to donate.

  6. Lung volume reduction for severe emphysema: do we need a scalpel or a scope?

    Directory of Open Access Journals (Sweden)

    D. Van Raemdonck


    Full Text Available Resectional lung volume reduction has proven to be superior to medical treatment in reducing dyspnoea and in increasing lung function, survival and quality of life in a very well selected, low risk group of hyperinflated patients with heterogeneous emphysema predominantly in the upper lobe. Nevertheless, this intervention is hampered by an important pulmonary (30% and cardiovascular (20% morbidity, mainly as a result of prolonged (>7 days air leak, and a 5% risk of death as a result of the surgical intervention. Results from ongoing randomised trials are awaited in order to determine whether less invasive, non-resectional lung volume treatment of emphysema via the bronchoscope using endobronchial valves, airway bypass stents or biological adhesives/heated water vapour will yield similar improvement with less morbidity and reduced mortality, compared with surgical resection. Furthermore, it is hoped that endoscopic lung volume reduction techniques may help patients with homogeneous emphysema currently excluded by most teams for the resectional procedure.

  7. Surgical technique for lung retransplantation in the mouse


    Li, Wenjun; Goldstein, Daniel R.; Bribriesco, Alejandro C.; Nava, Ruben G.; Spahn, Jessica H.; Wang, Xingan; Gelman, Andrew E.; Krupnick, Alexander S.; Kreisel, Daniel


    Microsurgical cuff techniques for orthotopic vascularized murine lung transplantation have allowed for the design of studies that examine mechanisms contributing to the high failure rate of pulmonary grafts. Here, we provide a detailed technical description of orthotopic lung retransplantation in mice, which we have thus far performed in 144 animals. The total time of the retransplantation procedure is approximately 55 minutes, 20 minutes for donor harvest and 35 minutes for the implantation,...

  8. Tuberculosis in Hematopoietic Stem Cell Transplant Recipients


    Ramos, Jéssica Fernandes; Batista, Marjorie Vieira; Costa, Silvia Figueiredo


    Literature on tuberculosis (TB) occurring in recipients of Hematopoietic Stem Cell Transplant (HSCT) is scanty even in countries where TB is common. Most reports of TB in HSCT patients were from ASIA, in fact the TB incidence ranging from 0.0014 (USA) to 16% (Pakistan). There are few reports of TB diagnosis during the first two weeks after HSCT; most of cases described in the literature occurred after 90 days of HSCT, and the lung was the organ most involved. The mortality ranged from 0 to 50...

  9. [Uterus transplantation. Current situation]. (United States)

    Gauthier, T; Piver, P; Mesnard, C; Marquet, P; Pichon, N; Guillaudeau, A; Drouet, M; Gardet, E; Laskar, M; Essig, M; Aubard, Y


    Except adoption, absolute uterine factor infertility lacks solution in case of motherhood desire. Gestational surrogacy is still not approved in France. Over the last decade, uterus transplantation experimentation made advances. Data from animal research, progress in immunosuppressive treatment and knowledge about pregnancy after transplantation provide a scenario in which a human allotransplantation project can become reality.

  10. Does vitamin C or its combination with vitamin E improve radial artery endothelium-dependent vasodilatation in patients awaiting coronary artery bypass surgery?


    Uzun, Alper; Yener, Umit; Cicek, Omer Faruk; Yalcinkaya, Adnan; Diken, Adem; Ozkan, Turgut; Ulas, Mahmut; Yener, Ozlem; Turkvatan, Aysel


    Background We evaluated the vasodilatory effects of two antioxidants, vitamins C (ascorbic acid) and E (α-tocopherol), on radial artery and endothelium-dependent responses in patients awaiting coronary artery bypass surgery. Methods The study was performed in three groups. The first group took 2 g of vitamin C orally (n = 31, vitamin C group), the second group took 2 g of vitamin C with 600 mg of vitamin E orally (n = 31, vitamins C + E group), and the third group took no medication (n = 31, ...

