1
|
Pérez MB, Garcia CB, Erro M, Ussetti P, Crespo E, Donadeu L, Bestard O, Anguera G, Sole A, Ponz R, Molloy B, Revilla E, Monforte V, Gomez S. Discordance Between Humoral and Cellular Immune Responses to Cytomegalovirus Infection in CMV Seropositive Recipients (R+). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
2
|
García-Masedo S, Laporta Hernandez R, Aguilar Perez M, García Fadul C, Anel Pedroche J, Cabrera Pineda M, Royuela Vicente A, Sánchez Romero I, Ussetti P. Compliance with CMV Prophylaxis Guidelines in Lung Transplantation: Do We Need New Recommendations? J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
3
|
Sanabrias R, Laporta R, Aguilar-Perez M, Teresa LM, Fadul CG, Aguado S, Royuela A, Ussetti P. Impact of Neutropenia and Granulocyte Colony-Stimulating Factor Treatment in Lung Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
4
|
Aguado Ibáñez S, Laporta Hernandez R, Aguilar Perez M, Sanabrias R, García Fadul C, Diaz Nuevo G, Lopez Garcia-Gallo C, Lázaro Carrasco de la Fuente M, Salas Antón C, Royuela Vicente A, Jara Chinarro B, Ussetti P. Role of BAL Lymphocytosis and Blood Eosinophils in the Prediction of Acute Rejection in Lung Transplant Patients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
5
|
Carbone J, Montanchez J, Cifrian J, Zatarain E, Laporta R, Ussetti P, Bravo C, Lopez S, Salcedo M, Rodriguez-Ferrero M, Gonzalez-Costello J, Sabe N, Segovia J, Gomez-Bueno M, De Pablos A, Sousa I, Alarcon A, Ezzahouri I, Sarmiento E. Intravenous Immunoglobulin is Associated with Lower Rates of Reinfection in Solid Organ Recipients with Infection and Secondary Antibody Deficiency: A Multicenter Randomized Clinical Trial. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
6
|
Hamandi B, Fegbeutel C, Silveira FP, Verschuuren EA, Younus M, Mo J, Yan J, Ussetti P, Chin-Hong PV, Solé A, Holmes-Liew CL, Billaud EM, Grossi PA, Manuel O, Levine DJ, Barbers RG, Hadjiliadis D, Aram J, Singer LG, Husain S. Voriconazole and squamous cell carcinoma after lung transplantation: A multicenter study. Am J Transplant 2018; 18:113-124. [PMID: 28898527 DOI: 10.1111/ajt.14500] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 06/22/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 01/25/2023]
Abstract
This study evaluated the independent contribution of voriconazole to the development of squamous cell carcinoma (SCC) in lung transplant recipients, by attempting to account for important confounding factors, particularly immunosuppression. This international, multicenter, retrospective, cohort study included adult patients who underwent lung transplantation during 2005-2008. Cox regression analysis was used to assess the effects of voriconazole and other azoles, analyzed as time-dependent variables, on the risk of developing biopsy-confirmed SCC. Nine hundred lung transplant recipients were included. Median follow-up time from transplantation to end of follow-up was 3.51 years. In a Cox regression model, exposure to voriconazole alone (adjusted hazard ratio 2.39, 95% confidence interval 1.31-4.37) and exposure to voriconazole and other azole(s) (adjusted hazard ratio 3.45, 95% confidence interval 1.07-11.06) were associated with SCC compared with those unexposed after controlling for important confounders including immunosuppressants. Exposure to voriconazole was associated with increased risk of SCC of the skin in lung transplant recipients. Residual confounding could not be ruled out because of the use of proxy variables to control for some confounders. Benefits of voriconazole use when prescribed to lung transplant recipients should be carefully weighed versus the potential risk of SCC. EU PAS registration number: EUPAS5269.
Collapse
Affiliation(s)
- B Hamandi
- Department of Pharmacy, University Health Network, Toronto, ON, Canada
| | - C Fegbeutel
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - F P Silveira
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - E A Verschuuren
- Department of Pulmonary Diseases, University Hospital Groningen, Groningen, the Netherlands
| | | | - J Mo
- Pfizer Inc., New York, NY, USA
| | - J Yan
- Pfizer Inc., New York, NY, USA
| | - P Ussetti
- Respiratory Department, Hospital Puerta de Hierro, Madrid, Spain
| | - P V Chin-Hong
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - A Solé
- Respiratory Department, University and Polytechnic Hospital La Fe, Universidad de Valencia, Valencia, Spain
| | - C L Holmes-Liew
- Lung Research, Hanson Institute, and Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - E M Billaud
- Service de Pharmacologie, AP-HP, Hôpital Européen G Pompidou, Paris, France
| | - P A Grossi
- Infectious Diseases Department, University of Insubria, Varese, Italy
| | - O Manuel
- Infectious Diseases Service and Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland
| | - D J Levine
- Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - R G Barbers
- Division of Pulmonary and Critical Care, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - D Hadjiliadis
- Department of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - J Aram
- Pfizer Inc., New York, NY, USA
| | - L G Singer
- Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada
| | - S Husain
- Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
| |
Collapse
|
7
|
Berastegui C, LaPorta R, López-Meseguer M, Romero L, Gómez-Ollés S, Riera J, Monforte V, Sáez B, Bravo C, Roman A, Ussetti P. Epidemiology and Risk Factors for Cancer After Lung Transplantation. Transplant Proc 2017; 49:2285-2291. [DOI: 10.1016/j.transproceed.2017.09.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
8
|
Calahorra L, Cifrian J, Sarmiento E, Ezzahouri I, Bravo C, Lopez S, Laporta R, Ussetti P, Sole A, De Pablos A, Jaramillo M, Carbone J. Elevated Serum BAFF Levels Are Associated with an Increased Risk of Acute Rejection in Lung Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
