Lung Transplantation for Primary Ciliary Dyskinesia and Kartagener Syndrome: A Multicenter Study.

Primary ciliary dyskinesia, with or without situs abnormalities, is a rare lung disease that can lead to an irreversible lung damage that may progress to respiratory failure. Lung transplant can be considered in end-stage disease. This study describes the outcomes of the largest lung transplant population for PCD and for PCD with situs abnormalities, also identified as Kartagener's syndrome. Retrospectively collected data of 36 patients who underwent lung transplantation for PCD from 1995 to 2020 with or without SA as part of the European Society of Thoracic Surgeons Lung Transplantation Working Group on rare diseases. Primary outcomes of interest included survival and freedom from chronic lung allograft dysfunction. Secondary outcomes included primary graft dysfunction within 72 h and the rate of rejection ≥A2 within the first year. Among PCD recipients with and without SA, the mean overall and CLAD-free survival were 5.9 and 5.2 years with no significant differences between groups in terms of time to CLAD (HR: 0.92, 95% CI: 0.27-3.14, p = 0.894) or mortality (HR: 0.45, 95% CI: 0.14-1.43, p = 0.178). Postoperative rates of PGD were comparable between groups; rejection grades ≥A2 on first biopsy or within the first year was more common in patients with SA. This study provides a valuable insight on international practices of lung transplantation in patients with PCD. Lung transplantation is an acceptable treatment option in this population.

Thoracic benign cystic mesothelioma.

BACKGROUND: Benign cystic mesotheliomas (BCMs), also known as multilocular mesothelial inclusion cysts, inflammatory inclusion cysts or multicystic mesothelial proliferation, are frequently observed in females and are localised localised in the pelvic peritoneum. They are rarely present in the thoracic and mediastinal areas; however, these locations have been reported in a few cases in the literature. CASE PRESENTATION: We present the case of a woman with an intrathoracic BCM. A 28-year-old female patient presented with a cystic mass of 8 × 6 × 6 cm in the left hemithorax shown by computed tomography of the thorax. The patient underwent cystic mass excision with video-assisted thoracoscopic surgery (VATS), which was completed without complications. The diagnosis was confirmed histopathologically after the surgical resection. CONCLUSIONS: Due to BCMs' non-specific clinical symptoms and radiological imaging, preoperative diagnosis is difficult, and they are often confused with pericardial cysts. There is no standard treatment protocol; however, VATS and en bloc resection are the most frequently used treatment options for mediastinal localization. Since these lesions slow proliferation rates have the potential for local recurrence and low malignant transformation, close follow-up is recommended. In this case report, we aimed to present a rare BCM case with intrathoracic paracardiac localization was completely excised through VATS. No recurrence has been detected in three years of follow-up.

COVID-19 in lung transplant recipients: A single-center experience.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a global health problem. However, the course of this disease in immunosuppressed patients remains unknown. This study aimed to describe the course of COVID-19 infection and its effects on lung transplant recipients. METHODS: This was a single-center, retrospective, observational study. The recipients with suspicious symptoms and/or a contact history with infected individuals were diagnosed with COVID-19 by performing a reverse transcription-polymerase chain reaction (RT-PCR) test using samples obtained from the nasopharynx swabs or bronchial lavage. We classified the patients into mild, moderate, and high severity groups according to their clinical conditions. In patients with positive RT-PCR results, cell cycle inhibitor drugs were withdrawn, while steroids were maintained at the same level as in patients without clinical deterioration. RESULTS: Of the seven recipients diagnosed with COVID-19 infection, one experienced a re-infection. Each recipient had at least one comorbidity. Smell disorder (12.5%), cough/dyspnea (37%), and fever/chills/shivering (37%) were the most frequent symptoms. The mean follow-up time after infection was 108 days. No deaths were recorded due to COVID-19; however, the pulmonary function test values of two recipients were decreased during subsequent follow-ups. CONCLUSION: In our small group of transplant recipients with COVID-19, there were two cases of pulmonary function deterioration and a case of re-infection, and no recipient died. It is suggested that steroid therapy should be initiated in the early period in patients with pulmonary opacities.

Pulmonary vascular alterations in explanted lung after transplantation.

