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F1000Research 2018Lung transplantation can improve quality of life and prolong survival for individuals with end-stage lung disease, and many advances in the realms of both basic science... (Review)
Review
Lung transplantation can improve quality of life and prolong survival for individuals with end-stage lung disease, and many advances in the realms of both basic science and clinical research aspects of lung transplantation have emerged over the past few decades. However, many challenges must yet be overcome to increase post-transplant survival. These include successfully bridging patients to transplant, expanding the lung donor pool, inducing tolerance, and preventing a myriad of post-transplant complications that include primary graft dysfunction, forms of cellular and antibody-mediated rejection, chronic lung allograft dysfunction, and infections. The goal of this manuscript is to review salient recent and evolving advances in the field of lung transplantation.
Topics: Animals; Graft Rejection; Humans; Immune Tolerance; Infection Control; Lung Transplantation; Quality Improvement; Quality of Life
PubMed: 30416706
DOI: 10.12688/f1000research.15393.1 -
International Journal of Chronic... 2015Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity. Lung transplantation is one of the few treatments available for end-stage... (Review)
Review
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity. Lung transplantation is one of the few treatments available for end-stage COPD with the potential to improve survival and quality of life. The selection of candidates and timing of listing present challenges, as COPD tends to progress fairly slowly, and survival after lung transplantation remains limited. Though the natural course of COPD is difficult to predict, the use of assessments of functional status and multivariable indices such as the BODE index can help identify which patients with COPD are at increased risk for mortality, and hence which are more likely to benefit from lung transplantation. Patients with COPD can undergo either single or bilateral lung transplantation. Although many studies suggest better long-term survival with bilateral lung transplant, especially in younger patients, this continues to be debated, and definitive recommendations about this cannot be made. Patients may be more susceptible to particular complications of transplant for COPD, including native lung hyperinflation, and development of lung cancer.
Topics: Humans; Lung Transplantation; Outcome Assessment, Health Care; Patient Selection; Prognosis; Pulmonary Disease, Chronic Obstructive; Quality of Life; Severity of Illness Index
PubMed: 26491282
DOI: 10.2147/COPD.S78677 -
Clinics in Chest Medicine Jun 2011Lung retransplantation comprises a small proportion of lung transplants performed throughout the world, but has become more frequent in recent years. The selection...
Lung retransplantation comprises a small proportion of lung transplants performed throughout the world, but has become more frequent in recent years. The selection criteria for lung retransplantation are similar to those for initial lung transplant. Survival after lung retransplantation has improved over time, but still lags behind that of initial lung transplantation. These differences in outcome may be attributable to medical comorbidities. Lung retransplantation appears to be ethically justified; however, the optimal approach to lung allocation for retransplantation needs to be defined.
Topics: Humans; Lung Transplantation; Patient Selection; Reoperation; Treatment Outcome
PubMed: 21511096
DOI: 10.1016/j.ccm.2011.02.013 -
Medicina (Kaunas, Lithuania) Oct 2019Despite the availability of antifibrotic therapies, many patients with idiopathic pulmonary fibrosis (IPF) will progress to advanced disease and require lung... (Review)
Review
Despite the availability of antifibrotic therapies, many patients with idiopathic pulmonary fibrosis (IPF) will progress to advanced disease and require lung transplantation. International guidelines for transplant referral and listing of patients with interstitial lung disease are not specific to those with IPF and were published before the widespread use of antifibrotic therapy. In this review, we discussed difficulties in decision-making when dealing with patients with IPF due to the wide variability in clinical course and life expectancy, as well as the acute deterioration associated with exacerbations. Indeed, the ideal timing for referral and listing for lung transplant remains challenging, and the acute deterioration might be influenced after transplant outcomes. Of note, patients with IPF are frequently affected by multimorbidity, thus a screening program for occurring conditions, such as coronary artery disease and pulmonary hypertension, before lung transplant listing is crucial to candidate selection, risk stratification, and optimal outcomes. Among several comorbidities, it is of extreme importance to highlight that the prevalence of lung cancer is increased amongst patients affected by IPF; therefore, candidates' surveillance is critical to avoid organ allocation to unsuitable patients. For all these reasons, early referral and close longitudinal follow-up for potential lung transplant candidates are widely encouraged.
Topics: Comorbidity; Humans; Idiopathic Pulmonary Fibrosis; Lung Transplantation; Referral and Consultation; Survival Analysis; Time Factors
PubMed: 31635104
DOI: 10.3390/medicina55100702 -
Digestive Diseases and Sciences Jun 2022
Topics: Gastric Emptying; Gastroparesis; Humans; Lung Transplantation
PubMed: 34524596
DOI: 10.1007/s10620-021-07251-4 -
Clinical Medicine (London, England) Oct 2007The last 30 years have seen lung transplantation grow from a procedure associated with absolute failure to one which now offers excellent outcomes for patients with...
The last 30 years have seen lung transplantation grow from a procedure associated with absolute failure to one which now offers excellent outcomes for patients with advanced lung disease. It has brought much needed hope and is truly a remarkable story of medical advancement in the field of respiratory medicine.
Topics: Humans; Immunosuppressive Agents; Lung Transplantation; Risk Factors; Treatment Outcome
PubMed: 17990709
DOI: 10.7861/clinmedicine.7-5-448 -
Respiratory Care Jun 2017Pediatric lung transplant is a viable option for treatment of end-stage lung disease in children, with > 100 pediatric lung transplants reported to the Registry of the...
