Transplant

2017 ◽  
Author(s):  
Jessica Barrett ◽  
Martin Carby
Keyword(s):  
Surgical Technique ◽  
Lung Transplant ◽  
Organ Transplant ◽  
Major Complication ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Initial Management ◽  
The World ◽  
Respiratory Physician ◽  
Technical Advances

Since the first successful lung transplant in 1981, tens of thousands of operations have been performed across the world. Yet despite significant technical advances, mortality is the highest of any solid organ transplant. Most patients will have a major complication within the first 5 years of the operation. These are best managed in transplant centres. However, a working knowledge of the presentation and initial management is essential for a respiratory physician. Although the rate of complications remains high, more than 80% of patients with surviving transplants report no limitation of activity at 1, 3, and 5 years. Developments in surgical technique have reduced immediate complications, and immunosuppressive regimens continue to improve. However, the incidence of obliterative bronchiolitis remains high and is responsible for the majority of graft failures.

653 LAPAROSCOPIC TOUPET FUNDOPLICATION RARELY INFLUENCES THE DECLINE IN FEV1 SEEN AFTER LUNG TRANSPLANT

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Adam Frankel ◽  
Trina Keller ◽  
Syeda Farah Zahir ◽  
David Gotley
Keyword(s):  
Lung Transplant ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Least Squares Method ◽  
Organ Transplant ◽  
Case Series ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Toupet Fundoplication ◽  
Laparoscopic Toupet Fundoplication

Abstract   Lung allografts have the shortest survival of any solid organ transplant. The leading cause of chronic lung allograft dysfunction (CLAD) is bronchiolitis obliterans syndrome (BOS). The aetiology of BOS remains poorly understood, with infections, immunosuppression and gastro-oesophageal reflux disease (GORD) amongst the proposed co-factors. A recent systematic review of GORD and BOS examined six retrospective case series with relatively small numbers and conflicting results. Our dataset is the largest cohort reported to date. Methods Retrospective review of a prospectively maintained database containing 149 consecutive lung transplant recipients undergoing laparoscopic Toupet fundoplication. A single expert surgeon (>5000 procedures) with published high-quality long-term outcomes in the non-transplant population did the operations. All were referred with symptoms of GORD and/or positive 24-hour ambulatory pH study. FEV1 was measured at three time points before (6, 3 and 1 month) and after (3, 6 and 12 months) surgery. Data were analysed using random intercept generalised linear (mixed) models to examine changes in FEV1 across time, as well as graphical methods (least squares method for FEV1 trendlines and two-tailed t-test). Results Median age was 56 (IQR 44–66) years; 84/149 were male. 132 had bilateral sequential single lung transplantation. The underlying pathologies were representative—emphysema, cystic fibrosis, interstitial lung disease. 8 patients died within 6 months of fundoplication. Using a linear mixed model there was no significant change in FEV1 across time after surgery compared with the last pre-operative measurement (p = 0.48). A significant reduction in FEV1 was seen in those undergoing fundoplication after CLAD was diagnosed (1.47 L, 95% CI 1.21–1.72, p < 0.001). There was no change in trajectory of FEV1 when trendlines for each patient were analysed (p = 0.777). Conclusion As with any solid organ transplant, lung allografts unfortunately suffer failure with time. Laparoscopic Toupet fundoplication performed in a high-volume centre by an experienced surgeon did not appear to alter this. In particular, once CLAD is diagnosed it seems that the decline in function (FEV1) is accelerated and cannot be salvaged by fundoplication. A minority of patients had their declining FEV1 stabilised or improved by surgery, but it is not yet possible to predict response.

scholarly journals 1101. Pulmonary Aspergillosis Complicating Non-Influenza Respiratory Virus Infections Among Solid Organ Transplant Recipients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S581-S581
Author(s):  
Anna Apostolopoulou ◽  
Cornelius J Clancy ◽  
J Alex Viehman ◽  
Minh Hong T Nguyen
Keyword(s):  
Median Time ◽  
Lung Transplant ◽  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Research Support ◽  
Pulmonary Aspergillosis ◽  
Steroid Dose ◽  
Syncytial Virus