Widespread pulmonary destruction and fibrosis can be seen in end-stage pulmonary diseases. This situation causes vascular remodeling of the pulmonary circulation and pulmonary hypertension. Lung transplantation is an alternative treatment for end-stage pulmonary diseases. The purpose of this study is to research pathological vascular alterations retrospectively in explanted lungs with or without pulmonary hypertension. 57 explanted lungs were evaluated for occlusive intimal fibroelastosis, smooth muscle proliferation, medial hypertrophy, intimal cellular or fibrous thickening, hemosiderosis, plexiform lesion, angiomatoid lesion, arteriosclerosis, venopathy, capillary duplication and arteriovenous malformation. Both systolic and mean pulmonary artery pressures were defined. The relationship between vascular patterns and pulmonary hypertension was investigated. Pathological vascular alterations in explanted lungs with or without pulmonary hyper- tension included medial hypertrophy (80.71%), intimal cellular or fibrous thickening (80.7%), arteriosclerosis (77.19%), smooth muscle proliferation (55.3%) and arteriovenous malformation (50.3%). Hemosiderosis (12.5%), plexiform lesion (14%) and venopathy (21%) were less frequent pathological vascular alterations. Capillary duplication was common in secondary pulmonary hypertension and was statistically meaningful. Although medial hypertrophy and intimal thickness were seen in pulmonary hypertension, they can also be observed in end-stage pulmonary diseases without pulmonary hypertension. Interstitial capillary duplication was an important histopathological finding in end-stage lung diseases with pulmonary arterial hypertension.

Can Sericin Prove Useful as a Pleurodesis Agent or Tissue Glue?

Background Sericin is a natural, gum-like, macromolecule protein, synthesized from silkworms for the formation of cocoon shells. The aim of the present study is to describe the effects of sericin when used for pleurodesis and/or as tissue glue. Methods Adult, male, 12-week-old Wistar albino rats, weighing 257 to 395 g were used in the present study (n = 12). The animals were randomly divided into two equal groups as the sericin and the control group. After intramuscular administration of the anesthetic agent, the rats were intubated and mechanically ventilated. A left thoracotomy was performed and 30 mg sericin powder was instilled into the thoraxes of the sericin group. The remaining rats were allocated to a sham thoracotomy group. The animals were housed in individual cages, fed ad-libitum, and sacrificed 8 days after. After sacrifice, the left hemithoraxes were removed en bloc and underwent histopathologic examination. Results Masson trichrome staining was applied on the visceral pleura sections of all the animals. Each animal specimen (n = 6, 100%) in the control group showed minimal collagen deposition, while only one rat (16.67%) in the sericin group had minimal collagen deposition. However, in the sericin group, five animals (83.33%) showed dense collagen deposition, fibroblastic activity, and fibrosis. According to the test method, independent t-test, developing fibroblastic activity and fibrosis are statistically significant between the two groups (p < 0.01). There were no foreign-body reactions and no evidence of biological glue on the specimens in the sericin group. The rats in the sericin group had lower inflammatory reactions compared with those in the control group. Emphysema was observed in two rats (33.33%) in the sericin group and in four rats (66.67%) in the control group. Therefore, sericin was found to be associated with an increase in fibroblastic activity and fibrosis in visceral pleura without exerting any adverse effect on the lung parenchyma. Conclusion Sericin is a new and researchable protein for chest diseases and thoracic surgery. To develop an effect of dense collagen deposition, fibroblastic activity, and fibrosis in the visceral pleura, without significant adverse effects, is remarkable. Therefore, sericin may be useful as a pleurodesis agent or natural biological glue in the future. Sericin treatment can add value to the disciplines of pulmonology and thoracic surgery.

A strange bullet which caused chylomediastinum and chyloptysis.

Chyloptysis and chylomediastinum are uncommon complications of various kinds of thoracic operations, malign and nonmalign diseases. In the English language medical literature, there were no cases of both chylomediastinum and chyloptysis following trauma. We discuss a case of chylomediastinum and chyloptysis after penetrating trauma. The patient sustained a bullet wound that caused chylomediastinum and chyloptysis without damaging major structures apart from the thoracic duct in the mediastinum. Following surgical intervention, the patient has remained problem-free for 5 months.

Intrathoracic neurogenic tumors.

