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Konoeda C, Sato M. Patient selection, surgery and perioperative management in lung transplantation in Japan. J Thorac Dis 2024; 16:2613-2622. [PMID: 38738216 PMCID: PMC11087615 DOI: 10.21037/jtd-23-374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 02/04/2024] [Indexed: 05/14/2024]
Abstract
Lung transplantation (LT) is the final treatment option for end-stage respiratory diseases. The current prognosis of LT recipients in Japan is good, however, the reason for the good prognosis is unclear. In Japan, the waiting time for cadaveric LT is long, which is approximately 900 days on average. A long waiting time affects several aspects of LT. The diseases progress while they await LT in most patients are waiting for LT. Along with the disease progression of the disease, secondary pulmonary hypertension can newly emerge. Some patients suffer from refractory secondary pneumothorax and may receive pleurodesis. Transplant operations can become more difficult, and postoperative management becomes more complicated owing to the disease progression. Thoracic surgeons in Japan have managed the tough difficult situation of LT patients with LT. Possible explanations for how we to maintain a better prognosis in such a situation include sophisticated surgical techniques and ideas, and vigorous postoperative management by thoracic surgeons. Thoracic surgeons are vigorously involved both in operations and in postoperative management in the intensive care unit with or without intensivists in Japan. On the other hand, the long waiting time in Japan and allocation rules with age restriction without considering the severity of patients may have resulted in the selection of recipients to include relatively young recipients, fewer patients with interstitial lung disease and fewer recipients with extracorporeal membrane oxygenation (ECMO) as a bridge to LT. These recipients' characteristics possibly may have affected the prognosis of LT patients with LT in Japan. There is a chance that a future increase in the number of cadaveric donors in Japan may result in a prognosis close that is similar to the international average if the current waiting time in Japan decreases. We review patient selection, surgery and perioperative management in LT in Japan to address the question of why the current prognosis of LT recipients in Japan is good.
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Affiliation(s)
- Chihiro Konoeda
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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2
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Zhou AL, Karius AK, Ruck JM, Shou BL, Larson EL, Casillan AJ, Ha JS, Shah PD, Merlo CA, Bush EL. Outcomes of Lung Transplant Candidates Aged ≥70 Years During the Lung Allocation Score Era. Ann Thorac Surg 2024; 117:725-732. [PMID: 37271446 PMCID: PMC10693648 DOI: 10.1016/j.athoracsur.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND With the increasing age of lung transplant candidates, we studied waitlist and posttransplantation outcomes of candidates ≥70 years during the Lung Allocation Score era. METHODS Adult lung transplant candidates from 2005 to 2020 in the United Network for Organ Sharing database were included and stratified on the basis of age at listing into 18 to 59 years old, 60 to 69 years old, and ≥70 years old. Baseline characteristics, waitlist outcomes, and posttransplantation outcomes were assessed. RESULTS A total of 37,623 candidates were included (52.3% aged 18-59 years, 40.6% aged 60-69 years, 7.1% aged ≥70 years). Candidates ≥70 years were more likely than younger candidates to receive a transplant (81.9% vs 72.7% [aged 60-69 years] vs 61.6% [aged 18-59 years]) and less likely to die or to deteriorate on the waitlist within 1 year (9.1% vs 10.1% [aged 60-69 years] vs 12.2% [aged 18-59 years]; P < .001). Donors for older recipients were more likely to be extended criteria (75.7% vs 70.1% [aged 60-69 years] vs 65.7% [aged 18-59 years]; P < .001). Recipients ≥70 years were found to have lower rates of acute rejection (6.7% vs 7.4% [aged 60-69 years] vs 9.2% [aged 18-59 years]; P < .001) and prolonged intubation (21.7% vs 27.4% [aged 60-69 years] vs 34.5% [aged 18-59 years]; P < .001). Recipients aged ≥70 years had increased 1-year (adjusted hazard ratio [aHR], 1.19 [95% CI, 1.06-1.33]; P < .001), 3-year (aHR, 1.28 [95% CI, 1.18-1.39]; P < .001), and 5-year mortality (aHR, 1.29 [95% CI, 1.21-1.38]; P < .001) compared with recipients aged 60 to 69 years. CONCLUSIONS Candidates ≥70 years had favorable waitlist and perioperative outcomes despite increased use of extended criteria donors. Careful selection of candidates and postoperative surveillance may improve posttransplantation survival in this population.
