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Lung transplant, intensive care

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https://www.readbyqxmd.com/read/28527964/impact-of-high-priority-allocation-on-lung-and-heart-lung-transplantation-for-pulmonary-hypertension
#1
Laurent Savale, Jérôme Le Pavec, Olaf Mercier, Sacha Mussot, Xavier Jaïs, Dominique Fabre, Caroline O'Connell, David Montani, François Stephan, Olivier Sitbon, Gérald Simonneau, Philippe Dartevelle, Marc Humbert, Elie Fadel
BACKGROUND: Since 2006 and 2007, patients in France with severe pulmonary hypertension (PH) who are at imminent risk of death, despite optimal treatment in the intensive care unit, are placed on a high-priority list (HPL) for heart-lung transplantation (HLT) or double-lung transplantation (DLT). We assessed the effect of this approach on the waiting list and outcomes after transplantation. METHODS: We conducted a single-center, retrospective, before-and-after study of consecutive patients with severe group 1, 1', or 4 PH listed for DLT or HLT between 2000 and 2013 (ie, 6 years before and 6 years after HPL implementation)...
May 18, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28457373/optimizing-the-use-of-available-lungs
#2
D Peritore, L Rizzato, S Trapani, V Morabito, P Fiaschetti, A Cacciotti, A Montemurro, E Del Sordo, A Ricci, A Nanni Costa
BACKGROUND: Organ transplantation, the treatment of choice in organ failure, is penalized by the lack of organs. Because the increase in the number of donors is not proportional throughout the different age groups, there is no increase in lung transplantations. The aim of this work was to analyze the use of available lungs and evaluate strategies that may help increase transplantations. METHODS: We analyzed the activity of lung transplantation in 2015, divided into various allocation programs...
May 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28455097/severity-of-acute-kidney-injury-in-the-post-lung-transplant-patient-is-associated-with-higher-healthcare-resources-and-cost
#3
Albert P Nguyen, Rodney A Gabriel, Eugene Golts, Erik B Kistler, Ulrich Schmidt
OBJECTIVE: Perioperative risk factors and the clinical impact of acute kidney injury (AKI) and failure after lung transplantation are not well described. The incidences of AKI and acute renal failure (ARF), potential perioperative contributors to their development, and postdischarge healthcare needs were evaluated. DESIGN: Retrospective. SETTING: University hospital. PARTICIPANTS: Patients undergoing lung transplantation between January 1, 2011 and December 31, 2015...
February 5, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28447929/five-year-follow-up-on-transplanted-organs-from-donors-after-brain-death-after-acute-stroke
#4
Vera Spatenkova, Eva Pokorna, Petr Suchomel
OBJECTIVES: Efficient intensive care donor management can help alleviate the shortage of organs for transplant. The aim of this study was to investigate the efficiency of management of donors after brain death from our neurointensive care unit. MATERIALS AND METHODS: We conducted a prospective observational 5-year follow-up on 29 transplanted organs from 14 brain-dead donors after acute stroke (7 subarachnoid and 4 intracerebral hemorrhages, 3 ischemic strokes)...
April 27, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28390643/a-46-year-old-man-with-dyspnea-hypoxemia-and-radiographic-asymmetry-after-redo-bilateral-lung-transplantation
#5
Sofya Tokman, Michael A Smith, A Samad Hashimi, Ashraf Omar
A 46-year-old man underwent redo bilateral sequential lung transplantation for rapidly progressive bronchiolitis obliterans syndrome that developed 3.5 years after initial transplantation. In the operating room, he was sedated and intubated with a dual lumen endotracheal tube with subsequent single right-lung ventilation and left allograft implantation. His pulmonary arterial pressure became elevated with reperfusion of the newly implanted left lung, which required initiation of cardiopulmonary bypass to facilitate implantation of the right lung...