  11. Preferential elevation of Prx I and Trx expression in lung cancer cells following hypoxia and in human lung cancer tissues. (United States)

    Kim, H J; Chae, H Z; Kim, Y J; Kim, Y H; Hwangs, T S; Park, E M; Park, Y M


    Transient/chronic microenvironmental hypoxia that exists within a majority of solid tumors has been suggested to have a profound influence on tumor growth and therapeutic outcome. Since the functions of novel antioxidant proteins, peroxiredoxin I (Prx I) and II, have been implicated in regulating cell proliferation, differentiation, and apoptosis, it was of our special interest to probe a possible role of Prx I and II in the context of hypoxic tumor microenvironment. Since both Prx I and II use thioredoxin (Trx) as an electron donor and Trx is a substrate for thioredoxin reductase (TrxR), we investigated the regulation of Trx and TrxR as well as Prx expression following hypoxia. Here we show a dynamic change of glutathione homeostasis in lung cancer A549 cells and an up-regulation of Prx I and Trx following hypoxia. Western blot analysis of 10 human lung cancer and paired normal lung tissues also revealed an elevated expression of Prx I and Trx proteins in lung cancer tissues. Immunohistochemical analysis of the lung cancer tissues confirmed an augmented Prx I and Trx expression in cancer cells with respect to the parenchymal cells in adjacent normal lung tissue. Based on these results, we suggest that the redox changes in lung tumor microenvironment could have acted as a trigger for the up-regulation of Prx I and Trx in lung cancer cells. Although the clinical significance of our finding awaits more rigorous future study, preferential augmentation of the Prx I and Trx in lung cancer cells may well represent an attempt of cancer cells to manipulate a dynamic redox change in tumor microenvironment in a manner that is beneficial for their proliferation and malignant progression.


    NARCIS (Netherlands)



    Airway damage resulting in bronchiolitis obliterans occurs frequently in patients after heart-lung and lung transplantation. Generally, chronic rejection is assumed to be the most important cause of bronchiolitis obliterans. However, viral infections might also be potential causes of airway damage a

  13. DCD lung donation : donor criteria, procedural criteria, pulmonary graft function validation, and preservation

    NARCIS (Netherlands)

    Erasmus, Michiel E.; van Raemdonck, Dirk; Akhtar, Mohammed Zeeshan; Neyrinck, Arne; de Antonio, David Gomez; Varela, Andreas; Dark, John


    In an era where there is a shortage of lungs for transplantation is increased utilization of lungs from donation after circulatory death (DCD) donors. We review the reports of 11 controlled and 1 uncontrolled DCD programs focusing on donor criteria, procedural criteria, graft assessment, and preserv

  14. Kidney transplantation in immunologically high-risk patients. (United States)

    Keven, K; Sengul, S; Celebi, Z K; Tuzuner, A; Yalcin, F; Duman, T; Tutkak, H


    An increased number of sensitized patients await kidney transplantation (KTx). Sensitization has a major impact on patient mortality and morbidity due to prolonged waiting time and may preclude live donor transplantation. However, recent reports have shown that KTx can be performed successfully using novel immunosuppressive protocols. This study presents our experience with patients displaying donor-specific antibody (DSA) (+). We enrolled 5 lymphocyte cross-match (LCM) negative (complement-dependent cytotoxicity) and panel-reactive antibody (PRA) plus DSA-positive patients mean fluorescein intensity [MFI] > 1000) who underwent living kidney donor procedures. All subjects were females and their mean age was 36.7 years. In our protocol, we started mycophenolate mofetil (2 g/d), tacrolimus (0.01 mg/kg) and prednisolone (0.5 mg/kg) on day -6. We performed 2 sessions of total plasma exchange (TPE) with albumin replacement and administered 2 doses of IVIG (5 g/d). On day -1, we added rituximab (200 mg). On the operation day and on day +4, the patients received doses of basiliximab. Serum samples were taken on days -6, 0, and 30 as well as at 1 year after transplantation. All patients displayed immediate graft function. Mean basal DSA titer was 5624 MFI. After desensitization, the MFI titers decreased at the time of transplantation to 2753 MFI, and were 2564 MFI at the 1st month and 802 MFI at 1st year. Three patients experienced acute rejection episodes (60%). After treatment for rejection, the average follow-up was 17 months and last creatinine levels were 0.6-0.8 mg/dL (minimum-maximum). In conclusion, KTx can be succesfully performed in sensitized patients displaying DSA. However, there seems to be a greater acute rejection risk. There is no consensus regarding adequate doses of IVIG or plasmapheresis treatments; furthermore, more studies are needed to clarify the safe MFI titer of the DSA.

