-
Minerva Chirurgica Feb 2009Lung transplantation (LTx) is an established therapy for end-stage lung disease (ESLD). Survival after LTx is limited by infection and rejection, particularly... (Review)
Review
Lung transplantation (LTx) is an established therapy for end-stage lung disease (ESLD). Survival after LTx is limited by infection and rejection, particularly bronchiolitis obliterans syndrome (BOS). New techniques with the potential to increase donor lung supply and prevent rejection continue to evolve. These developments hold promise for improved outcomes for a greater number of patients.
Topics: Animals; Bronchiolitis Obliterans; Donor Selection; Humans; Lung Diseases; Lung Transplantation; Patient Selection; Risk Factors; Survival Analysis; Syndrome; Tissue and Organ Procurement; Transplantation, Homologous; Treatment Outcome
PubMed: 19202534
DOI: No ID Found -
Seminars in Thoracic and Cardiovascular... Jul 1998Emphysema is the fifth leading cause of death in North America. It is now the most common indication for lung transplantation worldwide. Since 1986, evolution in... (Review)
Review
Emphysema is the fifth leading cause of death in North America. It is now the most common indication for lung transplantation worldwide. Since 1986, evolution in operative techniques and improvements in organ preservation and post-operative immunosuppression have resulted in impressive long-term survival results. Significant problems remain in terms of inadequate organ supply and chronic rejection; many more candidates could be transplanted if not for these two major limitations. However, other options are now available for the surgical management of patients with end-stage emphysema. The decision making surrounding transplantation for emphysema has been radically altered by the advent of lung volume reduction surgery. This review will highlight new data that pertains to recipient and donor selection, choice of transplant procedure, either single or bilateral, and the role of lung volume reduction surgery. At the University of Toronto we generally favour bilateral lung transplantation for superior functional results and possibly enhanced long-term survival. We have been particularly interested in combining lung transplantation with synchronous lung volume reduction surgery and the rationale and results of this procedure are reviewed.
Topics: Female; Humans; Lung Diseases, Obstructive; Lung Transplantation; Male; Patient Selection; Pneumonectomy; Surgicenters; Survival Rate; Tissue Donors; Treatment Outcome
PubMed: 9717908
DOI: 10.1016/s1043-0679(98)70037-1 -
Current Opinion in Organ Transplantation Jun 2016Airway microvessel injury following transplantation has been implicated in the development of chronic rejection. This review focuses on the most recent developments in... (Review)
Review
PURPOSE OF REVIEW
Airway microvessel injury following transplantation has been implicated in the development of chronic rejection. This review focuses on the most recent developments in the field describing preclinical and clinical findings that further implicate the loss of microvascular integrity as an important pathological event in the evolution of irreversible fibrotic remodeling.
RECENT FINDINGS
When lungs are transplanted, the airways appear vulnerable from the perspective of perfusion. Two vascular systems are lost, the bronchial artery and the lymphatic circulations, and the remaining vasculature in the airways expresses donor antigens susceptible to alloimmune-mediated injury via innate and adaptive immune mechanisms. Preclinical studies indicate the importance of hypoxia-inducible factor-1α in mediating microvascular repair and that hypoxia-inducible factor-1α can be upregulated to bolster endogenous repair.
SUMMARY
Airway microvascular injury is a feature of lung transplantation that limits short-term and long-term organ health. Although some problems are attributable to a missing bronchial artery circulation, another significant issue involves alloimmune-mediated injury to transplant airway microvessels. For a variety of reasons, bronchial artery revascularization surgery at the time of transplantation has not been widely adopted, and the current best hope for this era may be new medical approaches that offer protection against immune-mediated vascular injury or that promote microvascular repair.
Topics: Animals; Graft Rejection; Humans; Lung Transplantation; Microvessels
PubMed: 26967995
DOI: 10.1097/MOT.0000000000000307 -
Critical Care Nursing Clinics of North... Mar 1992Although the supply of donor organs remains extremely limited, improved methods of maintaining the lungs of potential donors to allow for transplantation are being...
