BACKGROUND:Prolonged invasive respiratory support and extracorporeal membrane oxygenation(ECMO)in patients requiring urgent lung transplantation(ULTx)present signifi cant challenges to clinical practice due to severe ...BACKGROUND:Prolonged invasive respiratory support and extracorporeal membrane oxygenation(ECMO)in patients requiring urgent lung transplantation(ULTx)present signifi cant challenges to clinical practice due to severe underlying diseases and complex conditions.The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center.METHODS:A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation(IMV)and ECMO between January 2018 and January 2023.Data were retrieved from electronic medical records at our lung transplant center.RESULTS:Fourteen patients(mean age 57.43±10.97 years;12 males,2 females)underwent ULTx with bridging ECMO and IMV.The mean body mass index was 23.94±3.33 kg/m²,and the mean Acute Physiology and Chronic Health Evaluation(APACHE)II score was 21.50±3.96.The Nutritional Risk Screening 2002(NRS 2002)scores were≥3.ULTx was performed after an 8.5-day waiting period(interquartile interval[IQR]5.0-26.5 d).Following the surgeries,the average lengths of ECMO and IMV were 1.0(IQR 1.0-2.0)d and 5.0(IQR 3.0-7.3)d,respectively.The total length of hospital stay was 60.1±30.8 d,with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d.Two patients died within 30 d after ULTx,with a 30-day survival rate of 85.71%.CONCLUSION:Patients receiving ULTx showed an acceptable short-term survival rate,validating the practicality and safety of the treatment protocols implemented in our center.展开更多
Lung transplantation is the treatment of choice for patients with end-stage lung disease.Currently,just under 5000 lung transplants are performed worldwide annually.However,a major scourge leading to 90-d and 1-year m...Lung transplantation is the treatment of choice for patients with end-stage lung disease.Currently,just under 5000 lung transplants are performed worldwide annually.However,a major scourge leading to 90-d and 1-year mortality remains primary graft dysfunction.It is a spectrum of lung injury ranging from mild to severe depending on the level of hypoxaemia and lung injury post-transplant.This review aims to provide an in-depth analysis of the epidemiology,pathophysiology,risk factors,outcomes,and future frontiers involved in mitigating primary graft dysfunction.The current diagnostic criteria are examined alongside changes from the previous definition.We also highlight the issues surrounding chronic lung allograft dysfunction and identify the novel therapies available for ex-vivo lung perfusion.Although primary graft dysfunction remains a significant contributor to 90-d and 1-year mortality,ongoing research and development abreast with current technological advancements have shed some light on the issue in pursuit of future diagnostic and therapeutic tools.展开更多
BACKGROUND Gastroesophageal reflux is associated with poorer outcomes after lung transplant,likely through recurrent aspiration and allograft injury.Although prior studies have demonstrated a relationship between impe...BACKGROUND Gastroesophageal reflux is associated with poorer outcomes after lung transplant,likely through recurrent aspiration and allograft injury.Although prior studies have demonstrated a relationship between impedance-pH results and transplant outcomes,the role of esophageal manometry in the assessment of lung transplant patients remains debated,and the impact of esophageal dysmotility on transplant outcomes is unclear.Of particular interest is ineffective esophageal motility(IEM)and its associated impact on esophageal clearance.AIM To assess the relationship between pre-transplant IEM diagnosis and acute rejection after lung transplantation.METHODS This was a retrospective cohort study of lung transplant recipients at a tertiary care center between 2007 and 2018.Patients with pre-transplant anti-reflux surgery were excluded.Manometric and reflux diagnoses were recorded from pre-transplant esophageal function testing.Time-to-event analysis using Cox proportional hazards model was applied to evaluate outcome of first episode of acute cellular rejection,defined histologically per International Society of Heart and Lung Transplantation guidelines.Subjects not meeting this endpoint were censored at time of post-transplant anti-reflux surgery,last clinic visit,or death.Fisher’s exact test for binary variables and student’s t-test for continuous variables were performed to assess for differences between groups.RESULTS Of 184 subjects(54%men,mean age:58,follow-up:443 person-years)met criteria for inclusion.Interstitial pulmonary fibrosis represented the predominant pulmonary diagnosis(41%).During the follow-up period,60 subjects(33.5%)developed acute rejection.The all-cause mortality was 16.3%.Time-to-event univariate analyses demonstrated significant association between IEM and acute rejection[hazard ratio(HR):1.984,95%CI:1.03-3.30,P=0.04],confirmed on Kaplan-Meier curve.On multivariable analysis,IEM remained independently associated with acute rejection,even after controlling for potential confounders such as the presence of acid and nonacid reflux(HR:2.20,95%CI:1.18-4.11,P=0.01).Nonacid reflux was also independently associated with acute rejection on both univariate(HR:2.16,95%CI:1.26-3.72,P=0.005)and multivariable analyses(HR:2.10,95%CI:1.21-3.64,P=0.009),adjusting for the presence of IEM.CONCLUSION Pre-transplant IEM was associated with acute rejection after transplantation,even after controlling for acid and nonacid reflux.Esophageal motility testing may be considered in lung transplant to predict outcomes.展开更多
