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Villeneuve T, Hermant C, Le Borgne A, Murris M, Plat G, Héluain V, Colombat M, Courtade-Saïdi M, Evrard S, Collot S, Salaün M, Guibert N. Real-time and non-invasive acute lung rejection diagnosis using confocal LASER Endomicroscopy in lung transplant recipients: Results from the CELTICS study. Pulmonology 2024:S2531-0437(24)00014-X. [PMID: 38402125 DOI: 10.1016/j.pulmoe.2024.02.003] [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: 11/14/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Traditionally, the diagnosis of acute rejection (AR) relies on invasive transbronchial biopsies (TBBs) to obtain histopathological samples. We aimed to evaluate the diagnostic yield of probe-based confocal laser endomicroscopy (pCLE) as a complementary and non-invasive tool for ACR screening, comparing its results with those obtained from TBBs. METHODS Between January 2015 and April 2022, we conducted a retrospective study of all lung transplant recipients aged over 18 years at Toulouse University Hospital (France). All patients who underwent bronchoscopies with both TBBs and pCLE imaging were included. Two experienced interpreters (TV and MS) reviewed the pCLE images independently, blinded to all clinical information and pathology results. RESULTS From 120 procedures in 85 patients, 34 abnormal histological samples were identified. Probe-based confocal laser endomicroscopy revealed significant associations between both alveolar (ALC) and perivascular (PVC) cellularities and abnormal histological samples (p<0.0001 and 0.003 respectively). Alveolar cellularity demonstrated a sensitivity (Se) of 85.3 %, specificity (Spe) of 43 %, positive predictive value (PPV) of 37.2 % and negative predictive value (NPV) of 88.1 %. For PVC, Se was 70.6 %, Spe 80.2 %, PPV 58.5 % and NPV 87.3 %. Intra-interpreter correlation (TV) was 88.3 % for the number of vessels (+/-1), 98.3 % for ALC and 90 % for PVC. Inter-interpreter correlation (TV and MS) was 80 % for vessels (+/-1), 97.5 % for ALC and 83.3 % for PVC. CONCLUSION Our study demonstrates the feasibility of incorporating pCLE into clinical practice, demonstrating good diagnostic yield and reproducible outcomes in the screening of AR in lung transplant recipients.
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Affiliation(s)
- T Villeneuve
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France.
| | - C Hermant
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - A Le Borgne
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - M Murris
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - G Plat
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - V Héluain
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
| | - M Colombat
- Cytology and Pathology Department, University Cancer Institute, Toulouse, France
| | - M Courtade-Saïdi
- Cytology and Pathology Department, University Cancer Institute, Toulouse, France
| | - S Evrard
- Cytology and Pathology Department, University Cancer Institute, Toulouse, France
| | - S Collot
- Radiology Department, Toulouse University Hospital, Toulouse, France
| | - M Salaün
- Respiratory Medicine Department, Department, Rouen University Hospital, Toulouse, France
| | - N Guibert
- Respiratory Medicine Department, Toulouse University Hospital, Toulouse, France
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2
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Galiatsatos P, Ekpo P, Schreiber R, Barker L, Shah P. Smoking Mechanics and Impact on Smoking Cessation: Two Cases of Smoking Lapse Status Post Lung Transplantation. Tob Use Insights 2022; 15:1179173X211069634. [PMID: 35023981 PMCID: PMC8744156 DOI: 10.1177/1179173x211069634] [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: 11/16/2022] Open
Abstract
Background Smoking behavior includes mechanisms taken on by persons to adjust for certain
characteristic changes of cigarettes. However, as lung function declines due to
lung-specific diseases, it is unclear how mechanical smoking behavior changes affect
persons who smoke. We review two cases of patients who stopped smoking prior to and then
subsequently resumed smoking after lung transplantation. Methods A retrospective review of two patients who were recipients of lung transplantation and
sustained from cigarette usage prior to transplantation. Results Patient A was a 54-year-old woman who received a double lung transplant secondary to
chronic obstructive pulmonary disease (COPD) in October 2017. She had stopped smoking
cigarettes in July 2015 (FEV1 .56 L). Patient B was a 40-year-old man who received a
double lung transplantation due to sarcoidosis in January 2015. He stopped smoking
cigarettes in February 2012 (FEV1 1.15 L). Post-transplant, Patient A resumed smoking on
March 2018 where her FEV1 was at 2.12 L (5 months post-transplantation), and Patient B
resumed smoking in April 2017 where his FEV1 was 2.37 L (26 months
post-transplantation). Conclusion We report on two patients who resumed smoking after lung transplantation. While
variations of smoking mechanics have been identified as a function of nicotine yield and
type of cigarette, it lung mechanics may play a role in active smoking as well.