BACKGROUND: Intrathoracic neurogenic tumors are uncommon neoplasms arising from nerve tissues. This study reports on our 24-year single-center experience with intrathoracic neurogenic tumors. PATIENTS AND METHODS: We retrospectively analyzed the postoperative pathological records of 19,378 operations performed in our clinic between January 1988 and December 2011 and included cases with diagnosis of neurogenic tumors. RESULTS: The study included 149 patients (90 females and 59 males) with an average age of 24.5 years (7 months to 77 years). The study group comprised 29 infants and children, and 120 adults. Of the patients, 72 had benign schwannomas, 10 malignant schwannomas, 17 neurofibromas, 24 ganglioneuromas, 9 ganglioneuroblastomas, 4 neuroblastomas, 9 primitive neuroectodermal tumors, and 4 paragangliomas. Concerning the location of these lesions, 131 were located in the posterior mediastinum, 8 in the lung parenchyma, 5 in the chest wall, 3 in the anterior mediastinum, and 2 in the thoracic inlet. The majority of nerve cell tumors were in infants and children (79.3%), whereas the nerve sheath tumors most commonly occurred in adults (78.3%). There were 117 benign and 32 malignant tumors across all age groups. The rate of malignancy was 41.4% in infants and children, compared with 16.7% in adults. Symptoms were seen in 65% of the adult patients and 79.3% of the infant and children patients. Seven tumors were associated with von Recklinghausen's disease. In six patients (4.0%), the tumor showed an intraspinal extension. Surgical resection of the tumor was complete in 142 of 149 patients (95.3%). CONCLUSION: The treatment of choice for malignant and benign thoracic neurogenic tumors is complete resection. The objective of resection is to avoid local invasion, facilitate differential histopathological diagnosis to determine other treatment options, and to prevent malignant degeneration.

Neo-carina after carina resection and right upper lobectomy in a patient with adenoid cystic carcinoma: Alternative technique.

Surgical treatment of carinal tumors that extend into the lobar bronchus is a procedure that challenges thoracic surgeons. There is no consensus on the suitable technique for a safe anastomosis in lobar lung resection with carina. The preferred Barclay technique has a high rate of anastomosis-related complications. Although a lobe-sparing end-to-end anastomosis technique has been previously described, the double-barrel method can be applied as an alternative technique. We present a case where we performed double-barrel anastomosis and neo-carina formation after tracheal sleeve right upper lobectomy.

Effects of intraoperative fluid therapy on intensive care process, morbidity, and mortality after lung transplantation.

Background: This study aims to evaluate the effect of intraoperative fluid therapy on intensive care process and first 90-day morbidity and mortality in patients undergoing lung transplantation. Methods: Between March 2013 and December 2020, a total of 77 patients (64 males, 13 females; mean age: 47.6±13.0 years; range, 19 to 67 years) who underwent lung transplantation were retrospectively analyzed. The patients were divided into two groups according to the amount of fluid given intraoperatively: Group 1 (<15 mL/kg-1/h-1) and Group 2 (>15 mL/kg-1/h-1). Demographic, clinical, intra- and postoperative data of the patients were recorded. Results: Less than 15 mL/kg-1/h-1 f luid w as a dministered t o 75.3% (n=58) of the patients (Group 1) and 24.7% (n=19) were administered more than 15 mL/kg-1/h-1 (Group 2). In t erms of native disease, the rate of diagnosis of chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis was higher in Group 1, and the rate of other diagnoses was higher in Group 2 (p<0.01). The ratio of women in Group 2 was higher (p<0.05), while the body mass index values were significantly lower in this group (p<0.01). The erythrocyte, fresh frozen plasma, platelet, crystalloid and total fluid given in Group 2 were significantly higher (p<0.001). Inotropic/vasopressor agent use rates and extracorporeal membrane oxygenation requirement were significantly higher in Group 2 (p<0.01). Primary graft dysfunction, gastrointestinal complications, and mortality rates were also significantly higher in Group 2 (p<0.05). Conclusion: The increased intraoperative fluid volume in lung transplantation is associated with primary graft dysfunction, gastrointestinal complications, and mortality rates.

Dynamic Thiol-Disulfide Homeostasis in Lung Transplant Recipients.