A relationship between lung transplant success and many features of recipients’/donors has long been studied.However,modeling a robust model of a potential impact on organ transplant success has proved challenging.In...A relationship between lung transplant success and many features of recipients’/donors has long been studied.However,modeling a robust model of a potential impact on organ transplant success has proved challenging.In this study,a hybrid feature selection model was developed based on ant colony opti-mization(ACO)and k-nearest neighbor(kNN)classifier to investigate the rela-tionship between the most defining features of recipients/donors and lung transplant success using data from the United Network of Organ Sharing(UNOS).The proposed ACO-kNN approach explores the features space to identify the representative attributes and classify patients’functional status(i.e.,quality of life)after lung transplantation.The efficacy of the proposed model was verified using 3,684 records and 118 input features from the UNOS.The developed approach examined the reliability and validity of the lung allocation process.The results are promising regarding accuracy prediction to be 91.3%and low computational time,along with better decision capabilities,emphasizing the potential for automatic classification of the lung and other organs allocation pro-cesses.In addition,the proposed model recommends a new perspective on how medical experts and clinicians respond to uncertain and challenging lung alloca-tion strategies.Having such ACO-kNN model,a medical professional can sum-marize information through the proposed method and make decisions for the upcoming transplants to allocate the donor organ.展开更多
Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transp...Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transplant recipients are still at a high risk of developing postoperative complications which tend to impact negatively the patients' outcome if not recognised early. The recognised complications post lung transplantation can be broadly categorised into acute and chronic complications. Recognising the radiological features of these complications has a significant positive impact on patients' survival post transplantation. This manuscript provides a comprehensive review of the radiological features of post lung transplantations complications over a time continuum.展开更多
Objective:MiRNAs have been recently implicated in the pathogenesis of ischemia-reperfusion(IR)injury.This study aimed to investigate the miRNA expression profiles,in the early stages after lung transplantation(LT)and ...Objective:MiRNAs have been recently implicated in the pathogenesis of ischemia-reperfusion(IR)injury.This study aimed to investigate the miRNA expression profiles,in the early stages after lung transplantation(LT)and to study the involvement of the Toll-like receptor(TLR)signaling pathway in lung IR injury following LT.Methods:We established the left LT model in mice and selected the miRNA-122 as a research target.The mice were injected with a miRNA-122-specific inhibitor,following which pathological changes in the lung tissue were studied using different lung injury indicators.In addition,we performed deep sequencing of transplanted lung tissues to identify differentially expressed(DE)miRNAs and their target genes.These target genes were used to further perform gene ontology(GO)enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis.Results:A total of 12 DE miRNAs were selected,and 2476 target genes were identified.The GO enrichment analysis predicted 6063 terms,and the KEGG analysis predicted 1554 biological pathways.Compared with the control group,inhibiting the expression of miRNA-122 significantly reduced the lung injury and lung wet/dry ratio(P<0.05).In addition,the activity of myeloperoxidase and the expression levels of tumor necrosis factor-alpha and TLR2/4 were decreased(P<0.05);whereas the expression of interleukin-10 was increased(P<0.05).Furthermore,the inhibition of miRNA-122 suppressed the IR injury-induced activation of the TLR signaling pathway.Conclusion:Our findings showed the differential expression of several miRNAs in the early inflammatory response following LT.Of these,miRNA-122 promoted IR injury following LT,whereas its inhibition prevented IR injury in a TLR-dependent manner.展开更多
The use of extracorporeal membrane oxygenation(ECMO)in the field of lung transplantation has rapidly expanded over the past 30 years.It has become an important tool in an increasing number of specialized centers as a ...The use of extracorporeal membrane oxygenation(ECMO)in the field of lung transplantation has rapidly expanded over the past 30 years.It has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative setting.ECMO is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the recipient.For example,patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous(VV)ECMO or peripheral veno-arterial(VA)ECMO in the case of hemodynamic instability.Moreover,in an intraoperative setting,VV ECMO can be maintained or switched to a VA ECMO.The routine use of intra-operative ECMO and its eventual prolongation in the postoperative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion injury.This review will assess the current evidence on the role of ECMO in the different phases of lung transplantation,while analyzing different studies on pre,intra-and post-operative utilization of this extracorporeal support.展开更多
Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment ...Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment of treatment.The consensus statement from the International Society for Heart and Lung Transplantation on CLAD in 2019 classified CLAD into two main phenotypes:Bronchiolitis obliterans syndrome and restrictive allograft syndrome.Along with this clear classification,further exploration of the mechanisms and the development of appropriate prevention and treatment strategies for each phenotype are desired.In this review,we summarize the new definition of CLAD and update and summarize the existing knowledge on the underlying mechanisms of bronchiolitis obliterans syndrome and restrictive allograft syndrome,which have been elucidated from clinicopathological observations and animal experiments worldwide.展开更多