  15. Donor-specific anti-HLA antibodies after bone-graft transplantation. Impact on a subsequent renal transplantation: a case report. (United States)

    Mosconi, G; Baraldi, O; Fantinati, C; Panicali, L; Veronesi, M; Cappuccilli, M L; Corsini, S; Zanelli, P; Bassi, A; Buscaroli, A; Feliciangeli, G; Stefoni, S


    Immunological evaluation by panel-reactive antibody (PRA) and determination of anti-HLA specificity are important phases in the evaluation of patients awaiting kidney transplantation. The main causes of immunization are previous solid organ transplantation, hemotransfusion, and pregnancy. It is also possible that immunogenicity can be triggered by vascularized tissue grafts. Immune induction by cryopreserved bone prostheses is not yet understood. A 19-year-old patient with osteosarcoma had undergone resection of the left proximal tibia with reconstruction using human bone in 1997. The donor HLA typing was as follows: A3, A29 (19); B44 (12), Bw4; DR13 (6), DR7, DR52, DR53. The patient was subsequently enrolled onto the waiting list for cadaveric donor kidney transplantation due to chronic kidney failure caused by cisplatin toxicity. Pretransplantation immunological screening using the complement-dependent cytotoxicity (CDC) technique revealed a PRA of 63%. IgG antibody specificities were detected against class I and class II donor antigens, specifically anti-A3, B44, DR7 antibodies, using flow cytometry (Tepnel Luminex). Further immunological studies using single HLA specificity analysis (LSA Class I degrees -II degrees , Tepnel-Luminex) showed direct antibodies against all donor antigen specificities. This case showed immune induction after the implantation of bone prosthesis in a kidney transplant candidate, underlining the importance of the availability of HLA typing data of donors of a human prosthesis.

  16. Lung surgery (United States)

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using a ... clot from the pulmonary artery ( pulmonary embolism ) Treat complications of tuberculosis Video-assisted thoracoscopic surgery can be used to treat many of these ...

  17. [Humidifier lung]. (United States)

    Gerber, P; de Haller, R; Pyrozynski, W J; Sturzenegger, E R; Brändli, O


    Breathing air from a humidifier or an air conditioning unit contaminated by various microorganisms can cause an acute lung disease involving fever, cough and dyspnea, termed "humidifier fever". This type of hypersensitivity pneumonitis was first described in 1959 by PESTALOZZI in the Swiss literature and subsequently by BANASZAK et al. in the Anglo-American. Here a chronic form of this disease which led to pulmonary fibrosis is described: A 37-year-old woman who works in a cheese shop presented with dyspnea which had been progressive over two years, weight loss, a diffuse reticular pattern radiographically and a severe restrictive defect in lung function tests. Open lung biopsy revealed chronic interstitial and alveolar inflammation with non-caseating granulomas and fibrotic changes. Circulating immune complexes and precipitins against the contaminated humidifier water and cheese mites were found, but no antibodies suggesting legionnaires' disease. Two out of five otherwise healthy employees of this cheese shop, where a new humidifying system had been installed 7 years earlier, also had precipitins against the contaminated water from the humidifier and the cheese mites. Despite ending of exposure and longterm steroid and immunosuppressive therapy, the signs and symptoms of pulmonary fibrosis persisted. Contrary to the acute disease, this chronic form is termed "humidifier lung". The importance is stressed of investigating the possibility of exposure to contaminated humidifiers or air conditioning units in all cases of newly detected pulmonary fibrosis.

  18. Lung cancer

    DEFF Research Database (Denmark)

    Hansen, H H; Rørth, M


    The results of the many clinical trials published in 1997 had only modest impact on the treatment results using either cytostatic agents alone or combined with radiotherapy in lung cancer. In SCLC, combination chemotherapy including platin-compounds (cisplatin, carboplatin) and the podophyllotoxins...