9
|
Aguilar C, Hamandi B, Fegbeutel C, Silveira F, Verschuuren E, Ussetti P, Chin-Hong P, Sole A, Holmes-Liew C, Billaud E, Grossi P, Manuel O, Levine D, Barbers R, Hadjiliadis D, Singer L, Husain S. Clinical Risk Factors for Invasive Aspergillosis in Lung Transplant Recipients: Results of an International Cohort Study. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
10
|
Solé A, Zurbano F, Borro JM, Monforte V, Ussetti P, Santos F. Prevalence and Diagnosis of Chronic Kidney Disease in Maintenance Lung Transplant Patients: ICEBERG Study. Transplant Proc 2016; 47:1966-71. [PMID: 26293082 DOI: 10.1016/j.transproceed.2015.04.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/26/2015] [Accepted: 04/15/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic renal dysfunction (CRD) after lung transplantation (LT) is a common and noteworthy complication associated with increased morbidity and mortality rates. The study objectives were to determine the prevalence of CRD according to different diagnostic criteria and describe its therapeutic management. METHODS This observational, multicenter, retrospective study included LT patients with ≥ 2 years of evolution. CRD was defined according to 2 different methods: (1) by the physician's subjective clinical criteria and (2) by analytical criteria (estimated glomerular filtration rate [eGFR] by Modification of Diet in Renal Disease of ≤ 59 mL/min). RESULTS We included 113 patients; 65.5% were men and the mean age at transplant was 49.1 (12.6) years. At 6 months after transplant, approximately half of patients had CRD according to analytical criteria, and, at 2 years after transplantation, the prevalence rose to 80%. Although clinical prevalence and analytical prevalence were similar (68.8% and 78.6%), a weak concordance was observed (Kappa index: 0.6). Among patients who were not classified as having CRD according to clinical criteria, 40.0% (14/35) were diagnosed with CRD according to analytical criteria. None of the patients underwent renal biopsy, and 5.1% of patients required dialysis. In 77.0% of patients with clinical CRD diagnosis, the immunosuppressive regimen was modified: reduction of isolated calcineurin inhibitors (CNIs) (35.0%), CNIs decreased with mycophenolic acid change (23.3%), and CNIs lowering with mammalian target of rapamycin introduction (6.7%). In a multivariate logistic regression model, the independent factors associated with CRD were an older recipient age, low body mass index (BMI) at transplant, treatment with cyclosporine/azathioprine, and low eGFR at the first month after transplant. CONCLUSIONS We found a high incidence of CRD at the first year after transplantation, which increased subsequently. Moreover, CRD was considerably underestimated by physicians' subjective clinical criteria. End points related to CRD development were older age, low BMI, azathioprine use, and low eGFR during the first month after transplant. The latter finding provides an opportunity to implement prevention strategies.
Collapse
Affiliation(s)
- A Solé
- Unidad de Trasplante Pulmonar, Hospital La Fe, Valencia, Spain.
| | - F Zurbano
- Servicio de Neumología, Unidad de Trasplante Pulmonar, Hospital Marqués de Valdecilla, Santander, Spain
| | - J M Borro
- Servicio de Neumología, Hospital Juan Canalejo, A Coruña, Spain
| | - V Monforte
- Servicio de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - P Ussetti
- Servicio de Neumología, Hospital Puerta de Hierro, Madrid, Spain
| | - F Santos
- Servicio de Neumología, Hospital Reina Sofia, Cordoba, Spain
| |
Collapse
|
11
|
Hamandi B, Fegbeutel C, Silveira F, Verschuuren E, Ussetti P, Chin-Hong P, Sole A, Holmes-Liew C, Billaud E, Grossi P, Manuel O, Levine D, Barbers R, Hadjiliadis D, Singer L, Husain S. Universal Versus Culture-Directed Pre-Emptive Treatment (CDPET) among Lung Transplant Recipients: A Propensity-Score Matched Analysis. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
12
|
Sarmiento E, Jaramillo M, Navarro J, Rodriguez-Molina J, Cifrian J, Laporta R, Ussetti P, Bravo C, Lopez S, De Pablos A, Morales P, Carbone J. Low IgM Anti-Polysaccharide Antibody Response and Severe Infection in a Cohort of Lung Recipients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
13
|
Sarmiento E, Cifrian J, Laporta R, Ussetti P, Bravo C, Lopez S, Morales P, de Pablos A, Jaramillo M, Navarro J, Rodriguez-Molina J, Carbone J. IgG Immunologic Monitoring To Identify Lung Recipients at Risk of Oportunistic Infections: Prospective Multicenter Study. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
14
|
de Pablo A, Santos F, Solé A, Borro JM, Cifrian JM, Laporta R, Monforte V, Román A, de la Torre M, Ussetti P, Zurbano F. Recommendations on the use of everolimus in lung transplantation. Transplant Rev (Orlando) 2012; 27:9-16. [PMID: 23276646 DOI: 10.1016/j.trre.2012.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/09/2012] [Indexed: 01/05/2023]
Abstract
The antiproliferative effect of everolimus provides a therapeutic option in the immunosuppression therapy of lung transplantation, by reducing both the risk of acute rejection and the process of progressive fibrosis that determines chronic graft rejection. However, few data on the use of everolimus in lung transplantation have been published to date, and the specific indications of the drug, along with the most adequate time for its introduction or dosing, have not been defined yet. The aim of this article is to propose recommendations for the use of everolimus in lung transplant recipients, including indications, dosing schedules and the use of concomitant immunosuppression. This consensus document has been developed by experts of all the Spanish lung transplant groups from the review of the existing literature and the clinical experience.