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Affiliation(s)
- Alice L Zhou
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Alexander K Karius
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jessica M Ruck
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Benjamin L Shou
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Emily L Larson
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Alfred J Casillan
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jinny S Ha
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Pali D Shah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Christian A Merlo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Errol L Bush
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
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Joshi PR. Pulmonary Diseases in Older Patients: Understanding and Addressing the Challenges. Geriatrics (Basel) 2024; 9:34. [PMID: 38525751 PMCID: PMC10961796 DOI: 10.3390/geriatrics9020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
As the global population ages, pulmonary diseases among older people have emerged as a significant and growing public health concern. The increasing incidence of these conditions has led to higher rates of morbidity and mortality among older adults. This perspective study offers a thorough overview of the prevalent pulmonary diseases affecting the elderly demographic. It delves into the challenges encountered during the diagnosis and management of these conditions in older individuals, considering factors such as comorbidities, functional limitations, and medication complexities. Furthermore, innovative strategies and personalized interventions such as precision medicine, advanced therapies, telemedicine solutions, and patient-centered support systems aimed at enhancing the care provided to older individuals grappling with pulmonary disorders are thoroughly explored. By addressing the unique needs and complexities of this vulnerable population, healthcare systems can strive towards improving outcomes and enhancing the quality of life for elderly individuals affected by pulmonary diseases.
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Affiliation(s)
- Pushpa Raj Joshi
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
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Zhou AL, Jenkins RT, Ruck JM, Shou BL, Larson EL, Casillan AJ, Ha JS, Merlo CA, Bush EL. Outcomes of Recipients Aged 65 Years and Older Bridged to Lung Transplant With Extracorporeal Membrane Oxygenation. ASAIO J 2024; 70:230-238. [PMID: 37939695 PMCID: PMC10922625 DOI: 10.1097/mat.0000000000002092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (BTT) has been used for critically ill candidates with excellent outcomes, but data on this strategy in older recipients remain limited. We compared outcomes of no BTT, mechanical ventilation (MV)-only BTT, and ECMO BTT in recipients of greater than or equal to 65 years. Lung-only recipients of greater than or equal to 65 years in the United Network for Organ Sharing database between 2008 and 2022 were included and stratified by bridging strategy. Of the 9,936 transplants included, 226 (2.3%) were MV-only BTT and 159 (1.6%) were ECMO BTT. Extracorporeal membrane oxygenation BTT recipients were more likely to have restrictive disease pathology, had higher median lung allocation score, and spent fewer days on the waitlist (all p < 0.001). Compared to no-BTT recipients, ECMO BTT recipients were more likely to be intubated or on ECMO at 72 hours posttransplant and had longer hospital lengths of stay (all p < 0.001). Extracorporeal membrane oxygenation BTT recipients had increased risk of 3 years mortality compared to both no-BTT (adjusted hazard ratio [aHR] = 1.48 [95% confidence interval {CI}: 1.14-1.91], p = 0.003) and MV-only recipients (aHR = 1.50 [95% CI: 1.08-2.07], p = 0.02). Overall, we found that ECMO BTT in older recipients is associated with inferior posttransplant outcomes compared to MV-only or no BTT, but over half of recipients remained alive at 3 years posttransplant.
