1
|
Freiberger D, Gould Delaney A, Forbes P, Manley D, Visner GA. Pediatric lung transplant: Correlation of pretransplant condition with post-transplant outcomes. Pediatr Transplant 2021; 25:e13889. [PMID: 33118294 DOI: 10.1111/petr.13889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/20/2020] [Accepted: 09/28/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND It is generally accepted that patients who have greater functional capacity are better candidates for lung transplantation. Accurate assessment of physical condition is important in identifying appropriate candidates for transplant. The focus of this study was to determine which measures of pretransplant physical condition correlate with positive post-transplant outcomes in children undergoing lung transplant. METHODS A retrospective chart review was done on 44 patients, ages 5 to 21 years. The pretransplant data collected included functional status, 6MWT, ambulatory status, and mechanical support. Post-transplant outcome data included time on the ventilator, days in the ICU, length of hospitalization, and 12-month survival. RESULTS Results were analyzed using Fisher exact and Kruskal-Wallis tests. Patients with limited ambulation had more days in the ICU compared to the most ambulatory group (P = .043). Patients independent or needing some help with ADL had less time on the ventilator compared to patients needing total help. (P = .014). Patients with 6MWT result greater than 500' had fewer ICU days (P = .044) and marginally better 12-month survival (P = .057). The 12-month survival of children needing invasive ventilatory support pretransplant was not significantly worse than those who did not; however, they required significantly more time on the ventilator (P = .004), days in ICU (P = .013), and longer hospitalization. DISCUSSION This study demonstrated that pretransplant physical condition affects post-transplant outcomes in children. Measures associated with positive post-transplant outcomes were identified and could be beneficial in determining which patients are optimal candidates for lung transplant.
Collapse
Affiliation(s)
- Dawn Freiberger
- Division of Pulmonary Medicine, Pediatric Transplant Center, Boston Children's Hospital, Boston, MA, USA
| | - Anne Gould Delaney
- Division of Pulmonary Medicine, Pediatric Transplant Center, Boston Children's Hospital, Boston, MA, USA
| | - Peter Forbes
- Division of Pulmonary Medicine, Pediatric Transplant Center, Boston Children's Hospital, Boston, MA, USA
| | - Donna Manley
- Division of Pediatric Allergy and Pulmonary, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Gary A Visner
- Division of Pulmonary Medicine, Pediatric Transplant Center, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
2
|
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
| |
Collapse
|
3
|
The Impact of Waiting List BMI Changes on the Short-term Outcomes of Lung Transplantation. Transplantation 2018; 102:318-325. [PMID: 28825952 DOI: 10.1097/tp.0000000000001919] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Obesity and underweight are associated with a higher postlung transplantation (LTx) mortality. This study aims to assess the impact of the changes in body mass index (BMI) during the waiting period for LTx on early postoperative outcomes. METHODS Medical records of 502 consecutive cases of LTx performed at our institution between 1999 and 2015 were reviewed. Patients were stratified per change in BMI category between pre-LTx assessment (candidate BMI) and transplant BMI as follows: A-candidate BMI, less than 18.5 or 18.5 to 29.9 and transplant BMI, less than 18.5; B-candidate BMI, less than 18.5 and transplant BMI, 18.5 to 29.9; C-candidate BMI, 18.5 to 29.9 and transplant BMI, 18.5 to 29.9; D-candidate BMI, 30 or greater and transplant BMI, 18.5 to 29.9; and E-candidate BMI, 30 or greater or 18.5 to 29.9 and transplant BMI, 30 or greater. Our primary outcome was in-hospital mortality and secondary outcomes were length of mechanical ventilation, intensive care unit length of stay (LOS), hospital LOS and postoperative complications. RESULTS BMI variation during the waiting time was common, as 1/3 of patients experienced a change in BMI category. Length of mechanical ventilation (21 days vs 9 days; P = 0.018), intensive care unit LOS (26 days vs 15 days; P = 0.035), and rates of surgical complications (76% vs 44%; P = 0.018) were significantly worse in patients of group E versus group D. Obese candidates who failed to decrease BMI less than 30 by transplant exhibited an increased risk of postoperative mortality (odds ratio, 2.62; 95% confidence interval, 1.01-6.48) compared with patients in group C. Pre-LTx BMI evolution had no impact on postoperative morbidity and mortality in underweight patients. CONCLUSIONS Our results suggest that obese candidates with an unfavorable pretransplant BMI evolution are at greater risk of worse post-LTx outcomes.
