Evaluation and reconditioning of donor organs for transplantation through ex vivo lung perfusion.

OBJECTIVE: To assess the feasibility and impact of ex vivo lung perfusion with hyperoncotic solution (Steen Solution™) in the utilization of these organs in Brazil. METHODS: In this prospective study, we subjected five lungs considered to be high risk for transplantation to 4 hours of ex vivo lung perfusion, with evaluation of oxygenation capacity. High-risk donor lungs were defined by specific criteria, including inflammatory infiltrates, pulmonary edema and partial pressure of arterial oxygen less than 300mmHg (inspired oxygen fraction of 100%). RESULTS: During reperfusion, the mean partial pressure of arterial oxygen (inspired oxygen fraction of 100%) of the lungs did not change significantly (p=0.315). In the first hour, the mean partial pressure of arterial oxygen was 302.7mmHg (±127.66mmHg); in the second hour, 214.2mmHg (±94.12mmHg); in the third hour, 214.4mmHg (±99.70mmHg); and in the fourth hour, 217.7mmHg (±73.93mmHg). Plasma levels of lactate and glucose remained stable during perfusion, with no statistical difference between the moments studied (p=0.216). CONCLUSION: Ex vivo lung perfusion was reproduced in our center and ensured the preservation of lungs during the study period, which was 4 hours. The technique did not provide enough improvement for indicating organs for transplantation; therefore, it did not impact on use of these organs.

Effect of vaporized perfluorocarbon on oxidative stress during the cold ischemia phase of lung graft preservation.

Liquid perfluorocarbon (PFC) instillation has been studied experimentally as an adjuvant therapy in the preservation of lung grafts during cold ischemia. The objective of this study was to evaluate whether vaporized PFC is also protective of lung grafts at different cold ischemia times. We performed histological analysis of and measured oxidative stress in the lungs of animals that received only preservation solution with low-potassium dextran (LPD) or vaporized PFC together with LPD. We conclude that vaporized PFC reduces the production of free radicals and the number of pulmonary structural changes resulting from cold ischemia.

Lung transplantation and organ allocation in Brazil: necessity or utility.

The philosophy of organ allocation is the result of two seemingly irreconcilable principles: utilitarianism and distributive justice. The process of organ donation and transplantation in Brazil reveals large inequalities between regions and units of the Federation, from the harvesting of organs to their implantation. In this context, lung transplantation is performed in only a few centers in the country and is still a treatment with limited long-term results. The allocation of the few organs harvested for the few procedures performed is defined mainly by chronology, a criterion that is not linked to necessity, which is a criterion of distributive justice, and neither to utility, a criterion of utilitarianism. This article reviews the organ allocation philosophy focusing on the case of lung transplantations in Brazil.

Chest X-ray and chest CT findings in patients diagnosed with pulmonary tuberculosis following solid organ transplantation: a systematic review.

The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.

High-resolution computed tomography findings of pulmonary tuberculosis in lung transplant recipients.

OBJECTIVE: Respiratory infections constitute a major cause of morbidity and mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is high among such patients. On imaging, tuberculosis has various presentations. Greater understanding of those presentations could reduce the impact of the disease by facilitating early diagnosis. Therefore, we attempted to describe the HRCT patterns of pulmonary tuberculosis in lung transplant recipients. METHODS: From two hospitals in southern Brazil, we collected the following data on lung transplant recipients who developed pulmonary tuberculosis: gender; age; symptoms; the lung disease that led to transplantation; HRCT pattern; distribution of findings; time from transplantation to pulmonary tuberculosis; and mortality rate. The HRCT findings were classified as miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation with consolidation; mediastinal lymph node enlargement; or pleural effusion. RESULTS: We evaluated 402 lung transplant recipients, 19 of whom developed pulmonary tuberculosis after transplantation. Among those 19 patients, the most common HRCT patterns were ground-glass attenuation with consolidation (in 42%); cavitation and centrilobular nodules with a tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). Among the patients with cavitation and centrilobular nodules with a tree-in-bud pattern, the distribution was within the upper lobes in 66.6%. No pleural effusion was observed. Despite treatment, one-year mortality was 47.3%. CONCLUSIONS: The predominant HRCT pattern was ground-glass attenuation with consolidation, followed by cavitation and centrilobular nodules with a tree-in-bud pattern. These findings are similar to those reported for immunocompetent patients with pulmonary tuberculosis and considerably different from those reported for AIDS patients with the same disease.

