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Li G, Liu Z, Salan-Gomez M, Keeney E, D’Silva E, Mankidy B, Leon A, Mattar A, Elsennousi A, Coster J, Kumar A, Rodrigues B, Li M, Shafii A, Garcha P, Loor G. Risk Factors, Incidence, and Outcomes Associated With Clinically Significant Airway Ischemia. Transpl Int 2024; 37:12751. [PMID: 38800671 PMCID: PMC11119282 DOI: 10.3389/ti.2024.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/10/2024] [Indexed: 05/29/2024]
Abstract
Airway complications following lung transplantation remain an important cause of morbidity and mortality. We aimed to identify the incidence, risk factors and outcomes associated with clinically significant airway ischemia (CSAI) in our center. We reviewed 217 lung transplants (386 airway anastomoses) performed at our institution between February 2016 and December 2020. Airway images were graded using the 2018 ISHLT grading guidelines modified slightly for retrospective analysis. Airways were considered to have CSAI if they developed ischemia severity >B2, stenosis >50%, and/or any degree of dehiscence within 6-months of transplant. Regression analyses were used to evaluate outcomes and risk factors for CSAI. Eighty-two patients (37.8%) met criteria for CSAI. Of these, twenty-six (32%) developed stenosis and/or dehiscence, and 17 (21%) required interventions. Patients with CSAI had lower one-year (80.5% vs. 91.9%, p = 0.05) and three-year (67.1% vs. 77.8%, p = 0.08) survival than patients without CSAI. Factors associated with CSAI included younger recipient age, recipient diabetes, single running suture technique, performance of the left anastomosis first, lower venous oxygen saturation within 48-h, and takeback for major bleeding. Our single-center analysis suggests that airway ischemia remains a major obstacle in contemporary lung transplantation. Improving the local healing milieu of the airway anastomosis could potentially mitigate this risk.
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Affiliation(s)
- Gloria Li
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Zejian Liu
- Department of Statistics, Rice University, Houston, TX, United States
| | - Marcelo Salan-Gomez
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Emma Keeney
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Ethan D’Silva
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Babith Mankidy
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Andres Leon
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Aladdein Mattar
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | | | - Jennalee Coster
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anupam Kumar
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Bruno Rodrigues
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Meng Li
- Department of Statistics, Rice University, Houston, TX, United States
| | - Alexis Shafii
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Puneet Garcha
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Gabriel Loor
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
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Ochman M, Zawadzki F, Galle D, Hrapkowicz T. Impact of Prolonged Cold Ischemia Time on Long-Term Survival in Lung Transplant Recipients. Transplant Proc 2024:S0041-1345(24)00240-9. [PMID: 38729831 DOI: 10.1016/j.transproceed.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Cold ischemia time (CIT) influences short- and long-term outcomes in lung transplant recipients. Most studies proved that prolonged CIT causes increased mortality. This study aimed to investigate the impact of prolonged CIT on patient survival time after lung transplantation (LTx). METHODS The retrospective study group consisted of 139 patients who underwent double LTx in a single center between January 2018 and August 2022. Prolonged ischemic time (PIT) was defined as total ischemic time >6 hours and divided into smaller time intervals according to increasing PIT (6-8, 8-10, 10-12, >12 hours). The assessed outcomes were 1- and 4-year survival. RESULTS Among the study group, PIT was observed in 98% (n = 137), and its average value was 10.33 hours. The prolonged CIT of 6 to 8 hours occurred in 10% (n = 14), 8 to 10 hours in 34% (n = 47), 10 to 12 hours in 36% (n = 49), and >12 hours in 20% (n = 27). In a comparison of 1-year survival between the PIT 6- to 10-hour group and the >10-hour arm (88% vs 78%), the difference was not statistically significant (P > .05). CONCLUSION PIT is a risk factor for reduced long-term survival in LTx recipients. Increasing PIT may be associated with higher mortality at 1 and 4 years. All efforts to reduce the duration of ischemic time can benefit patient survival after LTx.
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Affiliation(s)
- Marek Ochman
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - Fryderyk Zawadzki
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland; Department of Lung Diseases and Tuberculosis, Medical University of Silesia in Katowice, Stanisław Szyszko Independent Public Clinical Hospital No. 1, Zabrze, Poland
| | - Dagmara Galle
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Tomasz Hrapkowicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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Ruiz E, Fernández AM, Párraga JL, Cantador B, Salvatierra Á, Álvarez A. Surgical Complications After Lung Transplantation: The Reina Sofía Hospital Experience. Transplant Proc 2023; 55:2289-2291. [PMID: 37798165 DOI: 10.1016/j.transproceed.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To assess the incidence of surgical complications after lung transplantation and its influence on early mortality and long-term survival. METHODS Retrospective review of 792 lung transplants (LTs) performed from 1994 to 2022. Among them, 769 with complete data were selected. Patients with and without surgical complications were compared by univariable and multivariable analyses. RESULTS There were 385 single LTs (50%), 371 double LTs (48%), 8 bilobar LTs (1%), and 5 combined liver LTs (1%). Two hundred forty-nine patients presented surgical complications (32%) as follows: bronchial (n = 61), vascular (n = 55), pneumothorax (n = 33), and phrenic nerve palsy (n = 22). Thirty-day mortality (noncomplicated vs complicated) was 57 (41%) vs 80 (59%), P < .001. Transplants for bronchiectasis (58%), pulmonary hypertension (50%), and re-transplants (78%) presented more surgical complications (P < .001). Double LT (40%), bilobar LT (88%), and combined liver LT (100%) presented more surgical complications (P < .001). Complicated recipients were younger (49 ± 15 vs 45 ± 17 years; P = .001), with longer ischemic times (429 ± 67 vs 450 ± 76 min [2nd graft]; P = .007), and required extracorporeal support (ECLS) more often (43% vs 57%; P < .001). Survival at 1, 5, 10, 15, and 20 years (noncomplicated vs complicated): 78%, 63%, 52%, 41%, 31% vs 52%, 42%, 35%, 26%, 22%; P < .001). Predictors of mortality were the need for ECLS (odds ratio [OR] 4.14; P < .001), postoperative ventilation (hours) (OR 1.01; P < .001), and vascular complications (OR 4.78; P < .001). CONCLUSION Surgical complications remain an important source of morbidity and mortality after lung transplantation. Complex surgical procedures requiring ECLS develop frequent surgical complications needing long postoperative ventilation that are associated with early mortality and poorer long-term survival.
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Affiliation(s)
- Eloísa Ruiz
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba, University of Córdoba, Spain
| | - Alba María Fernández
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba, University of Córdoba, Spain
| | - Juan Luis Párraga
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba, University of Córdoba, Spain
| | - Benito Cantador
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba, University of Córdoba, Spain
| | - Ángel Salvatierra
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba, University of Córdoba, Spain
| | - Antonio Álvarez
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, Córdoba, Spain; Maimónides Biomedical Research Institute of Córdoba, University of Córdoba, Spain.
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van Pel R, Gan CT, van der Bij W, Verschuuren EAM, van Gemert JPA, Van De Wauwer C, Erasmus ME, Slebos DJ. Three Decades Single Center Experience of Airway Complications After Lung Transplantation. Transpl Int 2023; 36:11519. [PMID: 37908674 PMCID: PMC10613691 DOI: 10.3389/ti.2023.11519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023]
Abstract
Post lung transplantation airway complications like necrosis, stenosis, malacia and dehiscence cause significant morbidity, and are most likely caused by post-operative hypo perfusion of the anastomosis. Treatment can be challenging, and airway stent placement can be necessary in severe cases. Risk factors for development of airway complications vary between studies. In this single center retrospective cohort study, all lung transplant recipients between November 1990 and September 2020 were analyzed and clinically relevant airway complications of the anastomosis or distal airways were identified and scored according to the ISHLT grading system. We studied potential risk factors for development of airway complications and evaluated the impact on survival. The treatment modalities were described. In 651 patients with 1,191 airway anastomoses, 63 patients developed 76 clinically relevant airway complications of the airway anastomoses or distal airways leading to an incidence of 6.4% of all anastomoses, mainly consisting of airway stenosis (67%). Development of airway complications significantly affects median survival in post lung transplant patients compared to patients without airway complication (101 months versus 136 months, p = 0.044). No significant risk factors for development of airway complication could be identified. Previously described risk factors could not be confirmed. Airway stents were required in 55% of the affected patients. Median survival is impaired by airway complications after lung transplantation. In our cohort, no significant risk factors for the development of airway complications could be identified.
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Affiliation(s)
- R. van Pel
- Department of Respiratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Respiratory Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Erasmus MC Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - C. T. Gan
- Department of Respiratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - W. van der Bij
- Department of Respiratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - E. A. M. Verschuuren
- Department of Respiratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J. P. A. van Gemert
- Department of Respiratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - C. Van De Wauwer
- Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - M. E. Erasmus
- Department of Cardio-Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - D. J. Slebos
- Department of Respiratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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5
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Huang J, Lin J, Zheng Z, Liu Y, Lian Q, Zang Q, Huang S, Guo J, Ju C, Zhong C, Li S. Risk factors and prognosis of airway complications in lung transplant recipients: A systematic review and meta-analysis. J Heart Lung Transplant 2023; 42:1251-1260. [PMID: 37088339 DOI: 10.1016/j.healun.2023.04.011] [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: 11/28/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Airway complications (AC) are one of leading causes of morbidity and mortality after lung transplant (LTx), but their predictors and outcomes remain controversial. This study aimed to identify potential risk factors and prognosis of AC. METHODS A systematic review was performed by searching PubMed, Embase, and Cochrane Library. All observational studies reporting outcome and potential factors of AC after LTx were included. The incidence, mortality, and estimated effect of each factor for AC were pooled by using the fixed-effects model or random-effects model. RESULTS Thirty-eight eligible studies with 52,116 patients undergoing LTx were included for meta-analysis. The pooled incidence of AC was 12.4% (95% confidence interval [CI] 9.5-15.8) and the mean time of occurrence was 95.6 days. AC-related mortality rates at 30-days, 90-days, 6 months, 1 year, and 5 years were 6.7%, 17.9%, 18.2%, 23.6%, and 66.0%, respectively. Airway dehiscence was the most severe type with a high mortality at 30 days (60.9%, 95% CI 20.6-95.2). We found that AC was associated with a higher risk of mortality in LTx recipients (hazard ratio [HR] 1.71, 95% CI 1.04-2.81). Eleven significant predictors for AC were also identified, including male donor, male recipient, diagnosis of COPD, hospitalization, early rejection, postoperative infection, extracorporeal membrane oxygenation, mechanical ventilation, telescopic anastomosis, and bilateral and right-sided LTx. CONCLUSION AC was significantly associated with higher mortality after LTx, especially for dehiscence. Targeted prophylaxis for modifiable factors and enhanced early bronchoscopy surveillance after LTx may improve the disease burden of AC.