April 2017: Chest
https://www.readbyqxmd.com/read/28366682/indications-for-lung-resection-surgery-and-lung-transplant-in-south-american-children-with-cystic-fibrosis
#6
REVIEW
Fabíola Villac Adde, Sílvia Vidal Campos, Ricardo Henrique de Oliveira Braga Teixeira, Joaquim Carlos Rodrigues
The current available literature evaluating lung resection surgery and lung transplantation in children with cystic fibrosis (CF) was reviewed through a PubMed search and references from selected studies were additionally included. Pulmonary resections, i.e. lobectomy, segmentectomy, and pneumonectomy, are seldom performed in CF. The main indications, in patients with a forced expiratory volume in 1second (FEV1) that is greater than 30% predicted, are localized bronchiectasis/atelectasis, severe hemoptysis, and bronchopleural fistula refractory to medical management...
February 16, 2017: Paediatric Respiratory Reviews
https://www.readbyqxmd.com/read/28364392/burkholderia-cepacia-complex-in-cystic-fibrosis-in-the-post-epidemic-period-multilocus-sequence-typing-based-approach
#7
Libor Fila, Pavel Dřevínek
Cystic fibrosis (CF) patients in the Czech Republic suffered in the late 1990s from an epidemic with ST32 strain of Burkholderia cepacia complex (Bcc). Cohort segregation of Bcc and of ST32 positive patients was introduced in 1999 and 2002, respectively. We performed a study to evaluate the molecular epidemiology of Bcc infection after implementation of these infection control measures. Patients attending the Prague CF adult Centre from 2000 to 2015 were included in the present study. Demographic data and microbial statuses were collected from patient records...
March 31, 2017: Folia Microbiologica
https://www.readbyqxmd.com/read/28340839/incidence-of-early-acute-kidney-injury-in-lung-transplant-patients-a-single-center-experience
#8
M K Balci, M Vayvada, C Salturk, C A Kutlu, E Ari
BACKGROUND: Acute kidney injury (AKI) is a common complication in the early period of lung transplantation (LTx). We aimed to describe the incidence and perioperative risk factors associated with AKI following LTx. METHODS: Clinical data of 30 patients who underwent LTx were retrospectively reviewed. Primary outcomes were development of AKI and patient mortality within 30 postoperative days. Postoperative AKI is determined based on creatinine criteria from Acute Kidney Injury Network (AKIN) classification...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28314503/standard-donor-lung-procurement-with-normothermic-ex-vivo-lung-perfusion-a-prospective-randomized-clinical-trial
#9
Alexis Slama, Lukas Schillab, Maximilian Barta, Aris Benedek, Andreas Mitterbauer, Konrad Hoetzenecker, Shahrokh Taghavi, Gyoergy Lang, Jose Matilla, Hendrik Ankersmit, Helmut Hager, Georg Roth, Walter Klepetko, Clemens Aigner
BACKGROUND: Ex vivo lung perfusion (EVLP) was primarily developed for evaluation of impaired donor lungs. The good clinical results raise the question for its possible impact on lungs meeting standard criteria. Before application of EVLP on such lungs enters routine clinical practice, it must be demonstrated whether EVLP would affect or improve outcome when used in standard donor lungs. We performed a prospective randomized trial to investigate the role of EVLP in standard lung transplantation (Tx)...
February 20, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28314081/delirium-after-lung-transplantation-association-with-recipient-characteristics-hospital-resource-utilization-and-mortality
#10
Yelizaveta Sher, Joshua Mooney, Gundeep Dhillon, Roy Lee, José R Maldonado
BACKGROUND: Delirium is associated with increased morbidity and mortality. The factors associated with post-lung transplant delirium and its impact on outcomes are under characterized. METHODS: The medical records of 163 consecutive adult lung transplant recipients were reviewed for delirium within 5 days (early-onset) and 30 hospital days (ever-onset) post-transplantation. A multivariable logistic regression model assessed factors associated with delirium. Multivariable negative binomial regression and Cox proportional hazards models assessed the association of delirium with ventilator duration, intensive care unit (ICU) length of stay (LOS), hospital LOS, and one-year mortality...
May 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28301586/influence-of-early-neurological-complications-on-clinical-outcome-following-lung-transplant
#11
Josep Gamez, Maria Salvado, Alejandro Martinez-de La Ossa, Maria Deu, Laura Romero, Antonio Roman, Judith Sacanell, Cesar Laborda, Isabel Rochera, Miriam Nadal, Francesc Carmona, Estevo Santamarina, Nuria Raguer, Merce Canela, Joan Solé
BACKGROUND: Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. METHODS: We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014...
