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Lung transplant, intensive care

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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
#1
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
#2
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-two-years-of-activity-of-a-specialized-organ-procurement-centre-report-of-an-innovative-approach-to-improve-organ-donation
#3
Pierre Marsolais, Philippe Durand, Emmanuel Charbonney, Karim Serri, Anne-Marie Lagacé, Francis Bernard, Martin 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 Centre (OPC) with dedicated intensive care unit 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 and managed within the OPC...
November 22, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27866861/outcomes-after-transplantation-of-lungs-preserved-for-more-than-12-h-a-retrospective-study
#4
Jonathan C Yeung, Thorsten Krueger, Kazuhiro Yasufuku, Marc de Perrot, Andrew F Pierre, Thomas K Waddell, Lianne G Singer, Shaf Keshavjee, Marcelo Cypel
BACKGROUND: Ex-vivo lung perfusion (EVLP) can be used to extend overall lung preservation time by splitting one long cold ischaemic time into two shorter ones and interposing an additional EVLP time. We assessed the outcomes after clinical transplantation of lungs with more than 12 h of preservation time. METHODS: For this retrospective study, we searched the Toronto Lung Transplant Program database for patients who had received at least one lung transplant between Jan 1, 2006, and April 30, 2015, at a single hospital in Toronto, Canada...
November 17, 2016: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/27855591/effects-of-perioperative-fluid-replacement-therapy-in-lung-transplant-patients
#5
Emil Björkbom, Pekka Hämmäinen, Alexey Schramko
OBJECTIVES: Approximately 10 to 25 lung transplant procedures are performed annually in Finland, and 1-year survival has been 95% over the last 10 years. Our aim was to find associations between perioperative fluid replacement therapies and postoperative patient outcomes, with special emphasis on the use of colloids and blood products. MATERIALS AND METHODS: We retrospectively evaluated data from 100 patients who underwent lung transplant with cardiopulmonary bypass support in Finland from 2007 to 2013...
November 18, 2016: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/27842947/extracorporeal-support-during-bilateral-sequential-lung-transplantation-in-patients-with-pulmonary-hypertension-risk-factors-and-outcomes
#6
Pranav R Shah, Michael L Boisen, Daniel G Winger, Jose Marquez, Christian A Bermudez, Jay K Bhama, Norihisa Shigemura, Jonathan D'Cuhna, Kathirvel Subramaniam
OBJECTIVE: To identify preoperative predictors of extracorporeal support in patients with pulmonary hypertension (PH) undergoing bilateral sequential lung transplantation (LTx), and to examine outcomes associated with the use of extracorporeal support. DESIGN: Retrospective, observational study. SETTING: Single organ transplantation and tertiary care university medical center. PARTICIPANTS: Adults with PH (preoperative mean pulmonary artery pressure (mPAP)≥25 mmHg) who underwent primary bilateral sequential LTx during 2007 to 2013...
August 18, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27824870/clinical-course-radiological-manifestations-and-outcome-of-pneumocystis-jirovecii-pneumonia-in-hiv-patients-and-renal-transplant-recipients
#7
Lukas Ebner, Laura N Walti, Andri Rauch, Hansjakob Furrer, Alexia Cusini, Andreas M J Meyer, Stefan Weiler, Uyen Huynh-Do, Johannes Heverhagen, Spyridon Arampatzis, Andreas Christe
BACKGROUND: Pneumocystis jirovecii pneumonia (PCP) is a frequent opportunistic infection in immunocompromised patients. In literature, presentation and outcome of PCP differs between patients with human immunodeficiency virus (HIV) infection and renal transplant recipients (RTRs). METHODS: We conducted a cross-sectional study of patients with PCP based on the HIV and renal transplant registries at our institution. Radiological and clinical data from all confirmed PCP cases between 2005 and 2012 were compared...
2016: PloS One
https://www.readbyqxmd.com/read/27773457/lung-transplantation-in-patients-who-have-undergone-prior-cardiothoracic-procedures
#8
Mohamed Omara, Toshihiro Okamoto, Amr Arafat, Lucy Thuita, Eugene H Blackstone, Kenneth R McCurry
BACKGROUND: Patients who have undergone prior cardiothoracic procedures offer technical challenges that may affect post-transplant outcomes and be a reason to decline listing. Data are currently limited regarding the indication for lung transplantation among recipients who have had prior cardiothoracic procedures. METHODS: Of 453 lung transplants performed at Cleveland Clinic from January 2005 to July 2010, 206 recipients (45%) had undergone prior cardiothoracic procedures: 157 lung only, 15 cardiac only, 10 cardiac + lung, 10 pleurodesis + lung, and 14 other...