BACKGROUND Lung transplantation is considered an effective method for treating patients with end-stage coronavirus disease 2019(COVID-19).The nurses play a pivotal role in lung transplantation for COVID-19 patients.CA...BACKGROUND Lung transplantation is considered an effective method for treating patients with end-stage coronavirus disease 2019(COVID-19).The nurses play a pivotal role in lung transplantation for COVID-19 patients.CASE SUMMARY Two elderly patients were admitted to the emergency department due to cough,and the nucleic acid test was positive.The patients were preliminarily diagnosed with COVID-19.The chest computed tomography scan revealed massive lung consolidation,and the patients did not improve after treatment with antiviral drugs,glucocorticoids,antibiotics,and other drugs.Under the support of pure oxygen in extracorporeal membrane oxygenation,the patients’oxygen levels were still poor,indicating that they were in the terminal stage of viral pneumonia.The patients underwent double-lung transplantation and received intraoperative care.The extracorporeal membrane oxygenation device was removed within a week of the surgical procedure,and the respiratory circulation of the patients were stabilized.CONCLUSION High-quality care for COVID-19 patients undergoing lung transplantation ensures patient safety during operation while protecting the safety of the medical staff.展开更多
Dear Editor,I am Rosa Gutiérrez Bonet,former ophthalmology resident at Puerta de Hierro University Hospital,Madrid,Spain.I write to present four cases of cortical blindness(CB)after bilateral lung transplant(LT)....Dear Editor,I am Rosa Gutiérrez Bonet,former ophthalmology resident at Puerta de Hierro University Hospital,Madrid,Spain.I write to present four cases of cortical blindness(CB)after bilateral lung transplant(LT).LT is considered as a first-choice treatment for patients展开更多
<strong>Background:</strong> Extracorporeal membrane oxygenation (ECMO) is an effective adjuvant therapy for cardiopulmonary support during the period of lung transplantation (LTx). However, factors associ...<strong>Background:</strong> Extracorporeal membrane oxygenation (ECMO) is an effective adjuvant therapy for cardiopulmonary support during the period of lung transplantation (LTx). However, factors associated with the application of ECMO after LTx remain controversial. The purpose of this study is to clarify the risk factors of post-operative ECMO support and to evaluate the outcomes. <strong>Methods:</strong> It was a hospital, single-center, retrospective study. 266 patients underwent LTx supported by ECMO were included. According to whether or not the patients received continourly ECMO support after the surgery, the enrolled patients were further divided into intra-operative ECMO group (group I, 105 cases) and post-operative ECMO group (group P, 161 cases). The peri-operative data of the donors and recipients were collected. The independent risk factors associated with post-operative ECMO support during LTx were identified. The relationship between primary graft dysfunction (PGD)/post-operative survival and duration of ECMO support was also analyzed. <strong>Results:</strong> Prolonged donor ventilation ≥ 5 days, pre-operative recipient mechanical ventilation, bilateral lung transplantation (BLT), veno-venous (V-V) ECMO and PGD in recipient were independent risk factors for post-operative ECMO support. The risk of PGD and post-operative death increased along with the increase of ECMO bypass time, and the mortality risk in group P was 2.33 (95% confidence interval: 1.16 - 4.67) times as that in group I. <strong>Conclusions:</strong> Mechanical ventilation for donor ≥ 5 days, pre-operative mechanical ventilation, BLT, V-V-ECMO and PGD in recipient were independent risk factors for post-operative ECMO support after LTx, and post-operative ECMO could not reduce recipients’ hospital mortality.展开更多
Phrenic nerve injury can occur as a complication of lung transplantation. A 54-year-old man underwent single-lung transplantation due to interstitial pneumonia. The patient required circulatory support with venoarteri...Phrenic nerve injury can occur as a complication of lung transplantation. A 54-year-old man underwent single-lung transplantation due to interstitial pneumonia. The patient required circulatory support with venoarterial extracorporeal membrane oxygenation and was unable to be weaned from ventilatory support with nitric oxide. Although enhanced CT scanning showed stenotic anastomosis of the right pulmonary artery (PA), pulmonary angiograph findings revealed that PA flow was normal under sedation and considerably decreased with spontaneous breathing. Fluoroscopy showed that the right diaphragm moved inversely to the position of the left diaphragm, indicating that the right phrenic nerve was paralytic. We performed diaphragmatic plication 7 days after lung transplantation and weaning from ventilator support was accomplished soon thereafter. Phrenic nerve dysfunction is an important clinical problem following lung transplantation. In the present case, diaphragmatic plication was effective for treatment of circulatory failure due to phrenic nerve paralysis even in acute phase after lung transplantation.展开更多
Objective To investigate the expression of bradykinin as a substrate of CD26 /DPP IV in rats with ischemia/reperfusion injury following lung transplantation ( LTx) . Methods Thirty - six syngeneic male SD rats were ra...Objective To investigate the expression of bradykinin as a substrate of CD26 /DPP IV in rats with ischemia/reperfusion injury following lung transplantation ( LTx) . Methods Thirty - six syngeneic male SD rats were randomly allocated into control group and experimental group ( n = 18 each) ,and 36 rats served as do-展开更多
Objective To investigate the clinical value of transesophageal echocardiography during the lung transplantation. Methods From August 2005 to August 2009, 19 patients with advanced lung diseases received lung transplan...Objective To investigate the clinical value of transesophageal echocardiography during the lung transplantation. Methods From August 2005 to August 2009, 19 patients with advanced lung diseases received lung transplantation. The average age was (48. 35 ± 13. 04) years. The echocardiographic probe was placed in patient’ s esophagus before surgery. The left and right展开更多
Objective To estimate the indications,operative technique,perioperative treatment,postoperative complications and the outcome of lung transplantation ( LTx) for end - stage pulmonary diseases. Methods The clinical dat...Objective To estimate the indications,operative technique,perioperative treatment,postoperative complications and the outcome of lung transplantation ( LTx) for end - stage pulmonary diseases. Methods The clinical data of 100 patients with end - stage lung diseases receiving LTx in our hospital were retrospectively ana-展开更多
