Ethical dilemma: ELX/TEZ/IVA or Lung Transplantation in Cystic Fibrosis and End Stage Lung Disease?

CHEST Journal ◽  
2021 ◽  
Author(s):  
Oded Breuer ◽  
David Shoseyov ◽  
Shifra Koretz ◽  
Nadia Alyan ◽  
Joel Reiter ◽  
...  
Author(s):  
George Mallory ◽  
Ernestina Melicoff ◽  
Fadel Ruiz ◽  
Kathleen Hosek

Background: The largest age group among children and adolescents referred for lung transplantation for cystic fibrosis (CF) have been those who in the pubertal or post pubertal age range. However, over 100 younger patients with CF have undergone lung transplantation over the last three decades in the USA. Methods: We performed a retrospective review of our experience with 18 children with CF who underwent lung transplantation in our center before the age of 11 years. Results: Notable findings were a high prevalence of methicillin-resistant Staphylococcus aureus, a high prevalence of diabetes mellitus and an impressive prevalence of consolidated lobar or whole lung disease. Post-transplant outcomes, however, were comparable to those older than 10 years of age in our center. Conclusions: In an era of increasingly effective medications modifying the natural history of CF, identification of risk factors for early severe lung disease in CF remains relevant and potentially more important for effective intervention in order to extend life.


2015 ◽  
Vol 84 (2) ◽  
Author(s):  
Marina Praprotnik ◽  
Ana Kotnik Pirš ◽  
Barbara Salobir ◽  
Majda Oštir ◽  
Matjaž Turel ◽  
...  

Cystic fibrosis (CF) is a multi-organ disease,  affecting mostly lungs and gastrointestinal tract. Data from patient registries show that the survival of patients with CF has progressively improved over the past several decades, as a result of advances in antibiotic treatment, supplementation of pancreatic enzymes, better nutrition and a holistic approach to treatment in CF centres.The purpose of this review is to survey recent developments in the treatment of lung disease  in children and adolescents with CF.We describe newborn screening for CF.When chronic respiratory insufficiency occurs, lung transplantation becomes a very important issue.Lung disease is the most common cause of morbidity and mortality in CF patients. Emerging new therapies are targeted at all points in the pathogenesis of lung disease, from drugs that treat infection and inflammation in the airways to gene transfer studies  and to drugs that augment airway surface liquid height. A number of antibacterial agents formulated for inhalation are at various stages of study and there are several anti-inflammatory candidate drugs in  clinical trials.  The most important development  in the recent years is  modulation of the abnormal protein that causes CF, the cystic fibrosis transmembrane regulator (CFTR), where drugs are targeted at specific defects in the transcription, processing or functioning.When chronic respiratory insufficiency occurs, lung transplantation becomes a very important issue. The role of the CF nurse, who has responsibilities in educating and teaching clinical skills to patients and families, is described.


Respiration ◽  
2017 ◽  
Vol 95 (3) ◽  
pp. 161-168 ◽  
Author(s):  
Nikolaus Kneidinger ◽  
Rainer Gloeckl ◽  
Ursula Schönheit-Kenn ◽  
Katrin Milger ◽  
Wolfgang Hitzl ◽  
...  

2018 ◽  
Vol 39 (02) ◽  
pp. 117-125 ◽  
Author(s):  
Christian Merlo ◽  
Jonathan Orens

AbstractLung transplantation is a widely accepted treatment to manage the advanced stages of many lung diseases that have failed to respond to all other therapeutic interventions. There have been ever-expanding indications for lung transplantation as a treatment for lung disease. The International Society for Heart and Lung Transplantation (ISHLT) updated guidelines for candidate selection in 2014. This document was published to serve as a guide in selecting appropriate candidates for lung transplantation. Ideal candidates for lung transplantation are those with near-end stage disease, limited life expectancy due to their lung disease, and who experience significant loss in quality of life. At the same time, candidates should be free of significant comorbidities that might negatively impact successful transplantation. Despite well thought out published guidelines for candidate selection, many controversial issues surrounding selection of lung transplant candidates remain. This review will focus on some of the more common controversial issues and explain how most centers approach these issues when choosing candidates for lung transplantation.


2019 ◽  
Vol 30 (6) ◽  
pp. 1255-1263 ◽  
Author(s):  
E. Cairoli ◽  
C. Eller-Vainicher ◽  
L.C. Morlacchi ◽  
P. Tarsia ◽  
V. Rossetti ◽  
...  

1990 ◽  
Vol 4 (6) ◽  
pp. 318-322 ◽  
Author(s):  
L COURAUD ◽  
E BAUDET ◽  
J VELLY ◽  
X ROQUES ◽  
C MARTIGNE ◽  
...  

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