scholarly journals New methods for monitoring dynamic airway tissue oxygenation and perfusion in experimental and clinical transplantation

2012 ◽  
Vol 303 (10) ◽  
pp. L861-L869 ◽  
Author(s):  
Mohammad A. Khan ◽  
Gundeep Dhillon ◽  
Xinguo Jiang ◽  
Yu-Chun Lin ◽  
Mark R. Nicolls
Keyword(s):  
Lung Transplant ◽  
Tissue Oxygenation ◽  
Vascular System ◽  
Experimental Studies ◽  
Bronchiolitis Obliterans Syndrome ◽  
Autopsy Study ◽  
New Methods ◽  
Transplant Patients ◽  
Clinical Transplantation ◽  
Oxygenation Status

A dual circulation, supplied by bronchial and pulmonary artery-derived vessels, normally perfuses the airways from the trachea to the terminal bronchioles. This vascular system has been highly conserved through mammalian evolution and is disrupted at the time of lung transplantation. In most transplant centers, this circulation is not restored. The Papworth Hospital Autopsy study has revealed that an additional attrition of periairway vessels is associated with the development of chronic rejection, otherwise known as the bronchiolitis obliterans syndrome (BOS). Experimental studies subsequently demonstrated that airway vessels are subject to alloimmune injury and that the loss of a functional microvascular system identifies allografts that cannot be rescued with immunosuppressive therapy. Therefore, surgical and medical strategies, which preserve the functionality of the existent vasculature in lung transplant patients, may conceivably limit the incidence of BOS. Given these unique anatomic and physiological considerations, there is an emerging rationale to better understand the perfusion and oxygenation status of airways in transplanted lungs. This article describes novel methodologies, some newly developed by our group, for assessing airway tissue oxygenation and perfusion in experimental and clinical transplantation.

scholarly journals Twelve-month effects of everolimus on renal and lung function in lung transplantation: differences in chronic lung allograft dysfunction phenotypes

2021 ◽  
Vol 12 ◽  
pp. 204062232199344
Author(s):  
Filippo Patrucco ◽  
Elias Allara ◽  
Massimo Boffini ◽  
Mauro Rinaldi ◽  
Cristina Costa ◽  
...  
Keyword(s):  
Renal Function ◽  
Lung Function ◽  
Lung Transplant ◽  
Bronchiolitis Obliterans Syndrome ◽  
Forced Expiratory Volume ◽  
Chronic Lung Allograft Dysfunction ◽  
Allograft Dysfunction ◽  
Transplant Patients ◽  
Restrictive Allograft Syndrome ◽  
Trend Data

Background: Chronic lung allograft dysfunction (CLAD), a complication affecting the survival of lung transplanted patients, includes two clinical phenotypes: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). Everolimus is used in CLAD because of its antiproliferative mechanism. In lung transplant patients treated with everolimus, the clinical course of renal and lung function has not yet been assessed systematically in CLAD, BOS and RAS patients for more than 6 months. Methods: We retrospectively evaluated the 12-month follow-up of renal and lung function of lung-transplanted patients switched to everolimus and evaluated the reduction in immunosuppressant dosage (ISD) and mortality. Subgroups were based on indication for everolimus treatment: CLAD and non-CLAD patients, BOS and RAS among CLAD patients. Results: We included 26 patients, 17 with CLAD (10 BOS, seven RAS). After 1 year from the everolimus switch, we observed renal function improvement (serum creatinine −17%, estimated glomerular filtration rate +24%) and stable pulmonary function [forced expiratory volume in the first second (FEV1) −0.5%, forced vital capacity (FVC) +0.05%]. RAS patients had progressive functional loss, whereas BOS patients had FEV1 improvement and FVC stability. All-cause mortality was higher in the CLAD versus non-CLAD group (41% versus 11%), without differences between BOS and RAS patients ( p > 0.05). All patients had significant and persistent ISD reduction. Conclusion: Lung transplant patients treated with everolimus had improvements in renal function and reduced ISD. We observed sustained improvements in lung function for CLAD related to BOS subgroup results, whereas RAS confirmed the 1-year worsening functional trend. Data seem to suggest one more piece of the puzzle in CLAD phenotyping.

414 UPPER ESOPHAGEAL SPHINCTER ABNORMALITIES ARE ASSOCIATED WITH BRONCHIOLITIS OBLITERANS SYNDROME IN LUNG TRANSPLANT PATIENTS

2020 ◽  
Vol 158 (6) ◽  
pp. S-80
Author(s):  
Andrew R. Leopold ◽  
Padma Chamarthy ◽  
Aruj Choudhry ◽  
Alexandra G. Selby ◽  
Emily Friedman ◽  
...  
Keyword(s):  
Bronchiolitis Obliterans ◽  
Lung Transplant ◽  
Bronchiolitis Obliterans Syndrome ◽  
Upper Esophageal Sphincter ◽  
Transplant Patients ◽  
Esophageal Sphincter