Ex vivo lung perfusion in Brazil.

OBJECTIVE: To evaluate the use of ex vivo lung perfusion (EVLP) clinically to prepare donor lungs for transplantation. METHODS: A prospective study involving EVLP for the reconditioning of extended-criteria donor lungs, the criteria for which include aspects such as a PaO2/FiO2 ratio < 300 mmHg. Between February of 2013 and February of 2014, the lungs of five donors were submitted to EVLP for up to 4 h each. During EVLP, respiratory mechanics were continuously evaluated. Once every hour during the procedure, samples of the perfusate were collected and the function of the lungs was evaluated. RESULTS: The mean PaO2 of the recovered lungs was 262.9 ± 119.7 mmHg at baseline, compared with 357.0 ± 108.5 mmHg after 3 h of EVLP. The mean oxygenation capacity of the lungs improved slightly over the first 3 h of EVLP-246.1 ± 35.1, 257.9 ± 48.9, and 288.8 ± 120.5 mmHg after 1, 2, and 3 h, respectively-without significant differences among the time points (p = 0.508). The mean static compliance was 63.0 ± 18.7 mmHg, 75.6 ± 25.4 mmHg, and 70.4 ± 28.0 mmHg after 1, 2, and 3 h, respectively, with a significant improvement from hour 1 to hour 2 (p = 0.029) but not from hour 2 to hour 3 (p = 0.059). Pulmonary vascular resistance remained stable during EVLP, with no differences among time points (p = 0.284). CONCLUSIONS: Although the lungs evaluated remained under physiological conditions, the EVLP protocol did not effectively improve lung function, thus precluding transplantation.

Uso de imunossupressores (everolimo, sirolimo e tacrolimo) em transplantes pulmonares / Use of immunosuppressants (everolimus, sirolimus and tacrolimus) in lung transplants

Contexto: Os transplantes de pulmão salvaram mais de 378 vidas no SUS. Entretanto, os transplantes estão entre as trinta terapias mais dispendiosas acessíveis universalmente a toda população brasileira, reembolsadas pelo Sistema Único de Saúde do Brasil, SUS, e há crítica auto-limitação de órgãos e equipes transplantadoras disponíveis. Quase a metade deles apresenta episódios de rejeição que pode não responder aos tratamentos disponíveis no SUS. Além disto, 01 de cada 04 ou 05 transplantados pode desenvolver insuficiência renal em consequência do imunossupressor disponível no SUS. Estima-se que cerca de 300 transplantados poderiam ser beneficiados mediante resgate com alternativas terapêuticas. Perguntas: A incorporação de alternativas terapêuticas para a manutenção da imunossupressão em pacientes com pulmão transplantado, tais como tacrolimo, sirolimo e everolimo podem auxiliar a resgatar episódios de rejeição e eventos adversos graves, a qual custo e qual impacto orçamentário para o SUS? Evidências científicas: Duas das 13 meta-análises comparando ciclosporina e tacrolimo foram selecionadas. Estas incluíram os mesmos 03/30 estudos controlados randomizados, ECRs, já identificados. Dez ECRs com sirolimo e 06 com everolimo foram selecionados, com cada uma das alternativas terapêuticas mTOR. Quanto ao efeito das alternativas terapêuticas: Nas 02 meta-análises destes ECRs, tacrolimo ou ciclosporina não diferiram significativamente nas taxas de rejeição ou de ocorrência de progressão de insuficiência renal. (i) O tacrolimo auxiliou a reduzir mortalidade no 1º. ano pós-transplante. (ii) O estudo de sirolimo e everolimo associados com doses reduzidas de ciclosporina ou tacrolimo mostrou pouco ou nenhum impacto na sobrevida. (iii) Entretanto, a análise empírica dos últimos 224/252 transplantes pulmonares da coorte do InCor-HC/FMUSP mostrou que a probabilidade de sobrevida foi significativamente superior no 1º. ano do período de seguimento. Na coorte de transplantados que sobreviveram ao primeiro ano, observou-se a perda das diferenças de efeito e menor mortalidade na curva da ciclosporina, refletindo as graves condições de deterioro clínico e complicações que levaram ao switch destes pacientes para estas alternativas terapêuticas. O uso de tacrolimo e alternativas com mTORs no InCor-HC/FMUSP, de fato, proporcionou eficiente controle de episódios de rejeição em pacientes que se mostraram refratários ou tiveram eventos adversos, tais como a recidiva de rejeição, insuficiência renal ou intolerância. Discussão: O uso das alternativas terapêuticas varia com a tolerância dos pacientes e também podem causar eventos adversos. Por isto, observa-se uma dinâmica de trocas entre as alternativas visando superar os episódios de rejeição e de progressão de insuficiência renal. Embora a síntese da literatura não mostre taxa diferente de mortalidade entre os esquemas alternativos, estes diversos itinerários terapêuticos permitiram observar uma redução da significativa da mortalidade entre os 224 transplantados no InCor-HCFMUSP, sobretudo no 1º. Ano, resgatando-se os casos refratários. Esta experiência é comparável à evolução publicada na análise da base Heart & Lung Transplantation Registry da International Society, onde 69% dos transplantados são mantidos com alternativas. Decisão: Incorporar o uso dos imunossupressores (everolimo, sirolimo e tacrolimo) em transplante pulmonar, com terapia de resgate e conforme estabelecido em Protocolo do Ministério da Saúde, no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria SCTIE-MS nº 3, de 18 de janeiro de 2016, publicada no Diário Oficial da União nº 11 de 18 de janeiro de 2016.