Therefore, proper screening for tobacco usage post-lung transplantation should be
considered a priority in order to preserve transplanted lungs.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Tobacco Treatment Clinic, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Princess Ekpo
- Tobacco Treatment Clinic, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Raiza Schreiber
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Tobacco Treatment Clinic, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Lindsay Barker
- Office of Transplantation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Pali Shah
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Office of Transplantation, Johns Hopkins Hospital, Baltimore, MD, USA
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3
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Greer M, Welte T. Chronic Obstructive Pulmonary Disease and Lung Transplantation. Semin Respir Crit Care Med 2020; 41:862-873. [PMID: 32726838 DOI: 10.1055/s-0040-1714250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection-currently referred to as chronic lung allograft dysfunction-represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.
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Affiliation(s)
- Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
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4
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Tobacco Use After Lung Transplantation: A Retrospective Analysis of Patient Characteristics, Smoking Cessation Interventions, and Cessation Success Rates. Transplantation 2019; 103:1260-1266. [DOI: 10.1097/tp.0000000000002576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Hofmann P, Benden C, Kohler M, Schuurmans MM. Smoking resumption after heart or lung transplantation: a systematic review and suggestions for screening and management. J Thorac Dis 2018; 10:4609-4618. [PMID: 30174913 DOI: 10.21037/jtd.2018.07.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Smoking remains the leading cause of preventable disease and death in the developed world and kills half of all long-term users. Smoking resumption after heart or lung transplantation is associated with allograft dysfunction, higher incidence of cancer, and reduced overall survival. Although self-reporting is considered an unreliable method for tobacco use detection, implementing systematic cotinine-based screening has proven challenging. This review examines the prevalence of smoking resumption in thoracic transplant patients, explores the risk factors associated with a post-transplant smoking resumption and discusses the currently available smoking cessation interventions for transplant patients.
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Affiliation(s)
- Patrick Hofmann
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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6
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The Transplant Evaluation Rating Scale (TERS): A Tool for the Psychosocial Evaluation of Lung Transplant Candidates. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2018; 64:172-185. [PMID: 29862926 DOI: 10.13109/zptm.2018.64.2.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES An evaluation of psychosocial functioning prior to lung transplantation is advisable for anticipating behavioral difficulties and for screening for any psychological distress that might be harmful to posttransplantation outcomes and adjustment. METHODS In this cross-sectional, single-center study, the level of psychosocial functioning of N = 75 patients before lung transplantation was rated using the Transplant Evaluation Rating Scale (TERS). RESULTS he reliability of the TERS total score was satisfactory at α = 0.75. A two-factorial solution (emotional sensitivity; defiance) was found. Higher TERS scores were significantly associated with higher depressive and anxiety symptoms (r = .38/r = .42), lower quality of life (r = -.26), and fewer years abstinent from smoking (r = -.35). No associations were found with lung disease and symptom severity. CONCLUSIONS The TERS appears to be a reliable and valid measure with clinical utility for specifying behavioral concerns prior to lung transplantation.