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Affiliation(s)
- Junfeng Huang
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinsheng Lin
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ziwen Zheng
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Respiratory and Critical Care Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuheng Liu
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Respiratory and Critical Care Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qiaoyan Lian
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qing Zang
- Department of Respiratory and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Song Huang
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiaming Guo
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Respiratory and Critical Care Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chunrong Ju
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Changhao Zhong
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Shiyue Li
- Department of Respiratory and Critical Care Medicine, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Liu H, Xu H, Liu H, Zhao Z, Zhang X. Metagenomic next-generation sequencing in the diagnose of pulmonary infection with airway complications in a lung transplant recipient. Heliyon 2023; 9:e19611. [PMID: 37809439 PMCID: PMC10558871 DOI: 10.1016/j.heliyon.2023.e19611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
We reported a case of a 60-year-old male with fever, cough, expectoration, and chest distress after right lung transplanted. Blood examination showed elevated C-reaction protein (CRP), white blood cell (WBC), and ammonia. Computed tomography (CT) revealed patchy high-density shadows and few pleural effusions in the transplanted lung. Bronchoscopy illustrated anastomotic fistula, and pseudomembrane and mucus plugs around the right main bronchial anastomosis. Carbapenem-resistant Klebsiella pneumoniae, Ureaplasma urealyticum, and Aspergillus flavus was successively detected by metagenomic next-generation sequencing (mNGS). Targeted anti-microbial agents were administered and patient was successfully discharged. Unfortunately, a year later, patient died of respiratory failure due to recurrent pulmonary infections.
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Affiliation(s)
- Hongmei Liu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Huan Xu
- Department of Scientific Affairs, Vision Medicals Center for Infection Diseases, Guangzhou, China
| | - Hui Liu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zhigang Zhao
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
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7
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White C, Stuart A, Plit M, Malouf M, Lilburn P. A hole lot of trouble: Severe bilateral anastomotic dehiscence following bilateral single sequential lung transplant. Respirol Case Rep 2023; 11:e01164. [PMID: 37234754 PMCID: PMC10206412 DOI: 10.1002/rcr2.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Airway complications post lung transplant including ischaemia and dehiscence have a significant associated mortality (2%-4%) and morbidity. We describe a case of a 22-year-old female who developed significant bilateral anastomotic dehiscence with severe ischaemia following a bilateral single sequential lung transplant (BSSLTx). Following an intensive antimicrobial regimen, judicious bronchoscopic surveillance, and a prolonged inpatient stay, the dehiscence resolved without requiring further surgical intervention. Our case highlights a space in the literature for further research with regard to airway complications post-lung transplant and their management.
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Affiliation(s)
- Cameron White
- Department of MedicineThe Alfred, 55 Commercial RoadMelbourneVictoriaAustralia
- Respiratory DepartmentPrince of Wales HospitalSydneyNew South WalesAustralia
- School of Health SciencesUniversity of New South WalesSydneyNew South WalesAustralia
| | - Alice Stuart
- Department of MedicineThe Alfred, 55 Commercial RoadMelbourneVictoriaAustralia
| | - Marshall Plit
- Department of MedicineThe Alfred, 55 Commercial RoadMelbourneVictoriaAustralia
| | - Monique Malouf
- Department of MedicineThe Alfred, 55 Commercial RoadMelbourneVictoriaAustralia
| | - Paul Lilburn
- Respiratory DepartmentPrince of Wales HospitalSydneyNew South WalesAustralia
- School of Health SciencesUniversity of New South WalesSydneyNew South WalesAustralia
- MQ HealthMacquarie University HospitalSydneyNew South WalesAustralia
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Muñoz-Fos A, Moreno P, González FJ, Ruiz E, Vaquero JM, Baamonde C, Cerezo F, Algar J, Ramos-Izquierdo R, Salvatierra Á, Alvarez A. Airway Complications after Lung Transplantation-A Contemporary Series of 400 Bronchial Anastomoses from a Single Center. J Clin Med 2023; 12:jcm12093061. [PMID: 37176502 PMCID: PMC10179286 DOI: 10.3390/jcm12093061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Objective: To determine whether recent advances in lung transplantation (LT) have reduced the incidence and changed the risk factors for airway complications (AC). (2) Methods: Retrospective analysis of patients receiving a lung transplant between January 2007 and January 2019. An AC was defined as a bronchoscopic abnormality in the airway, either requiring or not requiring an endoscopic or surgical intervention. Both univariable and multivariable analyses were performed to identify risk factors for AC. (3) Results: 285 lung transplants (170 single and 115 bilateral lung transplants) were analysed, comprising 400 anastomoses at risk. A total of 50 anastomoses resulted in AC (12%). There were 14 anastomotic and 11 non-anastomotic stenoses, 4 dehiscences, and 3 malacias. Independent predictors for AC were: gender male (OR: 4.18; p = 0.002), cardiac comorbidities (OR: 2.74; p = 0.009), prolonged postoperative mechanical ventilation (OR: 2.5; p = 0.02), PaO2/FiO2 < 300 mmHg at 24 h post-LT (OR: 2.48; p = 0.01), graft infection (OR: 2.16; p = 0.05), and post-LT isolation of Aspergillus spp. (OR: 2.63; p = 0.03). (4) Conclusions: In spite of advances in lung transplantation practice, the risk factors, incidence, and lethality of AC after LT remains unchanged. Graft dysfunction, an infected environment, and the need of prolonged mechanical ventilation remain an Achilles heel for AC.
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Affiliation(s)
- Anna Muñoz-Fos
- Department of Thoracic Surgery, Bellvitge University Hospital, 08907 Barcelona, Spain
| | - Paula Moreno
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Francisco Javier González
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Eloisa Ruiz
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Jose Manuel Vaquero
- Department of Pulmonology and Lung Transplantation, University Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Carlos Baamonde
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Francisco Cerezo
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Javier Algar
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Ricard Ramos-Izquierdo
- Department of Thoracic Surgery, Bellvitge University Hospital, 08907 Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, University of Barcelona, 08036 Barcelona, Spain
| | - Ángel Salvatierra
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Antonio Alvarez
- Department of Thoracic Surgery and Lung Transplantation, University Hospital Reina Sofía, 14004 Córdoba, Spain
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9
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Mondoni M, Rinaldo RF, Solidoro P, Di Marco F, Patrucco F, Pavesi S, Baccelli A, Carlucci P, Radovanovic D, Santus P, Raimondi F, Vedovati S, Morlacchi LC, Blasi F, Sotgiu G, Centanni S. Interventional pulmonology techniques in lung transplantation. Respir Med 2023; 211:107212. [PMID: 36931574 DOI: 10.1016/j.rmed.2023.107212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/04/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
Lung transplantation is a key therapeutic option for several end-stage lung diseases. Interventional pulmonology techniques, mostly bronchoscopy, play a key role throughout the whole path of lung transplantation, from donor evaluation to diagnosis and management of post-transplant complications. We carried out a non-systematic, narrative literature review aimed at describing the main indications, contraindications, performance characteristics and safety profile of interventional pulmonology techniques in the context of lung transplantation. We highlighted the role of bronchoscopy during donor evaluation and described the debated role of surveillance bronchoscopy (with bronchoalveolar lavage and transbronchial biopsy) to detect early rejection, infections and airways complications. The conventional (transbronchial forceps biopsy) and the new techniques (i.e. cryobiopsy, biopsy molecular assessment, probe-based confocal laser endomicroscopy) can detect and grade rejection. Several endoscopic techniques (e.g. balloon dilations, stent placement, ablative techniques) are employed in the management of airways complications (ischemia and necrosis, dehiscence, stenosis and malacia). First line pleural interventions (i.e. thoracentesis, chest tube insertion, indwelling pleural catheters) may be useful in the context of early and late pleural complications occurring after lung transplantation. High quality studies are advocated to define endoscopic standard protocols and thus help improving long-term prognostic outcomes of lung transplant recipients.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
| | - Rocco Francesco Rinaldo
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Solidoro
- S.C. Pneumologia, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Filippo Patrucco
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità, Novara, Italy
| | - Stefano Pavesi
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Andrea Baccelli
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Paolo Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | | | - Sergio Vedovati
- Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Francesco Blasi
- Respiratory Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department Pathophysiology and Trasplantation, Università degli studi di Milano, Milano, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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10
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Grewal HS, Thaniyavarn T, Arcasoy SM, Goldberg HJ. Common Noninfectious Complications Following Lung Transplantation. Clin Chest Med 2023; 44:179-190. [PMID: 36774163 DOI: 10.1016/j.ccm.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
According to the Scientific Registry of Transplant Recipients, both transplant volume and survival among lung transplant recipients are improving over time. However, the outcomes of lung transplantation remain challenged by multiple thoracic and extrathoracic complications. With improving lung transplant survival, patients experience prolonged exposure to chronic immunosuppressive agents that can lead to multiple infectious and noninfectious complications. This article focuses on most common noninfectious complications with significant clinical impact.
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Affiliation(s)
- Harpreet Singh Grewal
- Lung Transplant Program, Columbia University, Irving Medical Center, 622 West 168th Street, PH 14E, Suite 104, New York, NY 10032, USA.
| | - Tany Thaniyavarn
- Lung Transplant Program, Brigham and Women's Hospital, 75 Francis Street, PBB Clinic 3, Boston, MA 02115, USA
| | - Selim M Arcasoy
- Lung Transplant Program, Columbia University, Irving Medical Center, 622 West 168th Street, PH 14E, Suite 104, New York, NY 10032, USA
| | - Hilary J Goldberg
- Lung Transplant Program, Brigham and Women's Hospital, 75 Francis Street, PBB Clinic 3, Boston, MA 02115, USA
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11
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Impact of Antifibrotic Treatment on Postoperative Complications in Patients with Interstitial Lung Diseases Undergoing Lung Transplantation: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12020655. [PMID: 36675583 PMCID: PMC9865259 DOI: 10.3390/jcm12020655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/09/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023] Open
Abstract
Antifibrotic treatment has been approved for reducing disease progression in fibrotic interstitial lung disease (ILD). As a result of increased bleeding risk, some experts suggest cessation of antifibrotics prior to lung transplantation (LT). However, extensive knowledge regarding the impact of antifibrotic treatment on postoperative complications remains unclear. We performed a comprehensive search of several databases from their inception through to 30 September 2021. Original studies were included in the final analysis if they compared postoperative complications, including surgical wound dehiscence, anastomosis complication, bleeding complications, and primary graft dysfunction, between those with and without antifibrotic treatment undergoing LT. Of 563 retrieved studies, 6 studies were included in the final analysis. A total of 543 ILD patients completing LT were included, with 161 patients continuing antifibrotic treatment up to the time of LT and 382 without prior treatment. Antifibrotic treatment was not significantly associated with surgical wound dehiscence (RR 1.05; 95% CI, 0.31-3.60; I2 = 0%), anastomotic complications (RR 0.88; 95% CI, 0.37-2.12; I2 = 31%), bleeding complications (RR 0.76; 95% CI, 0.33-1.76; I2 = 0%), or primary graft dysfunction (RR 0.87; 95% CI, 0.59-1.29; I2 = 0%). Finally, continuing antifibrotic treatment prior to LT was not significantly associated with decreased 1-year mortality (RR 0.80; 95% CI, 0.41-1.58; I2 = 0%). Our study suggests a similar risk of postoperative complications in ILD patients undergoing LT who received antifibrotic treatment compared to those not on antifibrotic therapy.
