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Simultaneous Thoracic and Abdominal Transplantation: Can We Justify Two Organs for One Recipient?

Fri, 05/31/2013 - 10:00

Simultaneous Thoracic and Abdominal Transplantation: Can We Justify Two Organs for One Recipient?

Am J Transplant. 2013 May 29;

Authors: Wolf JH, Sulewski ME, Cassuto JR, Levine MH, Naji A, Olthoff KM, Shaked A, Abt PL

Abstract
Simultaneous thoracic and abdominal (STA) transplantation is controversial because two organs are allocated to a single individual. We studied wait-list urgency, and whether transplantation led to successful outcomes. Candidates and recipients for heart-kidney (SHK), heart-liver (SHLi), lung-liver (SLuLi) and lung-kidney (SLuK) were identified through the United Network for Organ Sharing (UNOS) and outcomes were compared to single-organ transplantation. Since 1987, there were 1801 STA candidates and 836 recipients. Wait-list survival at 1- and 3 years for SHK (67.4%, 40.8%; N = 1420), SHLi (65.7%, 43.6%; N = 218) and SLuLi (65.7%, 41.0%; N = 122), was lower than controls (p < 0.001), whereas for SLuK (65.0%, 51.6%; N = 41) it was comparable (p = 0.34). All STA groups demonstrated similar 1- and 5 years posttransplant survival to thoracic controls. Compared to abdominal controls, 1- and 5 years posttransplant survival in SHK (85.3%, 74.0%; N = 684), SLuLi (75.5%, 59.0%; N = 42) and SLuK (66.7%, 55.6%; N = 18) was decreased (p < 0.01), but SHLi (85.9%, 74.3%; N = 92) was comparable (p = 0.81). In summary, STA candidates had greater risk of wait-list mortality compared to single-organ candidates. STA outcomes were similar to thoracic transplantation; however, outcomes were similar to abdominal transplantation for SHLi only. Although select patients benefit from STA, risk-exposure variables for decreased survival should be identified, aiming to eliminate futile transplantation.

PMID: 23718142 [PubMed - as supplied by publisher]

Interstitial Pneumonitis and the Risk of Chronic Allograft Rejection in Lung Transplant Recipients.

Thu, 05/30/2013 - 18:50

Interstitial Pneumonitis and the Risk of Chronic Allograft Rejection in Lung Transplant Recipients.

Chest. 2013 May 1;143(5):1430-1435

Authors: Mihalek AD, Rosas IO, Padera RF, Fuhlbrigge AL, Hunninghake GM, Demeo DL, Camp PC, Goldberg HJ

Abstract
BACKGROUND: The presence of interstitial pneumonitis (IP) on surveillance lung biopsy specimens in lung transplant recipients is poorly described, and its impact on posttransplant outcomes is not established. The following study assessed the association of posttransplant IP with the development of bronchiolitis obliterans syndrome (BOS). METHODS: We examined all recipients of primary cadaveric lung transplants at our institution between January 1, 2000, and December 31, 2007 (N = 145). Patients had bronchoscopies with BAL, and transbronchial biopsies performed for surveillance during posttransplant months 1, 3, 6, and 12 as well as when clinically indicated. Patients were given a diagnosis of IP if, in the absence of active infection and organizing pneumonia, they showed evidence of interstitial inflammation and fibrosis on two or more biopsy specimens. RESULTS: IP was a significant predictor of BOS (OR, 7.84; 95% CI, 2.84-21.67; P &lt; .0001) and was significantly associated with time to development of BOS (hazard ratio, 3.8; 95% CI, 1.93-7.39; P = .0001) within the first 6 years posttransplant. The presence of IP did not correlate with a significantly higher risk of mortality or time to death. There was no association between the presence of IP and the development of or time to acute rejection. CONCLUSIONS: The presence of IP on lung transplant biopsy specimens suggests an increased risk for BOS, which is independent of the presence of acute cellular rejection.