Effects of Basiliximab Induction on Development of Acute Rejection and Bronchiolitis Obliterans Syndrome (BOS) in Lung Transplant Patients

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 873A
Author(s):  
Rajeev Swarup ◽  
Alan D. Bentensley ◽  
Lisa L. Allenspach ◽  
Hassan W. Nemeh ◽  
Vaidehi Kaza ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Bronchiolitis Obliterans ◽  
Lung Transplant ◽  
Bronchiolitis Obliterans Syndrome ◽  
Transplant Patients

scholarly journals Effect of Maintenance Azithromycin on Established Bronchiolitis Obliterans Syndrome in Lung Transplant Patients

2008 ◽  
Vol 15 (4) ◽  
pp. 199-202 ◽  
Author(s):  
Nancy R Porhownik ◽  
Wael Batobara ◽  
Wayne Kepron ◽  
Helmut W Unruh ◽  
Zoheir Bshouty
Keyword(s):  
Bronchiolitis Obliterans ◽  
Lung Transplant ◽  
Treatment Initiation ◽  
Controlled Trial ◽  
Pulmonary Function Tests ◽  
Bronchiolitis Obliterans Syndrome ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Lung Transplant Recipients ◽  
Mean Time

BACKGROUND: Bronchiolitis obliterans syndrome (BOS), the main cause of late mortality following lung transplantation, is defined as an irreversible decline in forced expiratory volume in 1 s (FEV1).Previous studies using azithromycin for BOS in lung transplant patients have demonstrated a potential reversibility of the decline in FEV1.OBJECTIVES: To examine whether initiating azithromycin reverses decline in FEV1in lung transplant recipients with established BOS of at least three months.METHODS: Pulmonary function tests were performed every three months in seven lung transplant recipients with established BOS of at least three months. FEV1was recorded at six and three months before initiation, at time of initiation, and three, six, nine and 12 months postazithromycin initiation. The primary end point was change in FEV1. During the study, no immunosuppressive medication changes or acute rejection episodes occurred.RESULTS: Mean time from transplant to azithromycin initiation was 64 months (range 17 to 117 months). Mean time from BOS diagnosis to azithromycin initiation was 22 months (range three to 67 months). Rate of FEV1decline from six months before azithromycin initiation, and rates of FEV1increase from initiation to three and 12 months post-treatment initiation, were not statistically significant (P=0.32, P=0.16 and P=0.18, respectively). Following a trend toward improvement in the first three months after treatment initiation, FEV1tended to stabilize.DISCUSSION: Although several studies address the possible benefit of maintenance azithromycin in lung transplant patients with BOS, the role of the drug remains unproven in these patients, and would best be addressed by a large randomized controlled trial.

scholarly journals The Role of Galectins in Chronic Lung Allograft Dysfunction

Lung ◽  
2021 ◽  
Author(s):  
Miriana d’Alessandro ◽  
Laura Bergantini ◽  
Antonella Fossi ◽  
Elda De Vita ◽  
Felice Perillo ◽  
...  
Keyword(s):  
Lung Transplant ◽  
Inverse Correlation ◽  
Bronchiolitis Obliterans Syndrome ◽  
Operating Characteristics ◽  
Blood Concentrations ◽  
Chronic Lung Allograft Dysfunction ◽  
Independent Variables ◽  
Allograft Dysfunction ◽  
Transplant Patients ◽  
Clinical Biomarkers

Abstract Background Galectins are proteins that bind β-galactosides such as N-acetyllactosamine present in N-linked and O-linked glycoproteins and that seem to be implicated in inflammatory and immune responses as well as fibrotic mechanisms. This preliminary study investigated serum galectins as clinical biomarkers in lung transplant patients with chronic lung allograft dysfunction (CLAD), phenotype bronchiolitis obliterans syndrome (BOS). Materials and Methods Nineteen lung transplant patients [median age (IQR), 55 (45–62) years; 53% males] were enrolled in the study. Peripheral blood concentrations of galectins-1, 3 and 9 were determined with commercial ELISA kits. Results Galectin-1 concentrations were higher in BOS than in stable LTX patients (p = 0.0394). In logistic regression analysis, testing BOS group as dependent variable with Gal-1 and 3 as independent variables, area under the receiver operating characteristics (AUROC) curve was 98.9% (NPV 90% and PPV 88.9%, p = 0.0003). With the stable LTX group as dependent variable and Gal-1, 3 and 9 as independent variables, AUROC was 92.6% (NPV 100% and PPV 90%, p = 0.0023). In stable patients were observed an inverse correlation of Gal-3 with DLCO% and KCO%, and between Gal-9 and KCO%. Conclusion Galectins-1, 3 and 9 are possible clinical biomarkers in lung transplant patients with diagnostic and prognostic meaning. These molecules may be directly implicated in the pathological mechanisms of BOS. The hypothesis that they could be new therapeutic targets in BOS patients is intriguing and also worth exploring.

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