Development of a Chemiluminescence Assay for Total N-Terminal Propeptide of Type I Collagen and Its Evaluation in Lung Transplantation

Serum P1NP, one of the important biomarkers for bone turnover, is commonly used for the prediction of bone fracture and the prognosis of osteoporosis after therapy. We developed a P1NP chemiluminescence assay and evaluated changes in bone metabolism markers in lung transplant patients. The screened 2 P1NP antibodies with constructed antigens and α-1 chain antigens expressed by the Corynebacterium glutamate expression system were applied into assay development. The assay performance was evaluated to examine the reliability. A normal Q-Q plot was used to establish male reference interval. Changes of bone metabolism markers before and after lung transplantation in 19 patients were evaluated. The linear factor R of P1NP reagent was greater than 0.99. The limit of detection was 3.32 ng/ml. The precision of the three batches of P1NP reagents was lower than 8%. Method comparison with Roche P1NP reagent showed that the correlation coefficient R2 was 0.91. In the monitoring of bone mass in a short time, bone metabolism markers can better indicate the change of bone mass, while the traditional bone mineral density detection is lagging behind the bone metabolism markers. P1NP and β-CrossLap to bone mass change in patients after lung transplantation, and P1NP and β-CrossLap are very good clinical markers for bone mass monitoring.

Clinical Factors Associated With Failed Weaning From Intraoperative Extracorporeal Membrane Oxygenation Used During Lung Transplantation

Background: Extracorporeal membrane oxygenation (ECMO) promotes adequate oxygenation and hemodynamic stability during lung transplantation (LTx). However, some recipients cannot be weaned from ECMO following surgery. Thus, we evaluated the prognosis and risk factors of failed weaning from intraoperative ECMO during LTx.Methods: We retrospectively analyzed data from 274 patients receiving intraoperative ECMO during LTx. Risk factors were evaluated using logistic regression analyses.Results: Weaning failure occurred in 118 patients (43.1%). Intensive care unit stay was longer and mortality was higher in the failed weaning group than in the successful weaning group. The failed weaning group exhibited significantly older donor age, lower donor PaO2/FiO2 ratio, greater intraoperative transfusion volume, and longer operation time than the successful weaning group. Recipient age, body mass index, donor age, lower donor PaO2/FiO2 ratio, donor/recipient total lung capacity (TLC) ratio, greater intraoperative transfusion volume, and longer operation time were associated with weaning failure after adjustment. Conclusion: The failed weaning group showed a poor prognosis. Perioperative factors including donor age, donor PaO2/FiO2 ratio, donor/recipient TLC, operation time, and blood loss can predict postoperative ECMO weaning failure.

Acute worsening of native lung fibrosis after single lung transplantation for pulmonary fibrosis: two case reports

Background In patients receiving single lung transplantation for idiopathic pulmonary fibrosis, worsening of fibrosis of the native lung is usually progressive over time, with no significant effects on gas exchange. Case presentation Here, we describe the cases of two Caucasian male recipients of single lung transplants for idiopathic pulmonary fibrosis, 65 and 62 years of age, who exhibited acute worsening of lung fibrosis after an episode of serious viral infection (cytomegalovirus primo-infection in one case and COVID-19 in the other). In both cases, along with opacification of the native lung over several days, the patients presented acute respiratory failure that required the use of high-flow nasal oxygen therapy. Eventually, hypoxemic respiratory failure resolved, but with rapid progression of fibrosis of the native lung. Conclusion We conclude that acute worsening of fibrosis on the native lung secondary to a severe viral infection should be added to the list of potential complications developing on the native lung after single lung transplantation for idiopathic pulmonary fibrosis.