Inpatient Management of the Acutely Decompensating Lung Transplant Candidate.

Lung allocation in the US changed nearly 15 years ago from time accrued on the waiting list to disease severity and likelihood of posttransplant survival, represented by the lung allocation score (LAS). Notably, the risk of death within a year plays a stronger role on the score calculation than posttransplant survival. While this change was associated with the intended decrease in waitlist mortality (most recently reported at 14.6%), it was predictable that transplant teams would have to care for increasingly older and complex candidates and recipients. This urgency-based allocation also led centers to routinely consider transplanting patients with higher acuity, often hospitalized and, not infrequently, in the intensive care unit (ICU). According to the Scientific Registry for Transplant Recipients, from 2009 to 2019, the proportion of lung recipients hospitalized and those admitted to the ICU at the time of transplant increased from 18.9% to 26.8% and from 9.2% to 16.5%, respectively..

Surveillance Bronchoscopy in Lung Transplantation Recipients: A Single Center Experience Analysis.

Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy is the gold standard for the diagnosis of infection or acute cellular rejection in lung transplantation (LTx) recipients, but there is some controversy to perform it in asymptomatic patients. We conducted a retrospective analysis of medical reports of LTx recipients who survived in the first year after transplant during the period of August 2003 to February 2018 to evaluate the applicability of this procedure in the management of asymptomatic acute cellular rejection in our center. We assessed 1252 bronchoscopies of 247 patients during this period, and, facing the histopathological results, we defined our management that included conservative or intervention therapy. In our service the information obtained by surveillance bronchoscopy was sufficient to modify the management mainly in the first 2 surveillance bronchoscopies (second and sixth week post LTx). This effect seems to dilute after the second month, making its applicability more questionable.

A simple technique can reduce cardiopulmonary bypass use during lung transplantation.

Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure.

Pediatric lung transplantation: 10 years of experience.

Lung transplantation is a well-established treatment for advanced lung diseases. In children, the diseases that most commonly lead to the need for a transplantation are cystic fibrosis, pulmonary hypertension, and bronchiolitis. However, the number of pediatric lung transplantations being performed is low compared with the number of transplants performed in the adult age group. The objective of this study was to demonstrate our experience with pediatric lung transplants over a 10-year period in a program initially designed for adults.

A simple technique can reduce cardiopulmonary bypass use during lung transplantation

Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure.

Pediatric lung transplantation: 10 years of experience

Lung transplantation is a well-established treatment for advanced lung diseases. In children, the diseases that most commonly lead to the need for a transplantation are cystic fibrosis, pulmonary hypertension, and bronchiolitis. However, the number of pediatric lung transplantations being performed is low compared with the number of transplants performed in the adult age group. The objective of this study was to demonstrate our experience with pediatric lung transplants over a 10-year period in a program initially designed for adults.

A toracoscopia no diagnóstico e tratamento dos tumores mediastinais / Thoracoscopy in the diagnosis and treatment of mediastinal tumours

Sessenta pacientes foram submetidos a toracoscopia diagnóstica e terapêutica para abordagem de massas mediastinais, nos dois hospitais escola da Universidade de São Paulo (Hospital das Clinicas e Hospital Universitário), entre outubro de 1983 e outubro de 1997, analisados retrospectivamente com o obejetivo de se estabelecer a eficácia do procedimento e suas complicações. MÉTODOS: foram realizadas, entre 1983 e 1992, vinte e uma toracoscopias convencionais - Grupo I - (14 diagnósticas e 7 terapêuticas); e entre 1992 e 1997, trinta e nove videotoracoscopias; Grupo II - (16 diagnósticas e 23 terapêuticas). RESULTADOS: conversão para toracotomia foi necessária em 4 pacientes do Grupo I (pelas dimensões do tumor) e em 5 pacientes do Grupo II (3 pelas dimensões do tumor, 1 para suturar lesão iatrogênica do diafragma e 1 por lesão do gânglio estrelado). Houve 4 mortes (4/21) no Grupo I, nos primeiros 30 dias do pós-operatório, conseqüentes à síndorme da veia cava superior . No Grupo II não houve óbito. Os tipos histológiocs mais freqüentes foram: Timona e Schwanoma. CONCLUSÃO: a toracoscopia mostrou-se uma alternativa diagnóstica e terapêutica para os tumores mediastinais (au)