  19. Screening for lung cancer: Does MRI have a role? (United States)

    Biederer, Juergen; Ohno, Yoshiharu; Hatabu, Hiroto; Schiebler, Mark L; van Beek, Edwin J R; Vogel-Claussen, Jens; Kauczor, Hans-Ulrich


    While the inauguration of national low dose computed tomographic (LDCT) lung cancer screening programs has started in the USA, other countries remain undecided, awaiting the results of ongoing trials. The continuous technical development achieved by stronger gradients, parallel imaging and shorter echo time has made lung magnetic resonance imaging (MRI) an interesting alternative to CT. For the detection of solid lesions with lung MRI, experimental and clinical studies have shown a threshold size of 3-4mm for nodules, with detection rates of 60-90% for lesions of 5-8mm and close to 100% for lesions of 8mm or larger. From experimental work, the sensitivity for infiltrative, non-solid lesions would be expected to be similarly high as that for solid lesions, but the published data for the MRI detection of lepidic growth type adenocarcinoma is sparse. Moreover, biological features such as a longer T2 time of lung cancer tissue, tissue compliance and a more rapid uptake of contrast material compared to granulomatous diseases, in principle should allow for the multi-parametric characterization of lung pathology. Experience with the clinical use of lung MRI is growing. There are now standardized protocols which are easy to implement on current scanner hardware configurations. The image quality has become more robust and currently ongoing studies will help to further contribute experience with multi-center, multi-vendor and multi-platform implementation of this technology. All of the required prerequisites have now been achieved to allow for a dedicated prospective large scale MRI based lung cancer screening trial to investigate the outcomes from using MRI rather than CT for lung cancer screening. This is driven by the hypothesis that MRI would reach a similarly high sensitivity for the detection of early lung cancer with fewer false positive exams (better specificity) than LDCT. The purpose of this review article is to discuss the potential role of lung MRI for the early

  20. Managing bronchiolitis obliterans syndrome (BOS) and chronic lung allograft dysfunction (CLAD) in children: what does the future hold? (United States)

    Snell, Gregory I; Paraskeva, Miranda; Westall, Glen P


    The success of pediatric lung transplantation continues to be limited by long-term graft dysfunction. Historically this has been characterized as an obstructive spirometric defect in the form of the bronchiolitis obliterans syndrome (BOS). It is recognized, however, that this does not reflect many of the other acknowledged etiologies of chronic lung dysfunction-noting it is the sum of the parts that contribute to respiratory morbidity and mortality after transplant. The term chronic lung allograft dysfunction (CLAD) has been coined to reflect these other entities and, in particular, a group of relatively recently described lung disorders called the restrictive allograft syndrome (RAS). RAS is characterized by a restrictive spirometric defect. Although these entities have not yet been studied in a pediatric setting their association with poor compliance, antibody-mediated rejection (AMR), and post-infectious lung damage (particularly viral) warrants attention by pediatric lung transplant teams. Current therapy for the BOS subset of CLAD is otherwise limited to changing immunosuppressants and avoiding excessive infectious risk by avoiding over-immunosuppression. Long-term macrolide therapy in lung transplantation is not of proven efficacy. Reviewing previous BOS studies to explore restrictive spirometric cases and joint projects via groups like the International Pediatric Lung Transplant Collaborative will be the way forward to solve this pressing problem.

  1. [The experience of kidney transplantation at the Donetsk transplantation center]. (United States)

    Serniak, P S; Denisov, V K; Zakharov, V V; Oleshchenko, N D; Guba, G B; Rodin, I N; Chernobrivtsev, P A; Derkach, I A


    In Donetskiy transplantational centre during the period from 1986 to 1996 yr were conducted 305 operations of the kidney transplantation from the cadaveric and living donor. Kidney transplantation permits to achieve higher level of rehabilitation than while application of hemodialysis and must become the method of choice in treatment of terminal stage of chronic renal insufficiency. Considering large demand for the organs transplantation in Ukraine it is necessary to create an economically substantiated programme "Transplantation of organs".