PMID: 23715594 [PubMed - as supplied by publisher]

Health-Related Quality of Life After Solid Organ Transplantation: A Prospective, Multiorgan Cohort Study.

Thu, 05/30/2013 - 18:50

Health-Related Quality of Life After Solid Organ Transplantation: A Prospective, Multiorgan Cohort Study.

Transplantation. 2013 May 24;

Authors: Kugler C, Gottlieb J, Warnecke G, Schwarz A, Weissenborn K, Barg-Hock H, Bara C, Einhorn I, Haverich A, Haller H

Abstract
BACKGROUND: Short-term posttransplantation survival and health-related quality of life (HRQoL) is exceptionally high for all patients after organ transplantation; however, predictors of the HRQoL outcome are not well understood. Trajectories of patients' perceived benefit/burden ratio associated with the transplant procedure may differ when taking the organ type for transplantation into account. METHODS: A prospective, single-center cohort study assessed the trajectories of 354 patients after kidney (n=165), liver (n=53), heart (n=24), and lung (n=112) transplantation at 2, 6, 12, and 24 months with respect to psychosocial outcomes (HRQoL, anxiety, depression, social support, and work performance). RESULTS: Mean age was 50±13 years, and 61.6% were male in the overall sample. Demographics differed with respect to organ type. HRQoL measured by the mean SF-36 Physical Component Scale was 36.8 (95% confidence interval, 35.7-37.8) and 48.9 (95% confidence interval, 47.2-49.7) for the Psychosocial Component Scale for the entire sample at 2 months and showed a marginal decrease until 24 months after transplantation. Overall, HRQoL increased for all organ types with differing trajectories. Liver patients reported the lowest HRQoL benefit for the majority of the physical (P≤0.01) and psychosocial (P≤0.01) SF-36 subscales. Anxiety (17.4%) and depression (13.8%) were prevalent in the overall sample. Depression symptoms impaired HRQoL outcomes in both SF-36 components and unemployment impacted the SF-36 psychosocial outcomes. CONCLUSIONS: HRQoL improved after transplantation for all four types of transplant, but the trajectories were different. Regular screening for depression symptoms may diminish psychologic disorders and distress after transplantation and thus may further improve outcomes.

PMID: 23715048 [PubMed - as supplied by publisher]

[Suppression of the growth of subcutaneous transplanted human liver cancer and lung metastasis in nude mice treated by sorafenib combined with fluorouracil.]

Thu, 05/30/2013 - 18:50

[Suppression of the growth of subcutaneous transplanted human liver cancer and lung metastasis in nude mice treated by sorafenib combined with fluorouracil.]