Atuação fisioterapêutica no transplante pulmonar pediátrico: revisão de literatura / Physiotherapeutic performance in pediatric lung transplantation: literature review

A primeira tentativa de transplante pulmonar humano foi em 1963 por Hardy, conforme relatado no New England Journal of Medicine, na Universidade de Mississippi, porém sem sucesso. O primeiro transplante bem sucedido em longo prazo foi realizado em 1983, em Toronto, em um indivíduo de 16 anos de idade com fibrose pulmonar familiar em estágio final, apresentando sobrevida pós transplante de 6,5 anos. O transplante pulmonar requer habilidade da equipe multiprofissional, com profissionais capacitados, sendo o fisioterapeuta responsável pela reabilitação, com o objetivo de alcançar melhora funcional, maior sobrevida e melhoria da qualidade de vida dos pacientes...

Functional improvement in patients with idiopathic pulmonary fibrosis undergoing single lung transplantation.

OBJECTIVE: To evaluate the changes in lung function in the first year after single lung transplantation in patients with idiopathic pulmonary fibrosis (IPF). METHODS: We retrospectively evaluated patients with IPF who underwent single lung transplantation between January of 2006 and December of 2012, reviewing the changes in the lung function occurring during the first year after the procedure. RESULTS: Of the 218 patients undergoing lung transplantation during the study period, 79 (36.2%) had IPF. Of those 79 patients, 24 (30%) died, and 11 (14%) did not undergo spirometry at the end of the first year. Of the 44 patients included in the study, 29 (66%) were men. The mean age of the patients was 57 years. Before transplantation, mean FVC, FEV1, and FEV1/FVC ratio were 1.78 L (50% of predicted), 1.48 L (52% of predicted), and 83%, respectively. In the first month after transplantation, there was a mean increase of 12% in FVC (400 mL) and FEV1 (350 mL). In the third month after transplantation, there were additional increases, of 5% (170 mL) in FVC and 1% (50 mL) in FEV1. At the end of the first year, the functional improvement persisted, with a mean gain of 19% (620 mL) in FVC and 16% (430 mL) in FEV1. CONCLUSIONS: Single lung transplantation in IPF patients who survive for at least one year provides significant and progressive benefits in lung function during the first year. This procedure is an important therapeutic alternative in the management of IPF.

