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Fang YC, Cheng WH, Lu HI, Wang YS, Chuang KH, Lai HH, Chen Y, Chen LC, Tsai MY, Chang YP, Huang KT, Lo CM. Double lung transplantation is better than single lung transplantation for end-stage chronic obstructive pulmonary disease: a meta-analysis. J Cardiothorac Surg 2024; 19:162. [PMID: 38555450 PMCID: PMC10981328 DOI: 10.1186/s13019-024-02654-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Lung transplantation is one of the most common treatment options for patients with end-stage chronic obstructive pulmonary disease. However, the choice between single and double lung transplantation for these patients remains a matter of debate. Therefore, we performed a systematic search of medical databases for studies on single lung transplantation, double lung transplantation, and chronic obstructive pulmonary disease. METHODS The rate ratio and hazard ratio of survival were analyzed. The meta-analysis included 15 case-control and retrospective registry studies. RESULTS The rate ratios of the 3-year survival (0.937 and P = 0.041) and 5-year survival (0.775 and P = 0.000) were lower for single lung transplantation than for double lung transplantation. However, the hazard ratio did not differ significantly between the two. CONCLUSIONS Double lung transplantation was found to provide better benefits than single lung transplantation in terms of the long-term survival in patients with chronic obstructive pulmonary disease.
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Affiliation(s)
- Yu-Chi Fang
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123 Dapi Road, Niaosong Dist., Kaohsiung, Taiwan, ROC
| | - Wen-Hsin Cheng
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123 Dapi Road, Niaosong Dist., Kaohsiung, Taiwan, ROC
| | - Hung-I Lu
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123 Dapi Road, Niaosong Dist., Kaohsiung, Taiwan, ROC
| | - Yi-Shi Wang
- Department of Chest, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kai-Hao Chuang
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123 Dapi Road, Niaosong Dist., Kaohsiung, Taiwan, ROC
| | - Hsing-Hua Lai
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123 Dapi Road, Niaosong Dist., Kaohsiung, Taiwan, ROC
| | - Yu Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123 Dapi Road, Niaosong Dist., Kaohsiung, Taiwan, ROC
| | - Li-Chun Chen
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123 Dapi Road, Niaosong Dist., Kaohsiung, Taiwan, ROC
| | - Meng-Yun Tsai
- Department of Chest, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Ping Chang
- Department of Chest, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kuo-Tung Huang
- Department of Chest, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Ming Lo
- Department of Thoracic & Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123 Dapi Road, Niaosong Dist., Kaohsiung, Taiwan, ROC.
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2
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Kosciuk P, Meyer C, Wikenheiser-Brokamp KA, McCormack FX. Pulmonary alveolar microlithiasis. Eur Respir Rev 2020; 29:29/158/200024. [PMID: 33246992 PMCID: PMC9488654 DOI: 10.1183/16000617.0024-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a fascinating rare lung disease that is associated with the accumulation of hydroxyapatite microliths within the lumen of the alveolar spaces. In most patients, PAM is discovered incidentally on radiographs performed for other purposes, and the typical disease course is characterised by slowly progressive respiratory insufficiency over decades. Recent genetic analyses that have revealed that the deficiency of the sodium-phosphate cotransporter NPT2B is the cause of PAM have enabled the development of powerful animal models that inform our approach to disease management and treatment. Here we review the epidemiology and molecular pathophysiology of PAM, as well as the diagnostic approach, clinical manifestations, radiographic and pathologic features, and clinical management of the disease. Although there are no proven treatments for PAM, progress in our understanding of disease pathogenesis is providing insights that suggest strategies for trials. A review of the epidemiology and molecular pathophysiology of pulmonary alveolar microlithiasishttps://bit.ly/3lBgM7p
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Affiliation(s)
- Patrick Kosciuk
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Cristopher Meyer
- Division of Radiology, University of Wisconsin, Madison, WI, USA
| | - Kathryn A Wikenheiser-Brokamp
- Division of Pathology & Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Dept of Pathology & Laboratory Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Francis X McCormack
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
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3
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Ren XY, Fang XM, Chen JY, Ding H, Wang Y, Lu Q, Ming JL, Zhou LJ, Chen HW. Single-lung transplantation for pulmonary alveolar microlithiasis: A case report. World J Clin Cases 2019; 7:3851-3858. [PMID: 31799314 PMCID: PMC6887609 DOI: 10.12998/wjcc.v7.i22.3851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/24/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pulmonary alveolar microlithiasis (PAM) is a rare idiopathic lung disease characterized by the accumulation of innumerable microliths. Currently, effective therapeutics for PAM are not available, and the only treatment for end-stage lung disease is lung transplantation (LuTx). Further, there are few reports that focus on LuTx for the treatment of PAM, and the follow-up reports of postoperative imaging are even rarer.