Zhonghua Zhong Liu Za Zhi. 2013 Feb;35(2):98-102

Authors: Shen HJ, Wang YH, Xu J

Abstract
OBJECTIVE: The aim of this study was to explore the inhibitory effect of sorafenib and 5-Fu on transplanted human liver cancer in nude mice, and to investigate the synergistic effect and mechanism between sorafenib and 5-Fu. METHODS: The nude mouse model of human liver cancer was made by transplantation of human highly metastatic liver cancer cell line HCCLM3 cells, and the tumor-bearing nude mice were treated with sorafenib, 5-Fu or both, respectively, and mock-treated tumor-bearing nude mice as negative control. To assess the anti-tumor effect of sorafenib and the synergistic effect of sorafenib combined with 5-Fu by measuring the tumor weight and number of lung metastases. Moreover, the expressions of phosphorylated extracellular signal-regulated kinase (p-ERK), P-glycoprotein (P-gp) and topoisomerase 2-alpha (Topo IIa) in the nude mice were assayed by immunocytochemistry and Western blot. RESULTS: The tumor weights and numbers of lung metastases were: (2.7 ± 0.825) g and 12.714 ± 6.317 in the negative control group, (0.933 ± 0.333) g and 4.333 ± 3.983 in the sorafenib group, (0.786 ± 0.212) g and 5.429 ± 4.315 in the Sorafenib + 5-Fu combination group, and (2.438 ± 0.793) g and 10.429 ± 6.241 in the 5-Fu group. Statistically, the tumor weights and numbers of lung metastases in the sorafenib group and combination group were significantly decreased, compared with that in the control group (P < 0.05). There was no significant difference in the tumor weight and number of lung metastases between the sorafenib group and the combination treatment group (P > 0.05). The expression levels of p-ERK, P-gp and Topo IIa proteins in the tumors after normalization were: negative control (0.017 ± 0.010, 0.085 ± 0.012, 0.103 ± 0.093), sorafenib group (0.010 ± 0.008, 0.044 ± 0.020, 0.020 ± 0.018), combination group (0.011 ± 0.007, 0.043 ± 0.023, 0.062 ± 0.026), and 5-Fu group (0.018 ± 0.009, 0.063 ± 0.032, 0.065 ± 0.034), respectively. Statistically, the expression of p-ERK, P-gp and Topo IIa in the Sorafenib group was significantly reduced compared with that of the control group (P < 0.05), and there was no significant difference in the expression of p-ERK, P-gp and Topo IIa between the sorafenib group and the combination treatment group (P > 0.05). CONCLUSIONS: Sorafenib can inhibit not only the tumor growth and lung metastsis in the nude mouse models, but also reduce the expression of multidrug resistance proteins P-gp and Topo IIa as well. There is no significant advantage for the sorafenib + 5-Fu combination treatment than Sorafenib alone in inhibiting the expression of p-ERK, P-gp and Topo IIa.

PMID: 23714662 [PubMed - as supplied by publisher]

Impact of Multidrug-Resistant Organisms on Patients Considered for Lung Transplantation.

Thu, 05/30/2013 - 18:50

Impact of Multidrug-Resistant Organisms on Patients Considered for Lung Transplantation.

Infect Dis Clin North Am. 2013 Jun;27(2):343-358

Authors: Shoham S, Shah PD

Abstract
Infections with multidrug-resistant organisms are a growing problem in lung transplant recipients. Carriage of drug-resistant bacteria and fungi before transplantation is an important risk factor for such infections. In that regard Pseudomonas aeruginosa and species of Burkholderia, Acinetobacter, non-tuberculous mycobacteria and Scedosporium are particularly important. An understanding of the impact of these organisms is essential to the evaluation of lung transplant candidates. The microbiology, epidemiology, clinical manifestations, and approach to these pathogens before transplant are reviewed in this article.

PMID: 23714344 [PubMed - as supplied by publisher]

Left ventricular assist device to avoid heart-lung transplant in an adolescent with dilated cardiomyopathy and severely elevated pulmonary vascular resistance.

Wed, 05/29/2013 - 10:39

Left ventricular assist device to avoid heart-lung transplant in an adolescent with dilated cardiomyopathy and severely elevated pulmonary vascular resistance.

Pediatr Transplant. 2013 May 26;

Authors: Yilmaz B, Zuckerman WA, Lee TM, Beddows KD, Gilmore LA, Singh RK, Richmond ME, Chen JM, Addonizio LJ

Abstract
Orthotopic heart transplantation remains the definitive treatment of choice for patients with end-stage heart failure; however, elevated PVRI is a reported risk factor for mortality after heart transplant and, when severely elevated, is considered an absolute contraindication. Use of a ventricular assist device has been proposed as one treatment for reducing pulmonary vascular resistance index in potential heart transplant candidates refractory to medical vasodilator therapies. We report on a teenage patient with dilated cardiomyopathy and severely elevated PVRI, unresponsive to pulmonary vasodilator therapy, who underwent left ventricular assist device implantation to safely allow for aggressive pulmonary vasodilator therapy and to decrease PVRI. The resulting dramatic improvement in PVRI in a relatively short period of time allowed for successful heart transplantation, avoiding the need for heart-lung transplant.

PMID: 23710645 [PubMed - as supplied by publisher]

Epidemiology and Outcomes of Deep Surgical Site Infections Following Lung Transplantation.