Although the supply of donor organs remains extremely limited, improved methods of maintaining the lungs of potential donors to allow for transplantation are being developed along with improved techniques for lung preservation. Sufficient progress has been achieved to warrant continued application of lung transplantation for numerous types of end-stage pulmonary disease. As further refinements in lung transplantation techniques and postoperative management occur, there will be a greater need for advancing the knowledge and skills of nurses and other members of the interdisciplinary team. With improved resource management and quality outcomes, it is hoped that lung transplantation will be made available to a greater number of patients. All these continued advancements offer further challenges to improve patient care for lung transplant recipients.
Topics: Humans; Lung Transplantation; Nursing Diagnosis; Patient Discharge; Postoperative Care; Preoperative Care
PubMed: 1567602
DOI: No ID Found -
Swiss Medical Weekly 2011Lung transplantation is an established therapy for end-stage pulmonary disorders in selected patients without significant comorbidities. The particular constraints... (Review)
Review
Lung transplantation is an established therapy for end-stage pulmonary disorders in selected patients without significant comorbidities. The particular constraints associated with organ transplantation from deceased donors involve specific allocation rules in order to optimise the medical efficacy of the procedure. Comparison of different policies adopted by national transplant agencies reveals that an optimal and unique allocation system is an elusive goal, and that practical, geographical and logistic parameters must be taken into account. A solution to attenuate the imbalance between the number of lung transplant candidates and the limited availability of organs is to consider marginal donors. In particular, assessment and restoration of gas exchange capacity ex vivo in explanted lungs is a new and promising approach that some lung transplant programmes have started to apply in clinical practice. Chronic lung allograft dysfunction, and especially bronchiolitis obliterans, remains the major medium- and long-term problem in lung transplantation with a major impact on survival. Although there is to date no cure for established bronchiolitis obliterans, new preventive strategies have the potential to limit the burden of this feared complication. Unfortunately, randomised prospective studies are infrequent in the field of lung transplantation, and data obtained from larger studies involving kidney or liver recipients are not always relevant for this purpose.
Topics: Bronchiolitis Obliterans; Humans; Lung Transplantation; Postoperative Complications; Tissue and Organ Procurement
PubMed: 22065249
DOI: 10.4414/smw.2011.13292 -
Cells Feb 2022Primary graft dysfunction (PGD) is the clinical syndrome of acute lung injury after lung transplantation (LTx). However, PGD is an umbrella term that encompasses the... (Review)
Review
Primary graft dysfunction (PGD) is the clinical syndrome of acute lung injury after lung transplantation (LTx). However, PGD is an umbrella term that encompasses the ongoing pathophysiological and -biological mechanisms occurring in the lung grafts. Therefore, we aim to provide a focused review on the clinical, physiological, radiological, histological and cellular level of PGD. PGD is graded based on hypoxemia and chest X-ray (CXR) infiltrates. High-grade PGD is associated with inferior outcome after LTx. Lung edema is the main characteristic of PGD and alters pulmonary compliance, gas exchange and circulation. A conventional CXR provides a rough estimate of lung edema, while a chest computed tomography (CT) results in a more in-depth analysis. Macroscopically, interstitial and alveolar edema can be distinguished below the visceral lung surface. On the histological level, PGD correlates to a pattern of diffuse alveolar damage (DAD). At the cellular level, ischemia-reperfusion injury (IRI) is the main trigger for the disruption of the endothelial-epithelial alveolar barrier and inflammatory cascade. The multilevel approach integrating all PGD-related aspects results in a better understanding of acute lung failure after LTx, providing novel insights for future therapies.
Topics: Acute Lung Injury; Edema; Humans; Lung; Lung Transplantation; Primary Graft Dysfunction
PubMed: 35203392
DOI: 10.3390/cells11040745 -
Pediatric and Developmental Pathology :... 2008Lung transplantation offers life-saving and life-extending treatment for children and adolescents with congenital and acquired forms of pulmonary and pulmonary vascular... (Review)
Review
Lung transplantation offers life-saving and life-extending treatment for children and adolescents with congenital and acquired forms of pulmonary and pulmonary vascular disease, for whom medical therapy is ineffective or insufficient for sustained response. This review summarizes the pathology related to lung transplantation for the practicing pediatric pathologist and also highlights aspects of lung transplantation unique to the pediatric population. Clinical issues related to availability of organs, candidate eligibility, surgical technique, and postoperative monitoring are discussed. Pathologic evaluation of routine surveillance transbronchial biopsies requires attention to acute cellular rejection, opportunistic infection, and other forms of acute and resolving lung injury. These findings are correlated in some cases with endobronchial biopsies and bronchoalveolar lavage as adjunctive tools in surveillance. Open or thoracoscopic biopsies also have diagnostic utility in cases with acute or chronic graft deterioration of uncertain etiology. Future challenges in pediatric lung transplantation are similar to those in the adult population, with continued efforts focused on prolonging graft survival, prevention of bronchiolitis obliterans syndrome due to chronic cellular rejection, and evaluation of humoral rejection.