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12
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Incidence, risk factors, and clinical characteristics of airway complications after lung transplantation. Sci Rep 2023; 13:667. [PMID: 36635329 PMCID: PMC9837050 DOI: 10.1038/s41598-023-27864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
Airway complications may occur after lung transplantation and are associated with considerable morbidity and mortality. We investigated the incidence, risk factors, and clinical characteristics of these complications. We retrospectively reviewed the medical records of 137 patients who underwent lung transplantation between 2008 and 2021. The median follow-up period was 20 months. Of the 137 patients, 30 (21.9%) had postoperative airway complications, of which 2 had two different types of airway complications. The most common airway complication was bronchial stenosis, affecting 23 patients (16.8%). Multivariable Cox analysis revealed that a recipient's body mass index ≥ 25 kg/m2 (hazard ratio [HR], 2.663; p = 0.013) was a significant independent risk factor for airway complications, as was postoperative treatment with extracorporeal membrane oxygenation (ECMO; HR, 3.340; p = 0.034). Of the 30 patients who had airway complications, 21 (70.0%) were treated with bronchoscopic intervention. Survival rates did not differ significantly between patients with and without airway complications. Thus, our study revealed that one fifth of patients who underwent lung transplantation experienced airway complications during the follow-up period. Obesity and receiving postoperative ECMO are risk factors for airway complications, and close monitoring is warranted in such cases.
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13
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Sandot A, Grall N, Rodier T, Bunel V, Godet C, Weisenburger G, Tran-Dinh A, Montravers P, Mordant P, Castier Y, Eloy P, Armand-Lefevre L, Mal H, Messika J. Risk of Bronchial Complications After Lung Transplantation With Respiratory Corynebacteria. Results From a Monocenter Retrospective Cohort Study. Transpl Int 2023; 36:10942. [PMID: 36936442 PMCID: PMC10014466 DOI: 10.3389/ti.2023.10942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
Corynebacterium spp. are associated with respiratory infections in immunocompromised hosts. A link with bronchial complications after lung transplantation (LTx) has been suggested. We aimed to assess the link between respiratory sampling of Corynebacterium spp. and significant bronchial complication (SBC) after LTx. We performed a single center retrospective study. Inclusion of LTx recipients with at least one respiratory Corynebacterium spp. sample (July 2014 to December 2018). Subjects were matched to unexposed LTx recipients. Primary outcome was SBC occurrence after Corynebacterium spp. isolation. Secondary outcomes were Corynebacterium spp. persistent sampling, chronic lung allograft dysfunction (CLAD) onset and all-cause mortality. Fifty-nine patients with Corynebacterium spp. sampling with 59 without isolation were included. Corynebacterium spp. identification was not associated with SBC occurrence (32.4% vs. 21.6%, p = 0.342). Previous SBC was associated with further isolation of Corynebacterium spp. (OR 3.94, 95% CI [1.72-9.05]). Previous SBC and corticosteroids pulses in the last 3 months were the only factors associated with increased risk of Corynebacterium spp. isolation in multivariate analysis. Corynebacterium spp. sampling was significantly associated with CLAD onset (27.1% vs. 6.9%, p = 0.021). Corynebacterium spp. isolation was not associated with SBC but with higher risk of CLAD. Whether CLAD evolution is affected by Corynebacterium spp. eradication remains to be investigated.
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Affiliation(s)
- Adèle Sandot
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
| | - Nathalie Grall
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - Thomas Rodier
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- AP-HP, Hôpital Bichat, DEBRC, Paris, France
| | - Vincent Bunel
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Cendrine Godet
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Gaëlle Weisenburger
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
| | - Alexy Tran-Dinh
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Département d’Anesthésie et Réanimation, Paris, France
| | - Philippe Montravers
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Département d’Anesthésie et Réanimation, Paris, France
| | - Pierre Mordant
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Chirurgie Vasculaire, Thoracique et Transplantation, Paris, France
| | - Yves Castier
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- APHP, Hôpital Bichat, Chirurgie Vasculaire, Thoracique et Transplantation, Paris, France
| | - Philippine Eloy
- INSERM, CIC-EC 1425, Hôpital Bichat, Paris, France
- AP-HP, Hôpital Bichat, DEBRC, Paris, France
| | - Laurence Armand-Lefevre
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - Hervé Mal
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
| | - Jonathan Messika
- APHP Nord-Université Paris Cité, Hôpital Bichat, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France
- Université Paris Cité, PHERE UMRS 1152, LVTS UMRS 1148, IAME UMRS 1137, Paris, France
- Paris Transplant Group, Paris, France
- *Correspondence: Jonathan Messika,
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14
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Gottlieb J, Fuehner T, Zardo P. Management and outcome of obstructive airway complications after lung transplantation - a 12-year retrospective cohort study. Ther Adv Respir Dis 2023; 17:17534666231181541. [PMID: 37526226 PMCID: PMC10395170 DOI: 10.1177/17534666231181541] [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: 03/06/2023] [Accepted: 05/26/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Obstructive airway complications (OACs) represent a significant problem after lung transplantation (LTx). Bilateral OACs after double lung transplantation are infrequently reported. OBJECTIVES The aim of this study was to investigate management and outcome of OAC. DESIGN Retrospective single-center cohort study. METHODS Adult patients with bilateral LTx performed between 2010 and 2021 were included. Patients with follow-ups of less than 3 months and after heart-lung transplantation were excluded. OAC was defined either as the need for stenting, surgical revision, or balloon dilatation. Outcome parameters included graft survival, graft function, quality of life, and management. RESULTS During the study period, 1,170 patients were included. Hundred thirty-five (11.5%) patients developed OAC. Forty-six (4.4%) patients had significant bilateral OAC. Thirty-seven (80%) bilateral OAC patients were treated by stent insertion; in 34 patients, biodegradable stents were used. The median number of bronchoscopies in bilateral OAC was 26 during the first postoperative year compared with nine in controls (p < 0.001). Fourteen OAC patients (n = 10 bilateral) underwent surgical revision including six re-do transplantations. Graft loss occurred significantly more frequently in patients with bilateral OAC with a graft survival of 63% and 50% in these after 3 and 5 years compared with 83% and 73% in controls without OAC (p < 0.001). Baseline forced expiratory volume in 1 s (FEV1) in patients with bilateral OAC was median 58% predicted in comparison with 90% in controls (p < 0.001). Quality of life was significantly reduced. CONCLUSION Bilateral OACs impose a high burden of disease on patients after lung transplantation and were associated with early and late graft loss. Affected patients' OAC demonstrated reduced graft function and impaired quality of life. Most OACs were managed by bronchoscopy preferably by non-permanent stenting. Surgery including re-do transplantation was used in selected cases.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine and Infectious Diseases OE 6870, Hannover Medical School (Medizinische Hochschule Hannover, MHH), Carl Neuberg Strasse 1, 30625 Hannover, Germany. German Center for Lung Research (DZL), Gießen, Germany
| | - Thomas Fuehner
- Department of Respiratory Medicine, Siloah Hospital, Hannover, Germany
| | - Patrick Zardo
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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15
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Kopanczyk R, Lester J, Long MT, Kossbiel BJ, Hess AS, Rozycki A, Nunley DR, Habib A, Taylor A, Awad H, Bhatt AM. The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:47. [PMID: 36676669 PMCID: PMC9867461 DOI: 10.3390/medicina59010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Cardiothoracic surgical critical care medicine (CT-CCM) is a medical discipline centered on the perioperative care of diverse groups of patients. With an aging demographic and an increase in burden of chronic diseases the utilization of cardiothoracic surgical critical care units is likely to escalate in the coming decades. Given these projections, it is important to assess the state of cardiothoracic surgical intensive care, to develop goals and objectives for the future, and to identify knowledge gaps in need of scientific inquiry. This two-part review concentrates on CT-CCM as its own subspeciality of critical care and cardiothoracic surgery and provides aspirational goals for its practitioners and scientists. In part one, a list of guiding principles and a call-to-action agenda geared towards growth and promotion of CT-CCM are offered. In part two, an evaluation of selected scientific data is performed, identifying gaps in CT-CCM knowledge, and recommending direction to future scientific endeavors.
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Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jesse Lester
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Micah T. Long
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, Madison, WI 53792, USA
| | - Briana J. Kossbiel
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Aaron S. Hess
- Department of Anesthesiology and Pathology & Laboratory Medicine, University of Wisconsin Hospitals & Clinics, Madison, WI 53792, USA
| | - Alan Rozycki
- Department of Pharmacology, The Ohio State Wexner Medical Center, Columbus, OH 43210, USA
| | - David R. Nunley
- Department of Pulmonary, Critical Care & Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Alim Habib
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Ashley Taylor
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Hamdy Awad
- Department of Anesthesiology, Division of Cardiothoracic and Vascular Anesthesia, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Amar M. Bhatt
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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16
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Atchade E, Ren M, Jean-Baptiste S, Tran Dinh A, Tanaka S, Tashk P, Lortat-Jacob B, Assadi M, Weisenburger G, Mal H, Sénémaud JN, Castier Y, de Tymowski C, Montravers P. ECMO support as a bridge to lung transplantation is an independent risk factor for bronchial anastomotic dehiscence. BMC Pulm Med 2022; 22:482. [PMID: 36539752 PMCID: PMC9764472 DOI: 10.1186/s12890-022-02280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Airway complications are frequent after lung transplantation (LT), as they affect up to 23% of recipients. The implication of perioperative extracorporeal membrane oxygenation (ECMO) support and haemodynamic instability has never been specifically assessed. The first aim of this study was to explore the impact of perioperative ECMO support on bronchial anastomotic dehiscence (BAD) at Day 90 after LT. METHODS This prospective observational monocentric study analysed BAD in all consecutive patients who underwent LT in the Bichat Claude Bernard Hospital, Paris, France, between January 2016 and May 2019. BAD visible on bronchial endoscopy and/or tomodensitometry was recorded. A univariate analysis was performed (Fisher's exacts and Mann-Whitney tests), followed by a multivariate analysis to assess independent risk factors for BAD during the first 90 days after LT (p < 0.05 as significant). The Paris North Hospitals Institutional Review Board approved the study. RESULTS A total of 156 patients were analysed. BAD was observed in the first 90 days in 42 (27%) patients and was the main cause of death in 22 (14%) patients. BAD occurred during the first month after surgery in 34/42 (81%) patients. ECMO support was used as a bridge to LT, during and after surgery in 9 (6%), 117 (75%) and 40 (27%) patients, respectively. On multivariate analysis, ECMO as a bridge to LT (p = 0.04) and septic shock (p = 0.01) were independent risk factors for BAD. CONCLUSION ECMO as a bridge to LT is an independent risk factor for BAD during the first 90 days after surgery. Close monitoring of bronchial conditions must be performed in these high-risk recipients.
