HLA Donor Specific Antibody and HLA Antigen Bias are Independent Risk Factors for Chronic Lung Allograft Dysfunction

2018 ◽  
Vol 37 (4) ◽  
pp. S443
Author(s):  
T.K. Roberts ◽  
M. Steele ◽  
D. Nunley
Author(s):  
Angela Koutsokera ◽  
Pierre-Joseph Royer ◽  
Andreas Fritz ◽  
Christian Benden ◽  
Adrien Tissot ◽  
...  

2021 ◽  
Vol 42 (03) ◽  
pp. 392-410
Author(s):  
Olawale Amubieya ◽  
Allison Ramsey ◽  
Ariss DerHovanessian ◽  
Gregory A. Fishbein ◽  
Joseph P. Lynch ◽  
...  

AbstractThe primary factor that limits long-term survival after lung transplantation is chronic lung allograft dysfunction (CLAD). CLAD also impairs quality of life and increases the costs of medical care. Our understanding of CLAD continues to evolve. Consensus definitions of CLAD and the major CLAD phenotypes were recently updated and clarified, but it remains to be seen whether the current definitions will lead to advances in management or impact care. Understanding the potential differences in pathogenesis for each CLAD phenotype may lead to novel therapeutic strategies, including precision medicine. Recognition of CLAD risk factors may lead to earlier interventions to mitigate risk, or to avoid risk factors all together, to prevent the development of CLAD. Unfortunately, currently available therapies for CLAD are usually not effective. However, novel therapeutics aimed at both prevention and treatment are currently under investigation. We provide an overview of the updates to CLAD-related terminology, clinical phenotypes and their diagnosis, natural history, pathogenesis, and potential strategies to treat and prevent CLAD.


2021 ◽  
pp. 239719832110162
Author(s):  
Miguel M Leiva-Juárez ◽  
Andreacarola Urso ◽  
Joseph Costa ◽  
Bryan P Stanifer ◽  
Joshua R Sonett ◽  
...  

Introduction: Gastroesophageal reflux and aspiration are risk factors for chronic lung allograft dysfunction in lung transplant recipients. Patients with systemic sclerosis are at an increased risk of aspiration due to esophageal dysmotility and an ineffective lower esophageal sphincter. The aim of this study is to understand the effect of fundoplication on outcomes in systemic sclerosis recipients. Methods: Between 2001 and 2019, 168 systemic sclerosis patients were referred for lung transplantation—51 (30.3%) were listed and 36 (21.4%) were transplanted. Recipients were stratified whether they underwent a fundoplication (n = 10, 27.8%) or not (n = 26, 72.2%). Freedom from chronic lung allograft dysfunction and survival were analyzed using log-rank test. Multivariable analysis for known risk factors was performed using a Cox-proportional hazards model. Results: Median time to fundoplication after transplantation was 16.4 months (interquartile range: 9.6–25.1) and all were laparoscopic (Dor 50%, Nissen 40%, Toupet 10%). There were no differences in acute rejection ⩾ A1 (26.9% vs 30%), or primary graft dysfunction grades 2–3 at 72 h (42.3% vs 40%) between groups. Recipients with fundoplication had an increased freedom from chronic lung allograft dysfunction (p = 0.035) and overall survival (p = 0.01). Fundoplication was associated with a reduced risk of mortality adjusting for other comorbidities (hazard ratio = 0.13; 95% confidence interval = 0.02–0.65; p = 0.014). Double and single lung transplant did not have different post-transplant survival. Conclusion: Fundoplication in systemic sclerosis lung transplant recipients is associated with greater freedom from chronic lung allograft dysfunction and overall survival. Screening for reflux and aspiration followed by early fundoplication may delay graft deterioration in this population.


2005 ◽  
Vol 5 (1) ◽  
pp. 131-138 ◽  
Author(s):  
Alin L. Girnita ◽  
Rene Duquesnoy ◽  
Samuel A. Yousem ◽  
Aldo T. Iacono ◽  
Timothy E. Corcoran ◽  
...  

2004 ◽  
Vol 4 (7) ◽  
pp. 1171-1178 ◽  
Author(s):  
Michael E. Bowdish ◽  
Selim M. Arcasoy ◽  
Jessie S. Wilt ◽  
John V. Conte ◽  
Robert Duane Davis ◽  
...  

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