Providing post-lung transplant care during the time of COVID-19

The COVID-19 pandemic is a public health emergency of international concern. Solid organ transplant recipients have been identified as being at high risk of acquiring the virus SARS-CoV-2 and having a more severe COVID-19 disease. This article describes the experience of the National Lung Transplant Centre in Ireland in changing established care pathways for lung transplant recipients during the pandemic. The innovations which were put in place to protect this clinically vulnerable group are discussed. With the advancement of technology and remote monitoring systems available, patient-focused strategies and community-based interventions were implemented. Additional strategies have been implemented so that the new model of care can be safely maintained.

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Lung Transplant Recipient with Pulmonary Alveolar Proteinosis

Case Reports in Transplantation ◽

10.1155/2016/4628354 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Sofya Tokman ◽

M. Frances Hahn ◽

Hesham Abdelrazek ◽

Tanmay S. Panchabhai ◽

Vipul J. Patel ◽

...

Keyword(s):

Transplant Recipient ◽

Lung Transplant ◽

Pulmonary Alveolar Proteinosis ◽

Mammalian Target Of Rapamycin ◽

Organ Transplant ◽

Lung Transplant Recipient ◽

Solid Organ ◽

Transplant Recipients ◽

Solid Organ Transplant Recipients ◽

Alveolar Proteinosis

Pulmonary alveolar proteinosis (PAP) is a progressive lung disease characterized by accumulated surfactant-like lipoproteinaceous material in the alveoli and distal bronchioles. This accumulation is the result of impaired clearance by alveolar macrophages. PAP has been described in 11 solid organ transplant recipients, 9 of whom were treated with mammalian target of rapamycin inhibitors. We report a case of a lung transplant recipient treated with prednisone, mycophenolate mofetil (MMF), and tacrolimus who ultimately developed PAP, which worsened when MMF was replaced with everolimus.

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Cytomegalovirus in Lung Transplant

OBM Transplantation ◽

10.21926/obm.transplant.2102145 ◽

2021 ◽

Vol 05 (02) ◽

pp. 1-1

Author(s):

Justin P. Rosenheck ◽

◽

Mena M B otros ◽

David R Nunley ◽

◽

...

Keyword(s):

Lung Transplantation ◽

Lung Transplant ◽

Therapeutic Option ◽

Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Ongoing Research ◽

Complex Patients ◽

Lung Transplant Recipients ◽

New Generation

Lung transplantation is a therapeutic option for patients with advanced lung diseases. Lung transplant outcomes have improved over time with improvements in the management of these complex patients. Cytomegalovirus is a common opportunistic organism affecting all solid organ transplant recipients. Characteristics unique to lung transplantation can make this virus difficult to manage, with myriad complications including graft failure and death. Ongoing research into and understanding of cytomegalovirus has opened exciting new avenues of management. We discuss the various manifestations of CMV related pathologies in the lung transplant recipient. We discuss current mainstays of risk stratification, diagnosis, and treatment, as well as present new and evolving concepts. Current medications are highly effective at preventing and treating CMV manifestations, but may be poorly tolerated. A new generation of therapies carry the promise of efficacy, with a greater safety profile and improved tolerance of adverse effects. We discuss host-virus immune interactions, specifically how these can be utilized in clinical practice to individualize the cytomegalovirus related care of lung transplant recipients. Finally, we turn our attention to the near horizon as we continue to evolve the care of this unique population.

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Antibody-Mediated Rejection Management Following Lung Transplantation

Annals of Pharmacotherapy ◽

10.1177/10600280211012410 ◽

2021 ◽

pp. 106002802110124

Author(s):

Kristen Neuhaus ◽

Benjamin Hohlfelder ◽

Jessica Bollinger ◽

Marcus Haug ◽

Heather Torbic

Keyword(s):

Lung Transplantation ◽

Lung Transplant ◽

Management Strategies ◽

Organ Transplant ◽

Outcome Analysis ◽

Solid Organ ◽

Transplant Recipients ◽

Antibody Mediated Rejection ◽

Patient Admissions ◽

Lung Transplant Recipients

Background Although antibody-mediated rejection (AMR) is described in other solid organ transplant populations, the literature describing the management following lung transplantation is limited. Objective The purpose of this study is to evaluate the management strategies of AMR in lung transplant recipients. Methods This single-center, retrospective study described the management of AMR in adult lung transplant recipients who received treatment with rabbit antithymocyte globulin, bortezomib, rituximab, intravenous immune globulin (IVIG), and/or plasmapheresis between September 2015 and June 2019. Results A total of 270 medication orders for 55 patient admissions were included in the primary outcome analysis. The most commonly used regimen consisted of IVIG, plasmapheresis, and rituximab (49.1%; n = 27), followed by IVIG and plasmapheresis alone (27.3%, n = 15). A total of 51 patients (93%) received plasmapheresis as part of their AMR treatment, with a median of 4 [3, 5] sessions per encounter; 86% of patients with positive donor-specific antibodies (DSAs) had a reduction in DSAs following AMR treatment. Overall, 23.5% of patients had noted allograft failure or need for retransplantation. A total of 10 patients died during the AMR treatment hospital admission, and an additional 11 patients died within 1 year of the initial encounter. Conclusion and Relevance This represents the largest report describing management strategies of AMR in lung transplant recipients. Although practice varied, the most commonly used regimen consisted of plasmapheresis, IVIG, and rituximab.

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Rhinosinusitis in Solid Organ Transplant Recipients: Analysis of 4562 Transplanted Patients

American Journal of Rhinology and Allergy ◽

10.1177/1945892418808717 ◽

2018 ◽

Vol 33 (1) ◽

pp. 56-61 ◽

Cited By ~ 2

Author(s):

Sharon Tzelnick ◽

Ethan Soudry

Keyword(s):

Survival Rates ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Sinus Surgery ◽

Solid Organ ◽

Transplant Recipients ◽

Organ Transplant Recipients ◽

Transplant Patients ◽

Solid Organ Transplant Recipients ◽

Lung Transplant Recipients

Introduction Survival rates of solid organ transplant recipients are steadily increasing. Chronic immunosuppression is a key to sustain the transplanted organ. Thus, these patients are at a higher risk for fulminant disease and severe complications of rhinosinusitis (RS). Surprisingly, this has been scarcely discussed in the literature. Objective To analyze the characteristics and disease course of RS in solid organ transplant recipients. Materials and Methods Retrospective study. Medical records of all solid organ transplant recipients with a diagnosis RS treated at a national transplant center between the years 2001 and 2016 were reviewed. Results Of 4562 solid organ transplant recipients, a documented diagnosis of RS was identified only in 61 (1.3%) patients. Sixty-four patients presented with posttransplantation RS; of them, 54.5% had chronic RS (CRS) and the remaining 45.5% patients were diagnosed with acute RS. Microbial cultures grew almost exclusively bacterial pathogens. A documented invasive fungal infection was noted in only 2 patients. A total of 24 (40%) patients underwent endoscopic sinus surgery, the majority (22) for CRS. On subgroup analysis, surgical intervention was more frequent in lung transplant recipients ( P = .005). Neither specific disease nor surgical complications were found. Conclusions Interestingly, acute fulminant infection or sinusitis complications in solid organ transplant patients were much lower than expected. CRS in this patient group was less frequent than expected as well. Whether chronic immunosuppression minimizes the likelihood for CRS deserves further investigation. A more surgically oriented approach in CRS patients may be favored early in the management course of medically refractory patients in light of patients excellent outcomes.

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