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Affiliation(s)
- Enora Atchade
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Mélissa Ren
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Sylvain Jean-Baptiste
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Alexy Tran Dinh
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XINSERM U1148, LVTS, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France ,Université de Paris, UFR Diderot, Paris, France
| | - Sébastien Tanaka
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France ,grid.11642.300000 0001 2111 2608INSERM UMR 1188, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France
| | - Parvine Tashk
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Brice Lortat-Jacob
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Maksud Assadi
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France
| | - Gaelle Weisenburger
- grid.411119.d0000 0000 8588 831XService de Pneumologie B et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Hervé Mal
- grid.411119.d0000 0000 8588 831XService de Pneumologie B et Transplantation Pulmonaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Jean Nicolas Sénémaud
- grid.411119.d0000 0000 8588 831XService de Chirurgie Thoracique et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Yves Castier
- Université de Paris, UFR Diderot, Paris, France ,grid.411119.d0000 0000 8588 831XService de Chirurgie Thoracique et Vasculaire, APHP, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France ,grid.462432.50000 0004 4684 943XPhysiopathologie et Epidémiologie des Maladies Respiratoires, INSERM UMR 1152, Paris, France
| | - Christian de Tymowski
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XINSERM UMR 1149, Immunorecepteur et Immunopathologie Rénale, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Philippe Montravers
- grid.411119.d0000 0000 8588 831XAPHP, CHU Bichat-Claude Bernard, DMU PARABOL, 46 Rue Henri Huchard, 75018 Paris, France ,Université de Paris, UFR Diderot, Paris, France ,grid.462432.50000 0004 4684 943XPhysiopathologie et Epidémiologie des Maladies Respiratoires, INSERM UMR 1152, Paris, France
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17
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Jindal A, Avasaral S, Grewal H, Mehta A. Airway complications following lung transplantation. Indian J Thorac Cardiovasc Surg 2022; 38:326-334. [DOI: 10.1007/s12055-022-01376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022] Open
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18
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Anastomotic Suturing Techniques and Their Association With Post–lung Transplantation Complications. J Surg Res 2022; 274:9-15. [DOI: 10.1016/j.jss.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/10/2021] [Accepted: 12/27/2021] [Indexed: 11/20/2022]
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19
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Guinde J, Bismuth J, Laroumagne S, Coiffard B, Astoul P, Thomas PA, Reynaud-Gaubert M, Dutau H. Bifurcated Silicone Stents for the Management of Anastomotic Complications in Lung Transplanted Patients: Ten Years’ Experience. Respiration 2022; 101:675-682. [DOI: 10.1159/000523755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/18/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> In lung transplantation (LT), the actual surgical practice is to cut the donor bronchus as short as possible in order to reduce anastomotic complications (AC). Consequently, the anastomosis is very close to the secondary carina. If AC occur, regular straight stents may be unsatisfactory and on-site modified bifurcated stents may represent an alternative. <b><i>Objectives:</i></b> This retrospective study sought to assess the short- and long-term outcomes of patients treated with customized bifurcated stent (CBS) for the management of AC following LT. <b><i>Methods:</i></b> Data from patients with AC following LT requiring CBS placement between June 2010 and June 2020 were analyzed. <b><i>Results:</i></b> Four hundred patients underwent lung transplant. AC requiring airway stenting occurred in 32 patients (8%), and CBS were inserted in 15 patients (3.5%). Indications were stenosis (<i>n</i> = 12; 80%) and bronchial dehiscence (<i>n</i> = 3; 20%). CBS were successfully deployed in 14 patients and failed in 1 patient. No migration was recorded during the follow-up. The median number of complication was 1 per patient (0–5). CBS could be removed in 11 patients (78.6%), and 3 died with their stents in place. AC recurrence or complications requiring new stenting occurred in 4/11 patients (36.3%), with a median time of 7 days (0–29). Seven patients (63.7%) had no AC recurrence, with a median follow-up of 925 days (118–3,249). <b><i>Conclusions:</i></b> The actual surgical anastomotic technique in LT provides new endoscopic challenges. CBS seem ideally positioned to address these difficulties safely and effectively but are associated with stent related complications requiring further endoscopic management.
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20
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Latos M, Urlik M, Nęcki M, Pawlak D, Niepokój K, Stącel T, Zawadzki F, Przybyłowski P, Ochman M. Influence of Bronchoscopic Interventions on Graft Function of Double Lung Transplant Recipients due to Cystic Fibrosis. Transplant Proc 2022; 54:1092-1096. [PMID: 35459464 DOI: 10.1016/j.transproceed.2022.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Healing of bronchial anastomoses may sometimes be complicated and require bronchoscopic intervention (BI). The main aim of the study was to assess whether patients who require BI present comparable lung function after reaching 1-year posttransplant survival to those who did not require any BI by means of spirometry and 6-minute walk test (6MWT). METHODS This retrospective study included an analysis of 44 primary double lung transplant recipients who underwent transplant for end-stage respiratory failure in the course of cystic fibrosis transplanted in a single center between 2018 and 2021. Bronchoscopic intervention is defined as performing endoscopic bronchoplasty through balloon dilatation, cryoprobe, argon plasma, and/or laser treatment. Group 1 (25 patients who required at least 1 BI) presented similar spirometry parameters at qualification as group 2 (no BI). RESULTS Statistically significant differences between the groups for the following parameters were reported: forced expiratory volume in 1 second (FEV1), FEV1 (%), Tiffeneau-Pinelli index (FEV1/forced vital capacity percentage of predicted value), oxygen saturation after conclusion of 6MWT (%) and oxygen saturation before 6MWT (%). In each case, the mean for the BI group in the first year was lower. All patients in this group received an average amount of 6.8 ± 4.9 bronchoscopic procedures during the first year (minimum = 1; maximum = 18). Strong negative correlations were observed between the number of balloons in the first year and the FEV1 (%) and FEV1/forced vital capacity percentage of predicted value indicators after the first year. CONCLUSIONS Lung transplant recipients who underwent transplant because of cystic fibrosis and required at least 1 BI during the first posttransplant year presented inferior spirometry and 6MWT results in comparison with those who did not require any.
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Affiliation(s)
- Magdalena Latos
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - Maciej Urlik
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mirosław Nęcki
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Daria Pawlak
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Kornelia Niepokój
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Stącel
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Fryderyk Zawadzki
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marek Ochman
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
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21
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Effect of Bronchoscopic Interventions on Long-Term Lung Function Among Lung Transplant Recipients due to Cystic Fibrosis: A Single-Center Study. Transplant Proc 2022; 54:1086-1091. [DOI: 10.1016/j.transproceed.2022.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022]
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22
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Loebe M, Breda JR, Sinha N. Risk factors of bronchial dehiscence after primary lung transplantation. J Card Surg 2022; 37:958-959. [PMID: 35141941 DOI: 10.1111/jocs.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Complications of the bronchial anastomosis in lung transplantation, once the Achilles heel of the procedure, have become quite rare. The surgical technique is well established and safe. Risks contributing to anastomotic complications are primarily related to patients pre-existing conditions. The key factor is good blood flow to the bronchial stump. Postoperative infection can also contribute to the breakdown of the anastomosis. This may be the reason why different immunosuppressive regimes lead to differences in the incidence of bronchial dehiscence.
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23
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Delbove A, Senage T, Gazengel P, Tissot A, Lacoste P, Cellerin L, Perigaud C, Danner-Boucher I, Cavailles A, Lepoivre T, Mugniot A, Nicolet J, Horeau-Langlard D, Groleau N, Fedun Y, Rozec B, Magnan A, Roussel JC, Blanc FX. Incidence and risk factors of anastomotic complications after lung transplantation. Ther Adv Respir Dis 2022; 16:17534666221110354. [PMID: 35894432 PMCID: PMC9340386 DOI: 10.1177/17534666221110354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Anastomotic complications are common after lung transplantation (1.4–33% of
cases) and still associated with a high morbi-mortality. Methods: The current study is a monocenter retrospective analysis of symptomatic
anastomotic complications (SAC) occurring after lung transplantation between
2010 and 2016, using the macroscopic, diameter, and suture (M-D-S)
classification from consensus of French experts in bronchoscopy. The
objectives were to determine incidence from surgery, risk factors, and
impact of survival of SAC. We defined SAC as M-D-S abnormalities
(stenosis ⩾ 50% or dehiscence) requiring bronchoscopic or surgical
interventions. Results: A total of 121 patients were included. SAC occurred in 26.5% of patients
(n = 32), divided in symptomatic stenosis for 23.7%
(n = 29), and symptomatic dehiscence in 2.5%
(n = 3). In multivariate analysis, donor bacterial lung
infection [HR 2.08 (1.04–4.17), p = 0.04] and age above
50 years [HR 3.26 (1.04–10.26), p = 0.04] were associated
with SAC occurrence. Cystic fibrosis etiology was associated with better
survival on Kaplan–Meier curve (p < 0.001). SAC [HR 2.15
(1.07–4.32), p = 0.03] was independently associated with
worst survival. The 29 symptomatic patients because of stenosis required
endoscopic procedure, of whom 16 patients needed bronchial stent placement.
Four patients underwent surgery: three patients because of dehiscence and
one because of severe bilateral stenosis (re-transplantation). Discussion: SAC occurred in 26.5% of patients. Donor lung infection was the only
alterable identified factors. The increase rate of SAC in older patients
above 50 years of age encourages in regular endoscopic monitoring.