Wed, 05/29/2013 - 10:39

Epidemiology and Outcomes of Deep Surgical Site Infections Following Lung Transplantation.

Am J Transplant. 2013 May 24;

Authors: Shields RK, Clancy CJ, Minces LR, Shigemura N, Kwak EJ, Silveira FP, Abdel-Massih RC, Bhama JK, Bermudez CA, Pilewski JM, Crespo M, Toyoda Y, Nguyen MH

Abstract
We conducted a retrospective study of deep surgical site infections (SSIs) among consecutive patients who underwent lung transplantation (LTx) at a single center from 2006 through 2010. Thirty-one patients (5%) developed SSIs at median 25 days after LTx. Empyema was most common (42%), followed by surgical wound infections (29%), mediastinitis (16%), sternal osteomyelitis (6%), and pericarditis (6%). Pathogens included Gram-positive bacteria (41%), Gram-negative bacteria (41%), fungi (10%) and Mycobacterium abscessus, Mycoplasma hominis and Lactobacillus sp. (one each). Twenty-three percent of SSIs were due to pathogens colonizing recipients' native lungs at time of LTx, suggesting surgical seeding as a source. Patient-related independent risk factors for SSIs were diabetes and prior cardiothoracic surgery; procedure-related independent risk factors were LTx from a female donor, prolonged ischemic time and number of perioperative red blood cell transfusions. Mediastinitis and sternal infections were not observed among patients undergoing minimally invasive LTx. SSIs were associated with 35% mortality at 1 year post-LTx. Lengths of stay and mortality in-hospital and at 6 months and 1 year were significantly greater for patients with SSIs other than empyema. In conclusion, deep SSIs were uncommon, but important complications in LTx recipients because of their diverse microbiology and association with increased mortality.

PMID: 23710593 [PubMed - as supplied by publisher]

Lung transplant outcomes in cystic fibrosis patients with pre-operative Mycobacterium abscessus respiratory infections.

Wed, 05/29/2013 - 10:39

Lung transplant outcomes in cystic fibrosis patients with pre-operative Mycobacterium abscessus respiratory infections.

Clin Transplant. 2013 May 26;

Authors: Lobo LJ, Chang LC, Esther CR, Gilligan PH, Tulu Z, Noone PG

Abstract
BACKGROUND: Mycobacterium abscessus in cystic fibrosis (CF) patients is considered a contraindication to lung transplantation. We examine the post-transplant outcomes of CF patients with M. abscessus pre-transplant. METHODS: CF patients transplanted at the University of North Carolina from 1992 to 2012 were retrospectively examined. Patients with at least one respiratory sample positive for M. abscessus prior to transplantation were included. Data collected included age, FEV1 , body mass index (BMI), systemic steroid use, diabetes mellitus, ventilatory assistance, co-existent CF pathogens, imaging, post-transplant complications, and survival. RESULTS (N = 13): At transplant, mean age was 24.6 yr, mean BMI was 18.1 kg/m(2) , six had 3+ positive smears for M. abscessus, and three were ventilator dependent. All met American Thoracic Society microbiological criteria for disease pre-transplant. Three patients developed M. abscessus-related complications, with clearance of the organism following treatment. Survival post-transplant shows 77% alive at one yr, 64% at three yr, and 50% at five yr; none died of M. abscessus. The survival data showed no statistically significant difference (p = 0.8) compared with a contemporaneously transplanted population of CF patients without M. abscessus (n = 154). CONCLUSION: Lung transplantation, with favorable survival, is possible in CF patients with M. abscessus. Even if M. abscessus recurs, local control and clearance is possible.

PMID: 23710571 [PubMed - as supplied by publisher]

Gene Set Enrichment Analysis Identifies Key Innate Immune Pathways in Primary Graft Dysfunction After Lung Transplantation.

Wed, 05/29/2013 - 10:39

Gene Set Enrichment Analysis Identifies Key Innate Immune Pathways in Primary Graft Dysfunction After Lung Transplantation.