June 14, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27639947/-limitations-of-active-therapeutic-and-palliative-care-in-chronic-respiratory-disease
#9
L Sakhri, C Saint-Raymond, S Quetant, C Pison, E Lagrange, R Hamidfar Roy, J-P Janssens, C Maindet-Dominici, M Garrouste-Orgeas, M Levy-Soussan, N Terzi, A-C Toffart
The issue of intensive and palliative care in patients with chronic disease frequently arises. This review aims to describe the prognostic factors of chronic respiratory diseases in stable and in acute situations in order to improve the management of these complex situations. The various laws on patients' rights provide a legal framework and define the concept of unreasonable obstinacy. For patients with chronic obstructive pulmonary disease, the most robust decision factors are good knowledge of the respiratory disease, the comorbidities, the history of previous exacerbations and patient preferences...
September 14, 2016: Revue des Maladies Respiratoires
https://www.readbyqxmd.com/read/27621854/sarcopenia-of-thoracic-muscle-mass-is-not-a-risk-factor-for-survival-in-lung-transplant-recipients
#10
Seokkee Lee, Hyo Chae Paik, Seok Jin Haam, Chang Young Lee, Kyung Sik Nam, Hee Suk Jung, Young Woo Do, Jee Won Shu, Jin Gu Lee
BACKGROUND: In lung transplantation (LTx), patients with thoracic muscle sarcopenia may have to require longer to recovery. We measured thoracic muscle volume by using the cross sectional area (CSA) and assessed its effect on early outcomes after LTx. METHODS: A retrospective analysis was conducted to evaluate the effect of thoracic sarcopenia in patients undergoing LTx between January 2010 and July 2015. The lowest CSA quartile (Q1) was defined as sarcopenia. RESULTS: In total, 109 patients were enrolled...
August 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27496218/high-variability-in-the-reported-management-of-hepatic-veno-occlusive-disease-in-children-after-hematopoietic-stem-cell-transplantation
#11
Micah A Skeens, Jennifer McArthur, Ira M Cheifetz, Christine Duncan, Adrienne G Randolph, Joseph Stanek, Leslie Lehman, Rajinder Bajwa
Veno-occlusive disease (VOD) is a potentially fatal complication of hematopoietic stem cell transplantation (HSCT). Patients with VOD are often critically ill and require close collaboration between transplant physicians and intensivists. We surveyed members of a consortium of pediatric intensive care unit (PICU) and transplant physicians to assess variability in the self-reported approach to the diagnosis and management of VOD. An internet-based self-administered survey was sent to pediatric HSCT and PICU providers from September 2014 to February 2015...
October 2016: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/27487912/a-simple-and-robust-bedside-model-for-mortality-risk-in-pediatric-patients-with-acute-respiratory-distress-syndrome
#12
Aaron C Spicer, Carolyn S Calfee, Matthew S Zinter, Robinder G Khemani, Victoria P Lo, Mustafa F Alkhouli, Benjamin E Orwoll, Ana L Graciano, Juan P Boriosi, James P Howard, Heidi R Flori, Michael A Matthay, Anil Sapru
OBJECTIVES: Despite declining mortality, acute respiratory distress syndrome is still involved in up to one third of pediatric intensive care deaths. The recently convened Pediatric Acute Lung Injury Consensus Conference has outlined research priorities for the field, which include the need for accurate bedside risk stratification of patients. We aimed to develop a simple yet robust model of mortality risk among pediatric patients with acute respiratory distress syndrome to facilitate the targeted application of high-risk investigational therapies and stratification for enrollment in clinical trials...
October 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27435530/extracorporeal-membrane-oxygenation-as-a-bridge-to-lung-re-transplantation-is-there-a-role
#13
J W Awori Hayanga, Jonathan K Aboagye, Heather K Hayanga, James D Luketich, Jonathan D'Cunha
BACKGROUND: In this study we sought to determine survival rates after use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung re-transplantation (re-LT). METHODS: Propensity-adjusted analysis was performed on data from the Scientific Registry of Transplant Recipients (SRTR) to evaluate survival in recipients between the years 1988 and 2012, based on the use of ECMO before re-LT. RESULTS: A total of 854 adult re-LT recipients were identified...
July 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27399072/effects-of-intraoperative-inhaled-iloprost-on-primary-graft-dysfunction-after-lung-transplantation-a-retrospective-single-center-study
#14
Su Hyun Lee, Jin Gu Lee, Chang Yeong Lee, Namo Kim, Min-Yung Chang, Young-Chul You, Hyun Joo Kim, Hyo Chae Paik, Young Jun Oh
DESIGN: Inhaled iloprost was known to alleviate ischemic-reperfusion lung injury. We investigated whether intraoperative inhaled iloprost can prevent the development of primary graft dysfunction after lung transplantation. Data for a consecutive series of patients who underwent lung transplantation with extracorporeal membrane oxygenation were retrieved. By propensity score matching, 2 comparable groups of 30 patients were obtained: patients who inhaled iloprost immediately after reperfusion of the grafted lung (ILO group); patients who did not receive iloprost (non-ILO group)...