  2. Syngeneic transplantation in aplastic anemia

    DEFF Research Database (Denmark)

    Gerull, Sabine; Stern, Martin; Apperley, Jane


    Aplastic anemia is usually treated with immunosuppression or allogeneic transplant, depending on patient and disease characteristics. Syngeneic transplant offers a rare treatment opportunity with minimal transplant-related mortality, and offers an insight into disease mechanisms. We present here...... a retrospective analysis of all syngeneic transplants for aplastic anemia reported to the European Group for Blood and Marrow Transplantation. Between 1976 and 2009, 88 patients received 113 transplants. Most transplants (n=85) were preceded by a conditioning regimen, 22 of these including anti-thymocyte globulin...

  3. Transplant tourism: understanding the risks. (United States)

    Babik, Jennifer M; Chin-Hong, Peter


    Transplant tourism is commonly defined as travel abroad for the purpose of transplantation, but the term evokes ethical and legal concerns about commercial transplantation. Due to the mismatch in supply and demand for organs, transplant tourism has increased over the last several decades and now accounts for 10 % of transplants worldwide. Patients from the USA who pursue transplantation abroad do so most commonly for renal transplantation, and travel mostly to China, the Philippines, and India. Transplant tourism puts the organ recipient at risk for surgical complications, poor graft outcome, increased mortality, and a variety of infectious complications. Bacterial, viral, fungal, and parasitic infections have all been described, and most concerning are the high rates of blood-borne viral infections and invasive, often fatal, fungal infections. Transplant and infectious diseases physicians should have a high degree of suspicion for infectious complications in patients returning from transplantation abroad.

  4. Endovascular management in liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Kyu-Bo Sung


    @@ Liver transplantation was developed for the treatment of hepatic failure, and the first human liver transplantation was done in 1963. From the 1990 s,liver transplantation was generally accepted as a treatment modality for both end-stage liver disease and selected liver malignancies. Initially, liver transplantation was started with deceased donor whole-size liver transplantation (whole-size LT) as in other organ transplantation, but there is now a shortage of deceased liver donors has occurred. As a solution, deceased donor split liver transplantation (split LT) began in 1989 and living donor liver transplantation (LDLT) in the early 1990 s. Current liver transplantation techniques include whole-size LT, reduced-size liver transplantation (reduced-size LT), split LT and single or dual LDLT. Two donors give a part of their livers to one adult recipient simultaneously in dual LDLT.

  5. Multiple Cavitating Nodules in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Sharla-Rae J Olsen


    Full Text Available Pulmonary nodules are common following solid organ transplantation and vary in etiology. Nodules with central cavitation are most likely to be of infectious origin in the post-transplant population. A novel presentation of post-transplant lymphoproliferative disorder manifesting as multiple cavitating pulmonary nodules is described. The patient, a 45-year-old female renal transplant recipient, presented with constitutional symptoms and a chest x-ray showing multiple bilateral cavitating lesions. A computed tomography scan confirmed innumerable, randomly dispersed, cavitating nodules in the lung parenchyma. Multiple large hypodense lesions were identified in the liver and spleen. The appearance of the native and transplanted kidneys was normal. A liver biopsy identified an Epstein-Barr virus-negative, diffuse, large B cell lymphoma. Repeat imaging after treatment with a cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone/prednisolone regimen demonstrated dramatic resolution of all lesions. The present case represents a unique radiographic presentation of post-transplant lymphoproliferative disorder not previously reported in the literature.

  6. Patient selection for liver transplantation. (United States)

    Carrion, Andres F; Aye, Lydia; Martin, Paul


    Improved outcomes in liver transplant recipients reflect advances in surgical technique, post-operative care, immunosuppression as well as better selection of potential candidates. The pre-transplant evaluation is a multidisciplinary process intended to recognize and treat important comorbid conditions that may impair outcomes during the peri- and post-transplant periods. Important psychosocial issues should also be ascertained and tackled early during the pre-transplant evaluation with an overarching intention to improve the success of liver transplantation.

