scholarly journals Recent advances in lung transplantation

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1684 ◽  
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.

scholarly journals Developments in lung transplantation over the past decade

2020 ◽  
Vol 29 (157) ◽  
pp. 190132 ◽  
Author(s):  
Sophie C. van der Mark ◽  
Rogier A.S. Hoek ◽  
Merel E. Hellemons
Keyword(s):  
Lung Transplantation ◽  
Ex Vivo ◽  
Smoking Status ◽  
Lung Perfusion ◽  
Long Term Outcomes ◽  
Donor Pool ◽  
The Past ◽  
End Stage

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.

Primary Graft Dysfunction

2021 ◽  
Vol 42 (03) ◽  
pp. 368-379
Author(s):  
Jake G. Natalini ◽  
Joshua M. Diamond
Keyword(s):  
Risk Factors ◽  
Lung Transplantation ◽  
Ex Vivo ◽  
Significant Risk ◽  
Subsequent Development ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Donor Pool ◽  
Ex Vivo Lung Perfusion ◽  
Increased Risk

AbstractPrimary graft dysfunction (PGD) is a form of acute lung injury after transplantation characterized by hypoxemia and the development of alveolar infiltrates on chest radiograph that occurs within 72 hours of reperfusion. PGD is among the most common early complications following lung transplantation and significantly contributes to increased short-term morbidity and mortality. In addition, severe PGD has been associated with higher 90-day and 1-year mortality rates compared with absent or less severe PGD and is a significant risk factor for the subsequent development of chronic lung allograft dysfunction. The International Society for Heart and Lung Transplantation released updated consensus guidelines in 2017, defining grade 3 PGD, the most severe form, by the presence of alveolar infiltrates and a ratio of PaO2:FiO2 less than 200. Multiple donor-related, recipient-related, and perioperative risk factors for PGD have been identified, many of which are potentially modifiable. Consistently identified risk factors include donor tobacco and alcohol use; increased recipient body mass index; recipient history of pulmonary hypertension, sarcoidosis, or pulmonary fibrosis; single lung transplantation; and use of cardiopulmonary bypass, among others. Several cellular pathways have been implicated in the pathogenesis of PGD, thus presenting several possible therapeutic targets for preventing and treating PGD. Notably, use of ex vivo lung perfusion (EVLP) has become more widespread and offers a potential platform to safely investigate novel PGD treatments while expanding the lung donor pool. Even in the presence of significantly prolonged ischemic times, EVLP has not been associated with an increased risk for PGD.

scholarly journals Imaging indications and findings in evaluation of lung transplant graft dysfunction and rejection

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Mnahi Bin Saeedan ◽  
Sanjay Mukhopadhyay ◽  
C. Randall Lane ◽  
Rahul D. Renapurkar
Keyword(s):  
Differential Diagnosis ◽  
Lung Transplant ◽  
Imaging Features ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Contrast Imaging ◽  
Post Transplantation ◽  
Post Transplant ◽  
End Stage

AbstractLung transplantation is a treatment option in end-stage lung disease. Complications can develop along a continuum in the immediate or longer post-transplant period, including surgical and technical complications, primary graft dysfunction, rejection, infections, post-transplant lymphoproliferative disorder, and recurrence of the primary disease. These complications have overlapping clinical and imaging features and often co-exist. Time of onset after transplant is helpful in narrowing the differential diagnosis. In the early post transplantation period, imaging findings are non-specific and need to be interpreted in the context of the clinical picture and other investigations. In contrast, imaging plays a key role in diagnosing and monitoring patients with chronic lung allograft dysfunction. The goal of this article is to review primary graft dysfunction, acute rejection, and chronic rejection with emphasis on the role of imaging, pathology findings, and differential diagnosis.

scholarly journals Does continuation of antifibrotics before lung transplantation influence post-transplant outcomes in patients with idiopathic pulmonary fibrosis?

2021 ◽  
Author(s):  
Michael Z L Zhu ◽  
Joanna Yilin Huang ◽  
David Hongwei Liu ◽  
Gregory I Snell
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lung Transplantation ◽  
Anastomotic Dehiscence ◽  
Wound Complications ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Anastomotic Complications ◽  
Post Transplant ◽  
Transplant Outcomes

Summary A best evidence topic was written according to a structured protocol. The question addressed was: ‘Does continuation of antifibrotics before lung transplantation (LTx) influence post-transplant outcomes in patients with idiopathic pulmonary fibrosis (IPF) with regard to mortality, bronchial anastomotic dehiscence, reoperation for bleeding and wound complications, primary graft dysfunction or longer-term survival and allograft rejection?’ A total of 261 articles were found using the reported search strategy, of which 7 represented the best evidence to answer the clinical question. Six out of 7 studies demonstrated equivalent post-transplant survival among IPF patients on antifibrotics before LTx compared with controls. Five out of 6 studies showed no increase in the risk of major bleeding, wound or bronchial anastomotic complications. One bi-institutional study found a higher incidence of early bronchial anastomotic dehiscence, but this difference was not statistically significant after longer term follow-up. In a study that only included IPF patients who underwent single LTx, a lower incidence of grade 3 primary graft dysfunction was reported in the antifibrotic group compared with controls. Overall, to date, only small (N < 40 in the antifibrotic group), non-risk-adjusted, retrospective observational studies have been published. Notwithstanding, the summation of available evidence suggests that, in IPF patients, continuation of antifibrotic therapy before LTx is likely safe, and the rates of perioperative bleeding, wound or bronchial anastomotic complications, as well as 30-day and 1-year survival, are similar to patients not on antifibrotics before LTx.

scholarly journals Lung transplantation for acute exacerbation of interstitial lung disease

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-215681
Author(s):  
Mwelwa Chizinga ◽  
Tiago N Machuca ◽  
Abbas Shahmohammadi ◽  
Divya C Patel ◽  
Ayoub Innabi ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Stable Disease ◽  
Therapeutic Option ◽  
Group Versus ◽  
Hospital Length ◽  
Interstitial Lung Diseases ◽  
Hospital Length Of Stay ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Post Transplant

BackgroundAcute exacerbations of interstitial lung diseases (AE-ILD) have a high mortality rate with no effective medical therapies. Lung transplantation is a potentially life-saving option for patients with AE-ILD, but its role is not well established. The aim of this study is to determine if this therapy during AE-ILD significantly affects post-transplant outcomes in comparison to those transplanted with stable disease.MethodsWe conducted a retrospective study of consecutive patients with AE-ILD admitted to our institution from 2015 to 2018. The comparison group included patients with stable ILD listed for lung transplant during the same period. The primary end-points were in-hospital mortality for patients admitted with AE-ILD and 1-year survival for the transplanted patients.ResultsOf 53 patients admitted for AE-ILD, 28 were treated with medical therapy alone and 25 underwent transplantation. All patients with AE-ILD who underwent transplantation survived to hospital discharge, whereas only 43% of the AE-ILD medically treated did. During the same period, 67 patients with stable ILD underwent transplantation. Survival at 1 year for the transplanted patients was not different for the AE-ILD group versus stable ILD group (96% vs 92.5%). The rates of primary graft dysfunction, post-transplant hospital length-of-stay and acute cellular rejection were similar between the groups.ConclusionPatients with ILD transplanted during AE-ILD had no meaningful difference in overall survival, rate of primary graft dysfunction or acute rejection compared with those transplanted with stable disease. Our results suggest that lung transplantation can be considered as a therapeutic option for selected patients with AE-ILD.

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