Skip directly to content

Feed aggregator

8 Transplants in 10 days for Solid Organ Transplant

MedWorm Liver Transplant - Fri, 09/22/2017 - 20:08
The cases consisted of five kidney transplants, one pancreas transplant, and two liver transplants. Patients hail from Monroe County, Buffalo, Utica and Elmira. (Source: University of Rochester Medical Center Press Releases)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

Categories: Publications

Energy and Protein in Critically Ill Patients with AKI: A Prospective, Multicenter Observational Study Using Indirect Calorimetry and Protein Catabolic Rate.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Energy and Protein in Critically Ill Patients with AKI: A Prospective, Multicenter Observational Study Using Indirect Calorimetry and Protein Catabolic Rate.

Nutrients. 2017 Jul 26;9(8):

Authors: Sabatino A, Theilla M, Hellerman M, Singer P, Maggiore U, Barbagallo M, Regolisti G, Fiaccadori E

Abstract
The optimal nutritional support in Acute Kidney Injury (AKI) still remains an open issue. The present study was aimed at evaluating the validity of conventional predictive formulas for the calculation of both energy expenditure and protein needs in critically ill patients with AKI. A prospective, multicenter, observational study was conducted on adult patients hospitalized with AKI in three different intensive care units (ICU). Nutrient needs were estimated by different methods: the Guidelines of the European Society of Parenteral and Enteral Nutrition (ESPEN) for both calories and proteins, the Harris-Benedict equation, the Penn-State and Faisy-Fagon equations for energy. Actual energy and protein needs were repeatedly measured by indirect calorimetry (IC) and protein catabolic rate (PCR) until oral nutrition start, hospital discharge or renal function recovery. Forty-two patients with AKI were enrolled, with 130 IC and 123 PCR measurements obtained over 654 days of artificial nutrition. No predictive formula was precise enough, and Bland-Altman plots wide limits of agreement for all equations highlight the potential to under- or overfeed individual patients. Conventional predictive formulas may frequently lead to incorrect energy and protein need estimation. In critically ill patients with AKI an increased risk for under- or overfeeding is likely when nutrient needs are estimated instead of measured.

PMID: 28933744 [PubMed - in process]

C4d-expressing glomerulopathy and proteinuria post transplantation of a 
too-big-for-size mismatched kidney allograft: An unusual case with good outcome
.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

C4d-expressing glomerulopathy and proteinuria post transplantation of a 
too-big-for-size mismatched kidney allograft: An unusual case with good outcome
.

Clin Nephrol. 2017 Sep 21;:

Authors: Gougeon F, Mikhailov AV, Gibson K, Kozlowski T, Singh HK, Nickeleit V

Abstract
A 5-year-old severely growth-retarded child with tubulointerstitial, oliguric end-stage renal disease received an adult-size kidney transplant. Three years post grafting under standard triple immunosuppression (mycophenolate mofetil, tacrolimus, and prednisone) de novo nephrotic range proteinuria without the nephrotic syndrome developed. Graft function was normal (serum creatinine: 0.2 - 0.3 mg/dL), there were no donor-specific HLA antibodies (DSA), and the urine sediment was inactive. Two biopsies collected 3 and 4 years post-transplantation showed severe glomerular capillary wall remodeling and associated pseudolinear C4d staining as morphologic correlates for the proteinuria. Changes resembled those seen in so-called "size-mismatch transplant glomerulopathies". There was no evidence of a glomerulonephritis, acute or chronic rejection including transplant glomerulopathy, interstitial fibrosis, peritubular capillary C4d deposits, or multilamination of peritubular capillary basement membranes. The glomerular changes were not detected in the implantation zero-hour biopsy or the recipient's native renal biopsy. At the end of follow-up 64 months post transplantation, proteinuria persisted at subnephrotic levels in the setting of stable graft function and undetectable DSAs. This unique case adds to the list of causes of nonrejection-associated post-transplant proteinuria. It demonstrates for the first time that a too-large-for-body-size mismatched graft is associated with a presumably sheer stress-induced C4d expressing glomerulopathy, severe proteinuria, and favorable outcome.
.

