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Clinics in Chest Medicine

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https://www.readbyqxmd.com/read/29128027/pulmonary-considerations-in-solid-organ-and-hematopoietic-stem-cell-transplantation
#1
EDITORIAL
Vivek N Ahya, Joshua M Diamond
No abstract text is available yet for this article.
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128026/hepatopulmonary-syndrome-and-portopulmonary-hypertension-implications-for-liver-transplantation
#2
REVIEW
Shaz Iqbal, Kerri Akaya Smith, Vandana Khungar
Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PoPH) represent serious pulmonary complications of advanced liver diseases. Orthotopic liver transplantation (OLT) is capable of completely resolving the underlying abnormalities associated with HPS. On the other hand, post-OLT response in patients with PoPH is less predictable, although heavily influenced by pre-OLT mean pulmonary arterial pressure. It remains the case that the opportunity to reverse 2 potentially fatal organ dysfunctions in the liver and the lung make HPS and PoPH more than worthy for further clinical investigations...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128025/posttransplant-lymphoproliferative-disorder-in-solid-organ-and-hematopoietic-stem-cell-transplantation
#3
REVIEW
Sarah J Nagle, Ran Reshef, Donald E Tsai
Posttransplant lymphoproliferative disorders (PTLD) represent an immunosuppression-related lymphoid or plasmacytic proliferation that occur in the setting of solid organ transplant or allogeneic hematopoietic stem cell transplantation (HSCT). PTLD is a devastating consequence of HSCT and solid organ transplantation with a high morbidity and mortality. Most commonly, PTLD is related to Epstein-Barr virus (EBV) infection, but an increasing number of non-EBV-related cases are occurring. Initial therapy involves withdrawal of immunosuppression with or without antibody or cytotoxic chemotherapy...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128024/mycobacterial-infections-in-solid-organ-and-hematopoietic-stem-cell-transplantation
#4
REVIEW
Tahuanty Pena, Julia Klesney-Tait
Mycobacterial infections are uncommon in solid organ and hematopoietic stem cell transplant recipients but carry significant morbidity and mortality. Donor screening strategies for tuberculosis should be emphasized in high-risk populations. Both tuberculosis and nontuberculous mycobacterial infections can have pulmonary and extrapulmonary manifestations of infections. Recommended treatment regimens typically involve multiple drugs with significant adverse effects and drug interactions.
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128023/evaluation-and-management-of-the-potential-lung-donor
#5
REVIEW
Andrew Courtwright, Edward Cantu
The expansion of the donor lung pool has involved an evidence-driven redefinition of acceptable donors. Proceeding with transplantation with an acceptable rather than ideal donor depends on specific patient-related and organ-related risk factors as well as the severity of recipient illness. Although the physiologic optimization of brain-dead donors has not changed significantly in recent years, the use of donor management protocols has improved procurement rates. Ex vivo lung perfusion is an increasingly viable strategy to recondition lungs that would otherwise fall below the acceptable threshold for transplant...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128022/noninfectious-pulmonary-complications-of-liver-heart-and-kidney-transplantation-an-update
#6
REVIEW
Shruti Gadre, Robert M Kotloff
Despite significant advances in surgical techniques, perioperative care, and immunosuppressive therapy, solid organ transplantation still carries considerable risk of complications. Pulmonary complications, in particular, are a major cause of morbidity and mortality. Although infectious complications prevail, the lungs are also vulnerable to a variety of noninfectious complications related to the transplant surgery and adverse effects of the immunosuppressive regimen. This article focuses on noninfectious pulmonary complications associated with the 3 most commonly performed solid organ transplant procedures: liver, kidney, and heart...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128021/respiratory-fungal-infections-in-solid-organ-and-hematopoietic-stem-cell-transplantation
#7
REVIEW
Oveimar De La Cruz, Fernanda P Silveira
Respiratory fungal infections are associated with high morbidity and mortality in hematopoietic stem cell (HSCT) and solid organ (SOT) transplant recipients, and are caused primarily by molds. Aspergillus is the most common pathogen. The net state of immunosuppression plays a major role in the risk of respiratory fungal infections after transplantation. Clinical presentation can be atypical and diagnosis can be delayed due to low sensitivity of diagnostic methods or inability to obtain adequate specimens. Fungal infections in HSCT and SOT carry a higher risk of dissemination...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128020/respiratory-viral-infections-in-solid-organ-and-hematopoietic-stem-cell-transplantation
#8
REVIEW
Grant C Paulsen, Lara Danziger-Isakov
Respiratory viruses are common in solid organ and hematopoietic stem cell transplant recipients and a recognized cause of significant morbidity and mortality. Epidemiology, risk factors, and attributable mortality in both populations are reviewed. In addition, virus-specific prevention and treatment options, including emerging investigational therapies, are discussed for respiratory syncytial virus, influenza, adenovirus, parainfluenza, and other respiratory viruses.