Abstract Background Invasive pulmonary aspergillosis (IPA) complicating influenza (flu) has been increasingly recognized. We have shown that IPA occurred in 22% of solid organ transplant (SOT) patients (pts) with flu. Associations between IPA and non-flu respiratory infections (non-flu-RVI) in SOT are unknown. Methods Retrospective review of consecutive pts transplanted from Jan 15, 2010-Dec 19, 2017. Pts who died within 100 days of SOT were excluded. Non-flu-RVI IFI was defined according to revised EORTC/MSG criteria. IFI had to occur within 100 days of non-flu-RVI. Colonization (COL) was defined as recovery of mold from airways in absence of IFI. Results 3,077 pts were included. 256 cases of non-flu-RVI were identified in lung (28%), multi-organ (16%), heart (6%), liver (1.3%) and kidney (1%) SOT pts. Parainfluenza (PIV) was most common (44%), followed by Respiratory Syncytial Virus (RSV, 60%) and Adenovirus (ADV, 15%). Median time to non-flu-RVI infections was 18.1 mos. 24% of pts with non-flu-RVI had lower tract disease. ADV was associated with longer hospital stay (median 14.5 days) than PIV (6.5 days) or RSV (6 days) (p=0.004). 59% of pts with non-flu-RVI required admission, and 64% received augmented steroids. Aspergillus was recovered from respiratory culture in 17% of non-flu-RVI pts. No other fungi were identified. Median time from non-flu-RVI to + culture was 29 days (Figure). 23% of pts with + culture had proven (7) or probable IPA (3), respectively; 77% had COL. 8% (3/37), 5% (6/114) and 7% (1/15) of pts with ADV, PIV, RSV infections developed IPA, respectively. 36% of pts were treated with a mold-active azole after + culture. Multivariate analysis identified lung transplant (p=0.02), PIV infection (p=0.02) and cumulative steroid dose in preceding 7 days (p=0.015) as independent risk factors for Aspergillus culture positivity. Cumulative steroid dose in preceding 7 days was an independent risk factor for IPA (p=0.03). Cumulative incidence of Aspergillus infections within 100 days of non-flu RVI Conclusion IPA and COL occurred in 4% and 13% of non-flu-RVI in SOT recipients. Routine antifungal prophylaxis is not recommended for SOT pts with non-flu-RVI. The value of prophylaxis at time of PIV infection for lung transplant pts with recent steroid augmentation should be studied. Disclosures Cornelius J. Clancy, MD, Astellas (Consultant, Grant/Research Support)Cidara (Consultant, Research Grant or Support)Melinta (Grant/Research Support)Merck (Consultant, Grant/Research Support)Needham Associates (Consultant)Qpex (Consultant)Scynexis (Consultant)Shionogi (Consultant)

scholarly journals 1103. Respiratory Virus Infections In Solid Organ Transplant Recipients: A Single Center Experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S581-S582
Author(s):  
Maria A Mendoza ◽  
Mohammed A Raja ◽  
Gemma Rosello ◽  
Shweta Anjan ◽  
Jacques Simkins ◽  
...  
Keyword(s):  
Intensive Care ◽  
Lung Transplant ◽  
Respiratory Virus ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Virus Infections ◽  
Transplant Patients ◽  
Respiratory Virus Infections

