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.

A pulmonary mass extending into the left atrium through the pulmonary vein: a rare diagnosis with an unusual origin.

INTRODUCTION: Myxofibrosarcoma usually occurs in the extremities of middle-aged to older adults. Metastatic myxofibrosarcomas generally emerge in the lung. In this case report, we aim to present a case of primary pulmonary myxofibrosarcoma with tumor thrombus extending into the left atrium without pulmonary vein or atrial invasion. CASE PRESENTATION: A 55-year-old male who was being followed up due to a pulmonary nodule presented with a mass extending from the left lower lobe to the left atrium. No extrathoracic malignancy was detected in the pre-operative examination. The mass extending into the left atrium without invasion was excised with the lower lobe of the left lung. A post-operative histopathological examination revealed myxofibrosarcoma. CONCLUSION: Very few cases of cervical, thoracic wall, mediastinum and cardiac primary myxofibrosarcoma have been documented, and to the best of our knowledge, only one primary pulmonary myxofibrosarcoma case has previously been reported in the English literature. Here, we present a case of primary pulmonary myxofibrosarcoma that extended to the left atrium through the pulmonary vein. In such rare clinical presentations, intracardiac tumor resection should precede pulmonary resection due to the possibility of catastrophic tumor embolisms.

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.

Hydatid cysts of the lung: lesion size in relation to clinical presentation and therapeutic approach.

PURPOSES: The aim of this study was to assess the relationship between the pulmonary hydatid cyst size and the clinical presentation, surgical approach, and postoperative outcome. We review the problems encountered in treating large pulmonary hydatid cysts and highlight the risks associated with the rupture of the cyst and a delay of the surgical treatment. METHODS: The medical records of 169 patients surgically treated for lung hydatid cysts were reviewed. Patients were divided into two groups based on cyst size: group 1 (n = 128) with small (<10 cm) cysts and group 2 (n = 41) with giant (≥10 cm) cysts. Data related to symptoms, preoperative complications, surgical procedures performed and postoperative morbidity were analyzed and compared. RESULTS: In both groups, the most common symptom was chest pain, followed by dyspnea and cough, respectively. There were no differences between the two groups with respect to cyst-associated parenchymal or pleural complications before surgery (p = 0.80). In the large majority of cases, the surgical treatment was cystotomy, removal of the cystic membrane and capitonnage. Wedge resection was performed in nine patients in total (seven in group 1, two in group 2) and one patient in group 2 required a lobectomy. Decortication was required significantly more frequently in group 2 than in group 1 (p = 0.001). Sixteen patients in group 1 and 10 patients in group 2 developed postoperative complications (p = 0.19). There was no peri or postoperative mortality. There was no difference between the groups with respect to the duration of hospitalization (p = 0.17). Two patients with complicated hydatid cysts in group 1 had recurrent lesions during follow-up, whereas there was no recurrence in group 2. CONCLUSION: All pulmonary hydatid cysts should be surgically treated as soon as possible after their diagnosis in order to avoid complications. Most of these lesions, regardless of size, can be surgically managed with procedures that preserve the maximal lung parenchyma and yield excellent outcomes.

Analysis of thoracic trauma patients transferred to Türkiye's largest hospital after Kahramanmaras earthquake.

BACKGROUND: On February 6, 2023, an earthquake in Türkiye caused massive destruction. Over 50.000 people are known to have lost their lives, and over 100.000 are known to have been maimed. In our study, we aimed to analyze the treatment process of 267 METHODS: The demographic characteristics, the time spent under the rubble, the duration of transfer to the hospital, and the treatment process of patients admitted to our hospital have been evaluated. RESULTS: There are 125 (46.8%) men and 142 (53.2%) women in the study. The rate of thoracic trauma was 21.8%. Of all the patients, 15.7% (n=42) had pneumothorax, 18% (n=48) had contusion, 28.8% (n=77) had hemothorax, and 73% (n=195) had rib fractures. The mean time spent under the rubble was 17.6±26.5 h, the duration of transfer to the hospital was 138.5±113.6 h, and the hospitalization time was 93.8±152.3 h. The duration of hospitalization and transfer has been statistically longer for the patients who were under the rubble (85.4%) than for those who were not. (14.6%) (p=0.048). There is a statistically weak positive correlation between the time spent under the rubble and the time of transfer (p=0.048). CONCLUSION: The state, the time spent under the rubble, and the presence of hemothorax and pneumothorax should be effectively evaluated in earthquake-induced thoracic traumas. Considering these criteria in the transfer of patients to the centers operating at full capacity in a short time will minimize morbidity and mortality.

Treatment of persistent postpneumonectomy empyema by vacuum-assisted management: an analysis of nine patients.