Collapse
Affiliation(s)
- A de Pablo
- University Hospital, Doce de Octubre, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ortega F, Bravo J, Cantarell C, Cofán F, Gómez-Bravo MA, Miras M, Crespo-Leiro MG, Ussetti P, Guinea G. Development and validation of a specific questionnaire for evaluating the impact of gastrointestinal symptoms on the health-related quality of life of transplant patients. Transplant Proc 2012; 44:1281-6. [PMID: 22664001 DOI: 10.1016/j.transproceed.2012.01.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/21/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transplant patients receiving immunosuppressant treatment suffer gastrointestinal symptoms (GIS) limiting their health-related quality of life (HRQOL) and causing dose redíuctions and discontinuations. METHODS This observational, multicenter, cross-sectional study aims to develop and validate a questionnaire for detecting and quantifying the impact of GIS on the HRQOL of patients with functioning organ transplants. We developed a pilot version of the questionnaire SIGIT-QOL (Impact of Gastrointestinal Symptoms on Quality Of Life) and then evaluated the feasibility, validity, and reliability. We consecutively recruited 274 solid organ transplant patients from 20 hospitals. Sociodemographic and clinical data were collected. Patients completed the SIGIT-QOL and Gastrointestinal Quality of Life Index-GIQLI- questionnaires. RESULTS Mean age was 52.7 (SD, 7.59) and 181 were male; 43.4% showed an episode of GIS since transplantation (3-12 months before). Of all patients, 95.3% completed the SIGIT-QOL. Mean time of completion was 6.49 minutes. Exploratory factorial analysis identified a 1-dimensional structure (42% of total variance). Internal consistency was high (Cronbach's alpha, 0.889). A significant association was found between the SGITI-QOL and the presence of GIS (P < .01). Finally, correlation coefficients between SIGIT-QOL and GIQLI were moderate-high except for Social Function. CONCLUSION The brief SIGIT-QOL questionnaire can detect and quantify the GIS and their impact on the HRQOL of solid organ transplant patients.
Collapse
Affiliation(s)
- F Ortega
- Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Callejo DP, Laporta R, Casado EA, Palka M, Ruiz-Valdepeñas A, Cantos B, Maximiano C, García MM, Ussetti P, Pulla MP. Cancer and Lung Transplantation. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33962-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
17
|
Roman A, Ussetti P, Zurbano F, Borro JM, Solé A, Carreño MC, Santos F. A retrospective 12-month study of conversion to everolimus in lung transplant recipients. Transplant Proc 2012; 43:2693-8. [PMID: 21911148 DOI: 10.1016/j.transproceed.2011.06.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/16/2011] [Accepted: 06/06/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Everolimus has potent antifibrotic effects that may potentially affect the clinical course of bronchiolitis obliterans syndrome (BOS) or provide nephroprotective immunosuppressive regimens for lung transplantation. METHODS We retrospectively assessed the 12-month outcomes of the conversion to everolimus among lung recipients in six Spanish centers. RESULTS From March 2005 to December 2007, 65 lung recipients who were at a mean posttransplantation time of 10.2 ± 7.9 months were converted to everolimus, mainly because of BOS (64.6%) or renal insufficiency (RI; 12.3%). The initial dose of everolimus was 1.9 ± 0.6 mg/d and the mean blood trough levels were stable over time (6.4 ± 2.8 ng/mL at 12 months). Conversion to everolimus allowed us to eliminate the calcineurin inhibitor (CNI) in 21% of patients. Among the overall population, the forced expiratory volume at 1 second (FEV(1)) and renal function remained stable. Mean FEV(1) did not change among the 35 (81%) patients surviving BOS at 12 months: preconversion FEV(1): 1.449.5 ± 641.9 mL vs 12-month FEV(1): 1420.0 ± 734.6 mL (P = .866). There was a significant improvement in renal function among the RI patients with mean glomerular filtration rates of 42.2 ± 15.2 mL/min/1.73 m(2) (P = .043) at 6 and 44.4 ± 18.8 mL/min/1.73 m(2) at 12 months, (P = .063) and a decrease in the use of CNIs from 1% of RI patients preconversion to 57% at 6 and 75% at 12 months. With a mean of 8.1- months follow-up (range: 1-31.3) overall survival was 84.6% at 1 year and 50% at 22.3 months. Progressive BOS was the main cause of death. Reasons for everolimus discontinuation were patient death (n = 10), lack of efficacy (n = 4), gastrointestinal adverse events (n = 2), and edema (n = 2). CONCLUSIONS BOS and RI were the main indications for conversion to everolimus among lung recipients. Conversion to everolimus improved renal function among patients converted because of RI. The present results were inconclusive regarding effects of everolimus on BOS.