Collapse
|
4
|
Clausen ES, Frankel C, Palmer SM, Snyder LD, Smith PJ. Pre-transplant weight loss and clinical outcomes after lung transplantation. J Heart Lung Transplant 2018; 37:1443-1447. [PMID: 30228085 DOI: 10.1016/j.healun.2018.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/20/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Patients with greater adiposity before lung transplantation are at an increased risk for worse post-transplant outcomes. Few studies have addressed whether pre-transplant weight loss mitigates this risk. In this study we examined the association between pre-transplant weight loss and post-transplant clinical outcomes. METHODS We conducted a retrospective cohort study of patients who received a lung transplant at the Duke University Hospital from May 1, 2005 to April 30, 2015. The sample included adult transplant recipients with restrictive, obstructive, and vascular diseases. Cox proportional hazards models were used to examine mortality and chronic lung allograft dysfunction (CLAD)-free survival, and negative binomial regression analyses were used to examine length of stay (LOS). Weight loss was assessed from change in body mass index (BMI). RESULTS The cohort consisted of 810 patients. Initially, 403 (50%) were overweight and 109 (13%) were obese by BMI criteria. Greater pre-transplant weight loss was associated with dose-response improvements in survival (hazard ratio [HR] 0.83 [0.72 to 0.97], p = 0.018), with modest (0% to 3%, HR 0.91), moderate (7% to 10%, HR 0.83), and high (>15%, HR 0.71) levels of weight loss conferring longer survival, independent of initial weight (p = 0.533 for interaction). Weight loss was also associated with improved CLAD-free survival (HR 0.84 [0.71 to 0.99], p = 0.034) and shorter LOS (b = ‒0.17, p < 0.001). CONCLUSIONS Weight loss before transplantation was associated with improved short- and long-term clinical outcomes, independent of initial weight. Survival improved proportionally to percentage of weight lost. The mechanisms by which weight loss improve clinical outcomes warrant further exploration.
Collapse
Affiliation(s)
- Emily Siu Clausen
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA.
| | - Courtney Frankel
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Scott M Palmer
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Laurie D Snyder
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Patrick J Smith
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
5
|
DiCecco SR, Francisco-Ziller N. Obesity and organ transplantation: successes, failures, and opportunities. Nutr Clin Pract 2014; 29:171-91. [PMID: 24503157 DOI: 10.1177/0884533613518585] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The increasing rate of societal obesity is also affecting the transplant world through obesity in candidates and donors as well as its posttransplant repercussions. Being overweight and obese has been shown to have significant effects on both short- and long-term complications as well as patient and graft survival. However, much of the comorbidity can be controlled or prevented with careful patient selection and aggressive management. A team approach to managing obesity and its comorbidities both pre- and posttransplant is essential for successful transplant outcomes. Complicating understanding the results of obesity research is the inclusion different weight categories, use of listing vs transplant weights, patient populations large enough for statistical power, and changes in transplant management, especially immunosuppression protocols, anti-infection protocols, and operative techniques. Much more research is needed regarding many elements, including safe weight loss before transplantation, prevention of weight gain after transplant, genomic influences, and the role of bariatric surgery in the transplant process.
Collapse
Affiliation(s)
- Sara R DiCecco
- Sara R. DiCecco, Mayo Clinic Hospital-Rochester Methodist Campus, 201 West Center Street, Rochester, MN 55902, USA.
| | | |
Collapse
|
6
|
Abstract
For selected parenchymal lung disease patients who fail to respond to medical therapy and demonstrate declines in function that place them at increased risk for mortality, lung transplantation should be considered. Lung transplantation remains a complex medical intervention that requires a dedicated recipient and medical team. Despite the challenges, lung transplantation affords appropriate patients a reasonable chance at increased survival and improved quality of life. Lung transplantation remains an appropriate therapeutic option for selected patients with parenchymal lung disease.
Collapse
Affiliation(s)
- Timothy P M Whelan
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
| |
Collapse
|
7
|
Genao L, Whitson H, Zaas D, Sanders L, Schmader KE. Functional status after lung transplantation in older adults in the post-allocation score era. Am J Transplant 2013; 13:157-66. [PMID: 23167959 PMCID: PMC3535527 DOI: 10.1111/j.1600-6143.2012.04299.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 08/28/2012] [Accepted: 09/01/2012] [Indexed: 01/25/2023]
Abstract
This manuscript describes the functional status trajectory of older (age 65 or older) and younger (age 18-64) adults after lung transplantation (LT). After the implementation of the lung allocation score (LAS) in 2005, older adults became the fastest growing subgroup of recipients. Yet the impact of LT on physical function, a main determinant of quality of life in older adults, is unknown. We conducted a retrospective cohort study using United Network for Organ Sharing data on 4805 adults who received a LT during 2005-2009. We divided them into older (≥65; n = 774) and younger (18-64; n = 4031) cohorts. Functional status was measured by Karnofsky performance score (KPS). Mixed models estimated the impact of age group on the rate of functional decline starting at 1 year posttransplantation. We controlled for KPS at transplantation, gender, race, diagnosis, LAS and LT type. Age group was not associated with different rates of decline in KPS over time. On average, recipients who were older, received a single LT, or had a low KPS at transplantation had worse functional status posttransplantation when compared to their counterparts, but rarely reached disability at 48 months. Overall, LT had a positive and durable effect on physical function for both older and younger recipients.
