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Clinics in Chest Medicine Mar 2023
Topics: Humans; Lung Transplantation; Heart-Lung Transplantation
PubMed: 36774173
DOI: 10.1016/j.ccm.2022.12.001 -
Anesthesiology Clinics Dec 2019Injuries sustained by donor heart and lung allografts during the transplantation process are multiple and cumulative. Optimization of allograft function plays an... (Review)
Review
Injuries sustained by donor heart and lung allografts during the transplantation process are multiple and cumulative. Optimization of allograft function plays an essential role in short- and long-term outcomes after transplantation. Therapeutic targets to prevent or attenuate injury are present in the donor, the preservation process, during transplantation, and in postoperative management of the recipient. The newest and most promising methods of optimizing donor heart and lung allografts are found in alternative preservation strategies, which enable functional assessment of donor organs and provide a modality to initiate therapies for injured allografts or prevent injury during reperfusion in recipients.
Topics: Heart Transplantation; Humans; Lung Transplantation; Organ Preservation; Tissue Donors; Transplantation Tolerance
PubMed: 31677683
DOI: 10.1016/j.anclin.2019.08.010 -
Frontiers in Bioscience (Elite Edition) Jan 2013Lung transplantation is a life saving treatment for end stage pulmonary diseases. The development and refinement of this therapy required the utilization of various... (Review)
Review
Lung transplantation is a life saving treatment for end stage pulmonary diseases. The development and refinement of this therapy required the utilization of various animal models, without which this procedure would not have become a clinical reality. Canine models were critical in the initial breakthroughs in surgical technique and immunosuppressive regimens, which directly led to the first successful human lung transplantation. Orthotopic lung transplant models in the rat provided a platform for more detailed investigation of immune responses to pulmonary grafts. Investigation of chronic rejection of lungs has significantly been advanced through the use of mouse tracheal transplant experiments. And finally, the advent of orthotopic, vascularized lung transplantation in the mouse opened the door to the use of genetic and molecular tools that are necessary for the rigorous mechanistic study of alloimmune and non-alloimmune factors contributing to lung graft failure. Taken together, animal models will continue to be a cornerstone in the advancement of clinical success in lung transplantation.
Topics: Animals; Dogs; Immunosuppression Therapy; Lung Transplantation; Mice; Models, Animal; Rats; Swine; Trachea
PubMed: 23276988
DOI: 10.2741/e614 -
Journal of Cardiothoracic Surgery Jan 2019The inverse relationship between case-volume and surgical mortality has been reported in complex surgical procedures. The aim of this study was to evaluate the effect of...
BACKGROUND
The inverse relationship between case-volume and surgical mortality has been reported in complex surgical procedures. The aim of this study was to evaluate the effect of case-volume on mortality after lung transplantation in Korea.
METHODS
The National Health Insurance Service data was used to analyse all adult lung transplantations in Korea between 2007 and 2016. Institutions were categorized into low-volume (< 5 lung transplantations/year) centers or high-volume (≥ 5 lung transplantations/year) centers. Risk-adjusted in-hospital mortality and long-term survival according to case-volume was evaluated.
RESULTS
A total of 315 adult recipients underwent lung transplantation at 7 centers. The odds ratio for in-hospital mortality in low-volume centers was similar to high-volume centers (OR, 1.496; 95% CI, 0.81-2.76; p = 0.197). Log-rank analysis of Kaplan-Meier curves according to case-volume also did not show a difference in long-term survival between high- and low-volume centers (p = 0.052).
CONCLUSIONS
There was no association between case-volume and in-hospital mortality after lung transplantation in Korea, although there was a tendency towards better long-term survival associated with high-volume centers.
Topics: Adult; Cohort Studies; Female; Hospital Mortality; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Lung Transplantation; Male; Middle Aged; Republic of Korea; Retrospective Studies; Survival Analysis; Young Adult
PubMed: 30674327
DOI: 10.1186/s13019-019-0849-3 -
Immunity, Inflammation and Disease Dec 2021Normally functioning airway cilia is essential for efficient mucociliary clearance to protect the airway from various insults. Impaired clearance may lead to increased...
BACKGROUND
Normally functioning airway cilia is essential for efficient mucociliary clearance to protect the airway from various insults. Impaired clearance may lead to increased risk of infections and progressive lung damage. Significant morbidity in the immediate post lung transplantation period is associated with airway infection, which we hypothesize may be caused by impaired cilia function.
METHODS
Airway cilia beating pattern (CBP) and frequency (CBF) were studied on brushing samples taken from above and below the transplant anastomosis of adult lung transplant recipients (n = 20) during routine bronchoscopies at 6, 12, and 26 weeks posttransplant. Bronchoaveolar Lavage (BAL) samples were also collected at each time points.