July 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27381674/transplantation-after-ex-vivo-lung-perfusion-a-midterm-follow-up
#15
Andreas Wallinder, Gerdt C Riise, Sven-Erik Ricksten, Martin Silverborn, Göran Dellgren
BACKGROUND: A large proportion of donor lungs are discarded due to known or presumed organ dysfunction. Ex vivo lung perfusion (EVLP) has proven its value as a tool for discrimination between reversible and irreversible donor lung pathology. However, the long-term outcome after transplantation of lungs after EVLP is essentially unknown. We report short-term and midterm outcomes of recipients who received transplants of EVLP-evaluated lungs. METHODS: Single-center results of recipients of lungs with prior EVLP were compared with consecutive recipients of non-EVLP lungs (controls) during the same period...
May 31, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27316381/airway-complications-after-lung-transplantation-contemporary-survival-and-outcomes
#16
J W Awori Hayanga, Jonathan K Aboagye, Norihisa Shigemura, Heather K Hayanga, Edward Murphy, Asghar Khaghani, Jonathan D'Cunha
BACKGROUND: Airway complications are rare and cause increased morbidity and mortality after lung transplantation (LT). We sought to examine risk factors associated with this complication and its impact on survival. METHODS: We retrospectively evaluated United Network for Organ Sharing data from 2000 to 2012. A backward stepwise logistic regression was performed on recipient-, donor-, and transplant-related variables to select independent risk factors associated with airway complications and mortality...
May 6, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27312683/lung-ultrasound-utility-in-the-management-of-the-neurologically-deceased-organ-donor
#17
Daniel J Lebovitz, Matthew Tabbut, Samir Q Latifi, Lynn Dezelon, Robert Jones
CONTEXT: Lung transplantation is limited by donor lung availability with ∼20% of deceased donor lungs transplanted. Diagnostic testing identifying pulmonary derangements guide donor management strategies to maximize lung transplantation. Lung ultrasound (LUS) identifies pathology in critically ill patients equivalent or superior to chest radiograph (CXR) or computed tomography (CT) scans. No published studies have reported on LUS in neurologically deceased donors (DNDDs). OBJECTIVE: We evaluated LUS in identifying abnormal lung pathology in DNDDs and related these findings to the standard approach...
September 2016: Progress in Transplantation
https://www.readbyqxmd.com/read/27266805/how-important-is-coronary-artery-disease-when-considering-lung-transplant-candidates
#18
Marijan Koprivanac, Marie M Budev, James J Yun, Marta Kelava, Gösta B Pettersson, Kenneth R McCurry, Douglas R Johnston, Abeel A Mangi, Penny L Houghtaling, Eugene H Blackstone, Sudish C Murthy
BACKGROUND: Coronary artery disease (CAD) remains a relative contraindication for lung transplantation, but should it be if amenable to effective palliation? METHODS: From January 2005 to July 2010, 356 adults undergoing primary lung transplantation had no significant (<50%) coronary arterial stenosis and 70 had significant (≥50%) CAD requiring prior or concomitant revascularization. Propensity matching on 38 pre-transplant patient characteristics identified 61 well-matched pairs (87% of possible matches) and 295 no-CAD unmatched patients to compare post-operative morbidity, graft function, and time-related pulmonary function and survival...
March 30, 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27242362/donor-lung-assessment-using-selective-pulmonary-vein-gases
#19
Joseph Costa, Sowmyashree Sreekanth, Alex Kossar, Kashif Raza, David J Lederer, Hilary Robbins, Lori Shah, Joshua R Sonett, Selim Arcasoy, Frank D'Ovidio
OBJECTIVES: Standard donor lung assessment relies on imaging, challenge gases and subjective interpretation of bronchoscopic findings, palpation and visual assessment. Central gases may not accurately represent true quality of the lungs. We report our experience using selective pulmonary vein gases to corroborate the subjective judgement. METHODS: Starting, January 2012, donor lungs have been assessed by intraoperative bronchoscopy, palpation and visual judgement of lung collapse upon temporary disconnection from ventilator, central gases from the aorta and selective pulmonary vein gases...
May 30, 2016: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/27222774/scedosporium-apiospermum-and-s-prolificans-mixed-disseminated-infection-in-a-lung-transplant-recipient-an-unusual-case-of-long-term-survival-with-combined-systemic-and-local-antifungal-therapy-in-intensive-care-unit
#20
Bárbara Balandin, Miriam Aguilar, Isabel Sánchez, Araceli Monzón, Isabel Rivera, Clara Salas, Miguel Valdivia, Sara Alcántara, Aris Pérez, Piedad Ussetti
Infections due Scedosporium spp. in lung transplant recipients are associated with disseminated disease with high mortality rates. The adjunctive local antifungal therapy may be a useful option when systemic treatment is insufficient and/or surgery is not feasible. We present a case of mixed disseminated infection due Scedosporium apiospermum and S. prolificans in a lung transplant recipient. Combined local and systemic antifungal therapy provided an unusual long-term survival in the intensive care unit.
March 2016: Medical Mycology Case Reports
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