Collapse
Affiliation(s)
- L. Genao
- Division of Geriatrics, Duke University, Geriatrics Research Education and Clinical Center Durham VA Medical Center, Durham, NC
| | - H.E. Whitson
- Division of Geriatrics, Duke University, Geriatrics Research Education and Clinical Center Durham VA Medical Center, Durham, NC,Department of Medicine, Duke University, Geriatrics Research Education and Clinical Center Durham VA Medical Center, Durham, NC
| | - D. Zaas
- Division of Pulmonary and Lung Transplantation, Duke University, Geriatrics Research Education and Clinical Center Durham VA Medical Center, Durham, NC
| | - L.L. Sanders
- Division of General Internal Medicine, Duke University, Geriatrics Research Education and Clinical Center Durham VA Medical Center, Durham, NC
| | - K. E. Schmader
- Division of Geriatrics, Duke University, Geriatrics Research Education and Clinical Center Durham VA Medical Center, Durham, NC
| |
Collapse
|
8
|
Hoy HM, Feurer ID, Alexander S, Loyd J, Wells N, Pinson CW. Negative Effects of Pretransplant Body Mass Index on Physical Health—Related Quality of Life after Lung Transplant. Prog Transplant 2012. [DOI: 10.7182/pit2012582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Although current national data show improved graft and patient survival following lung transplant, the effects of several modifiable preexisting comorbid conditions on health-related quality of life after transplant have not been evaluated. This study examines the effects of 3 comorbid conditions present before lung transplant (reduced bone density, diabetes mellitus, and elevated body mass index) on health-related quality of life after lung transplant. Methods The Short Form 36 Health Survey was completed by 92 adult recipients at various times after lung transplant (mean, 41 months; range, 1–127 months). Multiple linear regression models that controlled for underlying disease, chronic rejection, and time after transplant tested the independent effects of the 3 pretransplant conditions on posttransplant health-related quality of life. Results The effects of pretransplant reduced bone density and diabetes mellitus were not statistically significant in these models. However, pretransplant body mass index had a significant negative effect (β = −.29, P = .007) on posttransplant physical health–related quality of life. Additionally, overweight status and obesity exerted comparable independent negative effects ( P = .01 and P = .03, respectively) on the physical function scale of the Short-Form 36 Health Survey compared with persons who were underweight or normal weight before transplant. Conclusions Reevaluation of elevated body mass index before transplant as a risk for reduced physical quality of life after lung transplant should be considered.
Collapse
Affiliation(s)
- Haley M. Hoy
- Vanderbilt Transplant Center, Nashville, Tennessee (HMH, IDF, JL, NW, CWP), University of Alabama, Huntsville (HMH, SA), Vanderbilt University Medical Center, Nashville, Tennessee (IDF, CWP)
| | - Irene D. Feurer
- Vanderbilt Transplant Center, Nashville, Tennessee (HMH, IDF, JL, NW, CWP), University of Alabama, Huntsville (HMH, SA), Vanderbilt University Medical Center, Nashville, Tennessee (IDF, CWP)
| | - Susan Alexander
- Vanderbilt Transplant Center, Nashville, Tennessee (HMH, IDF, JL, NW, CWP), University of Alabama, Huntsville (HMH, SA), Vanderbilt University Medical Center, Nashville, Tennessee (IDF, CWP)
| | - Jim Loyd
- Vanderbilt Transplant Center, Nashville, Tennessee (HMH, IDF, JL, NW, CWP), University of Alabama, Huntsville (HMH, SA), Vanderbilt University Medical Center, Nashville, Tennessee (IDF, CWP)
| | - Nancy Wells
- Vanderbilt Transplant Center, Nashville, Tennessee (HMH, IDF, JL, NW, CWP), University of Alabama, Huntsville (HMH, SA), Vanderbilt University Medical Center, Nashville, Tennessee (IDF, CWP)
| | - C. Wright Pinson
- Vanderbilt Transplant Center, Nashville, Tennessee (HMH, IDF, JL, NW, CWP), University of Alabama, Huntsville (HMH, SA), Vanderbilt University Medical Center, Nashville, Tennessee (IDF, CWP)
| |
Collapse
|
9
|
Neuringer IP, Noone P, Cicale RK, Davis K, Aris RM. Managing complications following lung transplantation. Expert Rev Respir Med 2012; 3:403-23. [PMID: 20477331 DOI: 10.1586/ers.09.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Lung transplantation has become a proven therapeutic option for patients with end-stage lung disease, extending life and providing improved quality of life to those who otherwise would continue to be breathless and oxygen-dependent. Over the past 20 years, considerable experience has been gained in understanding the multitude of medical and surgical issues that impact upon patient survival. Today, clinicians have an armamentarium of tools to manage diverse problems such as primary graft dysfunction, acute and chronic allograft rejection, airway anastomotic issues, infectious complications, renal dysfunction, diabetes and osteoporosis, hematological and gastrointestinal problems, malignancy, and other unique issues that confront immunosuppressed solid organ transplant recipients.