  7. Pediatric transplantation: preventing thrombosis. (United States)

    Robertson, J D


    Due to progressive advances in surgical techniques, immunosuppressive therapies, and supportive care, outcomes from both solid organ transplantation and hematopoietic stem cell transplantation continue to improve. Thrombosis remains a challenging management issue in this context, with implications for both graft survival and long-term quality of life. Unfortunately, there remains a general paucity of pediatric-specific data regarding thrombosis incidence, risk stratification, and the safety or efficacy of preventative strategies with which to guide treatment algorithms. This review summarizes the available evidence and rationale underlying the spectrum of current practices aimed at preventing thrombosis in the transplant recipient, with a particular focus on risk factors, pathophysiology, and described antithrombotic regimens.

  8. Islet transplantation: immunological perspectives. (United States)

    Inverardi, Luca; Kenyon, Norma S; Ricordi, Camillo


    Clinical trials of islet transplantation are showing remarkable success, but they require administration of chronic immunosuppression, and are underscoring the large gap that exists between the number of human donors available and the number of patients that could benefit from the procedure. Recent progress has been made in the definition of key immunological mechanisms that are involved in determining islet transplant outcome. Clinical and preclinical studies, and studies in small animal model systems, will all eventually contribute to the definition of efficient and safe protocols for islet transplantation. If the use of xenografts is successful, it might represent a solution to the shortage of human organs.

  9. Pancreatic islet transplantation

    Directory of Open Access Journals (Sweden)

    Corrêa-Giannella Maria


    Full Text Available Abstract Background No formulation of exogenous insulin available to date has yet been able to mimic the physiological nictemeral rhythms of this hormone, and despite all engineering advancements, the theoretical proposal of developing a mechanical replacement for pancreatic β cell still has not been reached. Thus, the replacement of β cells through pancreas and pancreatic islet transplantation are the only concrete alternatives for re-establishing the endogenous insulin secretion in type 1 diabetic patients. Since only 1 to 1.5% of the pancreatic mass corresponds to endocrine tissue, pancreatic islets transplantation arises as a natural alternative. Data from the International Islet Transplant Registry (ITR from 1983 to December 2000 document a total of 493 transplants performed around the world, with progressively worse rates of post-transplant insulin independence. In 2000, the "Edmonton Protocol" introduced several modifications to the transplantation procedure, such as the use of a steroid-free immunosuppression regimen and transplantation of a mean islet mass of 11,000 islet equivalents per kilogram, which significantly improved 1-year outcomes. Although the results of a 5-year follow-up in 65 patients demonstrated improvement in glycemic instability in a significant portion of them, only 7.5% of the patients have reached insulin independence, indicating the need of further advances in the preservation of the function of transplanted islet. In addition to the scarcity of organs available for transplantation, islets transplantation still faces major challenges, specially those related to cell loss during the process of islet isolation and the losses related to the graft site, apoptosis, allorejection, autoimmunity, and immunosuppression. The main strategies to optimize islet transplantation aim at improving all these aspects. Conclusion Human islet transplantation should be regarded as an intervention that can decrease the frequency of

  10. Surgical technique for lung retransplantation in the mouse (United States)

    Li, Wenjun; Goldstein, Daniel R.; Bribriesco, Alejandro C.; Nava, Ruben G.; Spahn, Jessica H.; Wang, Xingan; Gelman, Andrew E.; Krupnick, Alexander S.


    Microsurgical cuff techniques for orthotopic vascularized murine lung transplantation have allowed for the design of studies that examine mechanisms contributing to the high failure rate of pulmonary grafts. Here, we provide a detailed technical description of orthotopic lung retransplantation in mice, which we have thus far performed in 144 animals. The total time of the retransplantation procedure is approximately 55 minutes, 20 minutes for donor harvest and 35 minutes for the implantation, with a success rate exceeding 95%. The mouse lung retransplantation model represents a novel and powerful tool to examine how cells that reside in or infiltrate pulmonary grafts shape immune responses. PMID:23825768

  11. Demonstration of SLUMIS: a clinical database and management information system for a multi organ transplant program.


    Kurtz, M.; Bennett, T; Garvin, P.; Manuel, F; Williams, M.; Langreder, S.