OBJECTIVES: In this study, we investigated dynamic thiol-disulfide homeostasis as a new indicator of oxidative stress in lung transplant recipients. In addition, we compared dynamic thiol-disulfide homeostasis parameters according to transplant indication and time after transplant. MATERIALS AND METHODS: This study had a single-center, observational, randomized design. In terms of transplant indications, lung transplant recipients were grouped as chronic obstructive pulmonary disease, interstitial lung disease, bronchiectasis, and other indications. To make comparisons based on time after transplant, lung transplant recipients were categorized into the following groups: >6 and ≤24 months, >24 and ≤48 months, >48 and ≤72 months, and >72 months. A fully automated spectrophotometric technique was used to measure dynamic thiol-disulfide homeostasis in fasting blood samples. RESULTS: Our study included 34 lung transplant recipients and 36 healthy volunteers. Native thiol (P = .005) and total thiol levels (P = .06) were lower in lung transplant recipients. Disulfide levels were similar. Disulfide-to-native thiol (P = .027) and disulfide-to-total thiol ratios (P = .027) were significantly higher in lung transplant recipients. Native thiol-to-total thiol ratios were lower in lung transplant recipients (P = .027). When we examined patients according to transplant indication, no statistically significant differences were found in dynamic thiol-disulfide homeostasis parameters, except for total thiol and disulfide levels. We also found no significant differences when we examined dynamic thiol-disulfide homeostasis parameters according to time after transplant. CONCLUSIONS: Thiol-related antioxidant activity is significantly reduced after lung transplant, regardless of indication and transplant time. Ensuring oxidative balance in lung transplant recipients with an antioxidant supplement regimen can prevent damage from oxidative stress.

The Effect of Ideal/Standard Donor and Marginal Donor Use on Primary Graft Dysfunction After Lung Transplantation in Turkey.

OBJECTIVE: The transplantation waiting list is getting longer day by day with the spread of lung transplantation and awareness of it. However, the donor pool cannot keep up with this rate. Therefore, nonstandard (marginal) donors are widely used. By studying the lung donors presented at our center, we aimed to raise awareness of the donor shortage and compare clinical outcomes in recipients with standard and marginal donors. MATERIALS AND METHODS: The data from recipients and donors of lung transplants performed at our center between March 2013 and November 2022 were retrospectively reviewed and recorded. Transplants with ideal and standard donors were classified as group 1, and those with marginal donors were classified as group 2. Primary graft dysfunction rates, intensive care unit, and hospital stay days were compared. RESULTS: Eighty-nine lung transplants were performed. A total of 46 recipients were in group 1 and 43 were in group 2. There were no differences between groups in the development of stage 3 primary graft dysfunction. However, a significant difference was found in the marginal group for developing any stage primary graft dysfunction. Donors were mostly from the western and southern regions of the country and from the education and research hospitals. CONCLUSION: Because of the donor shortage in lung transplantation, transplant teams tend to use marginal donors. Stimulating and supportive education for healthcare professionals to recognize brain death and public education to raise awareness about organ donation are necessary to spread organ donation throughout the country. Although our results using marginal donors are similar with the standard group, each recipient and donor should be assessed individually.

Dynamic Thiol-Disulfide Homeostasis as a Marker for Oxidative Stress in Lung Transplant Candidates.

OBJECTIVES: Oxidative stress developing due to oxidant/antioxidant imbalance plays a crucial role in the etiopathogenesis of chronic progressive lung diseases.The condition is typically more severe in lung transplant candidates with end-stage lung disease. Here, we investigated dynamic thiol-disulfide homeostasis as a marker for oxidative stress in lung transplant candidates. MATERIALS AND METHODS: The study included 40 patients with end-stage lung disease with indications for lung transplant (candidate group) and 40 healthy controls. Patient demographic data, laboratory results, and thiol-disulfide homeostasis values were recorded. We categorized patients according to their primary diseases and noted clinical measurements of forced expiratory volume in 1 second, forced vital capacity, 6-minute walk test, systolic pulmonary artery pressure, and lung allocation scores.Thiol-disulfide homeostasis parameters were compared before and after transplant. RESULTS: Demographic characteristics were similar in the candidate and control groups. In the candidate group, native thiol and total thiol levels (antioxidant parameters of thiol-disulfide homeostasis) were significantly lower, whereas disulfide-to-native thiol and disulfide-to-total thiol ratios (oxidant parameters of thiol-disulfide homeostasis) were significantly higher. We observed no significant differences between the disease subgroups in terms of thioldisulfide homeostasis parameters. Moderately significant correlations were shown between the antioxidant markers ofthiol-disulfide homeostasis and the clinical measurements, including the lung allocation scores. Our multiple regression analyses showed that native thiol and total thiol were significant predictive factors to estimate the lung allocation score. During the study period, 6 patients (15%)received lung transplant. There were significant differences in antioxidant parameters ofthiol-disulfide homeostasis in the pre- versus posttransplant periods. CONCLUSIONS: In patients with end-stage lung disease, the dynamic thiol-disulfide homeostasis status is altered in favor of oxidants. Thus, thiol-disulfide homeostasis parameters can be used to detect oxidative stress and estimate lung allocation scores in these patients. Lung transplant may have positive effects on oxidative stress.