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Affiliation(s)
- Alice L. Zhou
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital
| | - Reed T. Jenkins
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital
| | - Jessica M. Ruck
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital
| | - Benjamin L. Shou
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital
| | - Emily L. Larson
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital
| | - Alfred J. Casillan
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital
| | - Jinny S. Ha
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital
| | - Christian A. Merlo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins Hospital
| | - Errol L. Bush
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital
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Cantu E, Jin D, McCurry M, Friskey J, Lisowski J, Saleh A, Diamond JM, Anderson M, Clausen E, Hsu J, Gallop R, Christie JD, Schaubel D. Transplanting candidates with stacked risks negatively affects outcomes. J Heart Lung Transplant 2023; 42:1455-1463. [PMID: 37290569 PMCID: PMC10527778 DOI: 10.1016/j.healun.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Lung transplant (LT) centers are increasingly evaluating patients with multiple risk factors for adverse outcomes. The effects of these stacked risks remains unclear. Our aim was to determine the relationship between the number of comorbidities and post-transplant outcomes. METHODS We performed a retrospective cohort study using the National Inpatient Sample (NIS) and UNOS Starfile (USF). We applied a probabilistic matching algorithm using 7 variables (transplant: month, year, and type; recipient: age, sex, race, payer). We matched recipients in the USF to transplant patients in the NIS between 2016 and 2019. The Elixhauser methodology was used to identify comorbidities present on admission. We determined the associations between mortality, length of stay (LOS), total charges, and disposition with comorbidity numbers using penalized cubic splines, Kaplan-Meier, and linear and logistic regression methods. RESULTS From 28,484,087 NIS admissions, we identified 1,821 LT recipients. Matches were exact in 76.8% of the cohort. While the remaining cohort had a probability match of ≥0.94. Penalized splines of Elixhauser comorbidity number identified 3 knots defining 3 groups of stacked risk: low (<3), medium (3-6), and high risk (>6). Inpatient mortality increased from low to medium to high-risk categories: (1.6%, 3.9%, and 7.0%; p < 0.001), as did LOS (16, 21, 29 days, p < 0.001), total charges ($553,057, $666,791, $821,641.5; p = 0.004) and discharge to a skilled nursing facility (15%, 20%, 31%; p < 0.001). CONCLUSIONS Stacked risks adversely affect post-LT mortality, LOS, charges, and discharge disposition. Further study to understand the details of specific stacked risks is warranted.
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Affiliation(s)
- Edward Cantu
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Dun Jin
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madeline McCurry
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacqueline Friskey
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica Lisowski
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aya Saleh
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua M Diamond
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michaela Anderson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Clausen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesse Hsu
- Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, Pennsylvania
| | - Jason D Christie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas Schaubel
- Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Criner GJ. Surgical and Interventional Approaches in COPD. Respir Care 2023; 68:939-960. [PMID: 37353329 PMCID: PMC10289622 DOI: 10.4187/respcare.10825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Many patients suffer from complaints of dyspnea, cough, and sputum production, clinical symptoms that hallmark the structural abnormalities that are present in patients with COPD. Although pharmacologic and non-pharmacologic medical therapies help reduce these symptoms, many of these symptoms, especially dyspnea, remain unchecked and contribute to the burden of disease in patients with COPD. Over the last 3 decades, several surgical and interventional treatments delivered via a bronchoscopic approach have been developed to complement medical therapies and show promise to improve patient outcomes. Surgical and interventional treatments target structural abnormalities of the airway and lung parenchyma that can be identified with a combination of imaging and physiological testing, factors that are key to select patients most likely to benefit from these treatments. This paper reviews surgical and bronchoscopic interventional treatment options for patients with emphysema and airways disorders.