Lymphangioleiomyomatosis (LAM) is a rare disease that affects women, especially in child-bearing age. Clinical manifestations include angiomyolipoma, pneumothorax, chylothorax, cystic changes of lungs and progressive ...Lymphangioleiomyomatosis (LAM) is a rare disease that affects women, especially in child-bearing age. Clinical manifestations include angiomyolipoma, pneumothorax, chylothorax, cystic changes of lungs and progressive pulmonary failure. In this article, we report a case of lung transplantation (LuTX) for end stage pulmonary LAM and the treatment of angiomyolipoma showing growth after LuTX resulting in complete remission with combination therapy of everolimus and tacrolimus.展开更多
The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation(LT)waiting list.A steady increase in the threshold at which age is taken into consideration for LT has been observe...The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation(LT)waiting list.A steady increase in the threshold at which age is taken into consideration for LT has been observed.This retrospective cohort study recruited 166 lung transplant recipients aged≥65 years between January 2016 and October 2020 in the largest LT center in China.In the cohort,subgroups of patients aged 65–70 years(111 recipients,group 65–70)and≥70 years(55 recipients,group≥70)were included.Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years.A significantly higher percentage of coronary artery stenosis was observed in the group≥70(30.9%vs.14.4%in group 65–70,P=0.014).ECMO bridging to LT was performed in 5.4%(group 65–70)and 7.3%(group≥70)of patients.Kaplan–Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality.After adjusting for potential confounders,cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality(HR 6.37,P=0.0060).Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.展开更多
Background:Lung transplantation(LT)has been demonstrated as the only effective therapy for patients with end-stage lung diseases.Increasing listed lung transplant candidates and expanding volumes of lung transplant ce...Background:Lung transplantation(LT)has been demonstrated as the only effective therapy for patients with end-stage lung diseases.Increasing listed lung transplant candidates and expanding volumes of lung transplant centers across China require wellorganized programs and registry data collection based on the large population.This study aimed to summarize and analyze the data of LT development in China.Methods:We retrospectively collected and analyzed data from the China Lung Transplantation Registry(CLuTR).Key data were reported from the registry with transplant types,indications,donor and recipient characteristics,outcomes and survival.The survival<30 days,1-year and 3-year survival rates were estimated with risk factors identified.Results:CLuTR contained data from 1053 lung transplants performed through January 1st,2015 to December 31st,2018 reported by 18 registered transplant centers.The largest category of diagnosis before transplantation was idiopathic interstitial pneumonitis.The total<30 days,1-year and 3-year survival rates in CLuTR were 81.45%,70.11%,and 61.16%with discrepancy by indications.Large proportion of recipients who were more than 60 years old required higher standard of care.Infection-related complications resulted in more death events in the early post-surgery periods.New York Heart Association grading at listing,extra-corporeal membrane oxygenation usage peri-transplantation,allograft dysfunction(primary graft dysfunction>Grade 0),renal insufficiency(estimated glomerular filtration rate<60 mL min_11.73 m^2),were independently associated with a higher risk for 3-year mortality in the entire cohort.Conclusions:Facing more end-stage of lung diseases and comorbidities,this study analyzed the outcomes and survival of LT recipients in China.Further prospectively stratified analyses with longer follow-up will be needed.展开更多
Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreve...Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreversible fatal respiratory failure.Lung transplantation(LT)as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.Methods:From February 10 to March 10,2020,three male patients were urgently assessed and listed for transplantation.After conducting a full ethical review and after obtaining assent from the family of the patients,we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.Results:Two of the three recipients survived post-LT and started participating in a rehabilitation program.Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved.The pathological results of the explanted lungs were concordant with the critical clinical manifestation,and provided insight towards better understanding of the disease.Government health affair systems,virology detection tools,and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.Conclusions:LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis.If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT,LT provided the final option for these patients to avoid certain death,with proper protection of transplant surgeons and medical staffs.By ensuring instant seamless care for both patients and medical teams,the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.展开更多