Outcomes of lung transplantation for chronic obstructive pulmonary disease.

Introduction: Chronic obstructive pulmonary disease is a progressive airway disease that can progress to the terminal stage requiring oxygen supply. In this period, lung volume reduction therapies and/or lung transplantation may be considered. Morbidity and mortality risks due to transplant surgery and posttransplant immunosuppressive therapy show the importance of selecting the best candidates who will benefit from transplantation. In this context, BODE index criteria serve as important markers. This study aimed to analyze the outcomes of lung transplantation in patients with chronic obstructive pulmonary disease and to identify variables that may affect post-transplant clinical outcomes. Materials and Methods: Lung transplants diagnosed with chronic obstructive pulmonary disease performed in our center between March 2013 and January 2023 were included in the study. Demographic information and both pre-op and post-op clinical data of the transplant patients were collected. The effect of BODE index criteria and other pre-transplant clinical data on short- and long-term outcomes after transplantation were investigated. Results: During the study period, 34 lung transplants were performed for chronic obstructive pulmonary disease. One patient died during the operation, three patients received single transplants, and 30 received double transplants. Post-operative primary graft dysfunction was more common in single transplant recipients. The results were comparable between single and double transplants in terms of post-transplant pulmonary function and the development of chronic lung allograft dysfunction. BODE index criteria had no effect on early and late post-operative clinical data, however intra-operative use of extracorporeal membrane oxygenation, primary graft dysfunction, and prolonged extubation were significantly higher in recipients younger than 60 years. Conclusion: Our study suggests that prelisting demographic and clinical data of chronic obstructive pulmonary disease patients had no significant effect on post-operative outcomes, however, intra-operative ECMO use, prolonged extubation, primary graft dysfunction (p< 0.05 for each) and chronic rejection (p> 0.05) were more common in patients who are <60 years of age. These data need to be confirmed by larger studies.

COVID-19 After Vaccination in Lung Transplant Recipients: Real-Life Data.

OBJECTIVES: The effectiveness of COVID-19 vaccines in lung transplant recipients is unclear. We retrospectively analyzed lung transplant recipients vaccinated with an inactivated virus vaccine (CoronaVac) and the mRNA vaccine BNT162b2 used against the SARS-CoV-2 virus in Turkey and shared their effects on COVID-19. MATERIALS AND METHODS: Demographic data of lung transplant recipients followed up for >3 months were collected, and vaccination dates and status against the SARS-CoV-2 virus were recorded. Recipients who received at least 3 doses of CoronaVac or 2 doses of BNT162b2, or 1 dose of CoronaVac plus 2 doses of BNT162b2, or 2 doses of CoronaVac plus 1 dose of BNT162b2 were considered fully vaccinated; those who were vaccinated less than this number were considered partially vaccinated. Patients with positive SARS-CoV-2 reverse transcription-polymerase chain reaction tests from respiratory tract samples were accepted as positive for COVID-19. Recipients were classified by number and type of vaccine, and groups were compared for infection, need for intensive care, and death as a result of COVID-19. RESULTS: Of the 53 lung transplant recipients, 51 were vaccinated (7 partially vaccinated, 44 fully vaccinated) and 2 were not vaccinated. Of fully vaccinated recipients, 13/44 received the inactivated vaccine, 5/44 received the mRNA vaccine, and 26/44 had a combination of the 2 vaccines. During the follow-up period, 13 patients (2/2 not vaccinated, 2/7 [28.5%] partially vaccinated, 9/44 [20.5%] fully vaccinated) were diagnosed with COVID-19. There was no significant difference in protection against infection between the inactivated, the mRNA, and combined vaccine groups. There was no significant association in cycle threshold values that determine the infection load and COVID-19 severity between transplant recipients who died and those who did not. CONCLUSIONS: In lung transplant recipients, 3 doses of inactivated vaccine, 2 doses of mRNA vaccine, or the combined heterologous vaccine provided similar protection. Prevention of exposure is one of the most crucial steps.