Cirurgia de transplante pulmonar intervivos: atuação da enfermagem no período transoperatório / Donor-related lung transplant surgeries: nursing practice in the transoperative period

Relatar a experiência de atuação da enfermagem no cuidado de transplante pulmonar intervivos. Método: Relato de experiência da atuação da equipe de enfermagem nas cirurgias de transplante pulmonar intervivos ocorridas no Centro Cirúrgico de um hospital de porto Alegre,RS, Brasil. Resultados: Foram realizados, entre 1999 e novembro de 2014, 33 transplantes de pulmão entre intervivos. Apresenta-se, neste trabalho, o relato em quatro etapas: aspectos éticos e legais do transplante intervivos; preparo do Centro Cirúrgico; assistência de enfermagem no transoperatório; e encaminhamento dos pacientes para UTI. Conclusão: O transplante é um procedimento complexo, envolvendo muitos profissionais, demandando da enfermagem conhecimento, integração, dedicação e comprometimento. O transplante pulmonar intervivos torna-se um desafio ainda maior por envolver, além do receptor, dois doadores sadiso, gerando grande expectativa no sucesso da cirurgia e recuperação dos três pacientes...

Lung transplantation.

Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first transplant successfully performed in 1983, more than 40 thousand transplants have been performed worldwide. Of these, about seven hundred were in Brazil. However, survival of the transplant is less than desired, with a high mortality rate related to primary graft dysfunction, infection, and chronic graft dysfunction, particularly in the form of bronchiolitis obliterans syndrome. New technologies have been developed to improve the various stages of lung transplant. To increase the supply of lungs, ex vivo lung reconditioning has been used in some countries, including Brazil. For advanced life support in the perioperative period, extracorporeal membrane oxygenation and hemodynamic support equipment have been used as a bridge to transplant in critically ill patients on the waiting list, and to keep patients alive until resolution of the primary dysfunction after graft transplant. There are patients requiring lung transplant in Brazil who do not even come to the point of being referred to a transplant center because there are only seven such centers active in the country. It is urgent to create new centers capable of performing lung transplantation to provide patients with some advanced forms of lung disease a chance to live longer and with better quality of life.

Psychological criteria for contraindication in lung transplant candidates: a five-year study.

Lung transplantation presents a wide range of challenges for multidisciplinary teams that manage the care of the recipients. Transplant teams should perform a thorough evaluation of transplant candidates, in order to ensure the best possible post-transplant outcomes. That is especially true for the psychologist, because psychological issues can arise at any point during the perioperative period. The objective of our study was to evaluate the psychological causes of contraindication to waiting list inclusion in a referral program for lung transplantation. We retrospectively analyzed data on psychological issues presented by lung transplant candidates, in order to understand these matters in our population and to reflect upon ways to improve the selection process.

Comparação entre duas soluções de recondicionamento pulmonar em pulmões humanos não-aceitos para transplante em modelo de avaliação e recondicionamento pulmonar ex vivo / Comparison between two pulmonary reconditioning solution in human lungs non-accepted for transplantation with an ex vivo lung assessment and reconditioning model

INTRODUÇÃO: O transplante pulmonar é terapia reconhecida de tratamento de doenças terminais pulmonares. Os pulmões, entretanto, são muito susceptíveis às transformações hormonais e hidroeletrolíticas ocorridas no doador após a morte encefálica. As baixas taxas de aproveitamento dos pulmões alavancam pesquisas e meios de utilizar pulmões considerados nãoideais. Um desses modelos é o recondicionamento pulmonar ex-vivo concebido por Steen, no qual se utiliza uma solução hiperosmolar (Steen Solution®) para avaliação e melhora dos pulmões doados. Consideramos que o desenvolvimento de uma solução de recondicionamento pulmonar produzida no Brasil seria conveniente aos serviços de transplante e aos pacientes. Foram comparadas a solução de recondicionamento Steen Solution® e uma solução de fabricação nacional em modelo de ex vivo de pulmões humanos não aceitos para transplante, através da avaliação da mecânica ventilatória, hemodinâmica, trocas gasosas e histologia. MÉTODOS: Foram utilizados 16 pulmões de doadores em morte encefálica, considerados inadequados para o transplante pulmonar. Os pulmões foram submetidos à captação habitual e acondicionados sob isquemia fria por 10 horas. Após este período, os pulmões foram designados, por sorteio, para reperfusão com a solução padrão (Steen solution®) ou a solução nacional por 1h em modelo ex vivo. A lesão pulmonar foi estudada através de parâmetros gasométricos, resistência pulmonar e complacência pulmonar. Foram medidos os pesos em três tempos e relação peso úmido/peso seco após a reperfusão para avaliação de edema. A partir de biópsias seriadas era calculado um score de lesão tecidual e grau de apoptose. RESULTADOS: A capacidade de oxigenação foi de 498,00 ± 37,53 mmHg no grupo STEEN e 521,00 ± 55,43 mmHg no grupo SRNac (p = 0,348). A capacidade relativa de oxigenação calculada ao final do recondicionamento foi 501,37 ± 207,77 no grupo STEEN e 470,30 ± 232,41 no grupo SRNac (p=0,782). Os pesos dos pulmões nos três...