Background:Acute kidney injury(AKI)is a common and serious complication following lung transplantation(LTx),and it is associated with high mortality and morbidity.This study assessed the incidence of AKI after LTx and...Background:Acute kidney injury(AKI)is a common and serious complication following lung transplantation(LTx),and it is associated with high mortality and morbidity.This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.Methods:This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019.The outcomes were AKI incidence,risk factors,mortality,and kidney recovery.Multivariate analysis was performed to identify independent risk factors.Survival analysis was presented using the Kaplan-Meier curves.Results:AKI occurred in 137 of the 191 patients(71.7%),with transient AKI in 43(22.5%)and persistent AKI in 94(49.2%).AKI stage 1 occurred in 27/191(14.1%),stage 2 in 46/191(24.1%),and stage 3 in 64/191(33.5%)of the AKI patients.Renal replacement therapy(RRT)was administered to 35/191(18.3%)of the patients.Male sex,older age,mechanical ventilation(MV),severe hypotension,septic shock,multiple organ dysfunction(MODS),prolonged extracorporeal membrane oxygenation(ECMO),reintubation,and nephrotoxic agents were associated with AKI(P<0.050).Persistent AKI was independently associated with pre-operative pulmonary hypertension,severe hypotension,post-operative MODS,and nephrotoxic agents.Severe hypotension,septic shock,MODS,reintubation,prolonged MV,and ECMO during or after LTx were related to severe AKI(stage 3)(P<0.050).Patients with persistent and severe AKI had a significantly longer duration of MV,longer duration in the intensive care unit(ICU),worse downstream kidney function,and reduced survival(P<0.050).Conclusions:AKI is common after LTx,but the pathogenic mechanism of AKI is complicated,and prerenal causes are important.Persistent and severe AKI were associated with poor short-and long-term kidney function and reduced survival in LTx patients.展开更多
文摘BACKGROUND:Prolonged invasive respiratory support and extracorporeal membrane oxygenation(ECMO)in patients requiring urgent lung transplantation(ULTx)present signifi cant challenges to clinical practice due to severe underlying diseases and complex conditions.The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center.METHODS:A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation(IMV)and ECMO between January 2018 and January 2023.Data were retrieved from electronic medical records at our lung transplant center.RESULTS:Fourteen patients(mean age 57.43±10.97 years;12 males,2 females)underwent ULTx with bridging ECMO and IMV.The mean body mass index was 23.94±3.33 kg/m²,and the mean Acute Physiology and Chronic Health Evaluation(APACHE)II score was 21.50±3.96.The Nutritional Risk Screening 2002(NRS 2002)scores were≥3.ULTx was performed after an 8.5-day waiting period(interquartile interval[IQR]5.0-26.5 d).Following the surgeries,the average lengths of ECMO and IMV were 1.0(IQR 1.0-2.0)d and 5.0(IQR 3.0-7.3)d,respectively.The total length of hospital stay was 60.1±30.8 d,with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d.Two patients died within 30 d after ULTx,with a 30-day survival rate of 85.71%.CONCLUSION:Patients receiving ULTx showed an acceptable short-term survival rate,validating the practicality and safety of the treatment protocols implemented in our center.
文摘Lung transplantation is the treatment of choice for patients with end-stage lung disease.Currently,just under 5000 lung transplants are performed worldwide annually.However,a major scourge leading to 90-d and 1-year mortality remains primary graft dysfunction.It is a spectrum of lung injury ranging from mild to severe depending on the level of hypoxaemia and lung injury post-transplant.This review aims to provide an in-depth analysis of the epidemiology,pathophysiology,risk factors,outcomes,and future frontiers involved in mitigating primary graft dysfunction.The current diagnostic criteria are examined alongside changes from the previous definition.We also highlight the issues surrounding chronic lung allograft dysfunction and identify the novel therapies available for ex-vivo lung perfusion.Although primary graft dysfunction remains a significant contributor to 90-d and 1-year mortality,ongoing research and development abreast with current technological advancements have shed some light on the issue in pursuit of future diagnostic and therapeutic tools.
文摘BACKGROUND Gastroesophageal reflux is associated with poorer outcomes after lung transplant,likely through recurrent aspiration and allograft injury.Although prior studies have demonstrated a relationship between impedance-pH results and transplant outcomes,the role of esophageal manometry in the assessment of lung transplant patients remains debated,and the impact of esophageal dysmotility on transplant outcomes is unclear.Of particular interest is ineffective esophageal motility(IEM)and its associated impact on esophageal clearance.AIM To assess the relationship between pre-transplant IEM diagnosis and acute rejection after lung transplantation.METHODS This was a retrospective cohort study of lung transplant recipients at a tertiary care center between 2007 and 2018.Patients with pre-transplant anti-reflux surgery were excluded.Manometric and reflux diagnoses were recorded from pre-transplant esophageal function testing.Time-to-event analysis using Cox proportional hazards model was applied to evaluate outcome of first episode of acute cellular rejection,defined histologically per International Society of Heart and Lung Transplantation guidelines.Subjects not meeting this endpoint were censored at time of post-transplant anti-reflux surgery,last clinic visit,or death.Fisher’s exact test for binary variables and student’s t-test for continuous variables were performed to assess for differences between groups.RESULTS Of 184 subjects(54%men,mean age:58,follow-up:443 person-years)met criteria for inclusion.Interstitial pulmonary fibrosis represented the predominant pulmonary diagnosis(41%).During the follow-up period,60 subjects(33.5%)developed acute rejection.The all-cause mortality was 16.3%.Time-to-event univariate analyses demonstrated significant association between IEM and acute rejection[hazard ratio(HR):1.984,95%CI:1.03-3.30,P=0.04],confirmed on Kaplan-Meier curve.On multivariable analysis,IEM remained independently associated with acute rejection,even after controlling for potential confounders such as the presence of acid and nonacid reflux(HR:2.20,95%CI:1.18-4.11,P=0.01).Nonacid reflux was also independently associated with acute rejection on both univariate(HR:2.16,95%CI:1.26-3.72,P=0.005)and multivariable analyses(HR:2.10,95%CI:1.21-3.64,P=0.009),adjusting for the presence of IEM.CONCLUSION Pre-transplant IEM was associated with acute rejection after transplantation,even after controlling for acid and nonacid reflux.Esophageal motility testing may be considered in lung transplant to predict outcomes.