Abstract Background Community acquired respiratory virus infections (RVI) are a major concern in solid organ transplant (SOT) recipients due to severe complications such as lower respiratory tract infection (LRTI), superimposed fungal and bacterial pneumonia, intensive care admission and mortality. Besides influenza and respiratory syncytial virus (RSV), there is paucity of data of RVI in SOT recipients. Table 1: Patients characteristics Table 2: Concomitant infections Methods Retrospective cohort study of a single large transplant center was performed. Data of multiplex qualitative PCR-based respiratory viral panel (RVP) samples collected between January 2017 and December 2019 were included. It is important to mention that our institution generally performs the RSV/influenza rapid detection assay as an initial test; if negative, the multiplex PCR panel is usually done. We did not include results from the RSV/influenza rapid test in this study. Results One hundred transplant patients with a single positive RVP were included (table 1). Transplanted organs include kidney (40%), followed by lung (33%) and liver (9%). Most common presenting symptoms were cough (52%), shortness of breath (28%) and rhinorrhea (26%). Of note fever was seen in only 24%. Most common RVI was Rhinovirus/Enterovirus (RHV/ENT) (59%), followed by non-SARS-CoV-2 Coronavirus (19%) and Parainfluenza (PIV) (14%). None of the patients had neutropenia, however, 52% had lymphocytopenia. Lung transplant patients developed LRTI in 70% of cases compared to non-lung transplant 64% (p=0.412). Multivariate analysis showed patients with PIV 3 were less likely to develop LRTI (p= 0.038). Significant Cytomegalovirus DNAemia (>137 IU/mL) was noted in 9.8% of the recipients. No proven or probable pulmonary fungal infection were noted within 3 months after diagnosis of RVI. Five patients were admitted to the Intensive care unit due to septic shock. Three patients died at 4, 5 and 35 days after diagnosis of RHV/ENT, PIV-3 and RHV/ENT respectively. Conclusion Most of the cases of RVI were due to RHV/ENT. Patients with PIV 3 were less likely to develop LRTI. Lung transplant recipients developed LRTI with similar incidence to non-lung recipients. Our data shows a very low mortality of 3% after RVI in our SOT cohort, which warrants larger studies. Disclosures Michele I. Morris, MD, Viracor Eurofins (Advisor or Review Panel member)

Urban Spread of Flaviviruses: A New Challenge in Solid-organ Transplant Recipients

2019 ◽  
Vol 70 (1) ◽  
pp. 149-151
Author(s):  
Paolo Antonio Grossi
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Yellow Fever ◽  
Kidney Transplant Recipient ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
The World ◽  
Solid Organ Transplant Recipients

Abstract Yellow fever has never previously been reported in transplant recipients. The first reported case of yellow fever in a kidney transplant recipient in Brazil and the re-emergence of arboviruses in many areas of the world dictate the need of studies aimed to answer multiple unanswered questions.

Epidemiology Of Post-Transplant Lymphoproliferative Disorders Following Solid Organ Transplant In a Major Canadian Transplant Centre

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4281-4281
Author(s):  
Anthea C Peters ◽  
Segun M Akinwumi ◽  
Marco Iafolla ◽  
Curtis Mabilangan ◽  
Karen Doucette ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Cumulative Incidence ◽  
Lung Transplant ◽  
Cox Regression ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Cox Regression Analysis ◽  
Post Transplant ◽  
Increased Risk