2017: PloS One
https://www.readbyqxmd.com/read/28296181/-white-out-after-lung-transplantation-a-multicentre-cohort-description-of-late-acute-graft-failure
#12
Stijn E Verleden, Jens Gottlieb, Adriana Dubbeldam, Geert M Verleden, Hendrik Suhling, Tobias Welte, Robin Vos, Mark Greer
Graft failure represents a leading cause of mortality following organ transplantation. Acute late-onset graft failure has not been widely reported. This paper describes the demographics, CT imaging pathology findings and treatment of patients presenting with the latter. A retrospective review of lung transplant recipients at 2 large-volume centres was performed. Acute late-onset graft failure was defined as sudden onset of bilateral infiltrates with an oxygenation index <200 without identifiable cause or concurrent extra-pulmonary organ failure...
March 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28256290/risk-factors-for-mortality-in-272-patients-with-lung-transplant-a-multicenter-analysis-of-7-intensive-care-units
#13
Jordi Rello, Irene Bello, Rosario de Vicente, Ana Hermira Anchuelo, Maria Ángeles Ballesteros, Reyes Iranzo, Luzdivina Rellán, Jordi Riera, Juan Carlos Robles
BACKGROUND: One-year survival in lung transplant is around 85%, but this figure has not increased in recent years, in spite of technical improvements. METHODS: Retrospective, multicenter cohort study. Data from 272 eligible adults with lung transplant were recorded at 7 intensive care units (ICU) in Spain in 2013. The objective was to identify variables that might help to guide future clinical interventions in order to reducethe risk of death in the postoperative period...
February 27, 2017: Archivos de Bronconeumología
https://www.readbyqxmd.com/read/28237439/esophagopericardial-fistula-septic-shock-and-intracranial-hemorrhage-with-hydrocephalus-after-lung-transplantation
#14
M M Schuurmans, C Benden, C Moehrlen, C Gubler, M Wilhelm, W Weder, I Inci
A 57-year old woman underwent lung transplantation for non-specific interstitial pneumonia. Primary graft dysfunction was diagnosed requiring continued use of extracorporeal membrane oxygenation (ECMO). Within three days she developed recurring hemothoraces requiring two surgical evacuations. After ECMO removal a series of complications occurred within four months: femoral thrombosis, persisting tachycardic atrial fibrillation, pneumopericardium with an esophagopericardial fistula and purulent pericarditis, septic shock, multiorgan failure and intracerebral hemorrhage with ventricular involvement requiring external ventricular drainage...
February 22, 2017: Revista Portuguesa de Pneumologia
https://www.readbyqxmd.com/read/28153472/conservative-management-of-distal-leg-necrosis-in-lung-transplant-recipients
#15
F Aigner, M Husmann, L C Huber, C Benden, M M Schuurmans
Critical limb ischemia (CLI) with distal leg necrosis in lung transplant recipients (LTR) is associated with a high risk for systemic infection and sepsis. Optimal management of CLI has not been defined so far in LTR. In immunocompetent individuals with leg necrosis, surgical amputation would be indicated and standard care. We report on the outcome of four conservatively managed LTR with distal leg necrosis due to peripheral arterial disease (PAD) with medial calcification of the distal limb vessels. Time interval from lung transplantation to CLI ranged from four years (n = 1) to more than a decade (n = 3)...