文摘A relationship between lung transplant success and many features of recipients’/donors has long been studied.However,modeling a robust model of a potential impact on organ transplant success has proved challenging.In this study,a hybrid feature selection model was developed based on ant colony opti-mization(ACO)and k-nearest neighbor(kNN)classifier to investigate the rela-tionship between the most defining features of recipients/donors and lung transplant success using data from the United Network of Organ Sharing(UNOS).The proposed ACO-kNN approach explores the features space to identify the representative attributes and classify patients’functional status(i.e.,quality of life)after lung transplantation.The efficacy of the proposed model was verified using 3,684 records and 118 input features from the UNOS.The developed approach examined the reliability and validity of the lung allocation process.The results are promising regarding accuracy prediction to be 91.3%and low computational time,along with better decision capabilities,emphasizing the potential for automatic classification of the lung and other organs allocation pro-cesses.In addition,the proposed model recommends a new perspective on how medical experts and clinicians respond to uncertain and challenging lung alloca-tion strategies.Having such ACO-kNN model,a medical professional can sum-marize information through the proposed method and make decisions for the upcoming transplants to allocate the donor organ.
文摘Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transplant recipients are still at a high risk of developing postoperative complications which tend to impact negatively the patients' outcome if not recognised early. The recognised complications post lung transplantation can be broadly categorised into acute and chronic complications. Recognising the radiological features of these complications has a significant positive impact on patients' survival post transplantation. This manuscript provides a comprehensive review of the radiological features of post lung transplantations complications over a time continuum.
基金supported by grants from the National Natural Science Foundation of China(No.81600074)Hubei Natural Science Foundation(No.2017CFB473).
文摘Objective:MiRNAs have been recently implicated in the pathogenesis of ischemia-reperfusion(IR)injury.This study aimed to investigate the miRNA expression profiles,in the early stages after lung transplantation(LT)and to study the involvement of the Toll-like receptor(TLR)signaling pathway in lung IR injury following LT.Methods:We established the left LT model in mice and selected the miRNA-122 as a research target.The mice were injected with a miRNA-122-specific inhibitor,following which pathological changes in the lung tissue were studied using different lung injury indicators.In addition,we performed deep sequencing of transplanted lung tissues to identify differentially expressed(DE)miRNAs and their target genes.These target genes were used to further perform gene ontology(GO)enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis.Results:A total of 12 DE miRNAs were selected,and 2476 target genes were identified.The GO enrichment analysis predicted 6063 terms,and the KEGG analysis predicted 1554 biological pathways.Compared with the control group,inhibiting the expression of miRNA-122 significantly reduced the lung injury and lung wet/dry ratio(P<0.05).In addition,the activity of myeloperoxidase and the expression levels of tumor necrosis factor-alpha and TLR2/4 were decreased(P<0.05);whereas the expression of interleukin-10 was increased(P<0.05).Furthermore,the inhibition of miRNA-122 suppressed the IR injury-induced activation of the TLR signaling pathway.Conclusion:Our findings showed the differential expression of several miRNAs in the early inflammatory response following LT.Of these,miRNA-122 promoted IR injury following LT,whereas its inhibition prevented IR injury in a TLR-dependent manner.
文摘The use of extracorporeal membrane oxygenation(ECMO)in the field of lung transplantation has rapidly expanded over the past 30 years.It has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative setting.ECMO is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the recipient.For example,patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous(VV)ECMO or peripheral veno-arterial(VA)ECMO in the case of hemodynamic instability.Moreover,in an intraoperative setting,VV ECMO can be maintained or switched to a VA ECMO.The routine use of intra-operative ECMO and its eventual prolongation in the postoperative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion injury.This review will assess the current evidence on the role of ECMO in the different phases of lung transplantation,while analyzing different studies on pre,intra-and post-operative utilization of this extracorporeal support.
文摘Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment of treatment.The consensus statement from the International Society for Heart and Lung Transplantation on CLAD in 2019 classified CLAD into two main phenotypes:Bronchiolitis obliterans syndrome and restrictive allograft syndrome.Along with this clear classification,further exploration of the mechanisms and the development of appropriate prevention and treatment strategies for each phenotype are desired.In this review,we summarize the new definition of CLAD and update and summarize the existing knowledge on the underlying mechanisms of bronchiolitis obliterans syndrome and restrictive allograft syndrome,which have been elucidated from clinicopathological observations and animal experiments worldwide.