RESULTS
At 6 weeks posttransplant (n = 16), CBP from the donated lung showed reduced beating amplitude with the overall CBF 2.28 Hz slower than the patients' native upper airway cilia (median ± SIQR: 5.36 ± 0.93 Hz vs. 7.64 ± 0.92 Hz, p value < .001). At 12 weeks (n = 16), donor lungs CBP showed recovery with the difference in CBF reduced to 0.74 Hz (6.36 ± 1.46 Hz vs. 7.10 ± 0.86 Hz, p value < .05). Impaired cilia function was not associated with positive BAL cultures.
CONCLUSION
Reduced cilia function is evident in the first 12 weeks post lung transplant, with both CBP and CBF returning to levels of function indistinguishable to the patients' upper airway cilia beyond this time.
Topics: Adult; Cilia; Humans; Lung; Lung Transplantation; Mucociliary Clearance; Trachea
PubMed: 34547188
DOI: 10.1002/iid3.527 -
Revista Portuguesa de Pneumologia 2015This is a review article on the main postoperative complications after lung transplantation: airways complications, vascular complications, pleural complications,... (Review)
Review
This is a review article on the main postoperative complications after lung transplantation: airways complications, vascular complications, pleural complications, surgical wound complications, and abdominal complications. Incidence data, severity, and major management regimens are reported. Postoperative complications after lung transplantation result in a significantly increased morbidity and mortality, with early diagnosis and therapy being extremely important.
Topics: Humans; Lung Transplantation; Postoperative Complications
PubMed: 25854134
DOI: 10.1016/j.rppnen.2014.09.007 -
Therapeutic Advances in Respiratory... Aug 2008Lung transplantation is a suitable treatment to improve the quality of life and the prognosis of patients with various end-stage pulmonary diseases. There is a shortage... (Review)
Review
Lung transplantation is a suitable treatment to improve the quality of life and the prognosis of patients with various end-stage pulmonary diseases. There is a shortage of organs and the number of patients on waiting list is exceeding the number of transplants per year approximately two-fold in most countries. Strategies to increase the donor pool are therefore crucial. The long-term prognosis after lung transplantation is not yet as good as for other transplantation procedures and special complications should be taken into account. Aside from infections chronic organ dysfunction is the main cause of death and the most important prognosis limiting factor. Other typical problems are rejection, bronchus complications, and primary transplant dysfunction. However, the results of large centers show promising improvements in recent years.
Topics: Continuity of Patient Care; Humans; Lung Transplantation; Patient Selection; Tissue Donors; Tissue and Organ Procurement; Waiting Lists
PubMed: 19124375
DOI: 10.1177/1753465808093514 -
Transplantation May 2021There is a severe shortage in the availability of donor organs for lung transplantation. Novel strategies are needed to optimize usage of available organs to address the... (Review)
Review
There is a severe shortage in the availability of donor organs for lung transplantation. Novel strategies are needed to optimize usage of available organs to address the growing global needs. Ex vivo lung perfusion has emerged as a powerful tool for the assessment, rehabilitation, and optimization of donor lungs before transplantation. In this review, we discuss the history of ex vivo lung perfusion, current evidence on its use for standard and extended criteria donors, and consider the exciting future opportunities that this technology provides for lung transplantation.
Topics: Animals; Diffusion of Innovation; Donor Selection; Forecasting; Graft Survival; Humans; Lung Transplantation; Organ Preservation; Perfusion; Pneumonectomy; Tissue Donors; Tissue Survival; Tissue and Organ Harvesting; Treatment Outcome
PubMed: 33044428
DOI: 10.1097/TP.0000000000003483 -
The European Respiratory Journal Dec 2003Over the last decade, improvements in surgical techniques, lung preservation, immunosuppression, and management of ischaemia/reperfusion injury and infections have made... (Review)
Review
Over the last decade, improvements in surgical techniques, lung preservation, immunosuppression, and management of ischaemia/reperfusion injury and infections have made intermediate-term survival after lung transplantation an achievable goal. However, chronic allograft dysfunction in the form of bronchiolitis obliterans remains a major hurdle that threatens both the quality of life and long-term survival of the recipients. It affects up to 50-60% of patients who survive 5 yrs after surgery, and it accounts for >30% of all deaths occurring after the third postoperative year. This article discusses the alloimmune-dependent and -independent risk factors for bronchiolitis obliterans, the current understanding of the pathogenesis of bronchiolitis obliterans based on results of animal and human studies, the clinical staging of the complication, strategies that may contribute to the prevention and/or early detection of bronchiolitis obliterans, and suggestions for future research.
Topics: Animals; Autoimmunity; Bronchiolitis Obliterans; Humans; Lung Transplantation; Models, Animal; Risk Factors
PubMed: 14680094
DOI: 10.1183/09031936.03.00039103 -
The Journal of Thoracic and... May 2021
Topics: Humans; Lung Transplantation; Tissue Donors
PubMed: 32532506
DOI: 10.1016/j.jtcvs.2020.04.084