1
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Moncomble E, Weisenburger G, Picard C, Dégot T, Reynaud-Gaubert M, Nieves A, Mornex JF, Dauriat G, Messika J, Godet C, Hirschi S, Le Pavec J, Borie R, Mordant P, Lortat-Jacob B, Mal H, Bunel V. Effect of antifibrotic agents on postoperative complications after lung transplantation for idiopathic pulmonary fibrosis. Respirology 2024; 29:71-79. [PMID: 37789612 DOI: 10.1111/resp.14605] [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: 02/27/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Antifibrotic agents (AFAs) are now standard-of-care for idiopathic pulmonary fibrosis (IPF). Concerns have arisen about the safety of these drugs in patients undergoing lung transplantation (LTx). METHODS We performed a multi-centre, nationwide, retrospective, observational study of French IPF patients undergoing LTx between 2011 and 2018 to determine whether maintaining AFAs in the peri-operative period leads to increased bronchial anastomoses issues, delay in skin healing and haemorrhagic complications. We compared the incidence of post-operative complications and the survival of patients according to AFA exposure. RESULTS Among 205 patients who underwent LTx for IPF during the study period, 58 (28%) had received AFAs within 4 weeks before LTx (AFA group): pirfenidone in 37 (18.0%) and nintedanib in 21 (10.2%). The median duration of AFA treatment before LTx was 13.8 (5.6-24) months. The AFA and control groups did not significantly differ in airway, bleeding or skin healing complications (p = 0.91, p = 0.12 and p = 0.70, respectively). Primary graft dysfunction was less frequent in the AFA than control group (26% vs. 43%, p = 0.02), and the 90-day mortality was lower (7% vs. 18%, p = 0.046). CONCLUSIONS AFA therapy did not increase airway, bleeding or wound post-operative complications after LTx and could be associated with reduced rates of primary graft dysfunction and 90-day mortality.
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Affiliation(s)
- Elsa Moncomble
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | - Gaelle Weisenburger
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | | | - Tristan Dégot
- Service de Pneumologie, Nouvel Hôpital Civil, Strasbourg, France
| | - Martine Reynaud-Gaubert
- Service de Pneumologie-Maladies Pulmonaires Rares-Centre de Transplantation Pulmonaire, Hôpital Nord, Marseille, France
| | - Ana Nieves
- Service de Pneumologie-Maladies Pulmonaires Rares-Centre de Transplantation Pulmonaire, Hôpital Nord, Marseille, France
| | - Jean François Mornex
- Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, Lyon, France
| | - Gaelle Dauriat
- Service de Transplantation, Chirurgie Thoracique et Vasculaire, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Jonathan Messika
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | - Cendrine Godet
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | - Sandrine Hirschi
- Service de Pneumologie, Nouvel Hôpital Civil, Strasbourg, France
| | - Jérôme Le Pavec
- Service de Transplantation, Chirurgie Thoracique et Vasculaire, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Raphael Borie
- Service de Pneumologie A, Hôpital Bichat, Paris, France
| | - Pierre Mordant
- Service de Chirurgie Thoracique, Hôpital Bichat, Paris, France
| | | | - Hervé Mal
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
| | - Vincent Bunel
- Service de Pneumologie B et Transplantation pulmonaire, Hôpital Bichat, APHP Nord-Université Paris Cité, Paris, France
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2
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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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3
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Wang Z, Zhao B, Deng M, Tong R, Bian Y, Zhang Q, Hou G. Utility and safety of airway stenting in airway stenosis after lung transplant: A systematic review. Front Med (Lausanne) 2023; 10:1061447. [PMID: 36968822 PMCID: PMC10034355 DOI: 10.3389/fmed.2023.1061447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundAirway complications seriously affect the clinical outcomes and long-term prognosis of lung-transplantation patients. Airway stenting provides effective palliation for patients with airway stenosis. However, a lack of consensus regarding the efficacy and safety of airway stents in airway stenosis after lung transplantation. This study critically evaluated all available evidence regarding this concern.MethodsWe retrieved studies from EMBASE, PubMed, and Cochrane Library databases. Studies were included if they reported baseline characteristics of airway complications after lung transplantation, stenting for airway stenosis, or prognosis.ResultsIn total, 279 papers were screened and 17 papers were included in final analysis. The short-term efficacy of airway stenting was assessed in almost all studies, with immediate palliation in symptom and improved pulmonary function reported. Eleven of the included studies evaluated the long-term efficacy of stent therapy, with no distinct lung function. The median overall survival time was 1,124 (95% confidence interval 415–1,833) days in stented patients only. Stent-related complications are common regardless of the material; However, serious complications are rare and can be improved with routine management.ConclusionWe demonstrated that airway stenting is a safe and effective method to treat airway stenosis after lung transplantation. The short-term effect was significant, while the long-term efficacy on survival rate needed further investigations.Systematic review registrationwww.crd.york.ac.uk/prospero/, identifier: CRD42022364427.