Successful method in the treatment of complicated sternal dehiscence and mediastinitis: Sternal reconstruction with osteosynthesis system supported by vacuum-assisted closure.

Background: This study aims to evaluate the results of the method we used to treat sternal dehiscence and mediastinitis due to median sternotomy following open heart surgery. Methods: Between July 2014 and March 2019, a total of 13 patients (8 males, 5 females; mean age: 60.3±2.9 years; range, 33 to 74 years) who underwent sternal reconstruction procedure and developed sternal dehiscence and mediastinitis after cardiac surgery were retrospectively analyzed. Data of the patients were retrieved from the hospital records. Results: Before the procedure, reconstruction was performed by using the Robiscek technique in three cases and a conventional rewiring technique was used in one case. Except for one case, all the other cases had sternal purulent discharge (n=12, 92%). Except for four cases, all cases had at least two fracture lines in the sternum (n=9, 69%). One to 10 sessions of (median=4) vacuum-assisted closure therapy were used in cases before the procedure. At least two bars were placed between the opposite ribs for sternal fixation. Except for three cases, all of the cases were placed transdiaphragmatic harvested omentum in the sternal cavity. Seroma and local infection recurrence occurred in two cases (n=2, 15.3%) and incisional hernia in one case (n=1, 7.6%). Thoracic stabilization was successfully achieved in all cases. Conclusion: Thoracic stabilization can be successfully achieved in complicated sternal dehiscence cases with sternal reconstruction with STRATOS system supported by vacuum-assisted closure therapy, until the culture turns negative in the preoperative period and by the use of transdiaphragmatic omentum intraoperatively inside the sternal cavity.

Analysis of 40 patients who underwent tracheal resection due to benign complex tracheal stenosis.

BACKGROUND: Benign tracheal stenosis is a common complication in patients followed up in intensive care units. We aimed to analyze the etiology, diagnostic approaches, treatment methods for benign tracheal stenosis, and the predicting factors for complications after tracheal resection for benign stenosis. MATERIAL-METHOD: Forty patients who underwent tracheal resection reconstruction due to benign tracheal stenosis were analyzed retrospectively. Predictive factors for complications were determined by statistical analysis. RESULTS: There were 23 patients (57.5%) in the intubation group, 11 patients (27.5%) in the tracheostomy group, and 6 patients (15%) in the subsequent tracheostomy group. Preoperatively, rigid dilatation was applied to all patients between 2 and 6 sessions (median = 3). Tracheal resections were performed in all patients after rigid dilatations. The mean of the resected segment lengths is 32.1 ± 8.8 mm. There was a statistically significant difference between preoperative bronchoscopic measurements, preoperative tomography measurements, and intraoperative measurements of the stenosis segment (ꭓ2 (2) = 71,500; p < 0.001). The patients' mean follow-up period was 27.4 ± 21.7 months (3-84). Mortality due to tracheal surgery and major anastomotic complications were not observed. The minor anastomotic complication rate was 12.5%, the non-anastomotic complication rate was 17.5%. The effect of resection length and surgical experience were found to be statistically significant risk factors for anastomotic complications. CONCLUSIONS: Rigid dilatation does not provide significant palliation in complex stenosis. Bronchoscopic measurements give closer results than CT measurements in the preoperative estimation of resection length. The risk of anastomotic complications increases when the length of the resection increases and when the surgical experience is less.

Complex Post-intubation Tracheal Stenosis in Covid-19 Patients.