    Because of the rapid evolution of the heart, heart/lung, liver, kidney and kidney/pancreas transplant programs at our institution, and because of a lack of an existing comprehensive database, we were required to develop a computerized management information system capable of supporting both clinical and research requirements of a multifaceted transplant program. SLUMIS (ST. LOUIS UNIVERSITY MULTI-ORGAN INFORMATION SYSTEM) was developed for the following reasons: 1) to comply with the reportin...

  12. Antagonistic effect of toll-like receptor signaling and bacterial infections on transplantation tolerance*


    Alegre, Maria-Luisa; Chen, Luqiu; Wang, Tongmin; Ahmed, Emily; Wang, Chyung-Ru; Chong, Anita


    The induction of donor-specific tolerance remains a major goal in the field of transplantation immunology. Therapies that target costimulatory molecules can induce tolerance to heart and pancreatic islet allografts in mouse models, but fail to do so following transplantation of skin or intestinal allografts. We have proposed that organs colonized by commensal bacteria such as skin, lung and intestine may be resistant to such therapies as a result of bacterial translocation at the time of tran...

  13. Health-Related Quality of Life After Different Types of Solid Organ Transplantation (United States)

    Pinson, C. Wright; Feurer, Irene D.; Payne, Jerita L.; Wise, Paul E.; Shockley, Shannon; Speroff, Theodore


    Objective To describe functional health and health-related quality of life (QOL) before and after transplantation; to compare and contrast outcomes among liver, heart, lung, and kidney transplant patients, and compare these outcomes with selected norms; and to explore whether physiologic performance, demographics, and other clinical variables are predictors of posttransplantation overall subjective QOL. Summary Background Data There is increasing demand for outcomes analysis, including health-related QOL, after medical and surgical interventions. Because of the high cost, interest in transplantation outcomes is particularly intense. With technical surgical experience and improved immunosuppression, survival after solid organ transplantation has matured to acceptable levels. More sensitive measures of outcomes are necessary to evaluate further developments in clinical transplantation, including data on objective functional outcome and subjective QOL. Methods The Karnofsky Performance Status was assessed objectively for patients before transplantation and up to 4 years after transplantation, and scores were compared by repeated measures analysis of variance. Subjective evaluation of QOL over time was obtained using the Short Form-36 (SF-36) and the Psychosocial Adjustment to Illness Scale (PAIS). These data were analyzed using multivariate and univariate analysis of variance. A summary model of health-related QOL was tested by path analysis. Results Tools were administered to 100 liver, 94 heart, 112 kidney, and 65 lung transplant patients. Mean age at transplantation was 48 years; 36% of recipients were female. The Karnofsky Performance Status before transplantation was 37±1 for lung, 38±2 for heart, 53±3 for liver, and 75±1 for kidney recipients. After transplantation, the scores improved to 67±1 at 3 months, 77±1 at 6 months, 82±1 at 12 months, 86±1 at 24 months, 84±2 at 36 months, and 83±3 at 48 months. When patients were stratified by initial

  14. Fecal microbiota transplantation for refractory Clostridium difficile colitis in solid organ transplant recipients. (United States)

    Friedman-Moraco, R J; Mehta, A K; Lyon, G M; Kraft, C S


    Fecal microbiota transplantation (FMT) has been shown to be safe and efficacious in individuals with refractory Clostridium difficile. It has not been widely studied in individuals with immunosuppression due to concerns about infectious complications. We describe two solid organ transplant recipients, one lung and one renal, in this case report that both had resolution of their diarrhea caused by C. difficile after FMT. Both recipients required two FMTs to achieve resolution of their symptoms and neither had infectious complications. Immunosuppressed individuals are at high risk for acquisition of C. difficile and close monitoring for infectious complications after FMT is necessary, but should not preclude its use in patients with refractory disease due to C. difficile. Sequential FMT may be used to achieve cure in these patients with damaged microbiota from antibiotic use and immunosuppression.