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Affiliation(s)
- Zilin Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Bo Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mingming Deng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Run Tong
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yiding Bian
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Qin Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Gang Hou
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4
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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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5
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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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6
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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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7
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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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8
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Fallis RJ, Jablonski L, Moss S, Axelrod P, Clauss H. Infectious complications of bronchial stenosis in lung transplant recipients. Transpl Infect Dis 2019; 21:e13100. [PMID: 31056837 DOI: 10.1111/tid.13100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/13/2019] [Accepted: 04/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bronchial stenosis is a known complication of lung transplantation, but there are limited data regarding whether transplant recipients with bronchial stenosis develop more infectious complications than those without bronchial stenosis. METHODS We conducted a retrospective single-center observational cohort study between January 1, 2011 and September 29, 2016 of 35 lung transplant recipients diagnosed with bronchial stenosis and a random sample of 35 lung transplant recipients without bronchial stenosis. Data collected included donor/recipient demographic and anatomic information, respiratory cultures, episodes of respiratory infections diagnosed using CDC-NNIS criteria, hospitalizations, and 1-year all-cause mortality. Patients were followed up to 1 year after transplant. RESULTS Bronchial stenosis occurred at a median of 54 days post-transplant (range 5-365 days). Bronchial stenosis patients spent more time in the hospital (87.4 vs 46.8 days, P = 0.011) and had more total hospitalizations (4.54 vs 2.37, P < 0.01) than their counterparts. The relative risk of pneumonia among cases vs controls was 4.0 (95% CI 2.2-7.3, P < 0.01); for purulent tracheobronchitis the relative risk was 3.1 (95% CI 1.6-6.1, P < 0.01). Patients with bronchial stenosis were significantly more likely to have respiratory cultures growing Staphylococcus aureus (RR 5.0; P = 0.001) and Pseudomonas aeruginosa (RR 2.1, P = 0.026). Mortality within the first year following transplant was equal in both the groups (14.3% vs 14.3%). CONCLUSIONS There was no significant increase in 1-year mortality for lung transplant patients who developed bronchial stenosis. However, bronchial stenosis patients had significantly higher risks of pneumonia and tracheobronchitis, and spent more days in the hospital than those without bronchial stenosis.
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Affiliation(s)
- Rebecca J Fallis
- Section of Infectious Diseases, Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | | | - Sean Moss
- Section of Infectious Diseases Tufts Medical Center, Boston, Massachusetts
| | - Peter Axelrod
- Section of Infectious Diseases, Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Heather Clauss
- Section of Infectious Diseases, Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
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9
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Mazzetta A, Porzio M, Riou M, Coiffard B, Olland A, Dégot T, Seitlinger J, Massard G, Renaud-Picard B, Kessler R. Patients Treated for Central Airway Stenosis After Lung Transplantation Have Persistent Airflow Limitation. Ann Transplant 2019; 24:84-92. [PMID: 30760698 PMCID: PMC6383442 DOI: 10.12659/aot.911923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Although central airway stenosis (CAS) is a common complication after lung transplantation, its consequences have been poorly evaluated. The objective of our study was to evaluate the impact of CAS on lung function after lung transplantation. Material/Methods All lung transplant recipients from June 2009 to August 2014 in a single center (Strasbourg, France) were retrospectively reviewed. Results A total of 191 lung transplantations were performed: 175 bilateral, 15 single, and 1 heart-lung transplantation. Of the 161 bilateral lung-transplanted patients who survived >3 months, 22 (13.6%) developed CAS requiring endobronchial treatment. All these patients were treated by endoscopic balloon dilatation, and 9 additionally needed endobronchial stents. Respiratory function tests demonstrated persistent obstructive ventilatory pattern despite endoscopic treatment in recipients with CAS compared to those without CAS at 6, 12, and 18 months post-transplant. At 18 months, CAS patients had significantly lower post-transplant FEV1 (1.96±0.60 L versus 2.57±0.76 L, p=0.001) and FEV1/FVC (61±14% versus 81±13%, p<0.001). The percentage of patients hospitalized for respiratory infections and number of hospital days were significantly increased in recipients with CAS (20 [91%] versus 92 [66%] p=0.036, and 144±110 days versus 103±83 days p=0.042, respectively). Survival in transplant recipients did not significantly differ between those with CAS and those without. Conclusions CAS after lung transplantation was not associated with worse survival, but it did have a significant and persistent effect on lung function, and was associated with increased rate of respiratory infection.