PMID: 28933341 [PubMed - as supplied by publisher]

Crossing Anatomic Barriers-Transplantation of a Kidney with 5 Arteries, Duplication of the Pyelocalyceal System, and Double Ureter.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Crossing Anatomic Barriers-Transplantation of a Kidney with 5 Arteries, Duplication of the Pyelocalyceal System, and Double Ureter.

Cell Transplant. 2017 Jan 01;:963689717722169

Authors: Bachul PJ, Osuch C, Chang ES, Bętkowska-Prokop A, Pasternak A, Szura M, Matyja A, Walocha JA

Abstract
During the time of organ harvest, it is crucial for the kidney procurement team to consider significant vascular anatomical variations. Multiple renal arteries are not uncommon, and unintentional injury can result in an irreversibly damaged kidney graft that needs to be discarded. We present a kidney graft with 5 renal arteries and a single vein that was successfully procured and implanted with good graft function at discharge and at 4-yr follow-up. According to the literature, additional renal arteries can be found in about 33% of kidneys. This is the first study on a kidney with 5 arteries in the published literature, especially in the context of transplantation.

PMID: 28933184 [PubMed - as supplied by publisher]

[Cytomegalovirus and polyomavirus infection after renal transplantation].

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

[Cytomegalovirus and polyomavirus infection after renal transplantation].

Vnitr Lek. 2017;63(7-8):488-497

Authors: Machová J, Reischig T

Abstract
Viral infections are among the most common infectious complications affecting transplant recipients. Due to immunosuppressive therapy predominantly affecting cellular immunity and thus successfully reducing the incidence of acute rejection, there is a higher incidence of viral infections. Herpesviruses and polyomaviruses are ubiquitous pathogens which have the ability to persist in a state of latent infection. In addition to post-transplant reactivation, donor-induced primoinfection can also occur, leading to increased morbidity and contributing to decreased survival of patients. Moreover, there are long-term indirect effects, resulting in an impaired function of the transplanted organs and their premature loss. This article provides a brief overview of infections which have the greatest impact on transplant recipients, i.e. cytomegalovirus and BK polyomavirus, their diagnosis, prevention and treatment.Key words: BK virus - cytomegalovirus - ganciclovir - immunosuppressive therapy - JC virus - kidney transplantation - polyomavirus - polyomavirus-associated nephropathy - preemptive therapy - prophylaxis - valaciclovir.

PMID: 28933173 [PubMed - in process]

Data on the relation between renal biomarkers and measured glomerular filtration rate.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Data on the relation between renal biomarkers and measured glomerular filtration rate.

Data Brief. 2017 Oct;14:763-772

Authors: Pottel H, Dubourg L, Schaeffner E, Eriksen BO, Melsom T, Lamb EJ, Rule AD, Turner ST, Glassock RJ, De Souza V, Selistre L, Goffin K, Pauwels S, Mariat C, Flamant M, Bevc S, Delanaye P, Ebert N

Abstract
The data presented in this article are related to the research article entitled "The Diagnostic Value of Rescaled Renal Biomarkers Serum Creatinine and Serum Cystatin C and their Relation with Measured Glomerular Filtration Rate" (Pottel et al. (2017) [1]). Data are presented demonstrating the rationale for the normalization or rescaling of serum cystatin C, equivalent to the rescaling of serum creatinine. Rescaling biomarkers brings them to a notionally common scale with reference interval [0.67-1.33]. This article illustrates the correlation between rescaled biomarkers serum creatinine and serum cystatin C by plotting them in a 2-dimensional graph. The diagnostic value in terms of sensitivity and specificity with measured Glomerular Filtration Rate as the reference method is calculated per age-decade for both rescaled biomarkers. Finally, the interchangeability between detecting impaired kidney function from renal biomarkers and from the Full Age Spectrum FAS-estimating GFR-equation and measured GFR using a fixed and an age-dependent threshold is shown.

PMID: 28932781 [PubMed]

Endovascular management of arterial injuries after blunt or iatrogenic renal trauma.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Endovascular management of arterial injuries after blunt or iatrogenic renal trauma.

