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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 -
European Respiratory Review : An... Dec 2020Exercise intolerance and impaired quality of life (QoL) are characteristic of lung transplant candidates and recipients. This review investigated the effects of exercise... (Review)
Review
Exercise intolerance and impaired quality of life (QoL) are characteristic of lung transplant candidates and recipients. This review investigated the effects of exercise training on exercise capacity, QoL and clinical outcomes in pre- and post-operative lung transplant patients.A systematic literature search of PubMed, Nursing and Allied Health, Cochrane (CENTRAL), Scopus and CINAHL databases was conducted from inception until February, 2020. The inclusion criteria were assessment of the impact of exercise training before or after lung transplantation on exercise capacity, QoL or clinical outcomes.21 studies met the inclusion criteria, comprising 1488 lung transplant candidates and 1108 recipients. Studies consisted of five RCTs, two quasi-experimental and 14 single-arm cohort or pilot studies. Exercise training improved or at least maintained exercise capacity and QoL before and after lung transplantation. The impact on clinical outcomes was less clear but suggested a survival benefit. The quality of evidence ranged from fair to excellent.Exercise training appears to be beneficial for patients before and after lung transplantation; however, the evidence for direct causation is limited by the lack of controlled trials. Well-designed RCTs are needed, as well as further research into the effect of exercise training on important post-transplant clinical outcomes, such as time to discharge, rejection, infection, survival and re-hospitalisation.
Topics: Exercise; Exercise Therapy; Exercise Tolerance; Humans; Lung Transplantation; Quality of Life
PubMed: 33115788
DOI: 10.1183/16000617.0053-2020 -
Respiratory Research Jan 2019Systemic sclerosis (SSc) is a rare connective tissue disease with a heterogeneous clinical course. Interstitial lung disease (ILD) is a common manifestation of SSc and a... (Review)
Review
BACKGROUND
Systemic sclerosis (SSc) is a rare connective tissue disease with a heterogeneous clinical course. Interstitial lung disease (ILD) is a common manifestation of SSc and a leading cause of death.
MAIN BODY
All patients newly diagnosed with SSc should receive a comprehensive clinical evaluation, including assessment of respiratory symptoms, a high-resolution computed tomography (HRCT) scan of the chest, and pulmonary function tests. ILD can develop in any patient with SSc, including those with pulmonary hypertension, but the risk is increased in those with diffuse (rather than limited) cutaneous SSc, those with anti-Scl-70/anti-topoisomerase I antibody, and in the absence of anti-centromere antibody. While it can occur at any time, the risk of developing ILD is greatest early in the course of SSc, so patients should be monitored closely in the first few years after diagnosis. An increased extent of lung fibrosis on HRCT and a low forced vital capacity (FVC) are predictors of early mortality. While not all patients will require treatment, current approaches to the treatment of progressive SSc-ILD focus on immunosuppressant therapies, including cyclophosphamide and mycophenolate mofetil. In patients with severe and/or rapidly progressive disease, both haematopoietic stem cell transplantation (HSCT) and lung transplantation have been successfully used. A number of medications, including the two drugs approved for the treatment of idiopathic pulmonary fibrosis (IPF), are under active investigation as potential new therapies for SSc-ILD.
CONCLUSIONS
Physicians managing patients with SSc should maintain a high level of suspicion and regularly monitor for ILD, particularly in the first few years after diagnosis.
Topics: Anti-Inflammatory Agents; Hematopoietic Stem Cell Transplantation; Humans; Lung Diseases, Interstitial; Lung Transplantation; Randomized Controlled Trials as Topic; Scleroderma, Systemic
PubMed: 30658650
DOI: 10.1186/s12931-019-0980-7 -
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 -
Cells Mar 2023Nowadays, lung transplantation is a clinical reality for the treatment of benign end-stage respiratory diseases [...].
Nowadays, lung transplantation is a clinical reality for the treatment of benign end-stage respiratory diseases [...].
Topics: Lung Transplantation; Humans
PubMed: 36980264
DOI: 10.3390/cells12060923 -
Transplant International : Official... Jun 2015This review outlines the new and promising technique of ex vivo lung perfusion and its clinical potential to increase the number of transplantable lungs and to improve... (Review)
Review
This review outlines the new and promising technique of ex vivo lung perfusion and its clinical potential to increase the number of transplantable lungs and to improve the early and late outcome after transplantation. The rationale, the experimental background, the technique and protocols, and available devices for ex vivo lung perfusion are discussed. The current clinical experience worldwide and ongoing clinical trials are reviewed.
Topics: Allografts; Animals; Clinical Trials as Topic; Equipment Design; Extracorporeal Circulation; Humans; Inflammation; Lung; Lung Transplantation; Organ Preservation; Perfusion; Temperature; Time Factors; Tissue Donors; Treatment Outcome
PubMed: 24629039
DOI: 10.1111/tri.12317 -
The Journal of Heart and Lung... Oct 2022
The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-ninth adult lung transplantation report-2022; focus on lung transplant recipients with chronic obstructive pulmonary disease.
Topics: Adult; Heart Transplantation; Heart-Lung Transplantation; Humans; Lung; Lung Transplantation; Organ Transplantation; Pulmonary Disease, Chronic Obstructive; Registries; Transplant Recipients
PubMed: 36050206
DOI: 10.1016/j.healun.2022.08.007 -
Current Opinion in Organ Transplantation Dec 2017This review describes the most recent progress in xeno lung transplantation (XLTx) to date. It describes the potential mechanisms of early xeno lung graft loss, as well... (Review)
Review
PURPOSE OF REVIEW
This review describes the most recent progress in xeno lung transplantation (XLTx) to date. It describes the potential mechanisms of early xeno lung graft loss, as well as the latest therapeutic strategies to overcome them.
RECENT FINDINGS
Using ex-vivo perfusion models of porcine lungs with human blood, the use of genetically modified pig lungs along with novel pharmaceutical approaches has recently been studied. Strategies that have demonstrated improved lung survival include the knockout of known xenoantigens (GalTKO and N-glycolylneuraminic acid-KO), genes that regulate complement activation (hCD46 and hCD55), as well as the inflammation/coagulation cascade (human leukocyte antigen-E, human thrombomodulin, human endothelial protein C receptor, hCD47, hCD39, hCD73 and heme oxygenase-1). Furthermore, pharmacologic interventions including the depletion of pulmonary intravascular macrophages or von Willebrand factor, inhibition of thromboxane synthase and blockade of histamine receptors have also demonstrated protective effects on xeno lung grafts. Using in-vivo pig to nonhuman primate lung transplant models, these approaches have been shown to extend pulmonary xenograft survival to 5 days.
SUMMARY
The development of new multitransgenic GalTKO pigs has demonstrated prolongation of porcine xenograft survival; however, advancement in XLTx has remained frustratingly limited. Further intensive and innovative strategies including genetic manipulation of donors, as well as inflammation/coagulation dysregulation, are required to make XLTx a clinical possibility.
Topics: Animals; Humans; Lung Transplantation; Transplantation, Heterologous
PubMed: 28872471
DOI: 10.1097/MOT.0000000000000465