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Affiliation(s)
- Agathe Delbove
- Service de Pneumologie, L'institut du thorax, Boulevard Jacques Monod, CHU Nantes, hôpital G. et R. Laennec, 44 093 Nantes cedex 1, France.,Current address: Service de Réanimation polyvalente, Centre Hospitalier Bretagne Atlantique, 20, Boulevard du Général Maurice Guillaudot, 56 017 Vannes Cedex, France
| | - Thomas Senage
- Service de chirurgie thoracique et cardiovasculaire, CHU Nantes, Nantes, France.,INSERM UMR 1246-SPHERE, Nantes University, Tours University, Nantes, France
| | - Pierre Gazengel
- Service de pneumologie, l'institut du thorax, CHU Nantes, Nantes, France.,Service de transplantation, Clinique chirurgicale Marie Lannelongue, Le Plessis Robinson, France
| | - Adrien Tissot
- Service de pneumologie, l'institut du thorax, CHU Nantes, Nantes, France
| | - Philippe Lacoste
- Service de chirurgie thoracique et cardiovasculaire, CHU Nantes, Nantes, France
| | - Laurent Cellerin
- Service de pneumologie, l'institut du thorax, CHU Nantes, Nantes, France
| | - Christian Perigaud
- Service de chirurgie thoracique et cardiovasculaire, CHU Nantes, Nantes, France
| | | | - Arnaud Cavailles
- Service de pneumologie, l'institut du thorax, CHU Nantes, Nantes, France
| | - Thierry Lepoivre
- INSERM UMR 1246-SPHERE, Nantes University, Tours University, Nantes, France
| | - Antoine Mugniot
- Service de chirurgie thoracique et cardiovasculaire, CHU Nantes, Nantes, France
| | - Johanna Nicolet
- Service de réanimation chirurgicale thoracique et cardiovasculaire, CHU Nantes, Nantes, France
| | | | - Nicolas Groleau
- Service de réanimation chirurgicale thoracique et cardiovasculaire, CHU Nantes, Nantes, France
| | - Yannick Fedun
- Service de réanimation polyvalente, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Bertrand Rozec
- Service de réanimation chirurgicale thoracique et cardiovasculaire, CHU Nantes, Nantes, France
| | - Antoine Magnan
- Service de pneumologie, l'institut du thorax, CHU Nantes, Nantes, France.,Service de Pneumologie, Hôpital Foch, Suresnes, France
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24
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Successful Recanalization of Complete Bronchus Intermedius Stenosis after Lung Transplantation Guided by Intraprocedural Computed Tomographic Imaging. Ann Am Thorac Soc 2021; 18:889-892. [PMID: 33929308 DOI: 10.1513/annalsats.202006-633cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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25
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Sekulovski M, Simonska B, Peruhova M, Krastev B, Peshevska-Sekulovska M, Spassov L, Velikova T. Factors affecting complications development and mortality after single lung transplant. World J Transplant 2021; 11:320-334. [PMID: 34447669 PMCID: PMC8371496 DOI: 10.5500/wjt.v11.i8.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/15/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Lung transplantation (LT) is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease. Furthermore, as a therapeutic option for high-risk candidates, single LT (SLT) can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single (double) LT (SSLTx). Still, the long-term overall survival is, in general, better for SSLTx. Despite the great success over the years, the early post-SLT period remains a perilous time for these patients. Patients who undergo SLT are predisposed to evolving early or late postoperative complications. This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction, native lung complications, anastomosis complications, infections, cardiovascular, gastrointestinal, renal, and metabolite complications, and their association with morbidity and mortality in these patients. Furthermore, we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.
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Affiliation(s)
- Metodija Sekulovski
- Department of Anesthesiology and Intensive care, University Hospital Lozenetz, Sofia 1407, Bulgaria
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Bilyana Simonska
- Department of Anesthesiology and Intensive care, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Milena Peruhova
- Department of Gastroenterology, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Boris Krastev
- Department of Clinical Oncology, MHAT Hospital for Women Health Nadezhda, Sofia 1330, Bulgaria
| | | | - Lubomir Spassov
- Department of Cardiothoracic Surgery, University Hospital Lozenetz, Sofia 1431, Bulgaria
| | - Tsvetelina Velikova
- Department of Clinical Immunology, University Hospital Lozenetz, Sofia 1407, Bulgaria
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26
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Levy J, Kashem A, Sunagawa G, Zhao H, Minakata K, Keshavamurthy S, Brann S, Leotta E, Shigemura N, Toyoda Y. POST-OPERATIVE BRONCHIAL COMPLICATIONS FOLLOWING LUNG TRANSPLANTATION RELATED TO ANASTOMOSIS SUTURE. Ann Thorac Surg 2021; 114:293-300. [PMID: 34358521 DOI: 10.1016/j.athoracsur.2021.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Post-operative bronchial anastomotic complications are not uncommon in lung transplant (LTx) recipients. We investigated two surgical techniques (continuous and interrupted sutures) during bronchial anastomosis, comparing survival and post-operative bronchial complications. METHODS We retrospectively analyzed 421 patients who were transplanted in our center (February-2012 to March-2018). Patients were divided according to bronchial anastomotic technique, continuous or interrupted. Demographics and clinical parameters were compared for significance (p<0.05). Comparison of post-operative morbidity included bronchial complications, Veno-Venous extracorporeal membrane oxygenation support and intervention requirements. Survival was assessed using Kaplan-Meier curve and log-rank tests (p<0.05). RESULTS Of the 421 patients, 290 underwent bronchial anastomoses with continuous suture; 44 patients had post-operative bronchial complications (15.2%). Contrarily, 131 patients underwent the interrupted suture technique; 9 patients had post-operative bronchial complications (6.9%). Demographics and clinical parameters included age, gender, ethnicity, etiology, lung allocation score, body mass index, donor age, LTx type, cardiopulmonary bypass usage, surgical approaches, and median length of stay. Post-operative complications (continuous vs. interrupted) were bronchial complications (p=0.017), Veno-venous extracorporeal membrane oxygenation support (p=0.41), Veno-arterial extracorporeal membrane oxygenation support (p=0.38), and complications requiring dilatation with stent placement (p=0.09). Kaplan-Meier curve showed better survival in the interrupted group (p=0.0002). CONCLUSIONS Our study demonstrated the comparable post-operative results between the continuous and interrupted technique.
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Affiliation(s)
- Jacob Levy
- Lankenau Medical Center, Division of General Surgery.
| | - Abul Kashem
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Gengo Sunagawa
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Kenji Minakata
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - Stacey Brann
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Eros Leotta
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Norihisa Shigemura
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Yoshiya Toyoda
- Temple Heart & Vascular Institute, Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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27
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Simonova MS, Rusakov MA, Parshin VD. [Airway complications after lung transplantation]. Khirurgiia (Mosk) 2021:77-83. [PMID: 34270198 DOI: 10.17116/hirurgia202107177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lung transplantations have been regularly performed in the Russian Federation since 2010. Therefore, the number of lung transplant recipients, as well as the number of patients with airway complications following lung transplantation has been increasing. Treatment of these patients takes place not only in transplantation centers, but also in other hospitals. This review is devoted to risk factors, clinical manifestations, treatment and prevention of airway complications after lung transplantation. We analyzed literature data over the last 15 years. It was confirmed that bronchoscopy is a «gold standard» for diagnosis of airway complications while bronchoscopic interventions are preferred for treatment. Balloon and rigid bronchodilation and endoscopic airway stenting are the most effective interventions. Silicone stents are the most optimal. Antimicrobial prophylaxis and timely use of antiproliferative immunosuppressive drugs are important factors in prevention and treatment of airway complications after lung transplantation.
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Affiliation(s)
- M S Simonova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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28
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Utility and Safety of Airway Stenting in Distal Airways Stenosis After Lung Transplant. J Bronchology Interv Pulmonol 2021; 27:274-279. [PMID: 32217948 DOI: 10.1097/lbr.0000000000000673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Airway complications after lung transplantation are a difficult to treat clinical entity. A subset of these patients develop progressive distal airway stenosis (DAS) and a total loss of lobar airways. Stents may be placed to prevent continued obstruction. However, there is little data to suggest stent placement provides durable airway patency or a reduction in the need for further interventions. METHODS A retrospective cohort study was conducted using patients with DAS who underwent a variety of interventions. Demographic information and complications were described using nonparametric methods. Lung function at 1 year and bronchoscopies per month were compared between stented and nonstented patients using a Mann-Whitney test. For patients treated with stenting, bronchoscopies per month were compared before and after stenting using a Wilcoxon signed-rank test. Airway patency was compared between stented and nonstented patients using the Fischer exact test. RESULTS Eleven airways were identified as DAS phenotype, 5 of which were treated with stents. Within the stented airways, a trend toward an increase in bronchoscopies per month was seen after stent placement. Comparing the stented versus nonstented patients, there was no improvement in lung function, no reduction in bronchoscopies per month, and no difference in airway patency for stented patients. CONCLUSION Patients with DAS phenotypes that were treated with endobronchial stenting did not require less airway intervention or have greater final airway patency compared with the nonstented airways. Among the stented patients, the need for airway manipulation did not decrease after stent placement.
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29
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Soetanto V, Grewal US, Mehta AC, Shah P, Varma M, Garg D, Majumdar T, Dangayach NS, Grewal HS. Early postoperative complications in lung transplant recipients. Indian J Thorac Cardiovasc Surg 2021; 38:260-270. [PMID: 34121821 PMCID: PMC8187456 DOI: 10.1007/s12055-021-01178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 10/28/2022] Open
Abstract
Lung transplantation has become an established therapy for end-stage lung diseases. Early postoperative complications can impact immediate, mid-term, and long-term outcomes. Appropriate management, prevention, and early detection of these early postoperative complications can improve the overall transplant course. In this review, we highlight the incidence, detection, and management of these early postoperative complications in lung transplant recipients.
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Affiliation(s)
- Vanessa Soetanto
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Udhayvir Singh Grewal
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA USA
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH USA
| | - Parth Shah
- Department of Medicine, Trumbull Regional Medical Center, Northeast Ohio Medical University, Warren, OH USA
| | - Manu Varma
- Division of Pediatric Cardiology, University of Texas Health Science Center at Houston, Houston, TX USA
| | - Delyse Garg
- Division of Pulmonary and Critical Care Medicine, Newark Beth Israel Medical Center, Newark, NJ USA
| | - Tilottama Majumdar
- Division of Pulmonary and Critical Care Medicine, Newark Beth Israel Medical Center, Newark, NJ USA
| | - Neha S Dangayach
- Department of Neurosurgery, Division of NeuroCritical Care, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Harpreet Singh Grewal
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine Lung Transplantation, NewYork-Presbyterian/Columbia University Medical Center, New York, NY USA
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30
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Nęcki M, Latos M, Urlik M, Antończyk R, Gawęda M, Pandel A, Stącel T, Przybyłowski P, Zembala M, Ochman M. Number of Bronchoscopic Interventions in Lung Transplant Recipients Correlates with Respiratory Function Assessed by Pulmonary Function Tests. Ann Transplant 2021; 26:e927025. [PMID: 33495435 PMCID: PMC7847086 DOI: 10.12659/aot.927025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Lung transplant recipients may suffer from airway stenosis (AS). The aim of this study was to assess whether pulmonary function (as measured by spirometry and a 6-minute walk test [6MWT]) in patients with AS treated consistently with bronchoscopic interventions (BIs) was comparable to that in their AS-free counterparts at the 1-year follow-up visit. Material/Methods Fifty patients who underwent primary double-lung transplantation between January 2015 and March 2019 at a single center (23 who received BIs and 27 who did not) were enrolled in this retrospective study. Graft function was assessed with spirometry, based on forced expiratory volume (FEV1) and forced vital capacity (FVC), both measured in liters (L) and percentages (%), and the Tiffeneau-Pinelli index (FEV1/FVC), and a 6MWT and parameters such as oxygen saturation measured before and after the test. Results Patients in need of BIs had significantly lower FEV1% compared with individuals who did not receive BIs during their first post-transplant year. Airway obstruction was present in 22% of patients who did not receive BIs and 65.23% of those who did receive the interventions. There were statistically significant, strong, negative correlations pertaining to the number of balloon BIs and 1-year FEV1% (rs=0.67) as well as the number of balloon BIs and 1-year FEV1/FVC (rs=0.72). A statistically significant, strong, negative correlation (rs=0.75) was found between the number of balloon bronchoplasty treatments and oxygen saturation after the 6WMT. Conclusions Despite receiving BIs, patients who experience bronchial stenosis may not obtain the expected ventilatory improvement at their 1-year follow-up visit. Their AS may recur or persist despite use of various procedures. Further study in that regard is required.