INTRODUCTION: Lung transplantation is routine treatment of end-stage lung diseases. The lungs, however, are very susceptible to hormonal and electrolyte changes occurred in the donor after brain death. The low recovery rates of the lungs leverage researches and ways to use lungs considered non-ideal. One such model is the lung ex vivo reconditioning designed by Steen, in which using a hyperosmolar solution (Steen Solution®) for evaluation and improvement of donor lungs. We believe that the development of a pulmonary reconditioning solution produced in Brazil would be convenient to transplantation service and patients. Were compared the standard Steen Solution® and a national manufacturing solution in ex vivo model with human lungs not accepted for transplant, through the evaluation of respiratory mechanics, hemodynamics, gas exchange and histology. METHODS: 16 brain-dead donors lungs, considered unsuitable for lung transplantation, were used. The lungs were harvest as usual, packed and stored in cold ischemia for 10 hours. After this period, the lungs were appointed by randomization to reperfusion with the standard solution (Steen Solution®) or national solution for 1 h in ex vivo model. Lung injury was accessed by blood gas parameters, lung resistance and lung compliance. The weights were measured in three times and the after reperfusion wet weight / dry weight ratio for evaluation of edema. The degree of apoptosis and tissue injury score was calculated from serial biopsies. RESULTS: The oxygenation capacity was 498.00 ± 37.53mmHg in STEEN group and 521.00 ± 55.43mmHg in SRNac group (p = 0.348). The relative oxygenation capacity calculated at the end of the reconditioning was 501.37 ± 207.77 in the STEEN group and 470.30 ± 232.41 in the SRNac group (p = 0.782). The weights of lungs in the three stages of evaluation were: onset of ischemia: STEEN = 1,026 ± 451g, SRNac = 745 ± 282g (p = 0.180); end of ischemia: STEEN = 998 ± 391g, SRNac = 738 ±...

The immediate post-operative period following lung transplantation: mapping of nursing interventions.

OBJECTIVES: To investigate the principle nursing interventions/actions, prescribed in the immediate post-operative period for patients who receive lung transplantation, recorded in the medical records, and to map these using the Nursing Interventions Classification (NIC) taxonomy. METHOD: Retrospective documental research using 183 medical records of patients who received lung transplantation (2007/2012). The data of the patients' profile were grouped in accordance with the variables investigated, and submitted to descriptive analysis. The nursing interventions prescribed were analyzed using the method of cross-mapping with the related interventions in the NIC. Medical records which did not contain nursing prescriptions were excluded. RESULTS: The majority of the patients were male, with medical diagnoses of pulmonary fibrosis, and underwent lung transplantation from a deceased donor. A total of 26 most frequently-cited interventions/actions were found. The majority (91.6%) were in the complex and basic physiological domains of the NIC. It was not possible to map two actions prescribed by the nurses. CONCLUSIONS: It was identified that the main prescriptions contained general care for the postoperative period of major surgery, rather than prescriptions individualized to the patient in the postoperative period following lung transplantation. Care measures related to pain were underestimated in the prescriptions. The mapping with the taxonomy can contribute to the elaboration of the care plan and to the use of computerized systems in this complex mode of therapy.

Cytokine levels in pleural fluid as markers of acute rejection after lung transplantation.

Our objective was to determine the levels of lactate dehydrogenase, IL-6, IL-8, and VEGF, as well as the total and differential cell counts, in the pleural fluid of lung transplant recipients, correlating those levels with the occurrence and severity of rejection. We analyzed pleural fluid samples collected from 18 patients at various time points (up to postoperative day 4). The levels of IL-6, IL-8, and VEGF tended to elevate in parallel with increases in the severity of rejection. Our results suggest that these levels are markers of acute graft rejection in lung transplant recipients.

