RESUMEN
BACKGROUND: Pleuroparenchymal fibroelastosis (PPFE) has no currently available specific treatment. Benefits of lung transplantation (LT) for PPFE are poorly documented. METHODS: We conducted a nation-wide multicentric retrospective study in patients who underwent lung or heart-lung transplantation for chronic end-stage lung disease secondary to PPFE between 2012 and 2022 in France. RESULTS: Thirty-one patients were included. At transplantation, median age was 48 years [IQR 35-55]. About 64.5% were women. Twenty-one (67.7%) had idiopathic PFFE. Sixteen (52%) had bilateral LT, 10 (32%) had single LT, 4 (13%) had lobar transplantation and one (3%) had heart-lung transplantation. Operative mortality was 3.2%. Early mortality (<90 days or during the first hospitalization) was 32%. Eleven patients (35.5%) underwent reoperation for hemostasis. Eight (30.8%) experienced bronchial complications. Mechanical ventilation time was 10 days [IQR 2-55]. Length of stay in intensive care unit and hospital were 34 [IQR 18-73] and 64 [IQR 36-103] days, respectively. Median survival was 21 months. Post-transplant survival rates after 1, 2, and 5 years were 57.9%, 42.6% and 38.3% respectively. Low albuminemia (p = 0.046), FVC (p = 0.021), FEV1 (p = 0.009) and high emergency lung transplantation (p = 0.04) were associated with increased early mortality. Oversized graft tended to be correlated to a higher mortality (p = 0.07). CONCLUSION: LT for PPFE is associated with high post-operative morbi-mortality rates. Patients requiring high emergency lung transplantation with advanced disease, malnutrition, or critical clinical status experienced worse outcomes. GOV IDENTIFIER: NCT05044390.
RESUMEN
BACKGROUND: Scant data are currently available about a potential link between comorbid chronic lung diseases (CLD) and the risk and severity of the coronavirus disease 2019 (COVID-19) infection. METHODS: To describe the clinical characteristics of and outcomes for patients with COVID-19 infection, including patients with comorbid respiratory diseases, who have been primarily hospitalized in the pulmonology department of Strasbourg University Hospital, France. In this retrospective, single-center study, we included all confirmed cases of COVID-19 from March 3 to April 15, 2020. We then compared the symptoms, biological and radiological findings, and outcomes for patients with and without CLD. RESULTS: Of the 124 patients that were enrolled, the median age was 62 years, and 75 patients (60%) were male. Overall, 40% of patients (n=50) had preexisting CLD, including chronic obstructive pulmonary disease (COPD) (n=15, 12%) and asthma (n=19, 15%). Twenty-eight patients were transferred to the intensive care unit (ICU), and six patients died in our unit. CLD were not predictive of ICU hospitalization, but a significantly higher total mortality was observed (17.6% vs. 5.5%, P<0.05) in these patients. CONCLUSIONS: Our results suggest the lack of an over-representation of CLD in COVID-19, representing 40% of patients in this cohort and even within a pulmonology department. CLD were not a risk factor for ICU management. However, a tendency to higher global mortality was observed in COVID-19 patients with CLD. Further studies are warranted to determine the risk of COVID-19 for patients with comorbid CLD.
Asunto(s)
COVID-19/terapia , Enfermedad Crónica/terapia , Enfermedades Pulmonares/terapia , Anciano , Antibacterianos/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , COVID-19/epidemiología , Enfermedad Crónica/epidemiología , Comorbilidad , Presión de las Vías Aéreas Positiva Contínua , Diabetes Mellitus/epidemiología , Femenino , Francia/epidemiología , Insuficiencia Cardíaca/epidemiología , Mortalidad Hospitalaria , Hospitalización , Hospitales Universitarios , Humanos , Hidroxicloroquina/uso terapéutico , Hipertensión/epidemiología , Unidades de Cuidados Intensivos , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Ventilación no Invasiva , Obesidad/epidemiología , Terapia por Inhalación de Oxígeno , Estudios Retrospectivos , Síndromes de la Apnea del Sueño/epidemiología , Fumar/epidemiologíaAsunto(s)
Adenina/análogos & derivados , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Aspergilosis/microbiología , Aspergillus/aislamiento & purificación , Discitis/microbiología , Inmunosupresores/efectos adversos , Piperidinas/efectos adversos , Inhibidores de Proteínas Quinasas/efectos adversos , Adenina/administración & dosificación , Adenina/efectos adversos , Anciano , Antifúngicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Aspergilosis/tratamiento farmacológico , Aspergilosis/cirugía , Aspergillus/efectos de los fármacos , Terapia Combinada , Discitis/tratamiento farmacológico , Discitis/cirugía , Humanos , Inmunosupresores/administración & dosificación , Laminectomía , Leucemia Linfocítica Crónica de Células B/complicaciones , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Masculino , Piperidinas/administración & dosificación , Inhibidores de Proteínas Quinasas/administración & dosificación , Rituximab/administración & dosificación , Rituximab/efectos adversos , Voriconazol/uso terapéuticoRESUMEN
INTRODUCTION: Pembrolizumab, a humanized monoclonal antibody IgG4 anti-PD-1, having offered promising results in patients suffering from non-small cell lung cancer metastatic and heavily pretreated. OBSERVATION: We report here the case of an unexpected good response after pembrolizumab failure obtained with paclitaxel in a 68-year-old patient with stage IV lung adenocarcinoma. Moreover, the response duration with paclitaxel was more than fourteen months. CONCLUSION: Our case suggests a mutual potentiation of chemotherapy and immunotherapy, and raises the issue of the treatment sequence to favor.