Pediatric lung transplant is a viable option for treatment of end-stage lung disease in children, with > 100 pediatric lung transplants reported to the Registry of the International Society of Heart and Lung Transplantation each year. Long-term success is limited by availability of donor organs, debilitation as a result of chronic disease, impaired mucus clearance resulting from both surgical and pharmacologic interventions, increased risk for infection resulting from immunosuppression, and most importantly late complications, such as chronic lung allograft dysfunction. Opportunities for investigation and innovation remain in all of these domains: (1) Ex vivo lung perfusion is a promising technology with the potential for increasing the lung donor pool, (2) evolving extracorporeal support strategies coupled with effective rehabilitation will effectively bridge critically ill patients to transplant, and most importantly, (3) research efforts intended to increase our understanding of the underlying mechanisms of chronic lung allograft dysfunction will ultimately lead to the development of effective therapies to prevent or treat the variety of chronic lung allograft dysfunction presentations.
Topics: Child; Humans; Lung; Lung Transplantation; Primary Graft Dysfunction; Respiratory Insufficiency
PubMed: 28546378
DOI: 10.4187/respcare.05304 -
Annals of Surgery Jan 1995More than 2700 lung transplants have been performed since the initial clinical success in 1983. The evolution in the techniques of lung transplantation and patient... (Review)
Review
OBJECTIVE
More than 2700 lung transplants have been performed since the initial clinical success in 1983. The evolution in the techniques of lung transplantation and patient management and the effects on results are reviewed.
SUMMARY BACKGROUND DATA
Improvements in donor management, lung preservation, operative techniques, immunosuppression management, infection prophylaxis and treatment, rejection surveillance, and long-term follow-up have occurred in the decade following the first clinically successful lung transplant. A wider spectrum of diseases and patients treated with lung transplant have accentuated the shortage of suitable lung donors. The organ shortage has led to the use of marginal donors and a limited experience using living, related donors.
METHODS
Changes in techniques and patient selection and management are reviewed and controversial issues and problems are highlighted.
RESULTS
One-year survival of greater than 90% for single-lung transplant recipients and greater than 85% for bilateral lung transplant recipients have been achieved. Complications caused by airway complications has been reduced greatly. Obliterative bronchiolitis develops in 20% to 50% of long-term survivors and is the leading cause of morbidity and mortality after the first year after transplant.
CONCLUSIONS
Lung transplantation has evolved into an effective therapy for a wide variety of causes of end-stage lung disease. Wider applicability requires solutions to the problems of donor shortage and development of obliterative bronchiolitis.
Topics: Humans; Immunosuppressive Agents; Lung Transplantation; Postoperative Complications; Tissue Donors
PubMed: 7826157
DOI: 10.1097/00000658-199501000-00003 -
The Annals of Thoracic Surgery Jul 2021Previous studies in the field of organ transplantation have shown a possible association between nighttime surgery and adverse outcomes. We aim to determine the impact...
BACKGROUND
Previous studies in the field of organ transplantation have shown a possible association between nighttime surgery and adverse outcomes. We aim to determine the impact of nighttime lung transplantation on postoperative outcomes, long-term survival, and overall cost.
METHODS
We performed a single-center retrospective cohort analysis of adult lung transplant recipients who underwent transplantation between January 2006 and December 2017. Data were extracted from our institutional Lung Transplant Registry and Mid-America Transplant services database. Patients were classified into 2 strata, daytime (5 AM to 6 PM) and nighttime (6 PM to 5 AM), based on time of incision. Major postoperative adverse events, 5-year overall survival, and 5-year bronchiolitis obliterans syndrome-free survival were examined after propensity score matching. Additionally we compared overall cost of transplantation between nighttime and daytime groups.
RESULTS
Of the 740 patients included in this study, 549 (74.2%) underwent daytime transplantation and 191 (25.8%) underwent nighttime transplantation (NT). Propensity score matching yielded 187 matched pairs. NT was associated with a higher risk of having any major postoperative adverse event (adjusted odds ratio, 1.731; 95% confidence interval, 1.093-2.741; P = .019), decreased 5-year overall survival (adjusted hazard ratio, 1.798; 95% confidence interval, 1.079-2.995; P = .024), and decreased 5-year bronchiolitis obliterans syndrome-free survival (adjusted hazard ratio, 1.556; 95% confidence interval, 1.098-2.205; P = .013) in doubly robust multivariable analyses after propensity score matching. Overall cost for NT and daytime transplantation was similar.
CONCLUSIONS
NT was associated with a higher risk of major postoperative adverse events, decreased 5-year overall survival, and decreased 5-year bronchiolitis obliterans syndrome-free survival. Our findings suggest potential benefits of delaying NT to daytime transplantation.
Topics: Adult; Analysis of Variance; Bronchiolitis Obliterans; Female; Hospital Costs; Humans; Logistic Models; Lung Transplantation; Male; Middle Aged; Postoperative Complications; Propensity Score; Proportional Hazards Models; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 33065051
DOI: 10.1016/j.athoracsur.2020.07.060 -
The Journal of Thoracic and... Mar 2022
Topics: COVID-19; Clinical Decision-Making; Extracorporeal Membrane Oxygenation; Humans; Lung Transplantation; Patient Selection; Practice Guidelines as Topic
PubMed: 34420791
DOI: 10.1016/j.jtcvs.2021.06.061