Development of lymphocytotoxic antibodies among lung transplant recipients: preliminary results

The aim of this study was to evaluate the incidence of postoperative lymphocytotoxic antibodies (LA) formation and to assess their potential utility in immunologic monitoring after lung transplantation. We determined prospectively the percentage LA against a reference panel reactive antibody in a complement-dependent microlymphocytotoxicity test in 137 sequential serum samples obtained from 14 consecutive lung transplant recipients who survived over the first postoperative year. Four patients developed high titers of LA (greater than 10% panel reactive antibody reactivity in at least 3 consecutive samples) by 2 to 24 months after surgery. Antibodies were mostly immunoglobulin M isotype, without any specificity against the donor's human leukocyte antigen and were correlated with the development of bronchiolitis obliterans syndrome (p=.01) and with chronic bronchial infectious colonization (p=.03). In conclusion, a polyclonal immunoglobulin M antibody production can be detected in serum samples from lung transplant recipients and seems to be involved in the progression of chronic rejection process. These preliminary results incline to carry on the cytotoxicity screening of a panel of lymphocytes to better understand the significance of such reactivity.

Long-term complications of extraperiosteal plombage

BACKGROUND

As soon as complications due to migration of extraperiosteal plombage material had been documented, early removal became the rule. Some patients who have escaped this rule may still present with long-term complications.

METHODS

Since 1980, 14 patients aged 54 +/- 10 years were admitted 28 +/- 11 years after collapse therapy. Eight presented with signs of infection, 4 with hemoptysis, and 2 with periscapular pain. Vascular erosion, suspected in 3 patients, was demonstrated with angiograms in 1.

RESULTS

Ablation of the material was combined with excision of the devitalized ribs in 13 patients. Femorofemoral bypass was used in 2 patients for repair of an aortic erosion. Single ablation of subcutaneously migrated material was performed in a poor-risk patient. Operative bleeding was moderate except in 2 patients; 1 of them died intraoperatively during repair of an aortic erosion. A second patient died postoperatively with a massive pulmonary embolus on day 11. Infection was diagnosed in 8 patients (Mycobacterium tuberculosis, 4; and pyogens, 4). Operative outcome was satisfactory in all 12 operative survivors. A single patient presented with an infected apical space at 1 year and underwent complementary resection of the first rib.

CONCLUSIONS

We recommend routine ablation of any residual plombage material whenever operative risk is acceptable because of the high incidence of spontaneous complications.

Video-assisted minithoracotomy versus muscle-sparing thoracotomy for performing lobectomy

We prospectively analyzed the outcome of lobectomy in a cohort of 67 patients. Operative time, postoperative pain, pulmonary function, and early outcome were compared between the patients undergoing video-assisted techniques (n = 44) and those undergoing standard muscle-sparing procedures (n = 23). Pain was quantified daily throughout the first week using the visual analog scale. The forced expiratory volume in 1 second and the forced vital capacity were measured at days 2, 4, and 8 postoperatively. The operative time was significantly longer (p < 0.02) and the postoperative pain was significantly less (p < 0.006) in the group undergoing video-assisted procedures. Pain-related morbidity, the mean duration of air leaks, the duration of chest tube placement, and the hospital stay were all less in the video-assisted group, but the differences did not reach statistical significance. However, the impairment in pulmonary function and the overall morbidity were identical for the two groups. Based on our findings, we conclude that video-assisted minithoracotomy is a safe and reliable approach for performing lobectomies, and that the decreased postoperative pain associated with this minimally invasive approach does not result in preserved pulmonary function and significantly reduced morbidity when compared with a muscle-sparing thoracotomy.