Am J Transplant. 2013 May 24;

Authors: Cantu E, Lederer DJ, Meyer K, Milewski K, Suzuki Y, Shah RJ, Diamond JM, Meyer NJ, Tobias JW, Baldwin DA, Van Deerlin VM, Olthoff KM, Shaked A, Christie JD, for the CTOT Investigators

Abstract
We hypothesized alterations in gene expression could identify important pathways involved in transplant lung injury. Broncho alveolar lavage fluid (BALF) was sampled from donors prior to procurement and in recipients within an hour of reperfusion as part of the NIAID Clinical Trials in Organ Transplantation Study. Twenty-three patients with Grade 3 primary graft dysfunction (PGD) were frequency matched with controls based on donor age and recipient diagnosis. RNA was analyzed using the Human Gene 1.0 ST array. Normalized mRNA expression was transformed and differences between donor and postreperfusion values were ranked then tested using Gene Set Enrichment Analysis. Three-hundred sixty-two gene sets were upregulated, with eight meeting significance (familywise-error rate, FWER p-value <0.05), including the NOD-like receptor inflammasome (NLR; p < 0.001), toll-like receptors (TLR; p < 0.001), IL-1 receptor (p = 0.001), myeloid differentiation primary response gene 88 (p = 0.001), NFkB activation by nontypeable Haemophilus influenzae (p = 0.001), TLR4 (p = 0.008) and TLR 9 (p = 0.018). The top five ranked individual transcripts from these pathways based on rank metric score are predominantly present in the NLR and TLR pathways, including IL1β (1.162), NLRP3 (1.135), IL1α (0.952), IL6 (0.931) and CCL4 (0.842). Gene set enrichment analyses implicate inflammasome-mediated and innate immune signaling pathways as key mediators of the development of PGD in lung transplant patients.

PMID: 23710539 [PubMed - as supplied by publisher]

Introduction to stem cells and regenerative medicine.

Wed, 05/29/2013 - 10:39
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Introduction to stem cells and regenerative medicine.

Respiration. 2013;85(1):3-10

Authors: Kolios G, Moodley Y

Abstract
Stem cells are a population of undifferentiated cells characterized by the ability to extensively proliferate (self-renewal), usually arise from a single cell (clonal), and differentiate into different types of cells and tissue (potent). There are several sources of stem cells with varying potencies. Pluripotent cells are embryonic stem cells derived from the inner cell mass of the embryo and induced pluripotent cells are formed following reprogramming of somatic cells. Pluripotent cells can differentiate into tissue from all 3 germ layers (endoderm, mesoderm, and ectoderm). Multipotent stem cells may differentiate into tissue derived from a single germ layer such as mesenchymal stem cells which form adipose tissue, bone, and cartilage. Tissue-resident stem cells are oligopotent since they can form terminally differentiated cells of a specific tissue. Stem cells can be used in cellular therapy to replace damaged cells or to regenerate organs. In addition, stem cells have expanded our understanding of development as well as the pathogenesis of disease. Disease-specific cell lines can also be propagated and used in drug development. Despite the significant advances in stem cell biology, issues such as ethical controversies with embryonic stem cells, tumor formation, and rejection limit their utility. However, many of these limitations are being bypassed and this could lead to major advances in the management of disease. This review is an introduction to the world of stem cells and discusses their definition, origin, and classification, as well as applications of these cells in regenerative medicine.

PMID: 23257690 [PubMed - in process]

Regenerative medicine and stem cells: prometheus revisited.

Wed, 05/29/2013 - 10:39
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Regenerative medicine and stem cells: prometheus revisited.

Respiration. 2013;85(1):1-2

Authors: Bouros D, Laurent G

PMID: 23207331 [PubMed - in process]

Tumor vessel-injuring ability improves antitumor effect of cytotoxic T lymphocytes in adoptive immunotherapy.