Abstract Post-transplant lymphoproliferative disorder (PTLD) is a consequence of organ transplantation with a high risk of mortality. We analyzed records of all patients who received a solid organ transplant at the University of Alberta between 1984 and 2011 (n=4525). 133 patients developed PTLD over the follow up period of January 1984 to November 2012, including 61 cases that occurred less than 2 years after transplant ( early), 33 cases between 2 and 7 years after transplant (late), and 39 cases more than 7 years after transplant (very late). We calculated the cumulative incidence rate for PTLD. We also used Cox regression analysis to determine whether variables year of transplant, age at transplant, organ, and EBV serology mismatch influenced the risk of development of any PTLD, early and very late PTLD, and central nervous system (CNS) PTLD (any PTLD and early PTLD shown in Table 1). The cumulative incidence of any PTLD occurrence was 1.4% at 1 year, 2.6% at 5 years, 4.3% at 10 years, 6.6% at 15 years, and 7.9% at 20 years. Univariate analyses showed that year of transplant (1984-92 vs. 1993-2001 vs. 2002-2011) was not predictive of PTLD development (p=0.27, HR 0.88, CI 0.68-1.12). Patients aged 0-5 years at transplant had significantly higher risk of PTLD development (mean freedom from disease (FFD) 18.90 yrs, 95% CI 17.52-20.28) followed by patients over 60 (mean FFD 25.49 yrs, 95% CI 24.97-26.0; p value 0.000, hazard ratio (HR) 0.57, 95% CI 0.49-0.68). Among organs transplanted, multivisceral transplant conferred the highest risk (mean FFD 5.94, 95% CI 4.19-7.69, n=12) followed by lung transplant (mean FFD 15.45 yrs, 95% CI 17.76-19.83), whereas kidney transplant conferred the lowest risk (mean FFD 27.52 yrs, 95% CI 27.15-27.88; p=0.000, HR 0.57, 95% CI 0.49-0.68). Patients with EBV serology recipient to donor mismatch (ie. recipient negative, donor positive) also had a higher risk of PTLD development (mean FFD 22.9 yrs, 95% CI 21.2-24.6 vs. mean FFD 27.2 yrs, 95% CI 26.90-27.54, p=0.000, HR 8.79, 95% CI 5.83-13.24). Variables associated with increased risk of early PTLD development were year of transplant, with the highest risk in patients transplanted between 1984-1991 (mean FFD 27.88 yrs, 95% CI 27.51-28.24) and the lowest risk in those transplanted in 2002-2011 (mean FFD 10.7 yrs, 95% CI 10.69-10.79, p=0.002, HR 0.68, 95% CI 0.49-0.94); age, with the highest risk in patients 0-5 yrs (mean FFD 20.66, 95% CI 19.68-21.63), followed by over 60 yrs (mean FFD 26.17 yrs, 95% CI 25.98-26.36, p=0.000, HR 0.55, 95% CI 0.45-0.68); organ, with the highest risk in lung transplant (mean FFD 16.50 yrs, 95% CI 16.21-16.80), and the lowest risk in kidney transplant (mean FFD 28.40 yrs, 95% CI 28.30-28.96; p=0.000, HR 0.58, 95% CI 0.46-0.74), and EBV serologic mismatch (p=0.000, HR 18.62, 95% CI 10.45-33.20). In contrast, only organ significantly predicted development of late PTLD, with lung conferring the highest risk (mean FFD 16.27 yrs, 95% CI 15.6-16.94; p= 0.002, HR 0.53, 95% CI 0.39-0.73). Risk of development of CNS PTLD (n=10, either primary or secondary) was greater in patients with EBV serology mismatch (p=0.000, HR 19.95, CI 4.98-79.92), but no other variables significantly predicted its development. In conclusion, the risk of PTLD after solid organ transplant is increased even 20 years after transplant, but the risk of early PTLD is declining over time. The risk of PTLD is highest in patients 0-5 years of age at transplant, patients receiving lung transplant, and patients with EBV serologic mismatch.Total n (%)PTLD Cases (n=133) (%)p valueHazard ratio95% CIEARLY PTLD Cases (n=61) (%)p valueHazard ratio95% CIYear of transplant0.270.880.68-1.120.020.680.49-0.941984-92655 (14.5)33 (24.8)14 (23.0)1993-20011558 (34.4)55 (41.3)24 (39.3)2002-20112312 (51.1)45 (33.8)23 (37.7)Age category0.0000.6450.55-0.750.0000.550.45-0.680-5231 (5.1)23 (17.3)13 (21.3)5-18225 (5.0)9 (6.8)7 (11.5)18-603242 (71.6)31 (23.3)34 (55.7)Over 60827 (18.3)16 (12.0)7 (11.5)Organ0.0000.570.49-0.680.0000.580.46-0.74Heart701 (15.5)35 (26.3)17 (26.9)Lung(18 Heart/Lung)512 (11.3)28 (21.0)16 (26.2)Kidney1983 (43.8)41 (30.8)12 (19.7)Liver1219 (26.9)28 (21.0)16 (26.2)Multivisceral (6 small bowel)12 (0.3)1 (0.75)0Pancreas98 (2.2)00EBV Serology Mismatch0.0008.795.83-13.240.00018.6210.45-33.20No3832 (84.7)75 (56.3)23 (37.7)Yes231 (5.1)33 (24.8)23 (37.7)Unknown460 (10.2)25 (18.8)15 (24.6) Disclosures: Peters: Lundbeck Canada: Honoraria; Hoffman LaRoche: Research Funding.

Sign in / Sign up

Export Citation Format

Share Document