Developments in lung transplantation over the past decade

With an improved median survival of 6.2 years, lung transplantation has become an increasingly acceptable treatment option for end-stage lung disease. Besides survival benefit, improvement of quality of life is achieved in the vast majority of patients. Many developments have taken place in the field of lung transplantation over the past decade. Broadened indication criteria and bridging techniques for patients awaiting lung transplantation have led to increased waiting lists and changes in allocation schemes worldwide. Moreover, the use of previously unacceptable donor lungs for lung transplantation has increased, with donations from donors after cardiac death, donors with increasing age and donors with positive smoking status extending the donor pool substantially. Use of ex vivo lung perfusion further increased the number of lungs suitable for lung transplantation. Nonetheless, the use of these previously unacceptable lungs did not have detrimental effects on survival and long-term graft outcomes, and has decreased waiting list mortality. To further improve long-term outcomes, strategies have been proposed to modify chronic lung allograft dysfunction progression and minimise toxic immunosuppressive effects. This review summarises the developments in clinical lung transplantation over the past decade.

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Recent advances in lung transplantation

F1000Research ◽

10.12688/f1000research.15393.1 ◽

2018 ◽

Vol 7 ◽

pp. 1684 ◽

Cited By ~ 13

Author(s):

Keith C Meyer

Keyword(s):

Lung Transplantation ◽

Primary Graft Dysfunction ◽

Graft Dysfunction ◽

Donor Pool ◽

Post Transplant ◽

Antibody Mediated Rejection ◽

The Past ◽

End Stage ◽

Transplant Complications

Lung transplantation can improve quality of life and prolong survival for individuals with end-stage lung disease, and many advances in the realms of both basic science and clinical research aspects of lung transplantation have emerged over the past few decades. However, many challenges must yet be overcome to increase post-transplant survival. These include successfully bridging patients to transplant, expanding the lung donor pool, inducing tolerance, and preventing a myriad of post-transplant complications that include primary graft dysfunction, forms of cellular and antibody-mediated rejection, chronic lung allograft dysfunction, and infections. The goal of this manuscript is to review salient recent and evolving advances in the field of lung transplantation.

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In lung transplantation, are pulmonary grafts from donors deceased from hanging as suitable as grafts from donors deceased from other causes?

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz218 ◽

2019 ◽

Vol 30 (1) ◽

pp. 30-32

Author(s):

João Santos Silva ◽

Anne Olland ◽

Gilbert Massard ◽

Pierre-Emmanuel Falcoz

Keyword(s):

Lung Transplantation ◽

Observational Studies ◽

Ex Vivo ◽

Lung Perfusion ◽

Graft Dysfunction ◽

Post Transplantation ◽

Donor Pool ◽

Ex Vivo Lung Perfusion ◽

Study Type

Abstract A best evidence topic was constructed according to a structured protocol. The question addressed was whether pulmonary grafts from donors deceased from hanging offer the same benefit as grafts from donors deceased from other causes in lung transplantation. Of the 17 papers found, 4 provided the best evidence to answer the question. The authors, date, journal, country of publication, study type, group studied, relevant outcomes and results of these papers are tabulated. One study reported a large cohort of donors and analysed the outcomes by cause of death, reporting no differences in survival. The remaining 3 papers analysed observational studies on the outcomes of lung transplantation using pulmonary grafts from donors deceased from hanging, compared with donors deceased from other causes. No differences in the rates of post-transplantation pulmonary graft dysfunction and long-term overall survival were reported. Although the cohort of donors deceased from hanging is small, we conclude that these donors are an important contribution to the donor pool. Ex vivo lung perfusion may have a role in assessing graft viability in this scenario.

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Children have type 2 diabetes too: an historical perspective

Biochemistry and Cell Biology ◽

10.1139/bcb-2014-0152 ◽

2015 ◽

Vol 93 (5) ◽

pp. 425-429 ◽

Cited By ~ 9

Author(s):

Heather J. Dean ◽

Elizabeth A.C. Sellers

Keyword(s):

Type 2 Diabetes ◽

Case Series ◽

Indigenous Populations ◽

Long Term Outcomes ◽

Global Epidemic ◽

The Past ◽

Treatment And Prevention ◽

End Stage

Prior to 1985, type 2 diabetes was a disease of adults. Simultaneously with the global epidemic of childhood obesity, type 2 diabetes has increased in children. Initially, the presentation of small case series of type 2 diabetes in children was met with skepticism. As the number and size of the case series grew and the first long-term outcomes of end-stage complications in young adults appeared in the literature, the international community took notice with guarded interest. Type 2 diabetes disproportionately affects the children of specific ethnic groups and from disadvantaged socioeconomic environments, especially Indigenous populations. The past decade has seen unprecedented intense global interest in the etiology, treatment, and prevention of type 2 diabetes in children.