  15. [Advances in respiratory health 2010: Techniques and Transplantation Section]. (United States)

    Cordovilla Pérez, Rosa; Marín, Pilar Morales; Salvatierra Velázquez, Angel


    Five articles and an editorial on interventional pneumology were published in Archivos de Bronconeumología. Two of these articles deal with bronchoscopy, one with lung biopsy with cryoprobes, one with thermoplasty in asthma and the last with tracheobronchomalacia. We also review several publications in international journals, with special emphasis on endobronchial ultrasound. Four original articles on idiopathic pulmonary fibrosis were published in Archivos de Bronconeumología: one special article comparing two treatments and a Cochrane systematic review on the efficacy of non-steroidal drugs in this disease. Finally, we highlight studies in lung transplantation, consisting of 14 publications from different continents and with highly diverse contents: one editorial, one letter to the editor, one procedures manual and nine international publications on donor characteristics, various types of complications, experimental results in the field of preservation, and the casuistics obtained in distinct diseases in which transplantation is an option.

  16. Hematopoietic Origin of Murine Lung Fibroblasts

    Directory of Open Access Journals (Sweden)

    Lindsay T. McDonald


    Full Text Available Multiple origins, including the bone marrow, have been suggested to contribute to fibroblast populations in the lung. Using bone marrow reconstitution strategies, the present study tested the hypothesis that the bone marrow hematopoietic stem cell (HSC gives rise to lung tissue fibroblasts in vivo. Data demonstrate that the nonadherent bone marrow fraction is enriched for CD45+ HSC-derived cells and was able to reconstitute hematopoiesis in lethally irradiated animals. Analysis of peripheral blood and lung tissues from engrafted mice demonstrated the ability of this population to give rise to CD45+/Discoidin-Domain Receptor-2+ (DDR2 circulating fibroblast precursors (CFPs in blood and fibroblast populations in lung. An HSC origin for lung fibroblasts was confirmed using a novel clonal cell transplantation method in which the bone marrow is reconstituted by a clonal population derived from a single HSC. Together, these findings provide evidence for an HSC contribution to lung fibroblasts and demonstrate a circulating intermediate through the CD45+/DDR2+ HSC-derived CFP.

  17. Rabies in Transplant Recipients

    Centers for Disease Control (CDC) Podcasts


    Dr. Richard Franka, a CDC scientist, discusses rabies in organ transplant recipients.  Created: 9/19/2016 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 9/19/2016.

  18. Experimental uterus transplantation. (United States)

    Johannesson, Liza; Enskog, Anders


    Today, most causes of infertility are successfully treated. Yet there is still a subgroup of female infertility affecting around 4%, which so far is untreatable because of an absolute uterine factor. To acquire motherhood, these women are today referred to either adoption or surrogacy. Research in the field of uterus transplantation has been evaluated in different animal models for decades and has presently reached a human clinical application as a possible treatment for absolute uterine factor infertility. Organ transplantation is no longer reserved to those with a life-threatening disease and neither is organ transplantation together with concurrent immunosuppression prohibiting pregnancy. Uterus transplantation involves four parties - recipient, donor, partner of recipient and future child - and is a subject of ethical controversies.

  19. Pancreatic Islet Transplantation (United States)

    ... and longer duration of organ function. The main disadvantage is that a whole organ transplant is a ... Privacy Policy Freedom of Information Act Accessibility Disclaimers Copyright Sitemap For Staff Only Jobs at NIDDK U.S. ...

  20. Kidney Transplantation in Iran

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    Behzad Einollahi


    Full Text Available Kidney transplantation in patients with end stage renal diseaseis preferred to dialysis because transplantation provides a betterquality of life and improved survival. However, the gapbetween the supply and demand for a renal allograft is wideningand the waiting time is increasing. Iranian protocol, a controlledtransplant program supported by the government forliving unrelated donors, was initiated for solving the problemof organ shortage. Although this system might experiencechallenges, clearly it has advantages over other organ procurementsystems primarily that thousands in need do not diewhile waiting for a compatible donor.In the present review I discuss the history of renal transplantationin Iran, "Iranian model" protocol, the situation ofIran’s kidney transplantation from either living or deceaseddonors compared with the Middle East countries, and our experiencesof unrelated renal transplantation.