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Affiliation(s)
- Mirosław Nęcki
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.,Silesian Center for Heart Diseases, Zabrze, Poland
| | - Magdalena Latos
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.,Silesian Center for Heart Diseases, Zabrze, Poland
| | - Maciej Urlik
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.,Silesian Center for Heart Diseases, Zabrze, Poland
| | - Remigiusz Antończyk
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.,Silesian Center for Heart Diseases, Zabrze, Poland
| | - Martyna Gawęda
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.,Silesian Center for Heart Diseases, Zabrze, Poland
| | - Anastazja Pandel
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.,Silesian Center for Heart Diseases, Zabrze, Poland
| | - Tomasz Stącel
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.,Silesian Center for Heart Diseases, Zabrze, Poland
| | - Piotr Przybyłowski
- First Chair of General Surgery, Jagiellonian University , Crcaow, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.,Silesian Center for Heart Diseases, Zabrze, Poland
| | - Marek Ochman
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Katowice, Poland.,Silesian Center for Heart Diseases, Zabrze, Poland
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Izhakian S, Wasser W, Unterman A, Fruchter O, Gorelik O, Kramer M. Long-Term Success of Metal Endobronchial Stents in Lung Transplant Recipients. Thorac Cardiovasc Surg 2021; 70:520-526. [PMID: 33477176 DOI: 10.1055/s-0040-1721461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bronchial stenosis is a common complication following lung transplantation. We evaluated long-term associations of the use of self-expandable metal stents (SEMSs) with lung function tests, patient safety, and survival. METHODS A retrospective chart review of 582 lung transplantations performed at our institution between January 2002 and January 2018. Fifty-four patients with SEMSs (intervention group) were matched one-to-one to patients without SEMSs (control group) using propensity score matching for age, sex, the year, and type of transplantation (unilateral/bilateral), and underlying disease. Data regarding long-term lung function and survival were compared between the groups. RESULTS During a median follow-up of 54.8 months, the difference in survival between the study groups was not statistically significant (p = 0.2). Following 5, 7.5 and 10 years, values of mean forced expiratory volume in 1 second (FEV1) were comparable between patients with and without SEMSs as follows: 59.5 versus 62.6% (p = 0.2), 55.9 versus 55.0% (p = 0.4), and 63.5 versus 61.9% (p = 0.3), respectively. In the intervention group, a significant increase in the mean FEV1 was observed in 60 days after stent insertion (from 41.9 ± 12.8 to 49.5 ± 16.7% days, p < 0.001). Long-term complications following stent insertion included severe bleeding (1.8%), stent fractures (7.4%), stent stenosis (7.4%), stent collapse (3.7%), endobronchial pressure ulcer (1.9%), and stent migration (1.9%). CONCLUSION SEMS insertion is associated with a positive sustained effect on lung function, without increasing long-term mortality. Thus, airway stenosis after lung transplantation can be safely and successfully treated using endobronchial metal stenting, with tight bronchoscopic follow-up and maintenance.
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Affiliation(s)
- Shimon Izhakian
- Rabin Medical Center, The Pulmonary Institute, Petah Tikva, Israel. Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Walter Wasser
- Rambam Health Care Campus, Haifa, Israel. Affiliated to Technion - Israel Institute of Technology, Haifa, Israel
| | - Avraham Unterman
- Rabin Medical Center, The Pulmonary Institute, Petah Tikva, Israel. Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Oren Fruchter
- Edith Wolfson Medical Center, Holon, Israel. Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Oleg Gorelik
- Assaf Harofeh Medical Center, Zerifin, Center Israel. Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Mordechai Kramer
- Edith Wolfson Medical Center, Holon, Israel. Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Kraft BD, Mahmood K, Harlan NP, Hartwig MG, Snyder LD, Suliman HB, Shofer SL. Hyperbaric oxygen therapy to prevent central airway stenosis after lung transplantation. J Heart Lung Transplant 2021; 40:269-278. [PMID: 33518452 DOI: 10.1016/j.healun.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Central airway stenosis (CAS) is a severe airway complication after lung transplantation associated with bronchial ischemia and necrosis. We sought to determine whether hyperbaric oxygen therapy (HBOT), an established treatment for tissue ischemia, attenuates post-transplant bronchial injury. METHODS We performed a randomized, controlled trial comparing usual care with HBOT (2 atm absolute for 2 hours × 20 sessions) in subjects with extensive airway necrosis 4 weeks after transplantation. Endobronchial biopsies were collected at 4, 7, and 10 weeks after transplantation for a quantitative polymerase chain reaction. Coprimary outcomes were incidence of airway stenting and acute cellular rejection (ACR) at 1 year. RESULTS The trial was stopped after enrolling 20 subjects (n = 10 per group) after a pre-planned interim analysis showed no difference between usual care and HBOT groups in stenting (both 40%), ACR (70% and 40%, respectively), or CAS (40% and 60%, respectively). Time to first stent placement (median [interquartile range]) was significantly shorter in the HBOT group (150 [73-150] vs 186 [167-206] days, p < 0.05). HIF gene expression was significantly increased in donor tissues at 4, 7, and 10 weeks after transplantation but was not altered by HBOT. Subjects who developed CAS or required stenting had significantly higher HMOX1 and VEGFA expression at 4 weeks (both p < 0.05). Subjects who developed ACR had significant FLT1, TIE2, and KDR expression at 4 weeks (all p < 0.05). CONCLUSIONS Incidence of CAS is high after severe, established airway necrosis after transplantation. HBOT does not reduce CAS severity or stenting. Elevated HMOX1 and VEGFA expressions appear to associate with airway complications.
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Affiliation(s)
- Bryan D Kraft
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine; Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.
| | - Kamran Mahmood
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
| | - Nicole P Harlan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine; Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Laurie D Snyder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
| | - Hagir B Suliman
- Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Scott L Shofer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
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Interstitial Emphysema as a Rare Radiographic Presentation of Bronchial Dehiscence after Lung Transplant. Case Rep Pulmonol 2020; 2020:8830361. [PMID: 33425421 PMCID: PMC7781711 DOI: 10.1155/2020/8830361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/11/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
Airway complications after lung transplantation are a major cause of morbidity and mortality. Bronchial dehiscence presents within a month of lung transplantation and is typically diagnosed radiographically as a sentinel gas pocket at the anastomotic site and confirmed with bronchoscopy. A 66-year-old man with idiopathic pulmonary fibrosis who underwent a right lung transplantation 4 weeks prior developed chest pain with palpable crepitus over his right chest wall. A chest X-ray revealed subcutaneous emphysema and a small right-sided pneumothorax. Computed tomography (CT) of the thorax without contrast revealed a gas pocket at the anastomotic site in the mediastinum as well as interstitial emphysema around the proximal bronchi of the right lung that had worsened when compared to CT from 11 days prior. A review of prior CT demonstrated interstitial emphysema without evidence of a sentinel gas pocket. These findings suggest that interstitial emphysema was the initial radiographic manifestation of the bronchial anastomotic site dehiscence. Interstitial emphysema is typically self-limiting, but severe cases can lead to major complications. Interstitial emphysema outside of the immediate postoperative period should be recognized as a possible early radiographic sign of bronchial dehiscence in lung transplant patients with vigilant monitoring of potential complications and strong consideration for early bronchoscopic investigation.
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Dunlap DG, Ma KC, DiBardino D. Airway Complications and Endoscopic Management After Lung Transplantation. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00260-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Frye BC, Gasplmayr M, Hettich I, Zissel G, Müller-Quernheim J. Surveillance Bronchoscopy for the Care of Lung Transplant Recipients: A Retrospective Single Center Analysis. Transplant Proc 2020; 53:265-272. [PMID: 32981692 DOI: 10.1016/j.transproceed.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/30/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lung transplantation is often the only treatment for end-stage lung disease. Following lung transplantation, infections and transplant rejections are major obstacles to short- and long-term success. Therefore, close monitoring for these complications is required after lung transplantation. The role of prescheduled surveillance bronchoscopies after lung transplantation is controversial. Thus, we aimed to retrospectively analyze the therapeutic implications of surveillance bronchoscopies in 110 consecutive lung transplant recipients. MATERIALS AND METHODS Results of 400 prescheduled surveillance bronchoscopies of 110 consecutive lung transplant recipients were analyzed. Positive results (pathologic histology, microbiology, or virology) were further investigated for their effect on clinical decision making. Additionally, cellular composition of bronchoalveolar lavage (BAL) was analyzed. RESULTS Two hundred five surveillance bronchoscopies showed pathologic findings. In 81 cases clinical treatment was changed based on the results. That is, 20% of all prescheduled bronchoscopies directly influenced clinical decision making. Furthermore, analyses of BAL indicate that increased alveolar eosinophils are associated with an increased risk of transplant rejection. CONCLUSIONS Prescheduled surveillance bronchoscopies identify clinically unsuspected but therapeutically relevant pathologic findings in approximately 20% of cases. BAL cell composition may confer additional information, especially in cases when biopsy is not possible.
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Affiliation(s)
- Björn Christian Frye
- Department of Pneumology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Markus Gasplmayr
- Department of Pneumology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ina Hettich
- Department of Pneumology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gernot Zissel
- Department of Pneumology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joachim Müller-Quernheim
- Department of Pneumology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Nęcki M, Pandel A, Urlik M, Antończyk R, Latos M, Gawęda M, Stącel T, Wajda-Pokrontka M, Zawadzki F, Okienica M, Przybyłowski P, Zembala M, Ochman M. The Impact of Airway Complications on Survival Among Lung Transplant Recipients. Transplant Proc 2020; 52:2173-2177. [DOI: 10.1016/j.transproceed.2020.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
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Li P, Zhu L, Tang FF, Xiong J, Ma MJ, Dsa M, Gao SH. A Simplified Continuous Two-stitch Suture for Bronchial Anastomosis of Left Single Lung Transplant in Dogs. Curr Med Sci 2020; 40:548-555. [PMID: 32681258 DOI: 10.1007/s11596-020-2212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/20/2020] [Indexed: 11/28/2022]
Abstract
Large animal models are essential to pre-clinical trials of pulmonary transplantation and bronchial anastomosis poses a great technical challenge to the procedure. Presented here is a simplified continuous two-stitch suture technique into bronchial anastomosis during the course of left single lung transplantation in canine. Animals were divided into three groups with each group having 6 animals. Left single lung transplantation in canine was performed to assess the feasibility of using this technique for bronchial anastomosis. In the control groups, all anastomoses were done by using traditional technique. Allograft functions and hemodynamic parameters were monitored during a 3-h reperfusion period. Quality of bronchial healing and airway complications were assessed by bronchoscopic surveillance after transplantation. We successfully completed left lung transplantation in 18 dogs, and all the dogs survived the procedures. The new technique substantially simplified the procedures for bronchial anastomosis and greatly reduced the time for bronchial anastomosis (P<<0.01) and the ischemic time of the grafts (P<0.05) compared to the control group. The continuous two-stitch suture attenuated the tissue injury to allografts and led to better blood gas exchange function as compared to the control group (P<0.05). Good bronchial healing (Grade I) was observed in all the groups. A canine left single lung transplantation model is feasible by using the novel suture technique, and the new technique is as safe as the traditional method. The technique is easy to learn, particularly for less experienced operators. Simpler and time-saving, the technique has great potential to be widely employed in clinical lung transplantation.
