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Transplant heart and lung

Ali H Hakim, Usman Ahmad, Kenneth R McCurry, Douglas R Johnston, Gosta B Pettersson, Marie Budev, Sudish Murthy, Eugene H Blackstone, Michael Z Tong
BACKGROUND: Extracorporeal membrane oxygenation (ECMO), when used as bridge to lung transplantation (BTT) identifies high-risk candidates. Recent advances in cannula design and patient selection fosters "awake ambulatory ECMO" as a viable option for critically ill candidates in an attempt to retard deconditioning while awaiting allografts. METHODS: From 2012 to 2015, 30 patients underwent ECMO as BTT. Candidacy for ECMO was determined prior to listing for transplant...
March 17, 2018: Annals of Thoracic Surgery
Michele D'Alto, Yoshiki Motoji, Emanuele Romeo, Paola Argiento, Giovanni Maria Di Marco, Agostino Mattera Iacono, Antonello D'Andrea, Gaetano Rea, Paolo Golino, Robert Naeije
AIM: A fluid challenge with rapid saline infusion during right heart catheterization has been shown to be useful for the differential diagnosis between pre- and post-capillary pulmonary hypertension. The aim of this study was to evaluate the prognostic relevance of fluid challenge-induced changes in pulmonary hemodynamics in patients with pulmonary arterial hypertension (PAH). METHODS: Overall, 118 PAH patients (mean age 57 ± 15 years, 80 female) underwent hemodynamic measurements before and after rapid saline infusion (7 mL/kg in 10 min) and were followed up for 19 ± 4 months...
March 7, 2018: International Journal of Cardiology
Berardo Sarubbi, Gaetano Rea, Giuseppe Santoro, Enrico Melillo, Giancarlo Scognamiglio, Maria Giovannna Russo
One of the major complications of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is pulmonary vein stenosis (PVS). The natural history of PVS, especially when it involves more than one vein, leads to severe and irreversible pulmonary hypertension with end-stage right heart failure that can require, in extreme cases, even heart-lung transplantation. We report the case of a young patient who underwent RFCA for a single lasting episode of AF and developed PVS years later. He was treated with ballon venoplasty followed by stent implantation in left pulmonary vein because of PVS relief...
March 9, 2018: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Maria M Crespo, Daniel P McCarthy, Peter M Hopkins, Stephen C Clark, Marie Budev, Christian A Bermudez, Christian Benden, Pirooz Eghtesady, Erika D Lease, Lorriana Leard, Jonathan D'Cunha, Christopher H Wigfield, Marcelo Cypel, Joshua M Diamond, James J Yun, Lonny Yarmus, Michael Machuzak, Walter Klepetko, Geert Verleden, Konrad Hoetzenecker, Göran Dellgren, Michael Mulligan
Airway complications remain a major cause of morbidity and mortality after cardiothoracic transplantation. The reported incidence of airway ischemic complications varies widely, contributed to by the lack of a universally accepted grading system and standardized definitions. Furthermore, the majority of the existing classification systems fail to integrate the wide range of possible bronchial complications that may develop after lung transplant. Hence, a Working Group was created by the International Society for Heart and Lung Transplantation with the aim of elaborating a universal definition of adult and pediatric airway complications and grading system...
February 7, 2018: Journal of Heart and Lung Transplantation
Shahid Husain, Archana Bhaskaran, Coleman Rotstein, Yanhong Li, Alyajahan Bhimji, Rhea Pavan, Deepali Kumar, Atul Humar, Shaf Keshavjee, Lianne G Singer
BACKGROUND: The optimal strategy for prevention of invasive fungal infections in lung transplant recipients remains undetermined. We studied strategies based on bronchoalveolar lavage fungal culture and galactomannan for prevention of invasive aspergillosis in lung transplant recipients. METHODS: Consecutive lung transplant recipients were evaluated during the period January 2010 to September 2014. Rates of invasive aspergillosis and all-cause mortality were recorded at 1 year...
February 16, 2018: Journal of Heart and Lung Transplantation
Lara Danziger-Isakov, William J Steinbach, Grant Paulsen, Flor M Munoz, Leigh R Sweet, Michael Green, Marian G Michaels, Janet A Englund, Alastair Murray, Natasha Halasa, Daniel E Dulek, Rebecca Pellett Madan, Betsy C Herold, Brian T Fisher
Background: Respiratory virus infection (RVI) in pediatric solid organ transplant (SOT) recipients poses a significant risk; however, the epidemiology and effects of an RVI after pediatric SOT in the era of current molecular diagnostic assays are unclear. Methods: A retrospective observational cohort of pediatric SOT recipients (January 2010 to June 2013) was assembled from 9 US pediatric transplant centers. Charts were reviewed for RVI events associated with hospitalization within 1 year after the transplant...