基金Supported by Medical and Health Science and Technology Project of Zhejiang Province(Fund Project No.2019KY394).
文摘BACKGROUND Lung transplantation is considered an effective method for treating patients with end-stage coronavirus disease 2019(COVID-19).The nurses play a pivotal role in lung transplantation for COVID-19 patients.CASE SUMMARY Two elderly patients were admitted to the emergency department due to cough,and the nucleic acid test was positive.The patients were preliminarily diagnosed with COVID-19.The chest computed tomography scan revealed massive lung consolidation,and the patients did not improve after treatment with antiviral drugs,glucocorticoids,antibiotics,and other drugs.Under the support of pure oxygen in extracorporeal membrane oxygenation,the patients’oxygen levels were still poor,indicating that they were in the terminal stage of viral pneumonia.The patients underwent double-lung transplantation and received intraoperative care.The extracorporeal membrane oxygenation device was removed within a week of the surgical procedure,and the respiratory circulation of the patients were stabilized.CONCLUSION High-quality care for COVID-19 patients undergoing lung transplantation ensures patient safety during operation while protecting the safety of the medical staff.
文摘Dear Editor,I am Rosa Gutiérrez Bonet,former ophthalmology resident at Puerta de Hierro University Hospital,Madrid,Spain.I write to present four cases of cortical blindness(CB)after bilateral lung transplant(LT).LT is considered as a first-choice treatment for patients
文摘<strong>Background:</strong> Extracorporeal membrane oxygenation (ECMO) is an effective adjuvant therapy for cardiopulmonary support during the period of lung transplantation (LTx). However, factors associated with the application of ECMO after LTx remain controversial. The purpose of this study is to clarify the risk factors of post-operative ECMO support and to evaluate the outcomes. <strong>Methods:</strong> It was a hospital, single-center, retrospective study. 266 patients underwent LTx supported by ECMO were included. According to whether or not the patients received continourly ECMO support after the surgery, the enrolled patients were further divided into intra-operative ECMO group (group I, 105 cases) and post-operative ECMO group (group P, 161 cases). The peri-operative data of the donors and recipients were collected. The independent risk factors associated with post-operative ECMO support during LTx were identified. The relationship between primary graft dysfunction (PGD)/post-operative survival and duration of ECMO support was also analyzed. <strong>Results:</strong> Prolonged donor ventilation ≥ 5 days, pre-operative recipient mechanical ventilation, bilateral lung transplantation (BLT), veno-venous (V-V) ECMO and PGD in recipient were independent risk factors for post-operative ECMO support. The risk of PGD and post-operative death increased along with the increase of ECMO bypass time, and the mortality risk in group P was 2.33 (95% confidence interval: 1.16 - 4.67) times as that in group I. <strong>Conclusions:</strong> Mechanical ventilation for donor ≥ 5 days, pre-operative mechanical ventilation, BLT, V-V-ECMO and PGD in recipient were independent risk factors for post-operative ECMO support after LTx, and post-operative ECMO could not reduce recipients’ hospital mortality.
文摘Phrenic nerve injury can occur as a complication of lung transplantation. A 54-year-old man underwent single-lung transplantation due to interstitial pneumonia. The patient required circulatory support with venoarterial extracorporeal membrane oxygenation and was unable to be weaned from ventilatory support with nitric oxide. Although enhanced CT scanning showed stenotic anastomosis of the right pulmonary artery (PA), pulmonary angiograph findings revealed that PA flow was normal under sedation and considerably decreased with spontaneous breathing. Fluoroscopy showed that the right diaphragm moved inversely to the position of the left diaphragm, indicating that the right phrenic nerve was paralytic. We performed diaphragmatic plication 7 days after lung transplantation and weaning from ventilator support was accomplished soon thereafter. Phrenic nerve dysfunction is an important clinical problem following lung transplantation. In the present case, diaphragmatic plication was effective for treatment of circulatory failure due to phrenic nerve paralysis even in acute phase after lung transplantation.
文摘Objective To investigate the expression of bradykinin as a substrate of CD26 /DPP IV in rats with ischemia/reperfusion injury following lung transplantation ( LTx) . Methods Thirty - six syngeneic male SD rats were randomly allocated into control group and experimental group ( n = 18 each) ,and 36 rats served as do-
文摘Objective To investigate the clinical value of transesophageal echocardiography during the lung transplantation. Methods From August 2005 to August 2009, 19 patients with advanced lung diseases received lung transplantation. The average age was (48. 35 ± 13. 04) years. The echocardiographic probe was placed in patient’ s esophagus before surgery. The left and right
文摘Objective To estimate the indications,operative technique,perioperative treatment,postoperative complications and the outcome of lung transplantation ( LTx) for end - stage pulmonary diseases. Methods The clinical data of 100 patients with end - stage lung diseases receiving LTx in our hospital were retrospectively ana-
文摘Lymphangioleiomyomatosis (LAM) is a rare disease that affects women, especially in child-bearing age. Clinical manifestations include angiomyolipoma, pneumothorax, chylothorax, cystic changes of lungs and progressive pulmonary failure. In this article, we report a case of lung transplantation (LuTX) for end stage pulmonary LAM and the treatment of angiomyolipoma showing growth after LuTX resulting in complete remission with combination therapy of everolimus and tacrolimus.