Collapse
Affiliation(s)
- A Roman
- Department of Pulmonology, University Hospital Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
18
|
Lázaro M, Ramos A, Ussetti P, Asensio A, Laporta R, Muñez E, Sánchez-Romero I, Tejerina E, Burgos R, Moñivas V, Varela A. Aspergillus endocarditis in lung transplant recipients: case report and literature review. Transpl Infect Dis 2011; 13:186-91. [DOI: 10.1111/j.1399-3062.2010.00589.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
|
20
|
Monforte V, Lopez C, Santos F, Zurbano F, de la Torre M, Sole A, Gavalda J, Ussetti P, Lama R, Cifrian J, Borro JM, Pastor A, Len O, Bravo C, Roman A. A multicenter study of valganciclovir prophylaxis up to day 120 in CMV-seropositive lung transplant recipients. Am J Transplant 2009; 9:1134-41. [PMID: 19344437 DOI: 10.1111/j.1600-6143.2009.02574.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Seventy-six cytomegalovirus (CMV)-seropositive lung transplant recipients receiving valganciclovir (900 mg/day) for CMV prophylaxis were compared with a group of 87 patients receiving oral ganciclovir (3000 mg/day). Prophylaxis was administered to day 120 post-transplantation and follow-up was 1 year. In addition, a study was conducted on risk factors for CMV infection/disease. CMV disease incidence was 7.9% and 16.1% for valganciclovir and oral ganciclovir, respectively (p = 0.11). Patients receiving valganciclovir had fewer viral syndromes (2.6% vs. 11.5%, p < 0.05), a similar rate of tissue-invasive disease (5.2% vs. 4.6%, p = ns), longer time-to-onset of CMV infection/disease (197.5 vs. 155.2 days, p < 0.05), and a lower probability of infection/disease while on prophylaxis (1.3% vs. 12.6%, p < 0.01). Nonetheless, leukopenia incidence was higher with valganciclovir (15.8% vs. 2.3%, p < 0.01), as was the need for treatment withdrawal due to adverse effects (11.8% vs. 1.1%, p < 0.01). CMV infection was similar in both groups (32.9% vs. 34.5%). Induction therapy with basiliximab and glucocorticosteroid treatment were independent risk factors for developing CMV infection/disease. In conclusion, valganciclovir prophylaxis results in a low incidence of CMV disease in lung transplant recipients and appears more effective than oral ganciclovir. Despite the comparatively higher incidence of adverse events with valganciclovir, the drug can be considered safe for prophylaxis.
Collapse
Affiliation(s)
- V Monforte
- Respiratory Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Mora G, Ussetti P, Garcia-Fadul C, Garcia-Gallo C, Laporta R, Carreno M, De Pablo A, Ferreiro M, Varela A. 48: Lung Transplantation in Lymphangioleiomyomatosis (LAM) ¿Which Is the Best Surgical Procedure? J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
22
|
Aguilar-Guisado M, Givaldá J, Ussetti P, Ramos A, Morales P, Blanes M, Bou G, de la Torre-Cisneros J, Román A, Borro JM, Lama R, Cisneros JM. Pneumonia after lung transplantation in the RESITRA Cohort: a multicenter prospective study. Am J Transplant 2007; 7:1989-96. [PMID: 17617864 DOI: 10.1111/j.1600-6143.2007.01882.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The aim of the present study is to evaluate the epidemiology, etiology and prognosis of pneumonia in lung transplant (LT) recipients. This is a prospective, multicenter study of a consecutive cohort of LT recipients in Spain. From September 2003 to November 2005, 85 episodes of pneumonia in 236 LT recipients were included (incidence 72 episodes per 100 LT/year). Bacterial pneumonia (82.7%) was more frequent than fungal (14%) and viral pneumonia (10.4%). The most frequent microorganisms in each etiological group were Pseudomonas aeruginosa (n = 14, 24.6%), CMV (n = 6, 10.4%) and Aspergillus spp. (n = 5, 8.8%). Incidence of Aspergillus spp. and CMV pneumonia is lower than previously reported, probably due to the spread of universal prophylaxis. Pneumonia caused by viruses appeared significantly later than pneumonia due to gram-negative bacilli, fungi and those without known etiology (p < 0.01, p = 0.03 and p = 0.02, respectively). The routine use of ganciclovir has changed the natural history of CMV infection, so that pneumonia appears later, once prophylaxis is suspended. The probability of survival during the first year of follow-up was significantly higher in the multivariate analysis in LT recipients who did not have a pneumonia episode compared with those that had at least one episode (p < 0.01).
Collapse
|
23
|
Ussetti P, Lopez Garcia-Gallo C, Gomez de Antonio D, Laporta R, Carreño C, Gamez P, Córdoba M, Ramos M, Ferreiro M, Varela A. 183: Comparative study of lung transplantion long term results with non heart beating donorse (NHBD): A sustanaible break through? J Heart Lung Transplant 2007. [DOI: 10.1016/j.healun.2006.11.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
24
|
Gómez de Antonio D, Laporta R, Mora G, Garcı́a-Gallo CL, Moradiellos J, Gamez P, Córdoba M, de Pablo A, Ussetti P, Carreño M, Varela A. 186. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
25
|
Román A, Calvo V, Ussetti P, Borro JM, Lama R, Zurbano F, Pacheco A, Morell F, Solé A, De la Torre M, Varela A, Salvatierra A, Maiz L, Hernández M, Cañón J. Urgent Lung Transplantation in Spain. Transplant Proc 2005; 37:3987-90. [PMID: 16386605 DOI: 10.1016/j.transproceed.2005.09.117] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lung donors are scarce and lung transplantation resources are limited. Because urgent lung transplantation (ULT) is assumed to yield poor results, its use is controversial. We assessed the outcome of patients who received ULT seeking to determine effectiveness and risk factors. PATIENTS AND METHOD We collected data from every ULT performed in Spain during 5 years (1998-2002). The survival of patients was studied using Kaplan-Meier, Cox regression, and chi-square statistical analyses. We compared outcomes and perioperative mortality (over 30 days) for ULT procedures, analyzing the influence of certain variables (age, type of transplant, diagnosis, indication, and time on waiting list). RESULTS Among 109 patients proposed for the procedure, 73 ULT were performed during the period. The most frequent indications were pulmonary fibrosis (19 cases) and cystic fibrosis (19 cases), showing the worst and the better survival rates, respectively. The bad prognosis, determined mainly by per operative mortality rate (35.62%), was significantly affected by age (worse for patients older than 40 years) and type of LT (single worse than double; P < .05). A longer time waiting for ULT also showed a worse prognosis (P < .005). CONCLUSIONS Long-term survival after ULT shows that the procedure is effective and efficient for a select group of patients, despite the high per operative risk. ULT should be reserved for younger patients. It also requires performance in a short period (just a few days), initially rejecting a single lung transplant, provided that the patient is adequately monitored.