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7
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Hu L, Lingler JH, Sereika SM, Burke LE, Malchano DK, DeVito Dabbs A, Dew MA. Nonadherence to the medical regimen after lung transplantation: A systematic review. Heart Lung 2017; 46:178-186. [DOI: 10.1016/j.hrtlng.2017.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 01/09/2023]
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8
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Van Laecke S, Nagler EV, Peeters P, Verbeke F, Van Biesen W. Former smoking and early and long-term graft outcome in renal transplant recipients: a retrospective cohort study. Transpl Int 2017; 30:187-195. [DOI: 10.1111/tri.12897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/18/2016] [Accepted: 11/21/2016] [Indexed: 01/16/2023]
Affiliation(s)
| | | | | | | | - Wim Van Biesen
- Renal Division; Ghent University Hospital; Ghent Belgium
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9
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Lewandowski AN, Skillings JL. Who gets a lung transplant? Assessing the psychosocial decision-making process for transplant listing. Glob Cardiol Sci Pract 2016; 2016:e201626. [PMID: 29043272 PMCID: PMC5642746 DOI: 10.21542/gcsp.2016.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/12/2016] [Indexed: 12/14/2022] Open
Abstract
In the United States, there is a significant shortage of available donor organs. This requires transplant professionals to hold simultaneous, yet divergent roles as (1) advocates for patients who are in need of a lifesaving transplant, and (2) responsible stewards in the allocation of scarce donor organs. In order to balance these roles, most transplant teams utilize a committee based decision-making process to select suitable candidates for the transplant waiting list. These committees use medical and psychosocial criteria to guide their decision to list a patient. Transplant regulatory bodies have established medical standards for identifying appropriate medical candidates for transplantation. However, transplant regulatory bodies have not developed policies to standardize psychosocial criteria for listing patients. This affords transplant centers the autonomy to develop their own psychosocial criteria for determining which patients will be placed on the transplant waiting list. This lack of a standardized policy has resulted in inconsistent psychosocial practices amongst transplant centers nationwide. Since there has been no formal review of the inconsistency in psychosocial policy and practice, this paper seeks to explore the non-standardized psychosocial approach to organ transplant listing. The authors review factors that are relevant to the standardization of the psychosocial decision-making process, including shared decision-making, clinician judgment, bias in decision-making and moral distress in transplant staff. We conclude with a discussion about the impact of these issues on psychosocial practices in solid organ transplantation.
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Affiliation(s)
- Amber N. Lewandowski
- Richard DeVos Heart and Lung Transplant Program, Spectrum Health, Grand Rapids, MI, USA
| | - Jared Lyon Skillings
- Richard DeVos Heart and Lung Transplant Program, Spectrum Health, Grand Rapids, MI, USA
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10
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Zmeškal M, Králíková E, Kurcová I, Pafko P, Lischke R, Fila L, Valentová Bartáková L, Fraser K. Continued Smoking in Lung Transplant Patients: A Cross Sectional Survey. Zdr Varst 2015; 55:29-35. [PMID: 27647086 PMCID: PMC4820179 DOI: 10.1515/sjph-2016-0005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Smoking is associated with a higher incidence of post-lung transplantation complications and mortality. Prior to inclusion on the lung transplant waiting list in the Czech Republic, patients are supposed to be tobacco free for at least 6 months. Our aim was to determine the prevalence of smoking, validated by urinary cotinine, among patients post lung transplantation and prior to inclusion on the transplant waiting list. Methods Between 2009 and 2012, we conducted a cross-sectional survey of urinary cotinine to assess tobacco exposure in 203 patients in the Lung Transplant Program in the Czech Republic. We measured urinary cotinine in 163 patients prior to inclusion on the transplantation waiting list, and 53 patients post bilateral lung transplantation. Results 15.1% (95% CI 0.078 to 0.269) of all lung transplant recipients had urinary cotinine levels corresponding to active smoking; and a further 3.8% (95% CI 0.007 to 0.116) had borderline results. Compared to patients with other diagnoses, patients with COPD were 35 times more likely to resume smoking post- transplantation (95% CI 1.92 to 637.37, p-value 0.016). All patients who tested positive for urinary cotinine levels were offered smoking cessation support. Only one Tx patient sought treatment for tobacco dependence, but was unsuccessful. Conclusion Smoking resumption may be an underrecognized risk for lung transplantation recipients, particularly among patients with chronic obstructive pulmonary disease. More rigorous screening, as well as support and treatment to stop smoking among these patients are needed.