BACKGROUND: Conventional treatment methods in postpneumonectomy empyemas (PPE) are associated with long stay in hospital, poor patient comfort, and high rate of postoperative mortality. Vacuum-assisted management (VAM) may be helpful in solving these problems. METHODS: VAM was performed on nine patients with PPE in our clinic between July 2010 and September 2011 to provide continuous drainage of empyema in the pouch and to improve empyema with obliteration of the pouch by accelerating tissue granulation. RESULTS: All nine patients were men (mean age: 54.5 years; range: 18-68 years). Empyema resolution and obliteration of the pouch were achieved with VAM in the cases with empyema without fistula (n = 7) after the pneumonectomy. In the patients with fistula (n = 2), VAM was performed after closure of the fistula. Mean duration of hospital stay was 36.5 (12-57) days. The treatment was successful in eight of nine patients (88.9%). Mean duration of follow-up in the successfully treated patients was 10.9 (3-17) months. CONCLUSION: Intrathoracic VAM was effective and safe in the treatment of PPE.

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.

An extremely rare tracheal tumor in coronavirus disease-2019 screening: Marginal zone lymphoma.

Mucosal-associated lymphoid tissue lymphoma is extremely rare due to the scarcity of lymphoid tissue in the trachea. To date, approximately 20 cases of tracheal mucosa-associated lymphoid tissue lymphoma have been reported. This case report presents a primary tracheal extranodal marginal zone lymphoma case detected incidentally during the coronavirus disease-2019 screening.

A rare lung tumor: Primary pulmonary synovial sarcoma.

ABSTRACT: Synovial sarcoma is one of the rare soft tissue sarcomas occurring in the periarticular region originating from synovia. Synovial sarcomas occur less frequently in the neck, tongue, larynx, mediastinum, heart, lung, abdominal wall, small intestine, mesentery, and retroperitoneum. Primary pulmonary synovial sarcoma is a poor pathological condition without extrapulmonary involvement. In these rapidly progressing tumors, making quick decisions is important and performing complete resection is the best treatment that contributes to survival. Herein, we present a case of primary pulmonary synovial sarcoma in which we were able to achieve long-term survival with the multimodal approach after complete resection.

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.

Can tumour budding change the future of pulmonary adenocarcinoma?

BACKGROUND: Pulmonary adenocarcinoma shows different prognosis even in the same pathological subtype and stage. In this study, it is aimed to investigate the relationship between tumour budding and known prognostic values and clinicopathological features in pulmonary adenocarcinoma. METHODS: In this study, there have been 77 patients diagnosed with primary pulmonary adenocarcinoma. In the evaluation process, the number of budding between 0 and 4 is accepted as low budding (Bd1), the number of budding between 5 and 9 is considered as medium budding (Bd2), and the number of budding above 10 is considered as high budding (Bd3). RESULTS: According to the findings of the study, it can be seen that there is a statistical difference between tumour budding and stromal fibrosis (p < 0.001). The presence of pleural invasion, lymph vascular invasion and perineural invasion in patients with Bd3 is found to be statistically higher than the patients with Bd1 (p = 0.048) (p = 0.041) (p = 0.029). CONCLUSIONS: Tumour budding has been associated with pleural invasion, lymph vascular invasion, perineural invasion, and stromal fibrosis. This study is the first to show the relationship between tumour budding and stromal fibrosis in pulmonary adenocarcinomas. The role of tumour budding in lung cancers remains to be clarified.

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.

Body Function and Structure, Activity, and Participation Limitations of Lung Transplant Recipients Within the Scope of the International Classification of Functioning, Disability, and Health.

OBJECTIVES: There is no study in the literature that specifically evaluates lung transplant recipients in the long-term under the framework of the International Classification of Functioning, Disability, and Health. The aim of this study was to evaluate the relationships between lung transplant recipient age, age at transplant, and comorbidity levels and the body structure and functions and the activity and participation levels of patients within the scope of the International Classification of Functioning, Disability, and Health. MATERIALS AND METHODS: We evaluated 27 lung transplant recipients according to the International Classification of Functioning, Disability, and Health items in domain b (body functions), domain s (body structures), and domain d (activities and participation). For domain b, sleep functions, psychosocial status, respiratory functions, and upper and lower extremity exercise capacity were evaluated. Posture was evaluated for the s domain. Balance, arm functional capacity, health-related quality of life, and physical activity were evaluated for domain d. RESULTS: As the age of lung transplant recipients and the age at transplant increase, their sleep quality and respiratory functions decreased, and postural impairment increased. There was a negative correlation between age at transplant and functional exercise capacity (P < .05). As the comorbidity level of the recipient increases, the upper and lower extremity exercise capacity, physical activity level, and quality of life declined. There was a moderately positive correlation between the level of comorbidity and balance disorder (P < .05). CONCLUSIONS: We found the International Classification of Functioning, Disability, and Health framework to be useful for the evaluation and for planning pulmonary rehabilitation for lung transplant recipients; it can bring a new perspective to physiotherapists specialized in cardiopulmonary rehabilitation.