Collapse
Affiliation(s)
- A Román
- Hospital General Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
OBJECTIVE Lung transplantation is a valid therapeutic approach for patients with bronchiectasis. The objective of the present study was to evaluate our experience with bronchiectasis patients and compare the results in patients with cystic fibrosis to results in those with bronchiectasis caused by other processes. PATIENTS AND METHOD We carried out a retrospective study of bronchiectasis patients treated by lung transplantation in order to analyze demographic, functional and microbiological characteristics before and after transplantation, and survival. RESULTS From 1991 to 2002 lung transplants were performed on 171 patients, 44 of whom had suppurative lung disease (27 had cystic fibrosis and 17 had bronchiectasis caused by other processes). There were no significant differences in the demographic variables between the 2 groups. At transplantation, lung function variables showed severe bronchial obstruction (mean [SD] forced expiratory volume in 1 second of 808 [342] mL and forced vital capacity of 1,390 [611] mL) and respiratory insufficiency (PaO2 at 52 [10] mm Hg and PaCO2 at 48 [9] mm Hg). Only PaO2 was significantly lower in patients with bronchiectasis from causes other than cystic fibrosis. Airway colonization was present in 91% of the patients; Pseudomonas spp germs were detected in 64% of the cases and were multiresistant in 9%. In the early postoperative period germs were isolated in 59% of the cases, half of which involved the same germ as had been isolated before transplantation. One year after lung transplantation, 34% of the patients continued to have bronchial colonization. Survival at 1 year was 79% and at 5 years, 49%, with no significant difference between the patients with cystic fibrosis and those with other suppurative diseases, nor between the patients with and without Pseudomonas colonization. Only 2 patients had died of bacterial pneumonia at 1 month after transplantation. CONCLUSIONS Although airway colonization in patients with suppurative diseases complicates postoperative management, the results in terms of survival are good.
Collapse
Affiliation(s)
- A de Pablo
- Servicio de Neumología. Clínica Puerta de Hierro. Madrid. España.
| | | | | | | | | | | | | |
Collapse
|
27
|
de Pablo A, López S, Ussetti P, Carreño M, Laporta R, López García-Gallo C, Ferreiro M. Trasplante pulmonar en enfermedades supurativas. Arch Bronconeumol 2005. [DOI: 10.1157/13074591] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
28
|
Varela A, Nuñez J, Gamez A, Rio F, Cordoba M, Calatayud J, Ussetti P, Carreño M, Alfageme F, Gomez D. Are out hospital non heart beating donors (NHBD) better than brain death lung donors? J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
29
|
de Pablo A, Ussetti P, Gámez P, Varela A. [Series 4: respiratory muscles in neuromuscular diseases and the chest cavity. Pathophysiological consequences of lung volume reduction surgery in patients with emphysema]. Arch Bronconeumol 2003; 39:464-8. [PMID: 14533996 DOI: 10.1016/s0300-2896(03)75429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A de Pablo
- Servicio de Neumología. Clínica Puerta de Hierro. Madrid. Spain
| | | | | | | |
Collapse
|
30
|
de Pablo A, Ussetti P, Gámez P, Varela A. Consecuencias fisiopatológicas de la cirugía de reducción de volumen en pacientes con enfisema. Arch Bronconeumol 2003. [DOI: 10.1157/13052133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
31
|
Abstract
OBJECTIVES Despite years of experience with lung transplantation, the rate of perioperative mortality remains high. The objective of this study was to look at our experience in the early postoperative period following lung transplantation in an effort to identify possible pre-, intra- and postoperative risk factors associated with mortality. PATIENTS AND METHODS A retrospective study of 68 consecutive patients receiving lung transplants over a period of 56 months. The conditions that led to transplantation were obstructive disease (40%), interstitial disease (33%) and suppurative disease (27%). Pre-, intra- and postoperative characteristics of donors and recipients were analyzed for their relation to morbidity and mortality. Statistical studies were done using SPSS 10.0 software. A p-value less than.05 was considered significant. Univariate analysis identified variables associated with the incidence of mortality in the postoperative recovery unit, and the variables with statistically significant associations were entered into multivariate analysis, using a logistic regression model to calculate odds ratio (OR) and 95% confidence intervals (CI). RESULTS No donor variables correlated with mortality. Patients with suppurative lung disease had a lower mortality rate (0% vs 30%; P = 0.04). Mortality was related to ischemic time longer than 300 minutes (OR = 2) and the use of extracorporeal circulation (OR = 4). A PaO2/FiO2 ratio less than 150 during the first 24 hours following transplantation (OR = 5) and reoperation due to bleeding (OR = 12) were the variables showing the highest correlations with mortality during the early postoperative period. CONCLUSIONS The mortality rate during the early postoperative period in our series was 22%. The survival rate was better in patients with suppurative lung disease. Bleeding that required reoperation and early graft dysfunction (defined in part by a PaO2/FiO2 ratio less than 150 during the first 24 hours) were the variables that best predicted death in the early postoperative period following lung transplantation.