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Affiliation(s)
- Miroslav Zmeškal
- Department of Orthopaedics and Traumatology, Regional Hospital Kolín, Kolín 280 02, Czech Republic
| | - Eva Králíková
- Center for Tobacco-Dependence, 3rd Medical Department - Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Prague 128 21, Czech Republic
| | - Ivana Kurcová
- Department of Forensic Medicine and Toxicology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague 128 21, Czech Republic
| | - Pavel Pafko
- 3rd Department of Surgery, 1st Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 121 08, Czech Republic
| | - Robert Lischke
- 3rd Department of Surgery, 1st Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 121 08, Czech Republic
| | - Libor Fila
- Department of Pneumology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 150 06, Czech Republic
| | - Lucie Valentová Bartáková
- Department of Pneumology, 2nd Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague 150 06, Czech Republic
| | - Keely Fraser
- Center for Tobacco-Dependence, 3rd Medical Department - Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Prague 128 21, Czech Republic
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11
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Picard C, Roux A. [Contraindications to lung transplantation: evolving limits?]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:156-163. [PMID: 24932503 DOI: 10.1016/j.pneumo.2013.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 11/05/2013] [Accepted: 11/05/2013] [Indexed: 06/03/2023]
Abstract
In France, the higher frequency of pulmonary sample in organ donors and the enhancement of surgical and perioperative life support techniques, have increased the number procedures and the short term prognosis of lung transplantation (LT). In this setting, the classical contraindications of LT need to be reconsidered. In this article, some of the classical contraindication of LT are confronted to the experience acquired in other solid organ transplantations or from some LT centers. Specific situations such as LT in patients with previous cancer, HIV infection, viral hepatitis, nutritional disorders, acutely ill LT candidates and aging candidates are addressed. Surgical contraindications are not reviewed.
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Affiliation(s)
- C Picard
- Service de pneumologie et de transplantation pulmonaire, groupe de transplantation pulmonaire, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - A Roux
- Service de pneumologie et de transplantation pulmonaire, groupe de transplantation pulmonaire, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
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12
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Hall EC, Pfeiffer RM, Segev DL, Engels EA. Cumulative incidence of cancer after solid organ transplantation. Cancer 2013; 119:2300-8. [PMID: 23559438 PMCID: PMC4241498 DOI: 10.1002/cncr.28043] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 11/04/2012] [Accepted: 12/04/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Solid organ transplantation recipients have elevated cancer incidence. Estimates of absolute cancer risk after transplantation can inform prevention and screening. METHODS The Transplant Cancer Match Study links the US transplantation registry with 14 state/regional cancer registries. The authors used nonparametric competing risk methods to estimate the cumulative incidence of cancer after transplantation for 2 periods (1987-1999 and 2000-2008). For recipients from 2000 to 2008, the 5-year cumulative incidence, stratified by organ, sex, and age at transplantation, was estimated for 6 preventable or screen-detectable cancers. For comparison, the 5-year cumulative incidence was calculated for the same cancers in the general population at representative ages using Surveillance, Epidemiology, and End Results data. RESULTS Among 164,156 recipients, 8520 incident cancers were identified. The absolute cancer risk was slightly higher for recipients during the period from 2000 to 2008 than during the period from 1987 to 1999 (5-year cumulative incidence: 4.4% vs. 4.2%; P = .006); this difference arose from the decreasing risk of competing events (5-year cumulative incidence of death, graft failure, or retransplantation: 26.6% vs. 31.9%; P < .001). From 2000 to 2008, the 5-year cumulative incidence of non-Hodgkin lymphoma was highest at extremes of age, especially in thoracic organ recipients (ages 0-34 years: range, 1.74%-3.28%; aged >50 years; range, 0.36%-2.22%). For recipients aged >50 years, the 5-year cumulative incidence was higher for colorectal cancer (range, 0.33%-1.94%) than for the general population at the recommended screening age (aged 50 years: range, 0.25%-0.33%). For recipients aged >50 years, the 5-year cumulative incidence was high for lung cancer among thoracic organ recipients (range, 1.16%-3.87%) and for kidney cancer among kidney recipients (range, 0.53%-0.84%). The 5-year cumulative incidence for prostate cancer and breast cancer was similar or lower in transplantation recipients than at the recommended ages of screening in the general population. CONCLUSIONS Subgroups of transplantation recipients have a high absolute risk of some cancers and may benefit from targeted prevention or screening.