CASE SUMMARY A 52-year-old man presented to Shanghai Pulmonary Hospital in 2017 after experiencing shortness of breath and exacerbation. The patient was diagnosed with PAM and referred for single-LuTx (SLuTx) on March 14, 2018. Preoperative imaging results from a chest X-ray demonstrated bilateral, diffuse, symmetrical, sandstorm-like radiopaque micronodules, and pneumothorax and a computed tomography scan revealed minute, calcified military nodules in both lungs. We performed a left SLuTx, and intraoperative pathology was consistent with PAM. One week after surgery, a chest X-ray revealed slight exudation of the left lung, and one month later, the left transplanted lung exhibited good dilation, mild pulmonary perfusion injury with local infection, and left pleural effusion. Fiberoptic bronchoscopy revealed left hyperplastic granulation at the left bronchial anastomosis. Multiple sputum cultures suggested the presence of Klebsiella pneumoniae and Acinetobacter baumannii. The last follow-up was conducted in April 2019; the patient recovered well.
CONCLUSION This case presents the imaging findings of a patient with PAM before and after LuTx and confirms the effectiveness of LuTx for the treatment of this disease.
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Affiliation(s)
- Xing-Yu Ren
- Department of Radiology, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Xiang-Ming Fang
- Department of Radiology, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Jing-Yu Chen
- Lung Transplantation Center, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Hao Ding
- Lung Transplantation Center, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Yan Wang
- Department of Radiology, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Qiu Lu
- Department of Radiology, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Jia-Lei Ming
- Department of Radiology, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Li-Juan Zhou
- Department of Radiology, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Hong-Wei Chen
- Department of Radiology, Wuxi People’s Hospital-Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
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4
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Alrossais NM, Alshammari AM, Alrayes AM, Mohammad N, Al-Amoodi MJH, Almutairi AM, Alsuhaymi AO, Alhadid DA, Alhammad FA, Ouf NH, Ahmed MH, Saleh W, AlAmodi AA. Pulmonary Hypertension and Polycythemia Secondary to Pulmonary Alveolar Microlithiasis Treated with Sequential Bilateral Lung Transplant: A Case Study and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1114-1119. [PMID: 31352464 PMCID: PMC6683309 DOI: 10.12659/ajcr.911045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patient: Male, 49 Final Diagnosis: Pulmonary alveolar microlithiasis Symptoms: Coughing • shortness of breath Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
| | - Abdullah M Alshammari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Department of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Najwa Mohammad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohamed J H Al-Amoodi
- The School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | | | | | - Daeya A Alhadid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Nida H Ouf
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed H Ahmed
- Department of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,Department of Cardiothoracic Surgery, Ain Shams University, Cairo, Egypt
| | - Waleed Saleh
- Department of Thoracic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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5
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Prasad KT, Sehgal IS, Dhooria S, Agarwal R, Singh RS, Singh H, Puri GD, Arya VK, Behera D, Aggarwal AN. Experience of the first lung transplantation performed in public sector in India. Lung India 2019; 36:66-69. [PMID: 30604708 PMCID: PMC6330790 DOI: 10.4103/lungindia.lungindia_74_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lung transplantation is the only modality that offers a long-term solution for end-stage lung diseases. Few centers in India have an active lung transplant program. Preoperative and postoperative considerations in lung transplantation may be different in the developing countries when compared to the developed world. In the early posttransplant period, infection could be the major consideration in developing countries, unlike graft rejection, that is usually the primary concern in the developed world. Herein, we report the first lung transplantation from a public sector hospital in India. The patient was a 33-year-old female, who underwent bilateral lung transplantation at our center, but succumbed to surgical and infectious complications in the early posttransplant period.