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Affiliation(s)
- Andrea Mazzetta
- Department of Respiratory Medicine, Federation of Translational Medicine of Strasbourg (FMTS), University Hospitals, Strasbourg, France
| | - Michele Porzio
- Department of Respiratory Medicine, Federation of Translational Medicine of Strasbourg (FMTS), University Hospitals, Strasbourg, France
| | - Marianne Riou
- Department of Respiratory Medicine, Federation of Translational Medicine of Strasbourg (FMTS), University Hospitals, Strasbourg, France
| | - Benjamin Coiffard
- Department of Respiratory Medicine, Federation of Translational Medicine of Strasbourg (FMTS), University Hospitals, Strasbourg, France
| | - Anne Olland
- Department of Thoracic Surgery, University Hospitals, Strasbourg, France.,EA 7293 Vascular and Tissue Stress in Transplantation, UNISTRA, Strasbourg, France
| | - Tristan Dégot
- Department of Respiratory Medicine, Federation of Translational Medicine of Strasbourg (FMTS), University Hospitals, Strasbourg, France
| | - Joseph Seitlinger
- Department of Thoracic Surgery, University Hospitals, Strasbourg, France
| | - Gilbert Massard
- Department of Thoracic Surgery, University Hospitals, Strasbourg, France.,EA 7293 Vascular and Tissue Stress in Transplantation, UNISTRA, Strasbourg, France
| | - Benjamin Renaud-Picard
- Department of Respiratory Medicine, Federation of Translational Medicine of Strasbourg (FMTS), University Hospitals, Strasbourg, France.,EA 7293 Vascular and Tissue Stress in Transplantation, UNISTRA, Strasbourg, France
| | - Romain Kessler
- Department of Respiratory Medicine, Federation of Translational Medicine of Strasbourg (FMTS), University Hospitals, Strasbourg, France.,EA 7293 Vascular and Tissue Stress in Transplantation, UNISTRA, Strasbourg, France
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10
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Jo KW, Hong SB, Kim DK, Jung SH, Kim HR, Choi SH, Lee GD, Lee SO, Do KH, Chae EJ, Choi IC, Choi DK, Kim IO, Park SI, Shim TS. Long-Term Outcomes of Adult Lung Transplantation Recipients: A Single-Center Experience in South Korea. Tuberc Respir Dis (Seoul) 2019; 82:348-356. [PMID: 31583875 PMCID: PMC6778743 DOI: 10.4046/trd.2019.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 12/28/2022] Open
Abstract
Background Recently, the number of lung transplants in South Korea has increased. However, the long-term outcome data is limited. In this study, we aimed to investigate the long-term outcomes of adult lung transplantation recipients. Methods Among the patients that underwent lung transplantation at a tertiary referral center in South Korea between 2008 and 2017, adults patient who underwent deceased-donor lung transplantation with available follow-up data were enrolled. Their medical records were retrospectively reviewed. Results Through eligibility screening, we identified 60 adult patients that underwent lung (n=51) or heart-lung transplantation (n=9) during the observation period. Idiopathic pulmonary fibrosis (46.7%, 28/60) was the most frequent cause of lung transplantation. For all the 60 patients, the median follow-up duration for post-transplantation was 2.6 years (range, 0.01–7.6). During the post-transplantation follow-up period, 19 patients (31.7%) died at a median duration of 194 days. The survival rates were 75.5%, 67.6%, and 61.8% at 1 year, 3 years, and 5 years, respectively. Out of the 60 patients, 8 (13.3%) were diagnosed with chronic lung allograft dysfunction (CLAD), after a mean duration of 3.3±2.8 years post-transplantation. The CLAD development rate was 0%, 17.7%, and 25.8% at 1 year, 3 years, and 5 years, respectively. The most common newly developed post-transplantation comorbidity was the chronic kidney disease (CKD; 54.0%), followed by diabetes mellitus (25.9%). Conclusion Among the adult lung transplantation recipients at a South Korea tertiary referral center, the long-term survival rates were favorable. The proportion of patients who developed CLAD was not substantial. CKD was the most common post-transplantation comorbidity.
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Affiliation(s)
- Kyung Wook Jo
- Division of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Bum Hong
- Division of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hyun Do
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Kee Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ok Kim
- Organ Transplantation Center, Asan Medical Center, Seoul, Korea
| | - Seung Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Tae Sun Shim
- Division of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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11
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Kim SY, Jeong SJ, Lee JG, Park MS, Paik HC, Na S, Kim J. Critical Care after Lung Transplantation. Acute Crit Care 2018; 33:206-215. [PMID: 31723887 PMCID: PMC6849028 DOI: 10.4266/acc.2018.00360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 12/28/2022] Open
Abstract
Since the first successful lung transplantation in 1983, there have been many advances in the field. Nevertheless, the latest data from the International Society for Heart and Lung Transplantation revealed that the risk of death from transplantation is 9%. Various aspects of postoperative management, including mechanical ventilation, could affect intensive care unit stay, hospital stay, and immediate postoperative morbidity and mortality. Complications such as reperfusion injury, graft rejection, infection, and dehiscence of anastomosis increase fatal adverse side effects immediately after surgery. In this article, we review the possible immediate complications after lung transplantation and summarize current knowledge on prevention and treatment.