January 28, 2017: Journal of Tissue Viability
https://www.readbyqxmd.com/read/28066607/risk-factors-and-outcome-of-primary-graft-dysfunction-after-lung-transplantation-in-korea
#16
Sungwoo Moon, Moo Suk Park, Jin Gu Lee, Ji Ye Jung, Young Ae Kang, Young Sam Kim, Se Kyu Kim, Joon Chang, Hyo Chae Paik, Song Yee Kim
BACKGROUND: Primary graft dysfunction (PGD) is a severe, acute and post-transplantation lung injury associated with early morbidity and mortality. We aimed to identify clinical risk factors for PGD, as well as the outcome of PGD after lung transplantation in Korea. METHODS: We retrospectively analyzed lung transplant patients in a South Korean Hospital. The primary outcome was grade 3 PGD, defined according to the International Society for Heart and Lung Transplantation criteria...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27916176/functional-assessment-and-transplantation-of-the-donor-heart-after-circulatory-death
#17
Simon J Messer, Richard G Axell, Simon Colah, Paul A White, Marian Ryan, Aravinda A Page, Barbora Parizkova, Kamen Valchanov, Christopher W White, Darren H Freed, Euan Ashley, John Dunning, Martin Goddard, Jayan Parameshwar, Christopher J Watson, Thomas Krieg, Ayyaz Ali, Steven Tsui, Stephen R Large
BACKGROUND: After a severe shortage of brain-dead donors, the demand for heart transplantation has never been greater. In an attempt to increase organ supply, abdominal and lung transplant programs have turned to the donation after circulatory-determined death (DCD) donor. However, because heart function cannot be assessed after circulatory death, DCD heart transplantation was deemed high risk and never adopted routinely. We report a novel method of functional assessment of the DCD heart resulting in a successful clinical program...
December 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27910193/use-of-organs-from-donors-with-bloodstream-infection-pneumonia-and-influenza-results-of-a-survey-of-infectious-diseases-practitioners
#18
Sanjay R Mehta, Cathy Logan, Camille N Kotton, Deepali Kumar, Saima Aslam
BACKGROUND: Potential organ donors may be admitted with an infection to an intensive care unit, or contract a nosocomial infection during their stay, increasing the risk of potential transmission to the recipient. Because of a lack of practice guidelines and large-scale data on this topic, we undertook a survey to assess the willingness of transplant infectious diseases (ID) physicians to accept such organs. METHODS: We performed a 10-question survey of ID providers from the American Society of Transplantation Infectious Disease Community of Practice to determine the scope of practice regarding acceptance of organs from donors with bloodstream infection, pneumonia, and influenza prior to organ procurement, as well as management of such infections following transplantation...
December 2, 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/27897967/an-observational-study-of-donor-ex-vivo-lung-perfusion-in-uk-lung-transplantation-develop-uk
#19
Andrew Fisher, Anders Andreasson, Alexandros Chrysos, Joanne Lally, Chrysovalanto Mamasoula, Catherine Exley, Jennifer Wilkinson, Jessica Qian, Gillian Watson, Oli Lewington, Thomas Chadwick, Elaine McColl, Mark Pearce, Kay Mann, Nicola McMeekin, Luke Vale, Steven Tsui, Nizar Yonan, Andre Simon, Nandor Marczin, Jorge Mascaro, John Dark
BACKGROUND: Many patients awaiting lung transplantation die before a donor organ becomes available. Ex vivo lung perfusion (EVLP) allows initially unusable donor lungs to be assessed and reconditioned for clinical use. OBJECTIVE: The objective of the Donor Ex Vivo Lung Perfusion in UK lung transplantation study was to evaluate the clinical effectiveness and cost-effectiveness of EVLP in increasing UK lung transplant activity. DESIGN: A multicentre, unblinded, non-randomised, non-inferiority observational study to compare transplant outcomes between EVLP-assessed and standard donor lungs...
November 2016: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/27873446/the-first-2-years-of-activity-of-a-specialized-organ-procurement-center-report-of-an-innovative-approach-to-improve-organ-donation
#20
P Marsolais, P Durand, E Charbonney, K Serri, A-M Lagacé, F Bernard, M Albert
The number of patients requiring organ transplants continues to outgrow the number of organs donated each year. In an attempt to improve the organ donation process and increase the number of organs available, we created a specialized multidisciplinary team within a specialized organ procurement center (OPC) with dedicated intensive care unit (ICU) beds and operating rooms. The OPC was staffed with ICU nurses, operating room nurses, organ donor management ICU physicians, and multidisciplinary staff. All organ donors within a designated geographic area were transferred to and managed within the OPC...
June 2017: American Journal of Transplantation
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