Management of tracheal complications due to endotracheal intubation in patients with coronavirus disease-2019 (COVID-19) is an important concern. This study aimed to present the results of patients who had undergone tracheal resection and reconstruction due to COVID-19-related complex post-intubation tracheal stenosis (PITS). We evaluated 15 patients who underwent tracheal resection and reconstruction due to complex PITS between March 2020 and April 2021 in a single center. Seven patients (46.6%) who underwent endotracheal intubation due to the COVID-19 constituted the COVID-19 group, and the remaining 8 patients (53.4%) constituted the non-COVID-19 group. We analyzed the patients' presenting symptoms, time to onset of symptoms, radiological and bronchoscopic features of stenosis, bronchoscopic intervention history, length of the resected tracheal segment, postoperative complications, length of hospital stay, and duration of follow-up. Six of the patients (40%) were female, and 9 (60%) were male. Mean age was 43.3 ± 20.5. We found no statistically significant difference between the COVID-19 and non-COVID-19 PITS groups in terms of presenting symptoms, time to onset of symptoms, stenosis location, stenosis severity, length of the stenotic segment, number of bronchoscopic dilatation sessions, dilatation time intervals, length of the resected tracheal segment, postoperative complications, and length of postoperative hospital stay. Endotracheal intubation duration was longer in the COVID-19 group than non-COVID-19 group (mean ± SD: 21.0 ± 4.04, 12.0 ± 1.15 days, respectively). Tracheal resection and reconstruction can be performed safely and successfully in COVID-19 patients with complex PITS. Comprehensive preoperative examination, appropriate selection of surgery technique, and close postoperative follow-up have favorable results.

Rapidly Progressive Pulmonary Kaposi Sarcoma After Bilateral Sequential Lung Transplant: A Case Report.

Skin cancers are among the rarely seen complications after solid-organ transplant. Kaposi sarcoma invasion to an allograft is an uncommon condition. In this study, we present a case of Kaposi sarcoma in a 58-year-old patient diagnosed at 8 months after bilateral sequential lung transplant due to chronic obstructive pulmonary disease. Kaposi sarcoma showed rapid progression despite immunosuppressive drug modification, resulting in lung involvement and respiratory failure. Rapid and complete improvement was achieved with rapid diagnosis and aggressive treatment that included combined chemotherapy after surgery. The patient presented with no complications from Kaposi sarcoma at month 26 after transplant.

Submucosal Injection of Mitomycin C in a Case of Vanishing Bronchus After Lung Transplant.

Segmental nonanastomotic stenosis, also known as vanishing bronchus intermedius syndrome (or simply, "vanishing bronchus"), is a rare complication that can occur after a lung transplant. It usually occurs in the first posttransplant year and often develops in the intermediate bronchus. Definitive diagnosis is established by bronchoscopy. The treatment management primarily includes bronchoscopic dilatation and stenting. In patients who do not benefit from these applications, lung resection or retransplant may be indicated. Our 58-year-old patient developed vanishing bronchus after lung transplant, and recurrence could not be prevented despite repeated bronchoscopic interventions. We applied submucosal mitomycin C injection to the bronchial wall of the stenotic segment and achieved significant benefit for reduction of recurrence. Our aim was to document the first reported case of a patient with vanishing bronchus who was treated with submucosal administration of mitomycin C, a strong fibroblast inhibitor, and to report the outcomes of submucosal mitomycin C administration with regard to recurrence.

Donor Lung Evaluation and Lung Transplantation in the COVID-19 Era.

OBJECTIVES: The COVID-19 pandemic, which emerged in late 2019, adversely affected all solid-organ transplant processes. Here we share the donor presentations evaluated in a lung transplant center during the COVID-19 pandemic,the measures taken at every stage of transplant management, and the outcomes of our transplants. MATERIALS AND METHODS: Data from 15 lung donors selected by the national coordination center presented to our lung transplant center as of March 11, 2020, when the first COVID-19 case was reported in Turkey, and data of 5 lung transplant cases in this period were retrospectively analyzed. All donors were examined in detail for COVID-19 disease. Procurement processes for accepted donors,transplant surgeries of recipients, and postoperative follow-up and care processes of recipients were carried out with the least number of personnel, but all with appropriate personal protective equipment. RESULTS: There were 15 donor organs procured by our center during a 9-month period coincident with the COVID-19 pandemic. The number of donor presentations to our center between the same dates in the previous year was 78. Five of the 15 donors were accepted, and of those accepted, 4 were male and 1 was female. There was no statistically significant difference between the accepted and rejected donors in terms of the ratio of Pao2 to fraction of inspired oxygen, age, duration of endotracheal intubation (days), and smoking (pack-years). All SARS-CoV-2 reverse transcription-polymerase chain reaction tests performed on bronchoalveolar lavage samples and nasopharyngeal, conjunctival, and rectal samples collected from the recipients during the follow-up period were negative. No pathological finding suggestive of COVID-19 infection was noted in the radiological evaluations. CONCLUSIONS: Lung transplant can be successfully managed during the COVID-19 pandemic period, despite the high risk of infection.The major obstacle to the continuity of lung transplantin this period was the limited number of donors.