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128019/airway-complications-after-lung-transplantation
#9
REVIEW
Laura Frye, Michael Machuzak
Airway complications remain a significant source of morbidity and mortality after lung transplantation. The incidence of complications is wide-ranging depending on the definition of the event, and there is still no universally accepted grading system for airway findings after transplantation. Additionally, although surgical technique and organ preservation have improved, other modifiable risk factors remain unclear. The management is as wide-ranging as the definitions. A multimodality approach is often needed with airway stenting reserved for refractory cases and stent management by a transplant team with expertise in placement and management of long-term complications...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128018/update-in-chronic-lung-allograft-dysfunction
#10
REVIEW
Rupal J Shah, Joshua M Diamond
Chronic lung allograft dysfunction (CLAD) is the major limitation to posttransplant survival. This review highlights the evolving definition of CLAD, risk factors, treatment, and expected outcomes after the development of CLAD.
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128017/acute-rejection-and-antibody-mediated-rejection-in-lung-transplantation
#11
REVIEW
Ramsey R Hachem
Despite advances in immunosuppression over the past 25 years, acute cellular rejection remains a common complication early after lung transplantation. Although acute cellular rejection has often not resulted in clinical signs or symptoms of allograft dysfunction, it has been widely recognized as a strong independent risk factor for the development of chronic rejection, emphasizing its clinical significance. In recent years, the role of humoral immunity in lung rejection has been increasingly appreciated, and antibody-mediated rejection is now recognized as a form of rejection that may result in allograft failure...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128016/extracorporeal-life-support-in-lung-transplantation
#12
REVIEW
Darryl Abrams, Daniel Brodie, Selim M Arcasoy
Extracorporeal life support in lung transplantation has been associated with poor posttransplant outcomes. However, recent advances have resulted in more favorable posttransplant outcomes. The increased use of this technology must be weighed against the risks inherent in its use, especially when complications arising in extracorporeal membrane oxygenation (ECMO)-dependent patients result in loss of transplant candidacy, leaving them with no viable alternative for long-term support. Existing and emerging data support the judicious use of this technology in carefully selected patients at high-volume transplant and ECMO centers that prioritize minimization of sedation, avoidance of endotracheal intubation, and early mobilization...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128015/primary-graft-dysfunction-after-lung-transplantation
#13
REVIEW
Mary K Porteous, James C Lee
Primary graft dysfunction is a form of acute injury after lung transplantation that is associated with significant short- and long-term morbidity and mortality. Multiple mechanisms contribute to the pathogenesis of primary graft dysfunction, including ischemia reperfusion injury, epithelial cell death, endothelial cell dysfunction, innate immune activation, oxidative stress, and release of inflammatory cytokines and chemokines. This article reviews the epidemiology, pathogenesis, risk factors, prevention, and treatment of primary graft dysfunction...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128014/overview-of-lung-transplantation-heart-lung-transplantation-liver-lung-transplantation-and-combined-hematopoietic-stem-cell-transplantation-and-lung-transplantation
#14
REVIEW
Shruti Gadre, Jason Turowski, Marie Budev
Lung transplantation (LTx) has evolved to represent the therapy of choice for many patients with end-stage lung diseases. Appropriate candidate selection for LTx is an important determinant of a positive outcome from transplantation. Posttransplantation survival has steadily improved, but long-term survival continues to be a challenge with a median survival of 5.8 years. Similarly, combined heart-lung transplantation and simultaneous liver-lung transplantation has been performed successfully in select patients who are not expected to survive either organ transplant alone...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128013/bronchiolitis-obliterans-syndrome-and-other-late-pulmonary-complications-after-allogeneic-hematopoietic-stem-cell-transplantation