Quant Imaging Med Surg. 2017 Aug;7(4):434-442

Authors: Loffroy R, Chevallier O, Gehin S, Midulla M, Berthod PE, Galland C, Briche P, Duperron C, Majbri N, Mousson C, Falvo N

Abstract
The kidney is the third most common abdominal organ to be injured in trauma, following the spleen and liver, respectively. The most commonly used classification scheme is the American Association for the Surgery of Trauma (AAST) classification of blunt renal injuries, which grades renal injury according to the size of laceration and its proximity to the renal hilum. Arteriovenous fistula and pseudoaneurysm are the most common iatrogenic biopsy-related or surgery-related vascular injuries in native kidneys. The approach to renal artery injuries has changed over time from more aggressive intervention to more conservative observational or endovascular management, including selective transcatheter arterial embolization (TAE) and the placement of stents/stent grafts. In this article, we describe the role and technical aspects of endovascular interventions in the management of arterial injuries after blunt or iatrogenic renal trauma.

PMID: 28932700 [PubMed]

Targeted Delivery of Neutralizing Anti-C5 Antibody to Renal Endothelium Prevents Complement-Dependent Tissue Damage.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Targeted Delivery of Neutralizing Anti-C5 Antibody to Renal Endothelium Prevents Complement-Dependent Tissue Damage.

Front Immunol. 2017;8:1093

Authors: Durigutto P, Sblattero D, Biffi S, De Maso L, Garrovo C, Baj G, Colombo F, Fischetti F, Di Naro AF, Tedesco F, Macor P

Abstract
Complement activation is largely implicated in the pathogenesis of several clinical conditions and its therapeutic neutralization has proven effective in preventing tissue and organ damage. A problem that still needs to be solved in the therapeutic control of complement-mediated diseases is how to avoid side effects associated with chronic neutralization of the complement system, in particular, the increased risk of infections. We addressed this issue developing a strategy based on the preferential delivery of a C5 complement inhibitor to the organ involved in the pathologic process. To this end, we generated Ergidina, a neutralizing recombinant anti-C5 human antibody coupled with a cyclic-RGD peptide, with a distinctive homing property for ischemic endothelial cells and effective in controlling tissue damage in a rat model of renal ischemia/reperfusion injury (IRI). As a result of its preferential localization on renal endothelium, the molecule induced complete inhibition of complement activation at tissue level, and local protection from complement-mediated tissue damage without affecting circulating C5. The ex vivo binding of Ergidina to surgically removed kidney exposed to cold ischemia supports its therapeutic use to prevent posttransplant IRI leading to delay of graft function. Moreover, the finding that the ex vivo binding of Ergidina was not restricted to the kidney, but was also seen on ischemic heart, suggests that this RGD-targeted anti-C5 antibody may represent a useful tool to treat organs prior to transplantation. Based on this evidence, we propose preliminary data showing that Ergidina is a novel targeted drug to prevent complement activation on the endothelium of ischemic kidney.

PMID: 28932227 [PubMed]

A suspected case of autoinduction of voriconazole metabolism in a patient with cerebral aspergillosis.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

A suspected case of autoinduction of voriconazole metabolism in a patient with cerebral aspergillosis.

Drug Healthc Patient Saf. 2017;9:89-91

Authors: Ferguson MJ, Randles ML, de Freitas DG

Abstract
OBJECTIVE: This study aims to report a case of accelerated metabolism of voriconazole in a patient with cerebral aspergillosis.
CASE SUMMARY: A 36-year-old woman developed cerebral aspergillosis after immunosuppressive treatment for suspected atypical hemolytic uremic syndrome/thrombotic thrombocytopenic purpura. She was treated with voriconazole using therapeutic drug monitoring to guide dosing. After an initial high level, her dose was reduced, but over the following weeks, she required several dose increases in order to achieve a voriconazole level within the target range. The patient's dose requirements eventually stabilized at 700 mg twice daily. Cimetidine and omeprazole were added in an effort to inhibit the metabolism of voriconazole.
DISCUSSION: The metabolism of voriconazole is known to be highly variable among different patients depending on pharmacogenetic factors; however, an increasing rate of voriconazole metabolism in a single patient over time is not well recognized. Therapeutic drug monitoring of voriconazole in this case facilitated the use of large doses while controlling for toxicity.
CONCLUSION: This case is further evidence of autoinduction in voriconazole metabolism. Therapeutic drug monitoring of voriconazole is useful in detecting variation in a patient's metabolism of voriconazole over time.