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Affiliation(s)
- Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
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7
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De Miguel-Diez J, Jimenez-Garcia R, Hernández-Barrera V, Carabantes-Alarcon D, Zamorano-Leon JJ, Cuadrado-Corrales N, Omaña-Palanco R, González-Barcala FJ, Lopez-de-Andres A. Time Trends in Clinical Characteristics and Hospital Outcomes of Hospitalizations for Lung Transplantation in COPD Patients in Spain from 2016 to 2020-Impact of the COVID-19 Pandemic. J Clin Med 2023; 12. [PMID: 36769611 DOI: 10.3390/jcm12030963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
(1) Background: To examine the clinical characteristics and hospital outcomes of hospitalization for lung transplantation in COPD patients in Spain from 2016 to 2020; and to assess if the COVID-19 pandemic has affected the number or the outcomes of lung transplantations in these patients. (2) Methods: We used the Spanish National Hospital Discharge Database to select subjects who had a code for COPD (ICD-10: J44) and had undergone a lung transplantation (ICD-10 codes OBYxxxx). (3) Results: During the study period, 704 lung transplants were performed among COPD patients (single 31.68%, bilateral 68.32%). The absolute number of transplants increased with raising rates of 8%, 14% and 19% annually from 2016 to 2019. However, a marked decrease of -18% was observed from 2019 to year 2020. Overall, 47.44% of the patients suffered at least one complication, being the most frequent lung transplant rejection (24.15%), followed by lung transplant infection (13.35%). The median length of hospital stay (LOHS) was 33 days and the in-hospital-mortality (IHM) was 9.94%. Variables associated with increased risk of mortality were a Comorbidity Charlson Index ≥ 1 (OR 1.82; 95%CI 1.08-3.05) and suffering any complication of the lung transplantation (OR 2.14; 95%CI 1.27-3.6). COPD patients in 2020 had a CCI ≥ 1 in a lower proportion than 2019 patients (29.37 vs. 38.51%; p = 0.015) and less frequently suffered any complications after the lung transplantation (41.26 vs. 54.6%; p = 0.013), no changes in the LOHS or the IHM were detected from 2019 to 2020. (4) Conclusions: Our study showed a constant increase in the number of lung transplantations from 2016 to 2019 in COPD patients, with a drop from 2019 to 2020, probably related to the COVID-19 pandemic. However, no changes in LOHS or IHM were detected over time.
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Attawar S, Manoly I, Shah U. Lung Transplantation in India: a Brief Review, Landmarks, Indian Scenario, and our Experience. Indian J Surg 2023; 85:1-12. [PMID: 36686557 PMCID: PMC9841148 DOI: 10.1007/s12262-023-03663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Lung transplantation is gaining widespread acceptance as the preferred therapeutic option for selected cases of end-stage lung disease in India. The indications of lung transplantation are increasing, with better post-operative survival, including the COVID affected lung, if we choose our patients well. The national acceptance of expanded criteria in lung donation, streamlining of the process of lung transplantation by governmental, and non-governmental organizations and significant increase in the number of organ donations in India have strengthened the lung transplantation program within the country. Through this article, we describe a brief history, the process, and our experience of lung transplantation since we started our program in 2017 until date.
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Affiliation(s)
- Sandeep Attawar
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences, Hyderabad, Telangana India
| | - Imthiaz Manoly
- Cardiothoracic Surgery , Burjeel Hospitals, Abu Dhabi, United Arab Emirates
- Department of Surgery, UAE University, Al Ain, United Arab Emirates
| | - Unmil Shah
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences, Hyderabad, Telangana India
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9
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Berikkhanov ZG, Nikolaev AM, Seryogina VY. [Treatment of chronic obstructive pulmonary disease and emphysema]. Khirurgiia (Mosk) 2023:79-85. [PMID: 37707336 DOI: 10.17116/hirurgia202309179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
We summarized the available data on therapeutic, surgical and endoscopic treatment of chronic obstructive pulmonary disease and emphysema that may be used like a bridge to lung transplantation. Treatment of chronic obstructive pulmonary disease and emphysema is expensive. Certain limitations in lung transplantation make to create new methods of treatment of severe emphysema. However, one should be ready for possible complications and carefully select patients for certain treatment to avoid false negative results. Reducing costs or developing cheaper treatments is important for the future and availability of care. The risks and complications associated with surgical treatment of emphysema can make endoscopic surgery preferable for these patients, and this undoubtedly requires further research.