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Affiliation(s)
- Ping Li
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Ministry of Education and Chinese Ministry of Health, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lan Zhu
- Key Laboratory of Organ Transplantation, Chinese Ministry of Education and Chinese Ministry of Health, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fei-Fei Tang
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Ministry of Education and Chinese Ministry of Health, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing Xiong
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ming-Jia Ma
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Ministry of Education and Chinese Ministry of Health, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mouniir Dsa
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Laboratory of Organ Transplantation, Chinese Ministry of Education and Chinese Ministry of Health, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Si-Hai Gao
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Key Laboratory of Organ Transplantation, Chinese Ministry of Education and Chinese Ministry of Health, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Ma KC, Li M, Haas AR, Lanfranco AR, Moon EK, DiBardino DM. Efficacy and safety of airway stenting to treat anastomotic complications after lung transplant: a cohort study. J Thorac Dis 2020; 12:3539-3548. [PMID: 32802433 PMCID: PMC7399444 DOI: 10.21037/jtd-20-677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Airway complications affect roughly 15–20% of lung transplant patients. Airway stents are an attractive therapeutic option; however, no experimental or controlled observational data exists to draw firm conclusions regarding airway stent efficacy and safety in this population. Methods We performed a retrospective cohort study of patients who underwent airway stent placement for post-transplant anastomotic airway complications. The primary outcomes were improvements in FEV1 and reduction in bronchoscopies post-stent. Results We identified 36 patients who underwent airway stenting between October 2012 and October 2017. A total of 47 airways underwent stent placement. Improvement in FEV1 after stent placement was only observed in patients who ultimately were able to undergo stent removal. Patients who expired prior to stent removal had no immediate FEV1 improvement after stent placement. Among subjects who underwent stent removal, there was a statistically significant reduction in number of bronchoscopies per month after stent removal compared to pre-stent placement. Male gender was the only predictor of FEV1 improvement after stent placement while male gender and dehiscence prior to stent placement predicted increased number of bronchoscopies after stent placement. Mucous plugging and granulation tissue formation were the most common stent related complications. Conclusions Only select patients benefit from stent placement for airways stenosis after lung transplant. Complications related to stent placement are common. Patients with airway complications treated with airway stents undergo a high volume of repeat procedures.
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Affiliation(s)
- Kevin C Ma
- Section of Interventional Pulmonology, Division of Pulmonary, Allergy, & Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Mingyang Li
- Departments of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew R Haas
- Section of Interventional Pulmonology, Division of Pulmonary, Allergy, & Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony R Lanfranco
- Section of Interventional Pulmonology, Division of Pulmonary, Allergy, & Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Edmund K Moon
- Section of Interventional Pulmonology, Division of Pulmonary, Allergy, & Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - David M DiBardino
- Section of Interventional Pulmonology, Division of Pulmonary, Allergy, & Critical Care, University of Pennsylvania, Philadelphia, PA, USA
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Nęcki M, Gawęda M, Pandel A, Urlik M, Antończyk R, Latos M, Wajda-Pokrontka M, Zawadzki F, Przybyłowski P, Zembala M, Stącel T, Ochman M. Microbiological Status as a Factor of Airway Complications After Lung Transplantation. Transplant Proc 2020; 52:2149-2154. [PMID: 32446686 DOI: 10.1016/j.transproceed.2020.02.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lung transplantation (LTx) is the only treatment for patients with end-stage lung disease. This procedure is associated with a risk of complications related to airway stenosis, which can be treated by means of bronchoscopic interventions (BI). Microbiological colonization may have an impact on airway complications. The aim of the study was to investigate the effect of presence of microbiological pathogens in graft among lung recipients and frequency of BI, considered as the indicator of severe complications. MATERIALS AND METHODS The study design was single-center retrospective cohort research; cases of 116 patients with complete microbiological data who underwent LTx from April 2013 to June 2019 were reviewed (70.3% of transplanted patients). All statistical analyses were performed with SPSS version 25.0 and R 3.5.3. For analyses involving the number of bronchoscopy interventions, univariate and multivariate Poisson regression were used. Interaction effect of variables in multivariate Poisson regression was assessed with partial response plot. RESULTS The mean number of pathogens colonizing each patient was approximately 4.66 (range, 0 to 19) with Candida albicans (n = 42, 36.2%), Aspergillus spp. (n = 33, 28.4%), Pseudomonas aeruginosa (n = 32, 27.59%), and methicillin-sensitive Staphylococcus aureus (MSSA) (n = 29, 25%) being the most prominent. Microbiological agents causing the greatest increase in the risk of intervention are as follows: Proteus mirabilis by 3.84 times, Aspergillus spp. by 3.53 times, and Stenotrophomonas maltophilia by 3.09 times. Burkholderia multivorans, Enterococcus spp., and Klebsiella spp. do not have a statistically significant impact on the number of BI. CONCLUSIONS Some pathogens increase the frequency of complications, which are associated with deterioration of the general condition. Therefore, patients should be monitored for the presence of pathogens in the airways.
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Affiliation(s)
| | - Martyna Gawęda
- Silesian Center for Heart Diseases, Zabrze Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Anastazja Pandel
- Silesian Center for Heart Diseases, Zabrze Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland.
| | - Maciej Urlik
- Silesian Center for Heart Diseases, Zabrze Poland
| | - Remigiusz Antończyk
- Silesian Center for Heart Diseases, Zabrze Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Magdalena Latos
- Silesian Center for Heart Diseases, Zabrze Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Marta Wajda-Pokrontka
- Silesian Center for Heart Diseases, Zabrze Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Fryderyk Zawadzki
- Silesian Center for Heart Diseases, Zabrze Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Piotr Przybyłowski
- Silesian Center for Heart Diseases, Zabrze Poland; First Chair of General Surgery, Jagiellonian University, Medical College, Kraków, Poland
| | - Marian Zembala
- Silesian Center for Heart Diseases, Zabrze Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
| | | | - Marek Ochman
- Silesian Center for Heart Diseases, Zabrze Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Zabrze, Poland
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40
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Nęcki M, Antończyk R, Pandel A, Gawęda M, Latos M, Urlik M, Stącel T, Wajda-Pokrontka M, Zawadzki F, Przybyłowski P, Zembala M, Ochman M. Impact of Cold Ischemia Time on Frequency of Airway Complications Among Lung Transplant Recipients. Transplant Proc 2020; 52:2160-2164. [PMID: 32430145 DOI: 10.1016/j.transproceed.2020.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND The cold ischemia time (CIT) is a period of time between harvesting an organ for transplant and its reperfusion just after implantation. CIT may have an impact on frequency of complications after lung transplant that can be treated by means of bronchoscopic intervention. The aim of the study was to investigate the correlation between CIT and frequency of bronchoscopic intervention. METHODS The retrospective study consists of 91 patients: 22 single lung recipients (24%) and 69 double lung recipients (76%) who underwent lung transplant from March 2012 to June 2019. All statistical analyses were performed in SPSS 25.0 and R 3.5.3. The P levels less than .05 were deemed statistically significant. RESULTS The average CIT in single lung transplant was 5.91 hours, and in double lung transplant it was 8.61 hours. For the 4- to 8-hour CIT the percentages were 80.95% for single lung recipients and 46.38% for double lung recipients. For CIT longer than 8 hours, the following percentages were observed: 9.53% in single lung transplant and 53.62% in double lung transplant. Each subsequent hour of CIT exponentially increases the risk of intervention 1505 times (50.05%). CONCLUSIONS Prolonged CIT seems to be a risk factor for airway complication, especially in the double lung recipient group.
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Affiliation(s)
| | - Remigiusz Antończyk
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Anastazja Pandel
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - Martyna Gawęda
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Magdalena Latos
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Maciej Urlik
- Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Marta Wajda-Pokrontka
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Fryderyk Zawadzki
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Piotr Przybyłowski
- Silesian Center for Heart Diseases, Zabrze, Poland; First Chair of General Surgery, Jagiellonian University, Medical College, Kraków, Poland
| | - Marian Zembala
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Marek Ochman
- Silesian Center for Heart Diseases, Zabrze, Poland; Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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Patoir A, Luchez A, Tiffet O, Vercherin P, Grima R, Tronc F, Philit F, Mornex JF, Vergnon JM, Maury JM. Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy. J Thorac Dis 2020; 12:2625-2634. [PMID: 32642170 PMCID: PMC7330399 DOI: 10.21037/jtd.2020.03.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background After lung transplantation (LT), between 2% and 25% of bronchial anastomoses develop complications requiring therapeutic intervention. The status of healing of both bronchial anastomoses and downhill airways are well described by the French consensual MDS standardized grading system (Macroscopic, Diameter, Suture). We analyzed risks factors for airway complications (AC) after transplantation and the way we managed them. We report here our challenging method of early rigid bronchoscopic intervention with airway stenting on bronchial healing. Methods All single center consecutives LTs were retrospectively analyzed between 2010-2016. Patient-level data (demographic, peri-operative data) and anastomosis-level data (surgical parameters, bronchoscopy findings) were monitored. The incidence and contributive factors of ACs are reported. We also reported modalities of the conservative treatment and outcome. Results A total of 121 LTs were performed, 39 single-lung and 82 bilateral sequential LT. Main indication for LT were cystic fibrosis (45%) and emphysema (25%) and 58 were male patients (n=70). After a waiting period of healing, 28 patients presented AC on 41 anastomoses (prevalence: 23%). A multivariate analysis found as contributive factors of ACs, post-operative infection by Aspergillus [odds ratio (OR) 2.7, 95% confidence interval (CI): 1.08-6.75; P=0.033] at the patient level, and at the anastomosis level, emphysema (OR 2.4, 95% CI: 1.02-5.6; P=0.045), early dehiscence (OR 11.2, 95% CI: 1.7-76; P=0.01) and cold ischemia time >264 min (OR 2.45, 95% CI: 1.08-5.6; P=0.03). All the 41 ACs were managed conservatively with rigid bronchoscopy (range, 1-10), 41 stents (21 in silicone and 20 fully-covered Silicone Expandable Metallic Stents) without major complication. Two AC were still under regular bronchoscopic care and silicone stenting for long left bronchus reason. No surgical intervention was needed. The 2-years overall survival rate where not different between AC group and controls, respectively 85% and 81%. Conclusions Airway healing after transplantation remains a scalable process and the French consensual MDS classification helped us for therapeutic decisions. Rigid bronchoscopy and safety use of current stenting devices may have the pivotal role in the conservative management of ACs, avoiding perilous situation of surgery for AC. Despite a high rate of AC, their favorable evolution may be explained by the cautious care of airway healing and maybe by the use of the Celsior antioxidant solution.