#15
REVIEW
Anne Bergeron, Guang-Shing Cheng
As more individuals survive their hematologic malignancies after allogeneic hematopoietic stem cell transplantation (HSCT), there is growing appreciation of the late organ complications of this curative procedure for malignant and nonmalignant hematologic disorders. Late noninfectious pulmonary complications encompass all aspects of the bronchopulmonary anatomy. There have been recent advances in the diagnostic recognition and management of bronchiolitis obliterans syndrome, which is recognized as a pulmonary manifestation of chronic graft-versus-host disease...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128012/noninfectious-acute-lung-injury-syndromes-early-after-hematopoietic-stem-cell-transplantation
#16
REVIEW
Vivek N Ahya
Noninfectious acute lung injury syndromes are major causes of respiratory failure and early mortality after hematopoietic stem cell transplantation (HSCT). Pulmonary edema and transfusion-related acute lung injuries are important respiratory complications seen after HSCT and in the nontransplant setting. Early transplant-specific causes of lung injury, such as idiopathic pneumonia syndrome, are reviewed. Several complications, such as drug-induced pneumonitis and cryptogenic organizing pneumonia, that occur in both the early and later time periods after HSCT are also briefly discussed...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29128011/overview-of-hematopoietic-cell-transplantation-for-the-treatment-of-hematologic-malignancies
#17
REVIEW
Nathan Singh, Alison W Loren
Allogeneic hematopoietic cell transplantation offers the best chance for cure in many hematologic malignancies. Key decisions include patient selection, donor and graft source, conditioning regimen, and graft-versus-host disease (GVHD) prophylaxis. Transplant is risky; only one-third survive long term. Complications include relapse, GVHD, infection, and end-organ dysfunction. Expanding indications for transplantation, advancing upper age limits, and improvements in patient care have resulted in increasing numbers of transplant survivors...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797496/diagnosis-and-treatment-of-fungal-chest-infections
#18
EDITORIAL
Eva M Carmona, Andrew H Limper
No abstract text is available yet for this article.
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797495/emergence-of-the-molds-other-than-aspergillus-in-immunocompromised-patients
#19
REVIEW
Sana Arif, John R Perfect
Immunocompromised patients are at high risk for invasive fungal infections (IFIs); although Aspergillus remains the most common IFI caused by molds, other fungi, such as Mucorales, dematiaceous molds, and Fusarium spp, are being seen with increasing frequency. Presentations can vary, but sinopulmonary and disseminated infections are common. Our understanding of the pathogenesis of these infections is rudimentary. Fungal cultures and histopathology remain the backbone of diagnostics, as no good serologic markers are available...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797494/laboratory-diagnostics-for-fungal-infections-a-review-of-current-and-future-diagnostic-assays
#20
REVIEW
Poornima Ramanan, Nancy L Wengenack, Elitza S Theel
This article reviews the current diagnostic approaches, both serologic and molecular, for the detection of fungi associated with pulmonary disease. Classic serologic techniques, including immunodiffusion and complement fixation, both of which remain a cornerstone for fungal diagnostic testing, are reviewed and their performance characteristics presented. More recent advances in this field, including novel lateral-flow assays for fungal antigen detection, are also described. Molecular techniques for fungal identification both from culture and directly from patient specimens, including nucleic acid probes, mass spectrometry-based methods, nucleic acid amplification testing, and traditional and broad-range sequencing, are discussed and their performance evaluated...
September 2017: Clinics in Chest Medicine
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