Collapse
Affiliation(s)
- F J Gómez
- Servicio de Anestesiología y Reanimación. Hospital Universitario Clínica Puerta de Hierro. Madrid. España
| | | | | | | | | |
Collapse
|
32
|
Abstract
INTRODUCTION Rapamycin is a potent immunosuppressive agent with a different mechanism of action and different adverse effects from those of calcineurin inhibitors (CNIs). OBJECTIVE To analyze our experience with rapamycin in patients undergoing lung transplantation and heart-lung transplantation in our center. PATIENTS AND METHODS Patients were treated with rapamycin when showing chronic rejection and/or toxicity associated with the CNI after lung transplantation or heartlung transplantation. Patients with chronic rejection were administered rapamycin in combination with CNIs, whereas the CNIs were eliminated in patients with toxicity. RESULTS Since October 2001, 7 patients (4 women), of mean age 45+/-15 years, received treatment with rapamycin (heart-lung transplantation, 2 cases; lung transplantation, 5 cases). The indications were chronic rejection in 4 patients and CMIs toxicity in 3 patients (kidney failure in 2 cases and optic neuropathy in 1 case). Pulmonary function stabilization was observed in 3 of 4 patients receiving rapamycin for chronic rejection. In the 3 patients with CNIs toxicity elimination of these drugs did not result in pulmonary functional deterioration. Patients with kidney failure showed an improvement in creatinine levels; visual acuity improved in the patient with optic neuropathy. We observed 2 infectious complications (pneumococcal pneumonia and pulmonary aspergillosis), which resolved with treatment. CONCLUSION Rapamycin is an alternative for lung-transplant recipients who develop chronic rejection and/or CNIs toxicity.
Collapse
Affiliation(s)
- P Ussetti
- Lung and Cardiopulmonary Transplant Unit, Clínica Puerta de Hierro, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
33
|
Gómez FJ, Planas A, Ussetti P, Tejada JJ, Varela A. Factores pronósticos de morbimortalidad en el postoperatorio inmediato del trasplante pulmonar. Arch Bronconeumol 2003. [DOI: 10.1157/13049954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
34
|
|
35
|
Abstract
Pulmonary sarcoidosis is an idiopathic granulomatosis with a clinical picture involving dyspnea, coughing, chest pain and characteristic radiologic changes. A review of English and Spanish language publications (PubMed 1990 through 2002) suggests that our report of a case of pulmonary sarcoidosis associated with primary antiphospholipid syndrome is the first one in the literature for this period. The patient was a 35-year-old man with venous thrombosis who later developed pulmonary sarcoidosis. The clinical course was not favorable in spite of good prognostic factors. We conclude that the association of these two clinical conditions is rare and that the presence of antiphospholipid syndrome may lead to greater morbidity and mortality.
Collapse
|
36
|
Varela A, Alvarez Kindelán A, Román A, Ussetti P, Zurbano F. [SEPAR (Spanish Society of Pneumology and Thoracic Surgery) Guidelines. Lung transplantation]. Arch Bronconeumol 2001; 37:307-15. [PMID: 11562316 DOI: 10.1016/s0300-2896(01)75100-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- A Varela
- Clínica Puerta de Hierro Madrid. España
| | | | | | | | | |
Collapse
|
37
|
de Pablo A, Ussetti P, Cruz Carreño M, Lázaro T, Ferreiro MJ, López A, Mendaza P, Estada J. [Aspergillosis in pulmonary transplantation]. Enferm Infecc Microbiol Clin 2000; 18:209-14. [PMID: 10974763] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Fungal infections are a frequent cause of morbidity an mortality in transplant recipients. Aspergillus spp. is an ubiquitous fungus capable of producing diverse clinical entities with varying severity. OBJECTIVE To study the incidence and severity of Aspergillus spp. infections in lung transplantation, analysing the different clinical presentations and response to antifungal drugs. METHODS A review was made of the clinical histories of all patients undergoing lung transplantation who developed positive Aspergillus spp. cultures in our centre between June 1991 and December 1996. RESULTS Eleven of 49 transplanted patients (22%) developed Aspergillus spp. infections. Four patients presented invasive aspergillosis forms and 7 tracheobronchitis. In spite of antifungal treatment 3 patients (30%) died of invasive aspergillosis as a direct consequence of the infection. Of the 7 patients with tracheobronchitis, 2 were ulcerative and 1 pseudomembranous, all responded to antifungal treatment. Three patients (10.3%) developed Aspergillus spp. infections despite prophylaxis with itraconazole. CONCLUSION Invasive aspergillosis in the immediate posttransplant period was mortal despite treatment. As opposed, aspergillar tracheobronchitis have been overcome using combined treatments of liposomal or lipidic amphotericin, itraconazole and nebulised amphotericin.
Collapse
Affiliation(s)
- A de Pablo
- Servicio de Neumología, Clínica Puerta de Hierro, Madrid
| | | | | | | | | | | | | | | |
Collapse
|
38
|
de Pablo A, Morales P, Román A, Lama R, García-López F, Borro JM, Baamonde C, Bravo C, Carreño MC, Estada J, Maestre J, Morant P, Morell F, Salvatierra A, Santos F, Solé A, Varela A, Ussetti P. [Chronic obstructive pulmonary disease and lung transplants: results in Spain]. Arch Bronconeumol 1999; 35:334-8. [PMID: 10439131] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To determine the outcome of lung transplantation in patients with chronic obstructive pulmonary disease (COPD) in Spain. METHODS In all COPD patients transplanted at four Spanish hospitals over a period of seven years, we studied actuarial survival rates retrospectively using the Kaplan Meier test in relation to demographic characteristics, type of transplant, underlying disease, lung function evolution in terms of forced vital capacity (FVC), maximum expiratory flow in 1 second (FEV1) and gasometric evolution (PaO2 and PaCO2). RESULTS Seventy-four transplants were performed in COPD patients over a five-year period. Mean age was 47 +/- 7 years (26-61) and 77% of the patients were men. A diagnosis of emphysema was made in 58%, alpha-1 antitrypsin deficiency emphysema in 14% and chronic bronchitis in 28%. The likelihood of survival was 75% for the first year, 63% for two years and 41% for the third year. Lung function and blood gases improved significantly by the third month after transplantation: FVC was 1677 +/- 637 ml before transplantation and 2631 +/- 670 ml afterwards; FEV1 was 585 +/- 189 ml before transplantation and 2118 +/- 673 ml afterwards (p < 0.001). Double lung transplants achieved significantly greater improvement in function variables than did single-lung transplants (FVC 2843 +/- 681 ml and FEV1 2543 +/- 620 ml by the third month in DLT patients versus FVC 2402 +/- 587 ml and FEV1 1659 +/- 350 ml for SLT), with no significant differences in blood gases after the two types of transplant. Half the sing-lung transplant patients developed hyperinflation of the native lung and reached maximum lung function values, which tended to be lower than those for patients who did not experience this complication (FEV1 1638 +/- 349 ml versus 1930 +/- 307 ml, p = 0.051). CONCLUSIONS First-year mortality in patients with COPD undergoing lung transplantation in Spain is similar to that described in the International Transplant Registry. We found no differences between double- and single-lung transplant patients. Functional change is good for both types of transplantation, although this aspect of outcome is significantly better when two lungs are transplanted.