Topics: Adolescent; Child; Child, Preschool; Graft Rejection; Humans; Lung Diseases; Lung Transplantation; Pathology, Surgical
PubMed: 18229970
DOI: 10.2350/07-09-0347.1 -
Clinics in Chest Medicine Dec 2017Despite advances in immunosuppression over the past 25 years, acute cellular rejection remains a common complication early after lung transplantation. Although acute... (Review)
Review
Despite advances in immunosuppression over the past 25 years, acute cellular rejection remains a common complication early after lung transplantation. Although acute cellular rejection has often not resulted in clinical signs or symptoms of allograft dysfunction, it has been widely recognized as a strong independent risk factor for the development of chronic rejection, emphasizing its clinical significance. In recent years, the role of humoral immunity in lung rejection has been increasingly appreciated, and antibody-mediated rejection is now recognized as a form of rejection that may result in allograft failure.
Topics: Acute Disease; Graft Rejection; Humans; Lung Transplantation; Risk Factors
PubMed: 29128017
DOI: 10.1016/j.ccm.2017.07.008 -
Clinics in Chest Medicine Dec 2017Lung transplantation (LTx) has evolved to represent the therapy of choice for many patients with end-stage lung diseases. Appropriate candidate selection for LTx is an... (Review)
Review
Lung transplantation (LTx) has evolved to represent the therapy of choice for many patients with end-stage lung diseases. Appropriate candidate selection for LTx is an important determinant of a positive outcome from transplantation. Posttransplantation survival has steadily improved, but long-term survival continues to be a challenge with a median survival of 5.8 years. Similarly, combined heart-lung transplantation and simultaneous liver-lung transplantation has been performed successfully in select patients who are not expected to survive either organ transplant alone. Moreover, LTx has been performed in patients who develop end-stage pulmonary complications following hematopoietic stem cell transplantation.
Topics: Female; Heart-Lung Transplantation; Hematopoietic Stem Cell Transplantation; Humans; Liver Transplantation; Lung Transplantation; Male; Transplantation Conditioning
PubMed: 29128014
DOI: 10.1016/j.ccm.2017.07.004 -
Current Opinion in Anaesthesiology Feb 2011For end-stage lung disease refractory to medical management, lung transplantation remains the definitive treatment. However, this procedure presents unique challenges... (Review)
Review
PURPOSE OF REVIEW
For end-stage lung disease refractory to medical management, lung transplantation remains the definitive treatment. However, this procedure presents unique challenges for the anesthesiologist. This review summarizes the recent literature regarding this procedure and its anesthetic management.
RECENT FINDINGS
Changes in the lung allocation system have had an impact on the characteristics of patients presenting for lung transplantation, resulting in patients who are older, sicker, and possibly presenting for retransplantation. In addition, various donor and recipient characteristics, including BMI, race, sex, and comorbidities such as diabetes and atrial fibrillation, have been shown to influence outcomes. Perioperative management, particularly colloid administration, adequate pain control, and treatment of pulmonary hypertension, may also affect outcomes.
SUMMARY
Careful preoperative assessment of pulmonary and cardiac function and comorbidities are particularly important for this patient population. Lung protective strategies, intra-operative transesophageal echocardiogram, pulmonary artery catheterization, cardiopulmonary bypass, inhaled nitric oxide, and inhaled prostacyclin are all important tools for the anesthesiologist to optimize patient care.
Topics: Anesthesia; Humans; Lung Transplantation; Morbidity; Patient Selection; Preoperative Care; Tissue Donors
PubMed: 21084981
DOI: 10.1097/ACO.0b013e328341881b