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Current Opinion in Organ Transplantation Jun 2020In this article, an overview of the survival after lung transplantation will be given, with a focus on factors affecting outcome and differences in survival determined... (Review)
Review
PURPOSE OF REVIEW
In this article, an overview of the survival after lung transplantation will be given, with a focus on factors affecting outcome and differences in survival determined by underlying disease.
RECENT FINDINGS
Lung transplantation is an established treatment modality for patients with various end-stage lung diseases. The most recent International Society for Heart and Lung Transplantation Registry reports a 1 and 5-year survival of 85 and 59%, respectively, for adult lung transplant recipients transplanted since 2010. Over the past decades, significant improvements in patient outcomes have been achieved related to changes in donor selection, organ preservation, perioperative management and better treatment of postoperative complications. However, long-term graft and patient outcomes still lag behind that of other solid organ transplantations. Chronic lung allograft dysfunction (CLAD) a condition which develops in about 50% of recipients 5 year after lung transplantation, remains the major barrier for long-term survival, although development of solid organ cancer is nowadays also an increasing cause of late mortality.
SUMMARY
Lung transplantation offers a survival benefit in well chosen patients with end-stage lung diseases. However, CLAD, side effects of immunosuppressive therapy and solid organ cancer remain important challenges impairing long-term survival. Advances in prevention and treatment of chronic rejection are critical to further improve outcome.
Topics: Adult; History, 21st Century; Humans; Lung Transplantation; Postoperative Complications
PubMed: 32332197
DOI: 10.1097/MOT.0000000000000753 -
Chest Mar 2019The field of lung transplant has made significant advances over the last several decades. Despite these advances, morbidity and mortality remain high when compared with... (Review)
Review
The field of lung transplant has made significant advances over the last several decades. Despite these advances, morbidity and mortality remain high when compared with other solid organ transplants. As the field moves forward, the speed by which progress can be made will in part be determined by our ability to overcome several stumbling blocks, including donor shortage, proper selection of candidates, primary graft dysfunction, and chronic lung allograft dysfunction. The advances and developments surrounding these factors will have a significant impact on shaping the field within the coming years. In this review, we look at the current climate (ripe for expanding the donor pool), new technology (ex vivo lung perfusion and bioengineered lungs), cutting-edge innovation (novel biomarkers and new ways to treat infected donors), and evidence-based medicine to discuss current trends and predict future developments for what we hope is a bright future for the field of lung transplantation.
Topics: Biomedical Technology; Donor Selection; Forecasting; Graft Rejection; Lung Diseases; Lung Transplantation; Primary Graft Dysfunction
PubMed: 30171860
DOI: 10.1016/j.chest.2018.08.1036 -
Chest Jul 2017Lung transplantation has evolved into a life-saving treatment with improved quality of life for patients with end-stage respiratory failure unresponsive to other... (Review)
Review
Lung transplantation has evolved into a life-saving treatment with improved quality of life for patients with end-stage respiratory failure unresponsive to other medical or surgical interventions. With improving survival rates, the number of lung transplant recipients with preexisting and posttransplant comorbidities that require attention continues to increase. A partnership between transplant and nontransplant care providers is necessary to deliver comprehensive and optimal care for transplant candidates and recipients. The goals of this partnership include timely referral and assistance with transplant evaluation, optimization of comorbidities and preparation for transplantation, management of common posttransplant medical comorbidities, immunization, screening for malignancy, and counseling for a healthy lifestyle to maximize the likelihood of a good outcome. We aim to provide an outline of the main aspects of the care of candidates for and recipients of lung transplants for nontransplant physicians and other care providers.
Topics: Disease Management; Humans; Lung Transplantation; Multiple Chronic Conditions; Postoperative Complications; Quality of Life; Respiratory Insufficiency; Severity of Illness Index
PubMed: 27729262
DOI: 10.1016/j.chest.2016.10.001 -
Current Opinion in Organ Transplantation Oct 2014
Topics: Humans; Lung Transplantation
PubMed: 25160700
DOI: 10.1097/MOT.0000000000000123 -
Pediatric Clinics of North America Aug 2016Despite improvement in median life expectancy and overall health, some children with cystic fibrosis (CF) progress to end-stage lung or liver disease and become... (Review)
Review
Despite improvement in median life expectancy and overall health, some children with cystic fibrosis (CF) progress to end-stage lung or liver disease and become candidates for transplant. Transplants for children with CF hold the promise to extend and improve the quality of life, but barriers to successful long-term outcomes include shortage of suitable donor organs; potential complications from the surgical procedure and immunosuppressants; risk of rejection and infection; and the need for lifelong, strict adherence to a complex medical regimen. This article reviews the indications and complications of lung and liver transplantation in children with CF.
Topics: Child; Cystic Fibrosis; Humans; Liver Transplantation; Lung Transplantation; Postoperative Complications
PubMed: 27469184
DOI: 10.1016/j.pcl.2016.04.010 -
Current Opinion in Organ Transplantation Jun 2019Lung transplantation survival is still limited compared with other solid organ transplant modalities, due to a range of factors that are continuing to be elucidated.... (Review)
Review
PURPOSE OF REVIEW
Lung transplantation survival is still limited compared with other solid organ transplant modalities, due to a range of factors that are continuing to be elucidated. However, new research is emerging which indicates that the microbiome of the lungs, and of other organs, may have important implications for immune response and mediating transplant outcomes. Pathogenic bacterial and viral species are known to have deleterious effects on the allograft, but taking a more global view, and considering the overall composition of the community of microbial species may undercover a greater understanding of the complex interplay involved in allograft dysfunction.