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Evaluation of the efficacy of a novel perfusion solution for normothermic ex vivo lung perfusion compared with Steen solution™ (animal experimental study)

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2021-3-82-89 ◽

2021 ◽

Vol 23 (3) ◽

pp. 82-89

Author(s):

S. V. Gautier ◽

O. M. Tsirulnikova ◽

I. V. Pashkov ◽

N. V. Grudinin ◽

D. O. Oleshkevich ◽

...

Keyword(s):

Lung Transplantation ◽

Lung Diseases ◽

Ex Vivo ◽

Infectious Complications ◽

Lung Perfusion ◽

Ex Vivo Lung Perfusion ◽

Perfusion Solution ◽

Number Of Patients ◽

Donor Lung ◽

End Stage

Respiratory diseases, together with infectious complications and hereditary lung diseases, rank third in international mortality statistics. Today, lung transplantation is a recognized method of treating end-stage lung diseases. However, the number of transplant surgeries performed is not much. This is down to the high requirements on the condition of a potential lung donor and directly on the quality of the donor lung. This has significantly limited the number of optimal donors. Rehabilitation of donor lungs to optimal gas exchange indicators can be achieved and objectively assessed in the course of ex vivo lung perfusion (EVLP). The EVLP procedure is widespread in leading transplantation centers in Europe and North America. It allows to significantly expand the pool of donor lungs, thereby serving a greater number of patients in need of lung transplantation. The possibility of EVLP procedure using publicly available perfusion equipment was demonstrated. The optimized protocol fully demonstrated its reliability and efficiency. The developed perfusion solution had no statistically significant differences in comparison with the Steen SolutionTM, which in the future will serve as an alternative for EVLP procedure.

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Long Term Outcomes of Ex Vivo Lung Perfusion: A Single Center 10 Year Experience

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2018.01.360 ◽

2018 ◽

Vol 37 (4) ◽

pp. S148-S149

Author(s):

C. Divithotawela ◽

M. Cypel ◽

S. Azad ◽

L. Singer ◽

M. Binnie ◽

...

Keyword(s):

Ex Vivo ◽

Lung Perfusion ◽

Single Center ◽

Long Term Outcomes ◽

Ex Vivo Lung Perfusion

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Functional outcomes and quality of life after normothermic ex vivo lung perfusion lung transplantation

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2014.09.044 ◽

2015 ◽

Vol 34 (4) ◽

pp. 547-556 ◽

Cited By ~ 59

Author(s):

Jussi M. Tikkanen ◽

Marcelo Cypel ◽

Tiago N. Machuca ◽

Sassan Azad ◽

Matthew Binnie ◽

...

Keyword(s):

Quality Of Life ◽

Lung Transplantation ◽

Functional Outcomes ◽

Ex Vivo ◽

Lung Perfusion ◽

Ex Vivo Lung Perfusion

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Medical Management Considerations for Patients With Lung Transplantation

Journal of Pharmacy Practice ◽

10.1106/7yoj-rukc-p7gv-v1uv ◽

2001 ◽

Vol 14 (4) ◽

pp. 258-276 ◽

Cited By ~ 1

Author(s):

Robert E. Dupuis ◽

David J. Taber ◽

Amy L. Fann ◽

Kevin P. Lumbert

Keyword(s):

Lung Transplantation ◽

Immunosuppressive Agents ◽

Chronic Obstructive ◽

Drug Induced ◽

Obstructive Pulmonary Disease ◽

Drug Regimens ◽

Short And Long Term ◽

End Stage

Lung transplantation has become an accepted modality for the treatment of end-stage lung disease. Adult and pediatric patients with a variety of lung diseases, including cystic fibrosis, chronic obstructive pulmonary disease, and idiopathic pulmonary fibrosis are candidates for lung transplantation. Lung transplantation can extend survival and improve quality of life for these patients. With the introduction of new immunosuppressive agents and enhanced surgical and medical care, both short- and long-term morbidity and mortality in these populations, although not as good as other transplant types, are improving. After lung transplantation, recipients continue to face a number of obstacles including post-operative complications, complex drug regimens, drug-induced toxicities, infection, and rejection. An understanding of the management and monitoring issues after lung transplantation is the focus of this review.