March 10, 2018: Journal of the Pediatric Infectious Diseases Society
Liaoran Wang, David K C Cooper, Lars Burdorf, Yi Wang, Hayato Iwase
There has recently been considerable progress in the results of pig organ transplantation in nonhuman primates (NHPs), largely associated with the availability of (i) pigs genetically-engineered to overcome coagulation dysregulation, and (ii) novel immunosuppressive agents. The barriers of thrombotic microangiopathy and/or consumptive coagulation were believed to be associated with (i) activation of the graft vascular endothelial cells (VECs) by a low level of anti-pig antibody binding and/or complement deposition and/or innate immune cell activity, and (ii) molecular incompatibilities between the NHP and pig coagulation-anticoagulation systems...
March 10, 2018: Transplantation
Genglong Liu, Haijin Lv, Yuling An, Xuxia Wei, Xiaomeng Yi, Huimin Yi
The aim of the present study was topreliminarily visualize the distribution of humanumbilical cord‑derivedmesenchymal stem cells (hUC‑MSCs) in treating acute lung injury (ALI) using a targeted fluorescent technique. Anovel fluorescent molecule probe was first synthesized via the specific binding of antigen and antibody in vitro to label the hUC‑MSCs. Two groups of mice, comprising a normal saline (NS)+MSC group and lipopolysaccharide (LPS)+MSC group, were subjected to optical imaging. At 4 h following ALI mouse model construction, the labeled hUC‑MSCs were transplanted into the mice in the NS+MSC group and LPS+MSC group by tail vein injection...
May 2018: International Journal of Molecular Medicine
S Perez-Protto, R Nazemian, M Matta, P Patel, K J Wagner, S Q Latifi, D J Lebovitz, J D Reynolds
Many deceased by neurologic criteria donors are administered inhalational agents during organ recovery surgery-a process that is characterised by warm and cold ischaemia followed by warm reperfusion. In certain settings, volatile anaesthetics (VA) are known to precondition organs to protect them from subsequent ischaemia-reperfusion injury. As such, we hypothesised that exposure to VA during organ procurement would improve post-graft survival. Lifebanc (organ procurement organisation [OPO] for NE Ohio) provided the investigators with a list of death by neurologic criteria organ donors cared for at three large tertiary hospitals in Cleveland between 2006 and 2016-details about the surgical recovery phase were extracted from the organ donors' medical records...
March 2018: Anaesthesia and Intensive Care
Francisca A Abanyie, Emily Valice, Kristin W Delli Carpini, Elizabeth B Gray, Isabel McAuliffe, Peter V Chin-Hong, Sukwan Handali, Susan P Montgomery, Shirish Huprikar
BACKGROUND: Targeted donor screening for strongyloidiasis performed at the time of organ procurement can prevent this life-threatening donor-derived infection. METHOD: The Association of Organ Procurement Organizations surveyed members to determine the number of U.S. organ procurement organizations (OPOs) performing donor screening for Strongyloides infection and their screening practices. RESULTS: All 58 OPOs responded to the survey. Only six (10%) currently screen donors for strongyloidiasis; most OPOs started 6-36 months before the survey, one started 6 years prior...
March 7, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
P Burgueño, C González, A Sarralde, F Gordo
Extracorporeal membrane oxygenation (ECMO) support is indicated in patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. Physician experience and quantity of necessary resources are reasons why regionalization could benefit patients of this kind, establishing ECMO reference centers and integrating a transportation network specialized in ECMO. This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and inter-territorial approach...
March 1, 2018: Medicina Intensiva
Sean Agbor-Enoh, Annette M Jackson, Ilker Tunc, Gerald J Berry, Adam Cochrane, David Grimm, Andrew Davis, Pali Shah, Anne W Brown, Yan Wang, Irina Timofte, Palak Shah, Sasha Gorham, Jennifer Wylie, Natalie Goodwin, Moon Kyoo Jang, Argit Marishta, Kenneth Bhatti, Ulgen Fideli, Yanqin Yang, Helen Luikart, Zeling Cao, Mehdi Pirooznia, Jun Zhu, Charles Marboe, Aldo Iacono, Steven D Nathan, Jonathan Orens, Hannah A Valantine, Kiran Khush
BACKGROUND: Antibody-mediated rejection (AMR) often progresses to poor health outcomes in lung transplant recipients (LTRs). This, combined with the relatively insensitive clinical tools used for its diagnosis (spirometry, histopathology) led us to determine whether clinical AMR is diagnosed significantly later than its pathologic onset. In this study, we leveraged the high sensitivity of donor-derived cell-free DNA (ddcfDNA), a novel genomic tool, to detect early graft injury after lung transplantation...
January 31, 2018: Journal of Heart and Lung Transplantation
Johan J A Van Cleemput, Tom O M Verbelen, Lucas N L Van Aelst, Filip R L Rega
We compared survival in our heart recipients with survival rates reported by the International Society of Heart and Lung Transplantation (ISHLT) Registry. As recipient and donor characteristics are changing over time, we studied four different eras. In order to differentiate between short- and long-term survival, we analyzed both overall survival and survival at one year. Obviously, this exercise is only relevant when baseline donor and recipient characteristics are comparable, as these differences may affect the outcome in opposite directions...