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Affiliation(s)
- Z G Berikkhanov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A M Nikolaev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V Yu Seryogina
- Sechenov First Moscow State Medical University, Moscow, Russia
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Boffini M, Cassoni P, Gambella A, Simonato E, Delsedime L, Marro M, Fanelli V, Costamagna A, Lausi PO, Solidoro P, Scalini F, Barbero C, Brazzi L, Rinaldi M, Bertero L. Is there life on the airway tree? A pilot study of bronchial cell vitality and tissue morphology in the ex vivo lung perfusion (EVLP) era of lung transplantation. Artif Organs 2022; 46:2234-2243. [PMID: 35717633 PMCID: PMC9796079 DOI: 10.1111/aor.14342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ex vivo lung perfusion (EVLP) is a relevant procedure to increase the lung donor pool but could potentially increase the airway tree ischemic injury risk. METHODS This study aimed to evaluate the direct effect of EVLP on the airway tree by evaluating bronchial cell vitality and tissue signs of injury on a series of 117 bronchial rings collected from 40 conventional and 19 EVLP-treated lung grafts. Bronchial rings and related scraped bronchial epithelial cells were collected before the EVLP procedure and surgical anastomosis. RESULTS The preimplantation interval was significantly increased in the EVLP graft group (p < 0.01). Conventional grafts presented cell viability percentages of 47.07 ± 23.41 and 49.65 ± 21.25 in the first and second grafts which did not differ significantly from the EVLP group (first graft 50.54 ± 25.83 and second graft 50.22 ± 20.90 cell viability percentage). No significant differences in terms of histopathological features (edema, inflammatory infiltrate, and mucosa ulceration) were observed comparing conventional and EVLP samples. A comparison of bronchial cell viability and histopathology of EVLP samples retrieved at different time intervals revealed no significant differences. Accordingly, major bronchial complications after lung transplant were not observed in both groups. CONCLUSIONS Based on these data, we observed that EVLP did not significantly impact bronchial cell vitality and airway tissue preservation nor interfere with bronchial anastomosis healing, further supporting it as a safe and useful procedure.
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Affiliation(s)
- Massimo Boffini
- Cardiac Surgery Division, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Paola Cassoni
- Pathology Unit, Department of Medical SciencesUniversity of TurinTurinItaly
| | | | - Erika Simonato
- Cardiac Surgery Division, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Luisa Delsedime
- Pathology Unit, AOU Città della Salute e della ScienzaUniversity HospitalTurinItaly
| | - Matteo Marro
- Cardiac Surgery Division, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Vito Fanelli
- Department of Anesthesia and Intensive Care Medicine, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Andrea Costamagna
- Department of Anesthesia and Intensive Care Medicine, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Paolo Olivo Lausi
- Thoracic Surgery Division, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Paolo Solidoro
- Pneumology Division, Department of Medical SciencesUniversity of TurinTurinItaly
| | - Fabrizio Scalini
- Cardiac Surgery Division, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Cristina Barbero
- Cardiac Surgery Division, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Luca Brazzi
- Department of Anesthesia and Intensive Care Medicine, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Mauro Rinaldi
- Cardiac Surgery Division, Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Luca Bertero
- Pathology Unit, Department of Medical SciencesUniversity of TurinTurinItaly
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11
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Kim HS, Park S. Recipient Management before Lung Transplantation. J Chest Surg 2022; 55:265-273. [PMID: 35924531 PMCID: PMC9358159 DOI: 10.5090/jcs.22.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Lung transplantation is considered a viable treatment option for patients with end-stage lung disease. Recent decades have seen a gradual increase in the number of lung transplantation patients worldwide, and in South Korea, the case number has increased at least 3-fold during the last decade. Furthermore, the waiting list time is becoming longer, and more elderly patients (>65 years) are undergoing lung transplantation; that is, the patients placed on the waiting list are older and sicker than in the past. Hence, proper management during the pre-transplantation period, as well as careful selection of candidates, is a key factor for transplant success and patient survival. Although referring and transplant centers should address many issues, the main areas of focus should be the timing of referral, nutrition, pulmonary rehabilitation, critical care (including mechanical ventilation and extracorporeal membrane oxygenation), psychological support, and the management of preexisting comorbid conditions (coronary artery disease, diabetes mellitus, gastroesophageal reflux disease, osteoporosis, malignancy, viral infections, and chronic infections). In this context, the present article reviews and summarizes the pre-transplantation management strategies for adult patients listed for lung transplantation.
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Affiliation(s)
- Hyoung Soo Kim
- Department of Cardiothoracic Surgery, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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