Collapse
Affiliation(s)
- Isabel P Neuringer
- Division of Pulmonary and Critical Care Medicine and the Cystic Fibrosis/Pulmonary Research and Treatment Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7524, USA.
| | | | | | | | | |
Collapse
|
10
|
Abstract
In the last 45 years, lung transplantation has evolved from its status as a rare extreme form of surgical therapy for the treatment of advanced lung diseases to an accepted therapeutic option for select patients. Although pulmonary fibrosis and pulmonary vascular diseases are important indications for lung transplantation, only a small percentage of transplants are performed in patients with collagen vascular diseases. The reasons for this low number are multifactorial. This article reviews issues relevant to all lung transplant candidates and recipients as well as those specific to patients with autoimmune diseases.
Collapse
Affiliation(s)
- James C Lee
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | | |
Collapse
|
11
|
Quétant S, Rochat T, Pison C. Résultats de la transplantation pulmonaire. Rev Mal Respir 2010; 27:921-38. [DOI: 10.1016/j.rmr.2010.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 04/07/2010] [Indexed: 11/30/2022]
|
12
|
de la Torre M, Delgado M, Paradela M, González D, Fernández R, García J, Fieira E, Borro J. Influence of Body Mass Index in the Postoperative Evolution After Lung Transplantation. Transplant Proc 2010; 42:3026-8. [DOI: 10.1016/j.transproceed.2010.07.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
13
|
Gerbase MW, Soccal PM, Spiliopoulos A, Nicod LP, Rochat T. Long-term health-related quality of life and walking capacity of lung recipients with and without bronchiolitis obliterans syndrome. J Heart Lung Transplant 2008; 27:898-904. [PMID: 18656804 DOI: 10.1016/j.healun.2008.04.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 04/18/2008] [Accepted: 04/28/2008] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Outcome after lung transplantation (LTx) is affected by the onset of bronchiolitis obliterans syndrome (BOS) and lung function decline. Reduced health-related quality of life (HRQL) and physical mobility have been shown in patients developing BOS, but the impact on the capacity to walk is unknown. We aimed to compare the long-term HRQL and 6-minute walk test (6MWT) between lung recipients affected or not by BOS Grade > or =2. METHODS Fifty-eight patients were prospectively followed for 5.6 +/- 2.9 years after LTx. Assessments included the St George's Respiratory Questionnaire (SGRQ) and the 6MWT, which were performed yearly. Moreover, clinical complications were recorded to estimate the proportion of the follow-up time lived without clinical intercurrences after transplant. Analyses were performed using adjusted linear regression and repeated-measures analysis of variance. RESULTS BOS was a significant predictor of lower SGRQ scores (p < 0.01) and reduced time free of clinical complications (p = 0.001), but not of 6MWT distance (p = 0.12). At 7 years post-transplant, results were: 69.0 +/- 21.8% vs 86.9 +/- 5.6%, p < 0.05 (SGRQ); 58.5 +/- 21.6% vs 88.7 +/- 11.4%, p < 0.01 (proportion of time lived without clinical complications); and 82.2 +/- 10.9% vs 91.9 +/- 14.2%, p = 0.27 (percent of predicted 6MWT), respectively, for patients with BOS and without BOS. CONCLUSIONS Despite significantly less time lived without clinical complications and progressive decline of self-reported health status, the capacity to walk of patients affected by BOS remained relatively stable over time. These findings may indicate that the development of moderate to severe BOS does not prevent lung recipients from walking independently and pursuing an autonomous life.