Wed, 05/29/2013 - 10:39
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Tumor vessel-injuring ability improves antitumor effect of cytotoxic T lymphocytes in adoptive immunotherapy.

Cancer Gene Ther. 2013 Jan;20(1):57-64

Authors: Kanagawa N, Yanagawa T, Nakagawa T, Okada N, Nakagawa S

Abstract
Angiogenesis is required for normal physiologic processes, but it is also involved in tumor growth, progression and metastasis. Here, we report the development of an immune-based antiangiogenic strategy based on the generation of T lymphocytes that possess killing specificity for cells expressing vascular endothelial growth factor receptor 2 (VEGFR2). To target VEGFR2-expressing cells, we engineered cytotoxic T lymphocyte (CTL) expressing chimeric T-cell receptors (cTCR-CTL) comprised of a single-chain variable fragment (scFv) against VEGFR2 linked to an intracellular signaling sequence derived from the CD3ζ chain of the TCR and CD28 by retroviral gene transduction methods. The cTCR-CTL exhibited efficient killing specificity against VEGFR2 and a tumor-targeting function in vitro and in vivo. Reflecting such abilities, we confirmed that the cTCR-CTL strongly inhibited the growth of a variety of syngeneic tumors after adoptive transfer into tumor-bearing mice without consequent damage to normal tissue. In addition, CTL expressing both cTCR and tumor-specific TCR induced complete tumor regression due to enhanced tumor infiltration by the CTL and long-term antigen-specific function. These findings provide evidence that the tumor vessel-injuring ability improved the antitumor effect of CTLs in adoptive immunotherapy for a broad range of cancers by inducing immune-mediated destruction of the tumor neovasculature.

PMID: 23175243 [PubMed - in process]

Mold attacks a beating heart.

Wed, 05/29/2013 - 10:39
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Mold attacks a beating heart.

Respiration. 2013;85(1):64-5

Authors: Weig T, Irlbeck M, Neurohr C, Winter H, Schramm R, Knösel T, Horst D

PMID: 23154342 [PubMed - in process]

Repopulation of ganciclovir-resistant cytomegalovirus by wild-type virus.

Wed, 05/29/2013 - 10:39
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Repopulation of ganciclovir-resistant cytomegalovirus by wild-type virus.

Clin Transplant. 2012 Nov;26(6):949-52

Authors: Drew WL, Liu C

Abstract
We report a patient in whom ganciclovir (GCV)-resistant cytomegalovirus (CMV) was replaced by wild-type virus after discontinuation of GCV/valganciclovir and review other similar cases. Repopulation by wild-type virus may occur soon after discontinuation and may be fostered by discontinuing GCV altogether rather than continuing it in combination with foscarnet when treating patients with GCV-resistant CMV disease.

PMID: 22774759 [PubMed - in process]

Improvement of defective cystic fibrosis airway epithelial wound repair after CFTR rescue.

Wed, 05/29/2013 - 10:39
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Improvement of defective cystic fibrosis airway epithelial wound repair after CFTR rescue.

Eur Respir J. 2012 Dec;40(6):1390-400

Authors: Trinh NT, Bardou O, Privé A, Maillé E, Adam D, Lingée S, Ferraro P, Desrosiers MY, Coraux C, Brochiero E

Abstract
Airway damage and remodelling are important components of lung pathology progression in cystic fibrosis (CF). Although repair mechanisms are engaged to restore the epithelial integrity, these processes are obviously insufficient to maintain lung function in CF airways. Our aims were therefore to study how the basic cystic fibrosis transmembrane conductance regulator (CFTR) defect could impact epithelial wound healing and to determine if CFTR correction could improve it. Wound-healing experiments, as well as cell migration and proliferation assays, were performed to study the early phases of epithelial repair in human CF and non-CF airway cells. CFTR function was evaluated using CFTR small interferring (si)RNA and inhibitor GlyH101 in non-CF cells, and conversely after CFTR rescue with the CFTR corrector VRT-325 in CF cells. Wound-healing experiments first showed that airway cells from CF patients repaired slower than non-CF cells. CFTR inhibition or silencing in non-CF primary airway cells significantly inhibited wound closure. GlyH101 also decreased cell migration and proliferation. Interestingly, wild-type CFTR transduction in CF airway cell lines or CFTR correction with VRT-325 in CFBE-ΔF508 and primary CF bronchial monolayers significantly improved wound healing. Altogether our results demonstrated that functional CFTR plays a critical role in wound repair, and CFTR correction may represent a novel strategy to promote the airway repair processes in CF.