PMID: 28932128 [PubMed]

An in vitro model of renal inflammation after ischemic oxidative stress injury: nephroprotective effects of a hyaluronan ester with butyric acid on mesangial cells.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

An in vitro model of renal inflammation after ischemic oxidative stress injury: nephroprotective effects of a hyaluronan ester with butyric acid on mesangial cells.

J Inflamm Res. 2017;10:135-142

Authors: Baraldi O, Bianchi F, Menghi V, Angeletti A, Croci Chiocchini AL, Cappuccilli M, Aiello V, Comai G, La Manna G

Abstract
BACKGROUND: Acute kidney injury, known as a major trigger for organ fibrosis and independent predictor of chronic kidney disease, is characterized by mesangial cell proliferation, inflammation and unbalance between biosynthesis and degradation of extracellular matrix. Therapeutic approaches targeting the inhibition of mesangial cell proliferation and matrix expansion may represent a promising opportunity for the treatment of kidney injury. An ester of hyaluronic acid and butyric acid (HB) has shown vasculogenic and regenerative properties in renal ischemic-damaged tissues, resulting in enhanced function recovery and minor degree of inflammation in vivo. This study evaluated the effect of HB treatment in mesangial cell cultures exposed to H2O2-induced oxidative stress.
MATERIALS AND METHODS: Lactate dehydrogenase release and caspase-3 activation were measured using mesangial cells prepared from rat kidneys to assess necrosis and apoptosis. Akt and p38 phosphorylation was analyzed to identify the possible mechanism underlying cell response to HB treatment. The relative expressions of matrix metallopeptidase 9 (MPP-9) and collagen type 1 alpha genes were also analyzed by quantitative real-time polymerase chain reaction. Cell proliferation rate and viability were measured using thiazolyl blue assay and flow cytometry analysis of cell cycle with propidium iodide.
RESULTS: HB treatment promoted apoptosis of mesangial cells after H2O2-induced damage, decreased cellular proliferation and activated p38 pathway, increasing expression of its target gene MPP-9.
CONCLUSION: This in vitro model shows that HB treatment seems to redirect mesangial cells toward apoptosis after oxidative damage and to reduce cell proliferation through p38 MAPK pathway activation and upregulation of MPP-9 gene expression involved in mesangial matrix remodeling.

PMID: 28932127 [PubMed]

Efficacy and safety of sofosbuvir and daclatasvir in treatment of kidney transplantation recipients with hepatitis C virus infection.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Efficacy and safety of sofosbuvir and daclatasvir in treatment of kidney transplantation recipients with hepatitis C virus infection.

World J Gastroenterol. 2017 Aug 28;23(32):5969-5976

Authors: Xue Y, Zhang LX, Wang L, Li T, Qu YD, Liu F

Abstract
AIM: To assess the efficacy and safety of sofosbuvir and daclatasvir regimens for kidney transplantation (KT) patients with hepatitis C virus (HCV) infection.
METHODS: This study enrolled a prospective cohort of consecutive Chinese KT patients with HCV infection. They were given sofosbuvir combined with daclatasvir, with or without ribavirin. They were monitored regularly during and after the treatment.
RESULTS: Six patients were recruited in our prospective study cohort. All patients were male and naive to direct-acting antiviral treatment. The treatment duration was 12 wk. Most patients (4/6) were infected with HCV genotype 1b. HCV RNA was undetectable at week 4 after treatment and at the end of treatment in all patients. Sustained virological response rate at 12 wk was 100% (6/6). Two patients had to accept a half dose of sofosbuvir due to serum creatinine elevation during treatment. Kidney function in the remaining patients was stable. No serious adverse events (AEs) were observed. No patient discontinued antiviral therapy due to side effects.
CONCLUSION: Sofosbuvir and daclatasvir for treatment of KT recipients with HCV infection are highly efficient and safe. Patients tolerated the medications well, and no serious AEs were observed. Larger prospective cohort studies are needed to validate these results.

PMID: 28932089 [PubMed - in process]

Molecular characterization of the transition from acute to chronic kidney injury following ischemia/reperfusion.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Molecular characterization of the transition from acute to chronic kidney injury following ischemia/reperfusion.