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Affiliation(s)
- Arnaud Patoir
- Department of Thoracic Surgery, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
| | - Antoine Luchez
- Pneumology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
| | - Olivier Tiffet
- Department of Thoracic Surgery, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France
| | - Paul Vercherin
- Department of Thoracic Surgery, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France.,Pneumology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France.,Public Health and Medical Informatics Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France.,Department of Thoracic Surgery and Lung and Heart-Lung Transplantation, Hospices Civils de Lyon, Lyon, France.,Pneumology and Lung Transplantation Department, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, UMR754, INRA, Lyon, France.,Université de Lyon, Université Jean Monnet de Saint-Etienne, INSERM, U 1059 Sainbiose, F-42023, Saint-Etienne, France
| | - Renaud Grima
- Department of Thoracic Surgery and Lung and Heart-Lung Transplantation, Hospices Civils de Lyon, Lyon, France
| | - François Tronc
- Department of Thoracic Surgery and Lung and Heart-Lung Transplantation, Hospices Civils de Lyon, Lyon, France
| | - François Philit
- Pneumology and Lung Transplantation Department, Hospices Civils de Lyon, Lyon, France
| | - Jean-François Mornex
- Pneumology and Lung Transplantation Department, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, UMR754, INRA, Lyon, France
| | - Jean-Michel Vergnon
- Pneumology Department, Saint-Etienne University Hospital, North Hospital, 42055 Saint Étienne CEDEX 2, France.,Université de Lyon, Université Jean Monnet de Saint-Etienne, INSERM, U 1059 Sainbiose, F-42023, Saint-Etienne, France
| | - Jean-Michel Maury
- Department of Thoracic Surgery and Lung and Heart-Lung Transplantation, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, UMR754, INRA, Lyon, France
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Commentary: Running bronchial anastomotic suture in lung transplantation: Should we run before we walk? J Thorac Cardiovasc Surg 2020; 160:1110-1111. [PMID: 32279959 DOI: 10.1016/j.jtcvs.2020.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 11/21/2022]
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Risk of Bronchial Dehiscence in Lung Transplant Recipients With Carbapenemase-producing Klebsiella. Ann Thorac Surg 2020; 110:265-271. [PMID: 32151582 DOI: 10.1016/j.athoracsur.2020.01.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/12/2020] [Accepted: 01/30/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Klebsiella pneumoniae is commonly isolated after lung transplantation. This study observed an increase in bronchial complications after an outbreak of Klebsiella pneumoniae carbapenemase-producing Klebsiella (KPC-KP). METHODS The study enrolled 173 patients who had undergone bilateral lung transplantation between 2012 and 2018 to examine the association between bronchial complications after lung transplantation and KPC-KP. The KPC-KP group was defined as patients whose isolates from sputum or bronchoalveolar lavage fluid were positive for KPC-KP. The presence of bronchial complications was defined as a positive finding on bronchoscopy in accordance with the criteria of the International Society for Heart and Lung Transplantation. Risk factors for bronchial complications were analyzed. RESULTS KPC-KP was identified in 29 patients (16.8%), and bronchial dehiscence was observed in 13 patients (7.5%). Smoking (odds ratio [OR], 5.690; 95% confidence interval [CI], 1.106- to 9.260; P = .037), the presence of KPC-KP (OR, 5.360; 95% CI, 1.380 to 20.810; P = .015), and bronchial necrosis (OR, 7.009; 95% CI, 1.811 to 27.124; P = .005) were associated with bronchial dehiscence in a multivariate logistic regression model. CONCLUSIONS The presence of KPC-KP in lung-transplant recipients significantly increased the risk of bronchial dehiscence, independent of bronchial necrosis. Thus, patients with KPC-KP require greater surveillance and follow-up bronchoscopy, irrespective of the presence or absence of bronchial necrosis or the overall patient condition.
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Schweiger T, Nenekidis I, Stadler JE, Schwarz S, Benazzo A, Jaksch P, Hoetzenecker K, Klepetko W. Single running suture technique is associated with low rate of bronchial complications after lung transplantation. J Thorac Cardiovasc Surg 2020; 160:1099-1108.e3. [PMID: 32580901 DOI: 10.1016/j.jtcvs.2019.12.119] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lung transplantation has evolved to a routinely performed surgical procedure in patients with end-stage pulmonary disease. Bronchial healing problems are rare but represent a potential life-threatening complication. Herein, we aimed to define the incidence, classification, and treatment of bronchial complications after lung transplantation. MATERIAL AND METHODS All patients receiving lung transplantation between January 1999 and December 2017 were included in this retrospective study. All bronchial anastomoses were performed in a standardized technique using a single, polydioxanone running suture. The rate of anastomotic complications requiring an intervention, type of complication according the 2018 International Society for Heart and Lung Transplantation classification, and the clinical management were retrospectively analyzed. RESULTS A total of 2941 anastomoses were performed in 1555 patients. The overall incidence of relevant anastomotic complications was 1.56%, 0.68% for left anastomoses, and 2.44% for right anastomoses. In 6 patients, a surgical revision or retransplantation was performed, whereas endoscopic treatment alone was sufficient in 39 patients. One patient underwent right-sided retransplantation 6 months after the first lung transplantation after failed endoscopic treatment attempts. International Society for Heart and Lung Transplantation grade "S Lc Ec" was the most common type of anastomotic complication. The overall incidence decreased within the study period from 2.4% in the era 1999 to 2003 to 0.8% in the era 2014 to 2017. We found no significant difference in overall survival of patients with and without anastomotic complications (P = .995; hazard ratio, 0.99; 95% confidence interval, 0.63-1.58). CONCLUSIONS The single running suture technique is associated with a very low rate of true anastomotic complications. Close follow-up and early endoscopic treatment of patients with anastomotic complications result in excellent long-term outcomes.
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Affiliation(s)
- Thomas Schweiger
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Stefan Schwarz
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Alberto Benazzo
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Walter Klepetko
- Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
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Impact of Cold Ischemic Time on Airway Complications After Lung Transplantation: A Single-center Cohort Study. Transplant Proc 2019; 51:2981-2985. [DOI: 10.1016/j.transproceed.2019.04.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/13/2019] [Indexed: 11/21/2022]
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Shigemura N, Toyoda Y. Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation. Transpl Int 2019; 33:347-355. [DOI: 10.1111/tri.13533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/26/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Norihisa Shigemura
- Division of Cardiovascular Surgery Temple University Health System and Lewis Katz School of Medicine Philadelphia PA USA
| | - Yoshiya Toyoda
- Division of Cardiovascular Surgery Temple University Health System and Lewis Katz School of Medicine Philadelphia PA USA
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Aslam S, Courtwright AM, Koval C, Lehman SM, Morales S, Langlais Furr CL, Rosas F, Brownstein MJ, Fackler JR, Sisson BM, Biswas B, Henry M, Luu T, Bivens BN, Hamilton T, Duplessis C, Logan C, Law N, Yung G, Turowski J, Anesi J, Strathdee SA, Schooley RT. Early clinical experience of bacteriophage therapy in 3 lung transplant recipients. Am J Transplant 2019; 19:2631-2639. [PMID: 31207123 PMCID: PMC6711787 DOI: 10.1111/ajt.15503] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 01/25/2023]
Abstract
Bacteriophage therapy (BT) uses bacteriophages to treat pathogenic bacteria and is an emerging strategy against multidrug-resistant (MDR) infections. Experience in solid organ transplant is limited. We describe BT in 3 lung transplant recipients (LTR) with life-threatening MDR infections caused by Pseudomonas aeruginosa (n = 2) and Burkholderia dolosa (n = 1). For each patient, lytic bacteriophages were selected against their bacterial isolates. BT was administered for variable durations under emergency Investigational New Drug applications and with patient informed consent. Safety was assessed using clinical/laboratory parameters and observed clinical improvements described, as appropriate. All patients received concurrent antibiotics. Two ventilator-dependent LTR with large airway complications and refractory MDR P. aeruginosa pneumonia received BT. Both responded clinically and were discharged from the hospital off ventilator support. A third patient had recurrent B. dolosa infection following transplant. Following BT initiation, consolidative opacities improved and ventilator weaning was begun. However, infection relapsed on BT and the patient died. No BT-related adverse events were identified in the 3 cases. BT was well tolerated and associated with clinical improvement in LTRs with MDR bacterial infection not responsive to antibiotics alone. BT may be a viable adjunct to antibiotics for patients with MDR infections.
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Affiliation(s)
- Saima Aslam
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Andrew M. Courtwright
- Department of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christine Koval
- Department of Infectious Diseases, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | | | | | | | | | | | - Biswajit Biswas
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick, MD
| | - Matthew Henry
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick, MD
| | - Truong Luu
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick, MD
| | - Brittany N. Bivens
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick, MD
| | - Theron Hamilton
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick, MD
| | - Christopher Duplessis
- Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick, MD
| | - Cathy Logan
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Nancy Law
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Gordon Yung
- Division of Pulmonary, Critical Care & Sleep Medicine, University of California San Diego, La Jolla, CA
| | - Jason Turowski
- Department of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Judith Anesi
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia PA
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Robert T. Schooley
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
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Malas J, Ranganath NK, Phillips KG, Bittle GJ, Hisamoto K, Smith DE, Lesko MB, Angel LF, Lonze BE, Kon ZN. Early airway dehiscence: Risk factors and outcomes with the rising incidence of extracorporeal membrane oxygenation as a bridge to lung transplantation. J Card Surg 2019; 34:933-940. [DOI: 10.1111/jocs.14157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jad Malas
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryNYU Langone Health New York New York
| | - Neel K. Ranganath
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryNYU Langone Health New York New York
| | - Katherine G. Phillips
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryNYU Langone Health New York New York
| | - Gregory J. Bittle
- Department of Cardiothoracic SurgeryUniversity of Maryland Medical Center Baltimore Maryland
| | - Kazuhiro Hisamoto
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryNYU Langone Health New York New York
| | - Deane E. Smith
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryNYU Langone Health New York New York
| | | | - Luis F. Angel
- Department of MedicineNYU Langone Health New York New York
| | - Bonnie E. Lonze
- Department of Surgery, Transplant InstituteNYU Langone Health New York New York
| | - Zachary N. Kon
- Department of Cardiothoracic Surgery, Division of Cardiac SurgeryNYU Langone Health New York New York
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Walters DM, Kuckelman JP, Mulligan MS. Electromagnetic navigational bronchoscopic airway recanalization in patients with vanishing bronchus. J Surg Res 2018; 231:154-160. [DOI: 10.1016/j.jss.2018.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 12/27/2022]
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