Collapse
Affiliation(s)
- Margaret W Gerbase
- Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva, Switzerland.
| | | | | | | | | |
Collapse
|
14
|
Maury G, Langer D, Verleden G, Dupont L, Gosselink R, Decramer M, Troosters T. Skeletal muscle force and functional exercise tolerance before and after lung transplantation: a cohort study. Am J Transplant 2008; 8:1275-81. [PMID: 18444941 DOI: 10.1111/j.1600-6143.2008.02209.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We investigated the impact of lung transplantation and outpatient pulmonary rehabilitation after lung transplantation on skeletal muscle function and exercise tolerance. Skeletal muscle force (Quadriceps force, QF), exercise tolerance (six minute walking distance, 6MWD) and lung function were assessed in 36 patients before and after lung transplantation. Seventeen male and 19 female patients (age 57 +/- 4) showed skeletal muscle weakness before the transplantation. A further 32 +/- 21% reduction was seen 1.2 (interquartile range 0.9 to 2.0) months after LTX. The number of days on the intensive care unit was significantly related to the observed deterioration in muscle force after LTX. At this time point 6MWD was comparable to pre-LTX. Rehabilitation started 37 (IQR 29 to 61) days after LTX. 6MWD and QF improved significantly (140 +/- 91 m, and 35 +/- 48%, respectively; p < 0.05) with rehabilitation. QF remained below pre-LTX values. The evolution of the 6MWD with the transplantation and the subsequent rehabilitation was less in female compared to male subjects. We conclude that muscle strength deteriorates after lung transplantation, particularly in patients with long ICU stay. Outpatient pulmonary rehabilitation is feasible after lung transplantation and leads to recovery of skeletal muscle function. In female patients this recovery is significantly less compared to male recipients.
Collapse
Affiliation(s)
- G Maury
- Pneumology, Université Catholique de Louvain, Yvoir, Belgium
| | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
Surgical therapies for the treatment of pulmonary arterial hypertension typically are reserved for patients who are deemed to be refractory to medical therapy and have evidence of progressive right-sided heart failure. Atrial septostomy, a primarily palliative procedure, may stave off hemodynamic collapse from right-sided heart failure long enough to permit a more definitive surgical treatment such as lung or combined heart-lung transplantation. This article discusses indications for and results of atrial septostomy and lung and heart-lung transplantation in patients who have pulmonary arterial hypertension.
Collapse
Affiliation(s)
- Jeffrey S Sager
- Lung Transplantation Program, Pulmonary, Allergy and Critical Care Division, University of Pennsylvania Medical Center, 828 West Gates Building, 3600 Spruce Street, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
16
|
Lama VN, Murray S, Lonigro RJ, Toews GB, Chang A, Lau C, Flint A, Chan KM, Martinez FJ. Course of FEV(1) after onset of bronchiolitis obliterans syndrome in lung transplant recipients. Am J Respir Crit Care Med 2007; 175:1192-8. [PMID: 17347496 PMCID: PMC1899272 DOI: 10.1164/rccm.200609-1344oc] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Bronchiolitis obliterans syndrome (BOS), defined by loss of lung function, develops in the majority of lung transplant recipients. However, there is a paucity of information on the subsequent course of lung function in these patients. OBJECTIVES To characterize the course of FEV(1) over time after development of BOS and to determine the predictors that influence the rate of functional decline of FEV(1). METHODS FEV(1)% predicted (FEV(1)%pred) trajectories were studied in 111 lung transplant recipients with BOS by multivariate, linear, mixed-effects statistical models. MEASUREMENTS AND MAIN RESULTS FEV(1)%pred varied over time after BOS onset, with the steepest decline typically seen in the first 6 months (12% decline; p < 0.0001). Bilateral lung transplant recipients had significantly higher FEV(1)%pred at BOS diagnosis (71 vs. 47%; p < 0.0001) and at 24 months after BOS onset (58 vs. 41%; p = 0.0001). Female gender and pretransplant diagnosis of idiopathic pulmonary fibrosis were associated with a steeper decline in FEV(1)%pred in the first 6 months after BOS diagnosis (p = 0.02 and 0.04, respectively). A fall in FEV(1) greater than 20% in the 6 months preceding BOS (termed "rapid onset") was associated with shorter time to BOS onset (p = 0.01), lower FEV(1)%pred at BOS onset (p < 0.0001), steeper decline in the first 6 months (p = 0.03), and lower FEV(1)%pred at 2 years after onset (p = 0.0002). CONCLUSIONS Rapid onset of BOS, female gender, pretransplant diagnosis of idiopathic pulmonary fibrosis, and single-lung transplantation are associated with worse pulmonary function after BOS onset.
Collapse
Affiliation(s)
- Vibha N Lama
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109-0360, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|