O acompanhamento da enfermagem de reabilitação na consulta de doentes pós transplante pulmonar / The follow-up of rehabilitation nursing in the consultation of patients after lung transplantation

O transplante de pulmão tem um impacto benéfico imediato na melhoria da função pulmonar. No entanto, os doentes transplantados de pulmão devem ser submetidos a um programa de reabilitação para uma melhoria na força muscular, na função pulmonar e consequentemente na qualidade de vida. Objetivo: Operacionalizar a Consulta de enfermagem Pós Transplante Pulmonar (Txp), Avaliar a Condição Física, Funcional e da Qualidade de Vida Pós Transplante Pulmonar e Caracterizar a população submetida a Txp em Portugal. Metodologia: Recorreu-se a um estudo de paradigma quantitativo, retrospectivo e descritivo-correlacional e foi avaliada a população Transplantada viva em Portugal até dezembro de 2013, relativamente ao Peso, Altura, Índice de massa corporal (IMC) e Volume expiratório forçado no primeiro segundo (FEV1), no pré-transplante, num total de 54 doentes. Foram depois em consulta pós-Txp avaliados 23 doentes quanto ao Peso, Altura e IMC, saturação periférica de oxigénio (SatO2), FEV1, aplicada bateria de testes de Rikli Jones modificado (Teste STS em 30 seg, Teste de equilíbrio unipodal 30 seg, Teste TUGT e avaliação da força na mão dominante) e aplicados os questionários EuroQol, qualidade de vida (SF36) e Medical Research Council Dyspnoea Questionnaire (MRCDQ). Resultados: A população transplantada viva até dezembro de 2013 é constituída por 33,3% mulheres (18) e 66,7% homens (36), num total de 54 doentes. Verificamos que no FEV1 avaliado pré-Txp apresentam em média um valor de 1,03 ± 0,42, a idade à altura do Txp é de 45,11±14,79 anos. As patologias mais frequentes que motivaram o transplante foram a Fibrose Quistíca 22,22% (12) e a Fibrose Pulmonar Idiopática (FIP) 18,52% (10). Na população avaliada em consulta pós-Txp, temos uma média de FEV1 de 2,02±0,73. Existe uma correlação negativa entre a idade e a SatO2 e uma correlação positiva entre a FEV1 e a SatO2, ou seja, os doentes com mais idade têm valores de SatO2 mais baixos. Quem tem valores da SatO2 mais elevados tem também melhores valores de FEV1. De notar que o ano do Tpx apenas se correlaciona negativamente com o teste levantar e andar, o que significa que os doentes com Tpx mais recentes foram os que demoraram menos tempo a executar o teste. Quem faz mais repetições no teste de flexão do membro superior direito é também quem faz mais repetições no teste de levantar e sentar. Existe uma correlação positiva nos domínios das respostas do questionário SF36 e as respostas do questionário EuroQol e uma correlação negativa com o questionário MRCDQ. Conclusões: Temos uma grande diferença de valores de FEV1 e de IMC na população transplantada muito mais elevados do que na população pré-Txp. Existe também uma relação do ponto de vista da qualidade de vida adquirida por estes doentes, com o grau de dispneia e o número de flexões realizadas pelo membro superior direito. Há também uma relação entre os doentes que referem sentir-se bem emocionalmente, e que sentiam que o seu estado de saúde geral estava bem classificado, também sentiam ter uma saúde mental em bom estado. Daí a importância de se instituir em consulta de Enfermagem de Reabilitação, podendo-se avaliar os parâmetros que foram avaliados para a realização deste estudo, permitindo o acompanhamento de todo o processo de evolução física e psicológica destes doentes.