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Affiliation(s)
- Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rana Sandip Singh
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harkant Singh
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Kumar Arya
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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Castellana G, Castellana G, Gentile M, Castellana R, Resta O. Pulmonary alveolar microlithiasis: review of the 1022 cases reported worldwide. Eur Respir Rev 2016; 24:607-20. [PMID: 26621975 PMCID: PMC9487614 DOI: 10.1183/16000617.0036-2015] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pulmonary alveolar microlithiasis (PAM) is a rare disease characterised by the widespread intra-alveolar accumulation of minute calculi called microliths. It is caused by mutation of the SLC34A2 gene encoding the type IIb sodium phosphate cotransporter in alveolar type II cells. The present study explores the epidemiological, familial, genetic, clinical, diagnostic, radiological and therapeutic aspects with the aim of contributing to a better understanding of this uncommon disease. We searched articles on PAM published up to December 2014 and 544 papers were found, accounting for 1022 cases. PAM is present in all continents and in many nations, in particular in Turkey, China, Japan, India, Italy and the USA. Familiality is frequent. The clinical course is not uniform and the causes of this clinical variability seem to be largely nongenetic. The optimal diagnostic procedure is the association of chest high-resolution computed tomography (HRCT) with bronchoalveolar lavage, but a chest radiograph may suffice in families in which a case has already been diagnosed. Moreover, chest radiography and HRCT allow the classification of the evolutionary phase of the disease and its severity. At present lung transplantation is the only effective therapy. However, better knowledge of the gene responsible offers hope for new therapies. Familial, genetic, clinical, radiological and therapeutic aspects of pulmonary alveolarmicrolithiasis epidemiologyhttp://ow.ly/St3Mw
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Affiliation(s)
| | - Giorgio Castellana
- Institute of Respiratory Disease, Aldo Moro University of Bari, Bari, Italy
| | - Mattia Gentile
- Medical Genetics Unit, Azienda Sanitaria Locale Bari, Bari, Italy
| | | | - Onofrio Resta
- Institute of Respiratory Disease, Aldo Moro University of Bari, Bari, Italy
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7
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Klikovits T, Slama A, Hoetzenecker K, Waseda R, Lambers C, Murakoezy G, Jaksch P, Aigner C, Taghavi S, Klepetko W, Lang G, Hoda MA. A rare indication for lung transplantation - pulmonary alveolar microlithiasis: institutional experience of five consecutive cases. Clin Transplant 2016; 30:429-34. [PMID: 26841075 DOI: 10.1111/ctr.12705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pulmonary alveolar microlithiasis (PAM) is a rare lung disease caused by calcifications within the alveolar space. The only known effective treatment for an end-stage PAM is lung transplantation (LuTX). METHODS We performed a retrospective chart review of all individuals that underwent lung transplantation at our center between 1989 and 2013. Five consecutive patients with PAM were identified. RESULTS Four females and one male with a mean age of 46.3 yr were identified. Extracorporeal membrane oxygenation (ECMO) support was required intraoperatively in four cases and post-operatively in one case. Mean post-operative intubation time was 3.3 (range, 2-5) d and mean intensive care unit (ICU) stay was 8.3 (range, 4-12) d. No intraoperative complications were observed. One early patient (operated in 1995) underwent acute re-transplantation on the second post-operative day (POD) and died from sepsis on the 11 POD. In one patient reperfusion edema was observed requiring a prolonged weaning process. No other severe perioperative complications were observed. Four of five patients are currently still alive with normal follow-up parameters. No recurrence of PAM was observed. CONCLUSIONS Lung transplantation is a feasible therapy option in patients with end-stage PAM showing good post-operative results comparable to other indications for LuTX.
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Affiliation(s)
- Thomas Klikovits
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexis Slama
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Ryuichi Waseda
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Lambers
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabriella Murakoezy
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Clemens Aigner
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gyoergy Lang
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Thoracic Surgery, Semmelweis University Budapest, Budapest, Hungary
| | - Mir Alireza Hoda
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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