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Ex vivo lung perfusion for donor lung assessment and repair: a review of translational interspecies models

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00295.2020 ◽

2020 ◽

Vol 319 (6) ◽

pp. L932-L940

Author(s):

Aizhou Wang ◽

Aadil Ali ◽

Shaf Keshavjee ◽

Mingyao Liu ◽

Marcelo Cypel

Keyword(s):

Therapeutic Potential ◽

Ex Vivo ◽

Small Animal ◽

Lung Perfusion ◽

Contributing Factors ◽

Donor Pool ◽

Ex Vivo Lung Perfusion ◽

Advantages And Disadvantages ◽

Number Of Patients ◽

End Stage

For patients with end-stage lung disease, lung transplantation is a lifesaving therapy. Currently however, the number of patients who require a transplant exceeds the number of donor lungs available. One of the contributing factors to this is the conservative mindset of physicians who are concerned about transplanting marginal lungs due to the potential risk of primary graft dysfunction. Ex vivo lung perfusion (EVLP) technology has allowed for the expansion of donor pool of organs by enabling assessment and reconditioning of these marginal grafts before transplant. Ongoing efforts to optimize the therapeutic potential of EVLP are underway. Researchers have adopted the use of different large and small animal models to generate translational preclinical data. This includes the use of rejected human lungs, pig lungs, and rat lungs. In this review, we summarize some of the key current literature studies relevant to each of the major EVLP model platforms and identify the advantages and disadvantages of each platform. The review aims to guide investigators in choosing an appropriate species model to suit their specific goals of study, and ultimately aid in translation of therapy to meet the growing needs of the patient population.

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Long-term outcomes in patients with encapsulating peritoneal sclerosis managed with nutritional support

Peritoneal Dialysis International ◽

10.1177/0896860819893565 ◽

2020 ◽

Vol 40 (5) ◽

pp. 487-495

Author(s):

Arunraj Navaratnarajah ◽

Nevine El-Sherbini ◽

Edwina A Brown

Keyword(s):

Quality Of Life ◽

Nutritional Support ◽

Nutritional Assessment ◽

Long Term Outcomes ◽

Term Survival ◽

Radiological Score ◽

Serial Ct ◽

End Stage

Background: Little is known about long-term survivors with encapsulating peritoneal sclerosis (EPS). Published literature focuses on patients managed surgically. We describe our experience of the long-term outcomes in patients with EPS conservatively managed with nutritional support alone. Methods: This is a single-centre retrospective observational study of patients who had survived for ≥5 years since diagnosis. EPS survivors were invited for review of symptoms, nutritional assessment and evaluation of quality of life. Radiological progression was assessed based on serial computed tomography (CT) scores for each patient. Results: A total of 23 patients with a diagnosis of EPS for at least 5 years were identified, with 18 patients alive at the time of the study. Of these 18 patients, 10 patients transferred to haemodialysis (HD) and 8 patients received kidney transplants. Commonest symptoms were nausea (91%) and vomiting (73%). Mean body mass index for patients was within the ideal and healthy range, with only 11% suffering from continued weight loss. In all, 70% EPS survivors on HD received nutritional support compared to 15% of those with transplants; 17% required ongoing parenteral nutrition. Of the 11 patients with serial CT scans at least 4 years apart, 10 had an increase in radiological score for EPS but with no apparent correlation to clinical outcomes. There were no significant differences in the reported quality of life between EPS survivors on HD and those transplanted, with self-rated health status equivalent to that reported for the general end-stage kidney disease (ESKD) population. Conclusion: Long-term survival following EPS managed conservatively with nutritional support is feasible, with the majority no longer requiring nutritional support and having a quality of life similar to other patients with ESKD.

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