Humoral Risk Factors Associated to Allograft Dysfunction after Lung Transplantation: The Alert of Non-HLA Auto Antibody and HLA-Donor Specific Antibody (DSA) with Non-DSA HLA Antibody

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.

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Lung Transplantation and Donor-Specific Antigens: Clinical and Serologic Factors Associated with Survival and Allograft Dysfunction

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2841 ◽

2020 ◽

Author(s):

D.M. Guidot ◽

S. Ghosh ◽

N. Madala ◽

J. Varghese ◽

A. Banga ◽

...

Keyword(s):

Lung Transplantation ◽

Factors Associated ◽

Allograft Dysfunction ◽

Specific Antigens

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

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2018.01.1150 ◽

2018 ◽

Vol 37 (4) ◽

pp. S443

Author(s):

T.K. Roberts ◽

M. Steele ◽

D. Nunley

Keyword(s):

Risk Factors ◽

Specific Antibody ◽

Hla Antigen ◽

Chronic Lung Allograft Dysfunction ◽

Allograft Dysfunction ◽

Independent Risk Factors

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A Closer Look at Risk Factors Associated with Airway Complications in Lung Transplantation

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.1002 ◽

2021 ◽

Vol 40 (4) ◽

pp. S356

Author(s):

G. Li ◽

B. Mankidy ◽

Z. Liu ◽

B. Rodrigues ◽

H. Choi ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Lung Transplantation ◽

Factors Associated ◽

Airway Complications

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An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

European Respiratory Journal ◽

10.1183/09031936.00107514 ◽

2014 ◽

Vol 44 (6) ◽

pp. 1479-1503 ◽

Cited By ~ 274

Author(s):

Keith C. Meyer ◽

Ganesh Raghu ◽

Geert M. Verleden ◽

Paul A. Corris ◽

Paul Aurora ◽

...

Keyword(s):

Risk Factors ◽

Lung Transplantation ◽

Bronchiolitis Obliterans ◽

Evidence Synthesis ◽

Bronchiolitis Obliterans Syndrome ◽

Expert Committee ◽

European Respiratory Society ◽

Post Transplant ◽

Allograft Dysfunction ◽

Definition Of

Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS.A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations.The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of post-transplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS.The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention.

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ACUTE KIDNEY INJURY AFTER LUNG TRANSPLANTATION: PERIOPERATIVE RISK FACTORS AND OUTCOME

10.21203/rs.2.10572/v1 ◽

2019 ◽

Author(s):

Enora Atchade ◽

Samira Barour ◽

Alexy Tran-Dinh ◽

Sylvain Jean-Baptiste ◽

Sébastien Tanaka ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Multivariate Analysis ◽

Lung Transplantation ◽

Kidney Injury ◽

Short Term ◽

Factors Associated ◽

Icu Stay ◽

Long Term Mortality

Abstract BACKGROUND Acute kidney injury (AKI) is associated with increased short-term and long-term mortality and morbidity after lung transplantation (LT). The primary objective of this study was to analyze the perioperative factors associated with AKI according to KDIGO criteria during hospitalization in an intensive care unit (ICU) after LT. METHODS This was a single-center observational, prospective study. AKI was defined according to KDIGO criteria. Results are expressed as median, interquartile range, absolute numbers and percentages. Statistical analyses were performed using Chi-square test, Fisher’s exact test and Mann-Witney U test (p<0.05 was considered to be significant). Multivariate analysis was performed to identify independent risk factors. RESULTS Between January 2016 and April 2018, 94 patients (pts) underwent LT (70% bilateral LT). AKI occurred during ICU stay in 46 pts (49%). KDIGO 1 AKI was observed in 16 pts (17%), KDIGO 2 in 14 pts (15%), and KDIGO 3 in 16 pts (17%) including 12 pts (75%) who required renal replacement therapy (RRT). AKI occurred before the fifth day after surgery for 38 patients (82% of the AKI patients). On multivariate analysis, independent factors associated with AKI were bilateral LT and mechanical ventilation (MV) > 3 days (OR 4.26 95%CI [1.49; 13.63] p=0.010 and OR 5.56 [1.25; 11.47] p=0.018, respectively). AKI and the need for RRT were significantly associated with ICU mortality, 28-day mortality and one-year mortality. CONCLUSION AKI is common during ICU stay after LT, especially after bilateral LT and is associated with prolonged MV, and increased short-term and long-term mortality.

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