Collapse
Affiliation(s)
- A de Pablo
- Unidad de Trasplante Pulmonar, Clínica Puerta de Hierro, Madrid
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Planas A, Ussetti P, Varela A, Abejo´n D, Go´mez-Nieto J, Tejada J, Carren˜o M. Inhaled nitric oxide in early severe allograft lung dysfunction. J Heart Lung Transplant 1999. [DOI: 10.1016/s1053-2498(99)80088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
40
|
Abstract
Lung transplantation has become the therapeutic hope of terminal respiratory patients. Infections are among the main causes of morbidity and mortality in these patients. We therefore analyze infections suffered after lung transplants performed at Clínica Puerta de Hierro over a two-year period. The cases of 14 transplanted patients, 6 bilateral and 8 unilateral, were analyzed. Pre-transplant data available for all included analysis of serum antibodies to several viruses, as well as bacterial and fungal cultures, and Ziehl's sputum test. All received prophylactic antibiotic, antifungal and antiviral treatment according to protocol. The bronchial aspirate of the donor, and recipient specimens of bronchial aspirate, bronchoalveolar lavage and biopsies obtained by bronchoscopy after transplantation were cultured. Bronchoscopies were performed according to protocol, based on clinical picture. Other cultures were obtained as needed. We recorded 27 respiratory infections, among which 4 were pneumonia transmitted by the donor, 3 were tuberculosis, 3 were Aspergillus infections, 5 were cytomegalovirus pneumonitis and one, P. carinii pneumonia. Lung infections have a strong impact on outcome of lung transplant patients. Knowledge of the chronological development of infections made appropriate prophylaxis and early detection possible, such that survival during the first two years after transplantation was approximately 70% in our hospital.
Collapse
Affiliation(s)
- M C Carreño
- Servicio de Medicina Interna, Clínica Puerta de Hierro, Madrid
| | | | | | | | | | | | | |
Collapse
|
41
|
Ussetti P, Melero C, Rey R. [Secondary chemoprophylaxis in tuberculosis and AIDS]. Enferm Infecc Microbiol Clin 1996; 14:332. [PMID: 8924484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
42
|
Ussetti P, Urbina J, Pantoja C, Sidne J, Martínez JA, Martínez MA, Sánchez I, Cobos J, Rojas O. [Tuberculin reactivity in the elderly. Comparison of PPD-RT23 and PPD-CT68]. Enferm Infecc Microbiol Clin 1996; 14:80-5. [PMID: 8714153] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tuberculin reactivity varies on the basis of the PPD lot and the population studied. AIMS To compare tuberculin reactivity in the elderly following successive applications of PPD from 2 different lots. POPULATION Elderly nursing-home residents, from the province of Guadalajara, Spain. METHODS The elderly were randomly selected and administered with a first Mantoux intradermoreaction of 2 UT of PPD-RT23 or 2 UT of PPD-CT68. The study was performed in a scaled basis, eliminating the reactors (transversal induration > or = 5 mm at 72 h). The non reactors were restudied with a second and third test in alternative arms at a 7-day interval with the same lot and initial dosis of PPD. At one year the scaled study was repeated with 2 UT of PPD-CT68. RESULTS Eight hundred and thirty elderly persons (79 +/- 9 years) were studied, with 410 receiving PPD-RT23 and 420 receiving PPD-CT68. No differences were observed in the percentage of initial reactors (31% vs 29%; p = 0.26) or in the booster reactors (23% vs 20%; p = 0.16). The PPD-RT23 was found to trigger more intensive reactions than the PPD-CT68 leading to a greater frequency of indurations > 14 mm. After one year, the percentage of stable reactions was similar in both groups (50.5% vs 49.5%; NS). CONCLUSIONS 1) In elderly nursing-home residents 2 UT of PPD-RT23 and 2 UT of PPD-CT68 showed similar results in regard to the number of reactors and the frequency of booster reactions. 2) The proportion of intense reactions was greater with 2 UT of PPD-RT23 than with 2 UT of PPD-CT68. 3) The stability of the reactions at one year was independent of the lot used in the first phase.