PMID: 22496330 [PubMed - in process]

The impact of arteriovenous fistula creation in pulmonary hypertension: measurement of pulmonary pressures by right heart catheterization in a patient with respiratory failure following arteriovenous fistula creation.

Wed, 05/29/2013 - 10:39
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The impact of arteriovenous fistula creation in pulmonary hypertension: measurement of pulmonary pressures by right heart catheterization in a patient with respiratory failure following arteriovenous fistula creation.

Hemodial Int. 2012 Oct;16(4):553-5

Authors: Poulikakos D, Theti D, Pau V, Banerjee D, Jones D

Abstract
Pulmonary hypertension (PHT) is frequent in patients receiving hemodialysis (HD) and carries a high mortality. While it has been suggested that arteriovenous fistulae (AVF) may exacerbate PHT in HD patients, it has also been observed that creating AVF in patients with chronic lung disease and normal renal function may lead to improved exercise tolerance. Most of the observations regarding HD patients using echocardiography demonstrated that temporary closure of AVF improved pulmonary pressures. We present the case of a 45-year-old patient with chronic obstructive pulmonary disease on HD who experienced respiratory failure following AVF formation and underwent right heart catheterization. Severe PHT was diagnosed but transient occlusion of the fistula failed to improve the PHT. This case supports the theory that fistula creation does not exacerbate pre-existing PHT and that AVF can be the access of choice in patients with known chronic lung disease and pulmonary hypertension.

PMID: 22360582 [PubMed - in process]

Lung transplantation.

Tue, 05/28/2013 - 16:17

Lung transplantation.

F1000Prime Rep. 2013;5:16

Authors: Meyer KC

Abstract
Lung transplantation may be the only intervention that can prolong survival and improve quality of life for those individuals with advanced lung disease who are acceptable candidates for the procedure. However, these candidates may be extremely ill and require ventilator and/or circulatory support as a bridge to transplantation, and lung transplantation recipients are at risk of numerous post-transplant complications that include surgical complications, primary graft dysfunction, acute rejection, opportunistic infection, and chronic lung allograft dysfunction (CLAD), which may be caused by chronic rejection. Many advances in pre- and post-transplant management have led to improved outcomes over the past decade. These include the creation of sound guidelines for candidate selection, improved surgical techniques, advances in donor lung preservation, an improving ability to suppress and treat allograft rejection, the development of prophylaxis protocols to decrease the incidence of opportunistic infection, more effective therapies for treating infectious complications, and the development of novel therapies to treat and manage CLAD. A major obstacle to prolonged survival beyond the early post-operative time period is the development of bronchiolitis obliterans syndrome (BOS), which is the most common form of CLAD. This manuscript discusses recent and evolving advances in the field of lung transplantation.

PMID: 23710330 [PubMed - as supplied by publisher]

[Lung transplantation program for Hungarian patients.]

Tue, 05/28/2013 - 16:17

[Lung transplantation program for Hungarian patients.]