JCI Insight. 2017 Sep 21;2(18):

Authors: Liu J, Kumar S, Dolzhenko E, Alvarado GF, Guo J, Lu C, Chen Y, Li M, Dessing MC, Parvez RK, Cippà PE, Krautzberger AM, Saribekyan G, Smith AD, McMahon AP

Abstract
Though an acute kidney injury (AKI) episode is associated with an increased risk of chronic kidney disease (CKD), the mechanisms determining the transition from acute to irreversible chronic injury are not well understood. To extend our understanding of renal repair, and its limits, we performed a detailed molecular characterization of a murine ischemia/reperfusion injury (IRI) model for 12 months after injury. Together, the data comprising RNA-sequencing (RNA-seq) analysis at multiple time points, histological studies, and molecular and cellular characterization of targeted gene activity provide a comprehensive profile of injury, repair, and long-term maladaptive responses following IRI. Tubular atrophy, interstitial fibrosis, inflammation, and development of multiple renal cysts were major long-term outcomes of IRI. Progressive proximal tubular injury tracks with de novo activation of multiple Krt genes, including Krt20, a biomarker of renal tubule injury. RNA-seq analysis highlights a cascade of temporal-specific gene expression patterns related to tubular injury/repair, fibrosis, and innate and adaptive immunity. Intersection of these data with human kidney transplant expression profiles identified overlapping gene expression signatures correlating with different stages of the murine IRI response. The comprehensive characterization of incomplete recovery after ischemic AKI provides a valuable resource for determining the underlying pathophysiology of human CKD.

PMID: 28931758 [PubMed - as supplied by publisher]

Cumulative Kidney Complication Risk by 50 Years of Type 1 Diabetes: The Effects of Sex, Age, and Calendar Year at Onset.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Cumulative Kidney Complication Risk by 50 Years of Type 1 Diabetes: The Effects of Sex, Age, and Calendar Year at Onset.

Diabetes Care. 2017 Sep 20;:

Authors: Costacou T, Orchard TJ

Abstract
OBJECTIVE: A common belief is that only a minority of patients with type 1 diabetes (T1D) develop advanced kidney disease and that incidence is higher among men and lower in those diagnosed at a younger age. However, because few patients with T1D survived to older ages until recently, long-term risks have been unclear.
RESEARCH DESIGN AND METHODS: We examined the 50-year cumulative kidney complication risk in a childhood-onset T1D cohort diagnosed during 1950-80 (n = 932; mean baseline age 29 years, duration 19 years). Participants were 144 who died before baseline, 130 followed with periodic surveys, and 658 followed with biennial surveys and a maximum of nine examinations for 25 years. Micro- and macroalbuminuria were defined as an albumin excretion rate of 20-199 and ≥200 μg/min, respectively, and end-stage renal disease (ESRD) as dialysis or kidney transplantation. Cumulative incidence was estimated at 10-year intervals between 20 and 50 years duration and compared by calendar year of diabetes onset.
RESULTS: By 50 years of T1D duration, ESRD affected 60% of the cohort; macroalbuminuria, 72%; and microalbuminuria, 88%. Little evidence existed for declines in cumulative incidence in recent cohorts, except for ESRD (microalbuminuria 3% increase, macroalbuminuria no change; ESRD 45% decrease by 40 years of T1D duration). Onset before age 6 years was associated with the lowest risk; incidence generally did not differ by sex.
CONCLUSIONS: Some degree of kidney disease in T1D is virtually universal at long durations and not declining, which has major implications for health care and research strategies. ESRD has declined, but continues to affect >25% of the population by 40 years duration.

PMID: 28931542 [PubMed - as supplied by publisher]

Ambulatory Blood Pressure Monitoring and Echocardiographic Findings in Renal Transplant Recipients.

PubMed Kidney Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Ambulatory Blood Pressure Monitoring and Echocardiographic Findings in Renal Transplant Recipients.