Collapse
Affiliation(s)
- P Ussetti
- Hospital General del INSALUD, Guadalajara
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Melero C, Rey R, Ussetti P, Muñoz L, Caballero J, Ortega A, Ramos A. Rifabutin vs rifampicin in the treatment of initial pulmonary tuberculosis. Follow-up at 5 years. ACTA ACUST UNITED AC 1994. [DOI: 10.1016/0962-8479(94)90741-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
44
|
Sánchez-Hernández IM, Pantoja C, Ussetti P, Gallardo J, Carrillo F, Cuevas J. Pleural fluid adenosine deaminase and lysozyme levels in the diagnosis of tuberculosis. Chest 1991; 100:1479-80. [PMID: 1935329 DOI: 10.1378/chest.100.5.1479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
|
45
|
Ussetti P. Valoracion funcional preoperatoria. Arch Bronconeumol 1991. [DOI: 10.1016/s0300-2896(15)31421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
46
|
Barbera JA, Roca J, Ramirez J, Wagner PD, Ussetti P, Rodriguez-Roisin R. Gas exchange during exercise in mild chronic obstructive pulmonary disease. Correlation with lung structure. Am Rev Respir Dis 1991; 144:520-5. [PMID: 1892290 DOI: 10.1164/ajrccm/144.3_pt_1.520] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To investigate whether or not the pathologic features in the lungs of patients with chronic obstructive pulmonary disease (COPD) are related to the gas exchange response during exercise, we studied 17 patients (15 men, two women) with mild-to-moderate airflow obstruction (FEV1/FVC ratio, 59 +/- 3%), undergoing resective lung surgery, at rest and during submaximal exercise (71 +/- 5% predicted VO2max). During exercise, arterial PO2 increased (from 81 +/- 3 to 86 +/- 3 mm Hg, p less than 0.05) as a result of an overall improvement in VA/Q relationships. This improvement included an increase in the mean VA/Q ratios of both ventilation and blood flow distributions, and a more homogeneous ventilation distribution (logSD V, from 0.66 +/- 0.06 to 0.50 +/- 0.03; p less than 0.01; normal value, less than or equal to 0.6). The morphologic evaluation of the resected specimens disclosed a moderate degree of emphysema (emphysema score, 16 +/- 4) and mild abnormalities in membranous bronchioles (total pathology score, 107 +/- 8). At rest, significant correlations were found between the severity of the pathologic findings and both the degree of hypoxemia and the extent of VA/Q mismatching. During exercise, no relationship between bronchiolar abnormalities and gas exchange measurements was observed, whereas the severity of emphysema was correlated with PaO2 (r = -0.54, p less than 0.05). Both the overall increase in and the more efficient distribution of ventilation accounted for the improvement in VA/Q distributions during exercise. These changes were more pronounced in patients with a greater degree of bronchiolar abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- J A Barbera
- Department of Medicine (Servei de Pneumologia), Hospital Clinic, Facultat de Medicina, Universitat de Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
47
|
Reyes A, Roca J, Rodriguez-Roisin R, Torres A, Ussetti P, Wagner PD. Effect of almitrine on ventilation-perfusion distribution in adult respiratory distress syndrome. Am Rev Respir Dis 1988; 137:1062-7. [PMID: 3195804 DOI: 10.1164/ajrccm/137.5.1062] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Almitrine improves ventilation/perfusion relationships (VA/Q) in COPD, but its effects in ARDS, in which VA/Q mismatching is the cause of severe hypoxemia, are not known. The effects of almitrine on pulmonary gas exchange and circulation were assessed in 9 patients with ARDS who were sedated, paralyzed, and mechanically ventilated at constant FlO2 (range, 0.48 to 0.74). Systemic and pulmonary hemodynamics, conventional gas exchange, and the VA/Q distribution by the multiple inert gas elimination technique (MIGT) were measured before (baseline), during (ALM 15), at the end of (ALM 30), and at 30-min intervals after (POSTALM 30, 60, and 90) the intravenous infusion of 0.5 mg/kg body weight of almitrine over 30 min. Almitrine significantly increased PaO2 from 78 +/- 15 mm Hg to 140 +/- 49 at ALM 15 and 138 +/- 52 at ALM 30. AaPO2 and QS/QT decreased during the administration of the drug. The MIGT showed that almitrine redistributed pulmonary blood flow from shunt areas (reduction from 29 +/- 11 to 17 +/- 11% of QT) to lung units with normal VA/Q ratios (increase from 63 +/- 9 to 73 +/- 6% of QT). The Ppa increased from 26 +/- 5 to 30 +/- 5 mm Hg without changes in QT. Changes were transient, returning toward baseline 30 min after stopping the infusion of the drug. Almitrine significantly reduced the VA/Q inequalities present in ARDS and may be useful in the management of those patients.
Collapse
Affiliation(s)
- A Reyes
- Servicio de Neumología, Hospital Clínico, Universidad de Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
48
|
Agustí C, Torres A, Ussetti P, Buges J, Rodríguez Roisín R, Ribalta MT, Agustí-Vidal A. [Aspergillus pneumonia in patients with chronic bronchopathy. Presentation of 3 cases]. Med Clin (Barc) 1987; 89:384-6. [PMID: 3312858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
49
|
Graus F, Elkon KB, Lloberes P, Ribalta T, Torres A, Ussetti P, Valls J, Obach J, Agusti-Vidal A. Neuronal antinuclear antibody (anti-Hu) in paraneoplastic encephalomyelitis simulating acute polyneuritis. Acta Neurol Scand 1987; 75:249-52. [PMID: 3035860 DOI: 10.1111/j.1600-0404.1987.tb07928.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A patient with paraneoplastic encephalomyelitis (PEM) and small cell lung cancer had a clinical presentation of acute polyneuritis. The patient had an antibody (anti-Hu) restricted to nuclei of neurons identical to that reported in patients with subacute sensory neuronopathy and lung cancer. This finding further supports the hypothesis that PEM and subacute sensory neuronopathy are closely related disorders of autoimmune origin. PEM should be considered in patients with small cell lung cancer and clinical features limited to the peripheral nervous system.
Collapse
|
50
|
Xaubet A, Torres A, Ramírez J, Faus R, Marín A, Barberá J, Ussetti P. [Diagnosis of pulmonary infiltrates in patients with acquired immunodeficiency syndrome]. Med Clin (Barc) 1987; 88:311-4. [PMID: 3561083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|