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Affiliation(s)
- Erin C. Hall
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eric A. Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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13
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Abstract
Smoking, both by donors and by recipients, has a major impact on outcomes after organ transplantation. Recipients of smokers' organs are at greater risk of death (lungs hazard ratio [HR], 1.36; heart HR, 1.8; and liver HR, 1.25), extended intensive care stays, and greater need for ventilation. Kidney function is significantly worse at 1 year after transplantation in recipients of grafts from smokers compared with nonsmokers. Clinicians must balance the use of such higher-risk organs with the consequences on waiting list mortality if the donor pool is reduced further by exclusion of such donors. Smoking by kidney transplant recipients significantly increases the risk of cardiovascular events (29.2% vs. 15.4%), renal fibrosis, rejection, and malignancy (HR, 2.56). Furthermore, liver recipients who smoke have higher rates of hepatic artery thrombosis, biliary complications, and malignancy (13% vs. 2%). Heart recipients with a smoking history have increased risk of developing coronary atherosclerosis (21.2% vs. 12.3%), graft dysfunction, and loss after transplantation. Self-reporting of smoking is commonplace but unreliable, which limits its use as a tool for selection of transplant candidates. Despite effective counseling and pharmacotherapy, recidivism rates after transplantation remain high (10-40%). Transplant services need to be more proactive in educating and implementing effective smoking cessation strategies to reduce rates of recidivism and the posttransplantation complications associated with smoking. The adverse impact of smoking by the recipient supports the requirement for a 6-month period of abstinence in lung recipients and cessation before other solid organs.
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14
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Hellemons ME, Agarwal PK, van der Bij W, Verschuuren EAM, Postmus D, Erasmus ME, Navis GJ, Bakker SJL. Former smoking is a risk factor for chronic kidney disease after lung transplantation. Am J Transplant 2011; 11:2490-8. [PMID: 21883906 DOI: 10.1111/j.1600-6143.2011.03701.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chronic kidney disease (CKD) is a common complication after lung transplantation (LTx). Smoking is a risk factor for many diseases, including CKD. Smoking cessation for >6 months is required for LTx enlistment. However, the impact of smoking history on CKD development after LTx remains unclear. We investigated the effect of former smoking on CKD and mortality after LTx. CKD was based on glomerular filtration rate (GFR) ((125) I-iothalamate measurements). GFR was measured before and repeatedly after LTx. One hundred thirty-four patients never smoked and 192 patients previously smoked for a median of 17.5 pack years. At 5 years after LTx, overall cumulative incidences of CKD-III, CKD-IV and death were 68.5%, 16.3% and 34.6%, respectively. Compared to never smokers, former smokers had a higher risk for CKD-III (hazard ratio [HR] 95% confidence interval [95%CI]= 1.69 [1.27-2.24]) and IV (HR = 1.90 [1.11-3.27]), but not for mortality (HR = 0.99 [0.71-1.38]). Adjustment for potential confounders did not change results. Thus, despite cessation, smoking history remained a risk factor for CKD in LTx recipients. Considering the increasing acceptance for LTx of older recipients with lower baseline renal function and an extensive smoking history, our data suggest that the problem of post-LTx CKD may increase in the future.
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Affiliation(s)
- M E Hellemons
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands.
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