J Clin Hypertens (Greenwich). 2016 Aug;18(8):766-71

Authors: Kendirlinan Demirkol O, Oruc M, Ikitimur B, Ozcan S, Gulcicek S, Soylu H, Trabulus S, Altiparmak MR, Seyahi N

Abstract
Hypertension is common in renal transplant recipients (RTRs). Ambulatory blood pressure (BP) monitoring (ABPM) is important in diagnosing hypertension and diurnal BP variation. The authors set out to compare office BP and ABPM measurements to determine diurnal pattern and to evaluate echocardiographic findings in RTRs. ABPM and office BP measurements were compared in 87 RTRs. Echocardiographic evaluation was performed for each patient. The correlations between office and 24-hour ABPM were 0.275 for mean systolic BP (P=.011) and 0.260 for mean diastolic BP (P=.017). Only 36.8% had concordant hypertension between office BP and ABPM, with a masked hypertension rate of 16.1% and white-coat effect rate of 24.1%. Circadian BP patterns showed a higher proportion of nondippers (67.8%). Left ventricular mass index was increased in 21.8% of all recipients. There was a significant but weak correlation between office BP and ABPM.

PMID: 26689296 [PubMed - indexed for MEDLINE]

The Value and Application of the Six Minute Walk Test in Idiopathic Pulmonary Fibrosis.

PubMed Lung Transplant - Fri, 09/22/2017 - 12:45
Related Articles

The Value and Application of the Six Minute Walk Test in Idiopathic Pulmonary Fibrosis.

Ann Am Thorac Soc. 2017 Sep 21;:

Authors: Brown AW, Nathan SD

Abstract
The 6 minute walk test (6MWT) is a commonly employed assessment of performance ability in a variety of cardiopulmonary diseases. It provides important functional information that is not captured in standardized pulmonary function testing. The test may be influenced by factors other than the severity of lung disease, including frailty, deconditioning, and musculoskeletal issues. The primary output measure from the six minute walk test is the distance walked, which appears to confer prognostic information in many diverse disease states. The 6MWT distance has served as a primary endpoint in many drug trials, most notably in the field of pulmonary arterial hypertension, and to a lesser extent in idiopathic pulmonary fibrosis (IPF). Although the 6MWT has been utilized in clinical practice and research trials of IPF, there are no specific guidelines regarding its implementation in this growing patient population. Given that there is increasing evidence and experience with its use in clinical trials, development of nuanced standards designed specifically for IPF are much needed. This review touches on a number of complex and crucial issues in the application of this test and provides a framework for future development of 6MWT guidelines customized for IPF.

PMID: 28933948 [PubMed - as supplied by publisher]

Single lung retrieval from a donor supported by a left ventricular assist device.

PubMed Lung Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Single lung retrieval from a donor supported by a left ventricular assist device.

J Thorac Dis. 2017 Aug;9(8):E685-E688

Authors: Matsumoto K, Yamasaki N, Tsuchiya T, Miyazaki T, Kamohara R, Hatachi G, Tanigawa K, Eishi K, Nagayasu T

Abstract
The number of patients who need cardiac support with a left ventricular assist device (LVAD) has increased over the last decade. However, the number of reports of organ retrieval from donors with an LVAD is still small. Successful lung retrieval for single lung transplantation was performed from a donor on LVAD support. This required special care not to injure the heart, great vessels, and the device, particularly the outflow conduit, because of significant conglutination around the device. A right single lung transplantation was performed successfully, with no postoperative complications. This means that patients on an LVAD could be potential donors for lung transplantation.

PMID: 28932586 [PubMed]

Outcomes after lung transplantation.

PubMed Lung Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Outcomes after lung transplantation.

J Thorac Dis. 2017 Aug;9(8):2684-2691

Authors: Thabut G, Mal H

Abstract
With more than 50,000 procedures having been performed worldwide, lung transplantation (LT) has become the standard of care for patients with end-stage chronic respiratory failure. LT leads to dramatic improvements in both pulmonary function and health related quality of life. Survival after LTs has steadily improved, but still lags far behind that observed after other solid organ transplantations, as evidenced by a median survival rate that currently stands at 5.8 years. Because of these disappointing results, the ability of LT to expand survival has been questioned. However, the most recent studies, based on sophisticated statistical modeling suggest that LT confers a survival benefit to the vast majority of lung transplant recipients. Chronic lung allograft dysfunction (CLAD) that develops in about 50% of recipients 5 years after LT is a major impediment to lung transplant survival. A better understanding of the mechanisms underlying CLAD could allow for better post-transplant survival.