Orv Hetil. 2013 Jun 1;154(22):868-871

Authors: Lang G, Czebe K, Gieszer B, Rényi-Vámos F

Abstract
When conservative treatment fails, lung transplantation often remains the only therapeutic option for patients with end stage parenchymal or vascular lung diseases. According to the statistics of the International Society for Heart and Lung Transplantation, in 2010 more than 3500 lung transplantations have been performed worldwide. The Department of Thoracic Surgery at the University of Vienna is considered to be one of the world's leading lung transplantation centres; in the last year 115, since 1989 more than 1500 lung transplantation procedures under the supervision of Prof. Dr. Walter Klepetko. Similar to other Central-European countries, lung transplantation procedures of Hungarian patients have also been performed in Vienna whithin the framework of a twinning aggreement. However, many crucial tasks in the process, such indication and patient selection preoperative rehabilitation organ procurement and long term follow-up care have been stepwise taken over by the Hungarian team. Although the surgery itself is still preformed in Vienna, professional experience is already available in Hungary, since the majority of Hungarian recipients have been transplanted by hungarian surgeons who are authors of this article the professional and personal requirements of performing lung transplantations are already available in Hungary. The demand of performing lung transplantation in Hungary has been raising since 1999 and it soon reaches the extent which justifies launching of an individual national program. Providing the technical requirements is a financial an organisational issue. In order to proceed, a health policy decision has to be made. Orv. Hetil., 2013, 154, 868-871.

PMID: 23708988 [PubMed - as supplied by publisher]

[Milestone in Hungarian organ transplantation: joining Eurotransplant.]

Tue, 05/28/2013 - 16:17

[Milestone in Hungarian organ transplantation: joining Eurotransplant.]

Orv Hetil. 2013 Jun 1;154(22):844-845

Authors: Langer R

Abstract
Hungarian organ transplantation reached a new milestone after half-a-century history, when becoming a full member of the 135-million Eurotransplant community this year. The transplantation of the five organs: kidney, liver, pancreas, heart and lung became a routine procedure. A handful of specialists performed nearly 7000 transplantations and doing so supported the evolution of a special branch of the Hungarian health care system. The author reports the latest results of the preliminary membership year, looking forward with great optimism by seeing new horizons with the advantages of the full membership. Orv. Hetil., 2013, 154, 844-845.

PMID: 23708983 [PubMed - as supplied by publisher]

Prognostic significance of 2-dimensional, M-mode, and Doppler echo indices of right ventricular function in children with pulmonary arterial hypertension.

Tue, 05/28/2013 - 16:17

Prognostic significance of 2-dimensional, M-mode, and Doppler echo indices of right ventricular function in children with pulmonary arterial hypertension.

Am Heart J. 2013 Jun;165(6):1024-1031

Authors: Kassem E, Humpl T, Friedberg MK

Abstract
BACKGROUND: Echocardiographic measures of right ventricular (RV) function are associated with adverse outcomes in adults with idiopathic pulmonary arterial hypertension (iPAH) but have not been adequately studied in children. We investigated the prognostic value of 2D, M-mode and Doppler indices of RV function in relation to death or lung transplant in children with iPAH and PAH associated with congenital heart diseases (cPAH). METHODS: Children with iPAH and cPAH were studied. Two echocardiograms were analyzed for each patient: at diagnosis and at last follow-up. Clinical data, catheter hemodynamics and 6-minute walk distance were recorded. Echo indices of RV function were compared between the first and follow-up echo, between iPAH and cPAH patients, and between iPAH patients alive at follow-up versus those who had died or had undergone lung transplant. Survival probability stratified by RV function was analyzed. RESULTS: Fifty-four children were studied: 36 cPAH patients (7.5 ± 5.9 years) and 18 iPAH patients (8.9 ± 5.7 years) of whom 12 were alive and 6 had died or were transplanted. Despite similar pulmonary hemodynamics, RV function, including right atrial volume, tricuspid annular planar excursion, fractional area of change, and left ventricular eccentricity index were worse in iPAH at presentation and at follow-up. At last echo there was further worsening of RV function in iPAH patients, particularly in those who had died or were transplanted, compared with improved or unchanged indices in cPAH patients or iPAH survivors. CONCLUSION: Conventional echo RV functional parameters are valuable to identify risk for transplant or death in children with PAH.

PMID: 23708176 [PubMed - as supplied by publisher]

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