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Affiliation(s)
- Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sungwon Na
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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12
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Mortensen A, Cherrier L, Walia R. Effect of pirfenidone on wound healing in lung transplant patients. Multidiscip Respir Med 2018; 13:16. [PMID: 29946463 PMCID: PMC6001132 DOI: 10.1186/s40248-018-0129-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/27/2018] [Indexed: 11/22/2022] Open
Abstract
Background The drug pirfenidone has been shown to slow the progression and decrease mortality of idiopathic pulmonary fibrosis (IPF). Its exact mechanism is unknown, but it likely inhibits pro-fibrotic cytokine transforming growth factor beta, a known contributor to wound healing. We evaluated whether patients taking pirfenidone until lung transplantation had increased risk of impaired wound healing post-transplant. This information could determine whether pirfenidone should be discontinued prior to listing to allow for a wash-out period. Methods We retrospectively reviewed patients who underwent lung transplantation for pulmonary fibrosis at Norton Thoracic Institute in Phoenix, Arizona, from January 2014 to December 2015. Results We describe 18 patients who took pirfenidone up to a month before transplant. Aside from one patient who experienced sternal dehiscence due to a surgical issue, all remaining patients did well with no evidence of airway dehiscence. Each of these 17 patients had been on pirfenidone for at least 30 days; nine patients had been on pirfenidone for over 90 days. Baseline characteristics including age, sex, body mass index, renal function, liver function, glucose level, pre-transplant corticosteroid use, and post-transplant immunosuppressant therapy were similar. Conclusions In our experience, pirfenidone may be safely continued until lung transplantation. Only one patient in our series experienced impaired wound healing related to a surgical issue, even when pirfenidone was continued until lung transplantation. We found no evidence of impaired wound healing or airway complications after lung transplantation in patients who were treated with pirfenidone before lung transplantation.
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Affiliation(s)
- Amber Mortensen
- 1Department of Pharmacy, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA
| | - Lauren Cherrier
- 1Department of Pharmacy, St. Joseph's Hospital and Medical Center, Phoenix, AZ USA
| | - Rajat Walia
- 2Division of Pulmonology, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Rd., Ste. 500, Phoenix, AZ USA
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13
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Lee SH, Park MS, Song JH, Kim YS, Lee JG, Paik HC, Kim SY. Perioperative factors associated with 1-year mortality after lung transplantation: a single-center experience in Korea. J Thorac Dis 2017; 9:4006-4016. [PMID: 29268411 DOI: 10.21037/jtd.2017.09.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Most studies about the risk factors of 1-year mortality after lung transplantation were performed on non-Asians. This study aimed to evaluate the perioperative factors related to the 1-year mortality after lung transplantation in Korea. Methods Sixty-eight consecutive patients who underwent lung transplantation without preoperative extracorporeal membrane oxygenation treatment at 1 tertiary hospital in South Korea between October 24, 2012, and October 16, 2015, were analyzed retrospectively. Results Forty-four patients (64.7%) lived for >1 year after lung transplantation. The median age of all patients was 55 years (range, 16-75 years), and men accounted for 57.4%. The major cause of lung transplantation was idiopathic pulmonary fibrosis (48.5%); the other causes were interstitial lung disease related to connective tissue disease (17.6%) and bronchiolitis obliterans after stem cell transplantation (14.7%). In univariate analysis, higher median age (52 vs. 61.5 years, P<0.001), male sex (45.5% vs. 79.2%, P=0.007), lower preoperative albumin level (<3 g/dL) (22.7% vs. 45.8%, P=0.049), need for renal replacement therapy (RRT) after surgery (4.5% vs. 37.5%, P=0.001), and postoperative delta neutrophil index (DNI) >5.5 higher than the preoperative DNI (22.7% vs. 70.8%, P<0.001) were significantly related to 1-year mortality. After adjustments, old age, postoperative increased DNI, and need for RRT after transplantation were the independent perioperative risk factors for 1-year mortality after lung transplantation. Conclusions Recipients with advanced age should be carefully selected, and patients who need RRT or with increased DNI after transplantation should be managed accordingly.
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Affiliation(s)
- Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Han Song
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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14
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Mahajan AK, Folch E, Khandhar SJ, Channick CL, Santacruz JF, Mehta AC, Nathan SD. The Diagnosis and Management of Airway Complications Following Lung Transplantation. Chest 2017; 152:627-638. [DOI: 10.1016/j.chest.2017.02.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/30/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022] Open
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