January 2018: Annals of Cardiothoracic Surgery
Claudia Del Fante, Jerard Seghatchian, Cesare Perotti
Renal rejection clinically represents a major cause of graft dysfunction and sadly the loss of the renal transplant. This is despite the considerable progress in immunosuppressive therapy. It is strongly believed that the complex immunologic network underlying the response against major histocompatibility molecules (MHC) is responsible for rejection, an unresolved issue that is, in part, not inhibited by the current prophylactic and therapeutic strategies. Extracorporeal photopheresis (ECP) is an effective cell therapy approach that was successfully used in immunomodulating heart rejection, acute and chronic GvHD, lung rejection and some selected autoimmune diseases...
February 21, 2018: Transfusion and Apheresis Science
Jane M Kurz
PURPOSE: To explore the reproductive decision-making process with women who were organ transplant recipients (renal, lung, & heart transplants). STUDY DESIGN AND METHODS: Grounded theory guided data collection and analyses. Mixed methods with audiotaped telephone interviews and a written survey measuring social support were used. As social support is critical for women who are organ transplant recipients considering pregnancy, a search for disconfirming evidence for social support via a survey and interviews was included...
March 2018: MCN. the American Journal of Maternal Child Nursing
O V Kamenskaya, I Y Loginova, D V Doronin, A M CHernyavskiy
Aim of the study was assessment of efficiency of lung ventilation and its relationship with quality of life in patients undergoing orthotopic heart transplantation (OHT). MATERIALS AND METHODS: The study involved 40 patients with terminal chronic heart failure (CHF) included in the waiting list for heart transplantation. Before surgery and after OHT all patients underwent cardiopulmonary exercise testing, evaluation of clinical status and quality of life (QL) according to the 36-Item Short Form Survey (SF-36)...
January 2018: Kardiologiia
Shanzhou Huang, Yunhua Tang, Zebin Zhu, Jie Yang, Zhiheng Zhang, Linhe Wang, Chengjun Sun, Yixi Zhang, Qiang Zhao, Maogen Chen, Linwei Wu, Dongping Wang, Weiqiang Ju, Zhiyong Guo, Xiaoshun He
BACKGROUND The inherent challenges of selecting an acceptable donor for the increasing number and acuity of recipients has forced programs to take increased risks, including accepting donors with a cancer history (DWCH). Outcomes of organ transplantation using organs from DWCH must be clarified. We assessed transplant outcomes of recipients of organs from DWCH. MATERIAL AND METHODS Retrospective analysis of the Scientific Registry of Transplant Recipients data from January 1, 2000 to December 31, 2014 identified 8385 cases of transplants from DWCH...
February 18, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Charles J Puza, Adela R Cardones, Paul J Mosca
Importance: The immunosuppression vital to maintaining transplanted organs comes with an increased incidence of cutaneous neoplasms. Understanding the genesis of malignant melanoma (MM) in transplant subpopulations is necessary for adequate disease surveillance. Objective: To determine the incidence and timing of presentation of MM in the cardiothoracic (heart and/or lung) transplant (CTT) population. Design, Setting, and Participants: This was a retrospective cohort study of 1164 patients who underwent a CTT from 2001 through 2016 with a median follow-up time of 4...
February 16, 2018: JAMA Dermatology
JoEllyn C Moore, Lena Trager, Lucille E Anzia, Walid Saliba, Mohamed Bassiouny, Mandeep Bhargava, Mina Chung, Milind Desai, Ross Garberich, Harry Lever, Bruce D Lindsay, Jay Sengupta, Patrick Tchou, Oussama Wazni, Bruce L Wilkoff
BACKGROUND: Limited medical options are available for rhythm control in patients with atrial fibrillation (AF) and hypertrophic cardiomyopathy (HCM). There are no published reports of dofetilide use in this population. METHODS: A retrospective chart review was conducted on1,404 patients loaded on dofetilide for AF suppression at the Cleveland Clinic from 2008-2012, 25 of whom were found to have HCM. RESULTS: The HCM cohort was 32% female, 76% with persistent AF, mean age of 59 ± 10 years and mean ejection fraction (EF) of 54 ± 9 %...
February 16, 2018: Pacing and Clinical Electrophysiology: PACE
Elana J Bernstein, Joan M Bathon, David J Lederer
Objectives: Pulmonary arterial hypertension (PAH) is a major cause of morbidity and mortality in adults with systemic autoimmune rheumatic diseases (ARDs). The aim of this study was to determine whether adults with ARDs and PAH on right-sided heart catheterization (ARD-PAH) have increased mortality following lung transplantation compared with those with PAH not due to an ARD. Methods: We conducted a retrospective cohort study of 93 adults with ARD-PAH and 222 adults with PAH who underwent lung transplantation in the USA between 4 May 2005 and 9 March 2015 using data from the United Network for Organ Sharing...
February 13, 2018: Rheumatology
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