Lung transplantation has an immediate beneficial impact on improving lung function. However, lung transplant patients should undergo a rehabilitation program for an improvement in muscle strength, lung function and consequently the quality of life. Objective: To implement the Post Lung Transplantation Nursing Consultation, Assessing the Physical and Functional Condition and the Quality of Life After Lung Transplantation and Characterize the Population Submitted to Transplantation in Portugal. Methodology: based in a quantitative paradigm, this retrospective, descriptive and correlational study evaluated the transplanted population living in Portugal by December 2013, with respect to weight, height, body mass index (BMI) and forced expiratory volume in one second (FEV1), in pre-transplantation of a total of 54 patients. Were then evaluated 23 patients in consultation regarding weight, height and BMI, peripheral oxygen saturation (SpO2), FEV1, applied the modified Rikli Jones protocol (sit to stand test in 30 seconds, one-leg balance test 30 sec, timed up and go test and evaluation of the strength in the dominant hand) and applied the EuroQol questionnaire, quality of life (SF36) and Medical Research Council Dyspnoea questionnaire (MRCDQ). Results: The alive transplanted by December 2013 consists of 33.3% women (18) and 66.7% men (36), a total of 54 patients. We found that the estimated FEV1 pre-transplantation have an average value of 1.03 ± 0.42, age at time of transplant is 45.11 ± 14.79 years. The most frequent pathologies that led to transplantation were cystic fibrosis 22,22% (12) and Idiopathic Pulmonary Fibrosis (FIP) 18.52% (10). In the population studied in post-transplantation, we get an average FEV1 of 2.02 ± 0.73. There is a negative correlation between age and SpO2 and a positive correlation between FEV1 and SpO2, ie, older patients have lower SpO2 values. Who has higher values of SpO2 also has better FEV1. Note that the year of transplant only correlates negatively with the timed up and go test, which means that patients with more recent transplantation were those who took less time to perform the test. Who makes more reps in the one-leg balance are also the ones who do more repetitions in the bending test of the right upper limb. There is a positive correlation in the areas of response of the SF36 and EuroQol questionnaire and a negative correlation with MRCDQ questionnaire. Conclusions: We have a large difference in FEV1 and BMI in the transplant population much higher than in the pre-transplantation population. There is also a link from the viewpoint of quality of life gained by these patients, the degree of dyspnea and the number of push-ups performed by the right arm. There is also a relationship between patients who reported feeling good emotionally or those who felt that their general health was rated well with a mental health in good condition. Hence the importance of instituting the Rehabilitation Nursing Consultation for being able to assess the parameters that were evaluated for this study, allowing the monitoring of the whole process, of physical and psychological evolution of these patients.

Transplante de pulmão: Indicações atuais / Lung Transplantation: Current Indications

A doença pulmonar obstrutiva crônica representa cerca de 40% de todos os transplantes de pulmão. A fibrose pulmonar, idiopática ou secundária, caracteriza a indicação básica de transplante unilateral. A fibrose cística é a principal indicação de transplante em doenças supurativas. Há uma crescente tendência a aumentar as indicações de transplante bilateral. O transplante bilobar com doadores vivos representa a melhor opção para os receptores pediátricos e adolescentes. A terapia vasodilatadora modificou substancialmente a indicação de transplante em hipertensão pulmonar, primária e secundária. É intransferível a necessidade de divulgação dos critérios de inclusão em lista de espera, demovendo o equivocado conceito de que transplante é a terapia de desespero e, com isso, prevenindo mortes evitáveis.

Impact of pulmonary rehabilitation on quality of life and functional capacity in patients on waiting lists for lung transplantation.

OBJECTIVE: To investigate the impact of a pulmonary rehabilitation program on the functional capacity and on the quality of life of patients on waiting lists for lung transplantation. METHODS: Patients on lung transplant waiting lists were referred to a pulmonary rehabilitation program consisting of 36 sessions. Before and after the program, participating patients were evaluated with the six-minute walk test and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The pulmonary rehabilitation program involved muscle strengthening exercises, aerobic training, clinical evaluation, psychiatric evaluation, nutritional counseling, social assistance, and educational lectures. RESULTS: Of the 112 patients initially referred to the program, 58 completed it. The mean age of the participants was 46 ± 14 years, and females accounted for 52%. Of those 58 patients, 37 (47%) had pulmonary fibrosis, 13 (22%) had pulmonary emphysema, and 18 (31%) had other types of advanced lung disease. The six-minute walk distance was significantly greater after the program than before (439 ± 114 m vs. 367 ± 136 m, p = 0.001), the mean increase being 72 m. There were significant point increases in the scores on the following SF-36 domains: physical functioning, up 22 (p = 0.001), role-physical, up 10 (p = 0.045); vitality, up 10 (p < 0.001); social functioning, up 15 (p = 0.001); and mental health, up 8 (p = 0.001). CONCLUSIONS: Pulmonary rehabilitation had a positive impact on exercise capacity and quality of life in patients on lung transplant waiting lists.