文摘The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation(LT)waiting list.A steady increase in the threshold at which age is taken into consideration for LT has been observed.This retrospective cohort study recruited 166 lung transplant recipients aged≥65 years between January 2016 and October 2020 in the largest LT center in China.In the cohort,subgroups of patients aged 65–70 years(111 recipients,group 65–70)and≥70 years(55 recipients,group≥70)were included.Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years.A significantly higher percentage of coronary artery stenosis was observed in the group≥70(30.9%vs.14.4%in group 65–70,P=0.014).ECMO bridging to LT was performed in 5.4%(group 65–70)and 7.3%(group≥70)of patients.Kaplan–Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality.After adjusting for potential confounders,cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality(HR 6.37,P=0.0060).Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.
文摘Background:Lung transplantation(LT)has been demonstrated as the only effective therapy for patients with end-stage lung diseases.Increasing listed lung transplant candidates and expanding volumes of lung transplant centers across China require wellorganized programs and registry data collection based on the large population.This study aimed to summarize and analyze the data of LT development in China.Methods:We retrospectively collected and analyzed data from the China Lung Transplantation Registry(CLuTR).Key data were reported from the registry with transplant types,indications,donor and recipient characteristics,outcomes and survival.The survival<30 days,1-year and 3-year survival rates were estimated with risk factors identified.Results:CLuTR contained data from 1053 lung transplants performed through January 1st,2015 to December 31st,2018 reported by 18 registered transplant centers.The largest category of diagnosis before transplantation was idiopathic interstitial pneumonitis.The total<30 days,1-year and 3-year survival rates in CLuTR were 81.45%,70.11%,and 61.16%with discrepancy by indications.Large proportion of recipients who were more than 60 years old required higher standard of care.Infection-related complications resulted in more death events in the early post-surgery periods.New York Heart Association grading at listing,extra-corporeal membrane oxygenation usage peri-transplantation,allograft dysfunction(primary graft dysfunction>Grade 0),renal insufficiency(estimated glomerular filtration rate<60 mL min_11.73 m^2),were independently associated with a higher risk for 3-year mortality in the entire cohort.Conclusions:Facing more end-stage of lung diseases and comorbidities,this study analyzed the outcomes and survival of LT recipients in China.Further prospectively stratified analyses with longer follow-up will be needed.
基金This study was supported by grants from the Chen Jingyu team of“Sanming Project of Medicine”in Shenzhen(No.SZSM201812058)the Foundation for Special Projects of COVID-19 Prevention and Control in Wuxi City.
文摘Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreversible fatal respiratory failure.Lung transplantation(LT)as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.Methods:From February 10 to March 10,2020,three male patients were urgently assessed and listed for transplantation.After conducting a full ethical review and after obtaining assent from the family of the patients,we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.Results:Two of the three recipients survived post-LT and started participating in a rehabilitation program.Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved.The pathological results of the explanted lungs were concordant with the critical clinical manifestation,and provided insight towards better understanding of the disease.Government health affair systems,virology detection tools,and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.Conclusions:LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis.If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT,LT provided the final option for these patients to avoid certain death,with proper protection of transplant surgeons and medical staffs.By ensuring instant seamless care for both patients and medical teams,the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.
基金This work was supported by the Non-profit Central Research Institute Fund of the Chinese Academy of Medical Sciences(No.2019PT320020).
文摘Background:Acute kidney injury(AKI)is a common and serious complication following lung transplantation(LTx),and it is associated with high mortality and morbidity.This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.Methods:This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019.The outcomes were AKI incidence,risk factors,mortality,and kidney recovery.Multivariate analysis was performed to identify independent risk factors.Survival analysis was presented using the Kaplan-Meier curves.Results:AKI occurred in 137 of the 191 patients(71.7%),with transient AKI in 43(22.5%)and persistent AKI in 94(49.2%).AKI stage 1 occurred in 27/191(14.1%),stage 2 in 46/191(24.1%),and stage 3 in 64/191(33.5%)of the AKI patients.Renal replacement therapy(RRT)was administered to 35/191(18.3%)of the patients.Male sex,older age,mechanical ventilation(MV),severe hypotension,septic shock,multiple organ dysfunction(MODS),prolonged extracorporeal membrane oxygenation(ECMO),reintubation,and nephrotoxic agents were associated with AKI(P<0.050).Persistent AKI was independently associated with pre-operative pulmonary hypertension,severe hypotension,post-operative MODS,and nephrotoxic agents.Severe hypotension,septic shock,MODS,reintubation,prolonged MV,and ECMO during or after LTx were related to severe AKI(stage 3)(P<0.050).Patients with persistent and severe AKI had a significantly longer duration of MV,longer duration in the intensive care unit(ICU),worse downstream kidney function,and reduced survival(P<0.050).Conclusions:AKI is common after LTx,but the pathogenic mechanism of AKI is complicated,and prerenal causes are important.Persistent and severe AKI were associated with poor short-and long-term kidney function and reduced survival in LTx patients.