RECENT FINDINGS
The microbiome appears to have an important modulatory role on immune response in both normal development, and after transplantation. A range of microbial species contributes to the resident microscopic community, with the gut and blood microbiomes having a significant impact on the function of the lungs and resistance to infection. Movement of species from within and outside the respiratory tract occurs in the early transplant period, leading to a modified donor microbiome in the recipient. There is evidence to suggest that chronic lung allograft dysfunction may be facilitated by the respiratory microbiome and interactions with immune cells within the allograft.
SUMMARY
Further investigation of the respiratory microbiome, interactions with the microbiome of other organs and impact on immune and allograft function posttransplantation is needed. Promising insights are being gained regarding certain microbial profiles which may be associated with negative outcomes, and the mechanisms through which this occurs. As our understanding expands, the ability to modify the microbiome offers novel treatment strategies for combating allograft dysfunction.
Topics: Humans; Lung Transplantation; Microbiota
PubMed: 31090640
DOI: 10.1097/MOT.0000000000000631 -
Current Opinion in Anaesthesiology Feb 2020Ex-vivo lung perfusion (EVLP) has been developed to expand the donor pool for lung transplantation recipients. The role of EVLP in organ preservation, evaluation and... (Review)
Review
PURPOSE OF REVIEW
Ex-vivo lung perfusion (EVLP) has been developed to expand the donor pool for lung transplantation recipients. The role of EVLP in organ preservation, evaluation and potential reconditioning is reviewed.
RECENT FINDINGS
EVLP has been shown to significantly increase the utilization of donor lungs for transplantation. Evidence suggests that patient outcomes from EVLP lungs are comparable to standard procurement technique. Novel strategies are being developed to treat and recondition injured donor lungs. EVLP may also prove to be a tool for translational research of lung diseases.
SUMMARY
EVLP has been shown to be an effective system to expand donor pool for lung transplantation without detriment to recipients. Future potential ex-vivo developments may further improve patient outcomes as well as increasing availability of donor organs.
Topics: Extracorporeal Circulation; Humans; Lung; Lung Diseases; Lung Transplantation; Organ Preservation; Perfusion; Tissue Donors
PubMed: 31688085
DOI: 10.1097/ACO.0000000000000804 -
American Journal of Transplantation :... Jan 2016Lungs are allocated to adult and adolescent transplant candidates (aged ≥ 12 years) on the basis of age, geography, blood type compatibility, and the lung allocation...
Lungs are allocated to adult and adolescent transplant candidates (aged ≥ 12 years) on the basis of age, geography, blood type compatibility, and the lung allocation score (LAS), which reflects risk of waitlist mortality and probability of posttransplant survival. In 2014, 2458 active candidates aged 12 years or older, the most of any year, were added to the list; 1949 transplants were performed. Overall median waiting time to transplant for candidates listed in 2014 was 3.7 months. Candidates undergoing lung transplant in 2014 were sicker than ever before with median LAS 44.4. Measures of short-term survival continue to improve; however, long-term survival has plateaued since the implementation of the LAS in 2005; at 5 years posttransplant, 42.4% of recipients had died. In 2014, 30 new active child (ages 0-11) candidates were added to the list; 19 transplants were performed. Incidence of patient death was 7.1% at 6 months and 10.8% at 1 year for transplants in 2013, 29.7% at 3 years for transplants in 2009-2010, and 42.7% at 5 years for transplants in 2007-2008. By age, 5-year patient survival was poorest for recipients aged younger than 1 year.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Incidence; Infant; Infant, Newborn; Lung Diseases; Lung Transplantation; Male; Middle Aged; Probability; Tissue and Organ Procurement; Treatment Outcome; United States; Young Adult
PubMed: 26755267
DOI: 10.1111/ajt.13671 -
Einstein (Sao Paulo, Brazil) 2015Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first... (Review)
Review
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.
Topics: Age Factors; Brazil; Cause of Death; Contraindications; Donor Selection; Graft Rejection; Humans; Idiopathic Pulmonary Fibrosis; Lung Transplantation; Perioperative Period; Pulmonary Disease, Chronic Obstructive; Risk Assessment; Survival Analysis; Waiting Lists
PubMed: 26154550
DOI: 10.1590/S1679-45082015RW3156 -
Seminars in Pediatric Surgery Aug 2017Pediatric lung transplantation is a highly specialized clinical endeavor. Since the late 1980's, there have only been slightly more than 2200 implants reported to the... (Review)
Review
Pediatric lung transplantation is a highly specialized clinical endeavor. Since the late 1980's, there have only been slightly more than 2200 implants reported to the International Society for Heart and Lung transplantation registry. This review will discuss the historical aspects of pediatric lung transplantation. It will familiarize the reader with the current indications for transplant and the referral and listing process. The current state of lung assist devices as a bridge to pediatric lung transplantation is discussed in addition to the technical aspects of the transplant procedure. Finally, posttransplant outcomes, including anticipated morbidity and the role of retransplantation, are clarified.
Topics: Child; Extracorporeal Membrane Oxygenation; Humans; Lung Diseases; Lung Transplantation; Referral and Consultation; Reoperation
PubMed: 28964476
DOI: 10.1053/j.sempedsurg.2017.07.005