PMID: 28932576 [PubMed]

Pediatric lung transplantation.

PubMed Lung Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Pediatric lung transplantation.

J Thorac Dis. 2017 Aug;9(8):2675-2683

Authors: Benden C

Abstract
Pediatric lung transplantation has been undertaken since the 1980s, and it is today considered an accepted therapy option in carefully selected children with end-stage pulmonary diseases, providing carefully selected children a net survival benefit and improved health-related quality of life. Nowadays, >100 pediatric lung transplants are done worldwide every year. Here, specific pediatric aspects of lung transplantation are reviewed such as the surgical challenge, effects of immunosuppression on the developing pediatric immune system, and typical infections of childhood, as it is vital to comprehend that children undergoing lung transplants present a real challenge as children are not 'just small adults'. Further, an update on the management of the pediatric lung transplant patient is provided in this review, and future challenges outlined. Indications for lung transplantation in children are different compared to adults, the most common being cystic fibrosis (CF). However, the primary diagnoses leading to pediatric lung transplantation vary considerably by age group. Furthermore, there are regional differences regarding the primary indication for lung transplantation in children. Overall, early referral, careful patient selection and appropriate timing of listing are crucial to achieve real survival benefit. Although allograft function is to be preserved, immunosuppressant-related side effects are common in children post-transplantation. Strategies need to be put into practice to reduce drug-related side effects through careful therapeutic drug monitoring and lowering of target levels of immunosuppression, to avoid acute-reversible and chronic-irreversible renal damage. Instead of a "one fits all approach", tailored immunosuppression and a personalized therapy is to be advocated, particularly in children. Further, infectious complications are a common in children of all ages, accounting for almost 50% of death in the first year post-transplantation. However, chronic lung allograft dysfunction (CLAD) remains the major obstacle for improved long-term survival.

PMID: 28932575 [PubMed]

Lung allocation.

PubMed Lung Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Lung allocation.

J Thorac Dis. 2017 Aug;9(8):2670-2674

Authors: Gottlieb J

Abstract
Shortage of donor lungs in most western countries and broadening of indications for lung transplantation (LTx) has led increased waiting list mortality in the past. Usually donor lungs and recipients are matched by size as measured by total lung capacity and blood type in first order. In some countries regional allocation comes first, in other countries a national wait list exists and some nations are organized in supranational allocation systems. Organ distribution should respect the ethical principles of equity, justice, beneficence and utility. Generally, top priority on the list should be given to patients with the least amount of time to live but outcome is an important factor to consider to avoid futile transplantations. Installation of an urgency status will decrease mortality of the sickest candidates on the waitlist unless the proportion of patients on urgency status will be too high. Urgency can be determined by clinical judgment (so called center decision), an audit process or objectively by a score system. Among the 3,500 transplants performed worldwide annually, approximately 60% are allocated by lung allocation score (LAS) (US, Germany, the Netherlands). With the LAS a model for survival prediction after lung transplantation and wait list survival probability was created. Clinical experience in the US since 2005 and in Germany since 2011 favourable reports regarding effects on waiting list outflow, transplant activity and outcomes have been published. Future perspectives will focus on broader geographic sharing, updating and further development of the LAS.

PMID: 28932574 [PubMed]

Donors after cardiocirculatory death and lung transplantation.

PubMed Lung Transplant - Fri, 09/22/2017 - 12:45
Related Articles

Donors after cardiocirculatory death and lung transplantation.

J Thorac Dis. 2017 Aug;9(8):2660-2669

Authors: Inci I

Abstract
The number of patients actively awaiting lung transplantation (LTx) is more than the number of suitable donor lungs. The percentage of lung retrieval rate is lower when compared to other solid organs. The use of lungs from donation after cardiocirculatory death (DCD) donors is one of the options to avoid organ shortage in LTx. After extensive experimental research, clinical application of DCD donation is becoming wider. The results from most of the centers show at least equal survival rate compared to donors from brain death. This review paper will summarize experimental background and clinical experience from DCD donors.

PMID: 28932573 [PubMed]

Pages