Lung Transplantation in Patients With Systemic Scleroderma-Description of the First Consecutive Cases in Poland: Case Series Report and a Short Literature Review.

Pulmonary complications of systemic scleroderma (SSc), such as interstitial lung disease and pulmonary hypertension (PH), are responsible for up to 60% of deaths among patients. For many years, most centers considered SSc a contraindication to lung transplantation (LTx); however, recent publications show that appropriately selected SSc candidates for LTx give results comparable to patients with idiopathic PH or idiopathic pulmonary fibrosis. This paper presents the cases of a 60-year-old male patient (patient 1) and a 42-year-old female patient (patient 2) diagnosed with SSc in 2019 and 2013, respectively. In both patients, interstitial-fibrotic changes in the lungs leading to respiratory failure were confirmed by high-resolution computed tomography as well as pulmonary hypertension (WHO group 3), which was also diagnosed during right heart catheterization. In both cases, despite pharmacotherapy, pulmonary fibrosis progressed, leading to severe respiratory failure. The patients were referred for LTx qualification. LTx was possible to consider in patients due to the lack of significant changes in other internal organs. Double LTx was successfully performed in both patients (patient 1-July 19, 2022; patient 2-September 14, 2022). They were discharged from the hospital in good condition on the 22nd and 20th postoperative day, respectively. LTx is a last-chance therapy that saves lives among patients with extreme respiratory failure in the course of SSc. It prolongs and improves the quality of life. The selection of appropriate patients is key to the success of the procedure.

Lung Transplantation in Patients With Pulmonary Hypertension With Extracorporeal Membrane Oxygenation (ECMO) Support: 5-Year Experience.

Lung transplantation (LTx) is the only treatment option of patients (pts) with pulmo-nary hypertension (PH) when pharmacologic treatment is unsatisfactory. ECMO is essential during LTx in every patient with pulmonary arterial hypertension and in most patients with sec-ondary PH. This is a retrospective, single-center study comparing LTx outcomes in patients with and without PH covering a 5-year experience. In the years 2018-2023, 219 LTx were performed, of which 56 (25.6%) with ECMO support, among which PH was diagnosed in 34pts (60.7%) in WHO groups 1,3,4: 19pts, 14pts. and 1pt respectively. The veno-arterial type of ECMO was used in patients with PH as intraoperative support (n = 34; 100%). The early (30-day) and long-term survival (1 year) of patients with and without PH did not differ statistically: 91.2% (95% CI: 82.1%-100%) vs. 77.3% (95% CI: 82.1%-100%)(P = .48) and 53.0% (95% CI: 36.6%-76.7 %) vs. 41.3% (95%CI: 23.1-74.0) (P = .48) respectively and the median hospitalization time from ECMO weaning to dis-charge was also comparable: 31 days (Q1-Q3: 21-40; IQR 20) vs. 28 days (Q1-Q3: 24-42; IQR :18) (P = .99). Patients with or without PH undergoing LTx with ECMO have comparable survival and hospital stay outcomes despite being the most challenging of all lung diseases treated with lung transplantation.

First in Poland Simultaneous Liver-Lung Transplantation With Liver-First Approach for Recipient Due to Cystic Fibrosis: A Case Report.

Cystic fibrosis is an autosomal progressive disease affecting the lung, pancreas, and liver. Some patients develop end-stage respiratory and liver failure. For such patients, combined lung-liver transplantation remains the only therapeutic option. In this article we present the first simultaneous lung-liver transplantation in Poland, as well as in Central and Eastern Europe, with detailed clinical history, surgical aspects, and postoperative course.

Results of Lung Transplantations Among Cystic Fibrosis Patients: A Single-Center Study.

BACKGROUND: Lung transplantation remains the ultimate treatment for patients who have exhausted all other therapeutic options in the course of end-stage lung disease due to cystic fibrosis (CF). The aim of the study was to assess the results of lung transplantations performed via mini-thoracotomy in a single center. METHODS: This retrospective study assesses the survival and need for reoperation among 56 primary lung transplant recipients due to CF in a single center between 2018 and 2021. Intraoperative death was also assessed, yet it was established as an exclusion criterion for the post-transplant survival analysis. RESULTS: Only one patient died intraoperatively (1.79%). Reoperation at an early postoperative stage was required among 2 patients (3.58%), due to vascular complication for one and pulmonary leakage for the other. Mortality at 30 days was 0%. In-hospital mortality was low (3.58%). Survival at 1, 2, and 3 years was respectively 87%, 85%, and 75%. Mean forced expiratory volume in 1 second as a percentage of predicted value at discharge was approximately 60% and did not decrease after 12 and 24 months. Mean BMI at 12-month follow-up was 20.11 (range, 13-28.7) with 71.4% of patients being qualified as presenting within the normal range of 18.5 to 24.9. CONCLUSIONS: Double lung transplantation is a safe and feasible surgical option. Despite being more technically difficult and challenging than clamshell approach for surgeons, it is more beneficial for patients.

Effect of Bronchoscopic Interventions on Long-Term Lung Function Among Lung Transplant Recipients due to Cystic Fibrosis: A Single-Center Study.

BACKGROUND: Patients with end-stage lung disease owing to cystic fibrosis may require lung transplant, provided other therapeutic options were exhausted. During the posttransplant period, bronchial anastomoses' healing may sometimes be complicated and require bronchoscopic intervention (BI). The main aim of this study was to assess BI and its effect on long-term lung function among cystic fibrosis lung transplant recipients who have reached 2-year survival. METHODS: This retrospective study includes 22 patients with cystic fibrosis who underwent primary double lung transplant in a single center between 2018 and 2020 and have checked in for their 2-year follow-up visit. BI is defined as performing endoscopic bronchoplasty through balloon dilatation, cryoprobe, argon plasma, and/or laser treatment. RESULTS: All patients, who did not require BI during the first year, did not need bronchoplasty during the second posttransplant year as well. Results of forced expiratory volume in 1 second as percentage of predicted value and the 6-minute walk distance were similar at 2-year follow-up to those obtained at the end of 1 year for all patients. Significant time effects were observed for forced vital capacity (FVC) (weak effect), FVC as percentage of predicted value (weak effect), and forced expiratory volume in 1 second/FVC (moderate effect). CONCLUSIONS: Patients who had never had bronchoscopic intervention owing to airway stenosis, as well as those who did in the first posttransplant year, maintained forced expiratory volume in 1 second as percentage of predicted value at a comparable level at the second posttransplant year follow-up visit. The number of BIs significantly decreased among patients, who were undergoing such procedures during the first posttransplant year.

Assessment of the Serologic Status in Epstein-Barr Virus in Patients Qualified for Lung Transplantation in the First Half of 2021.

BACKGROUND: The aim of the study was to assessment serologic status of Epstein-Barr virus (EBV) infections in patients qualificated for lung transplantation in the first half of 2021. METHODS: The study included 72 patients qualified for lung transplantation from January to June 2021. The youngest patient was aged 14 years and the oldest was aged 65 years. The study group consisted of 36 women and 36 men. In the serum of patients, a multi-parameter, comprehensive diagnosis of EBV infections was performed using the IIFT BIOCHIP EBV sequence tests. This test is based on a combination of several substrates, enabling the simultaneous evaluation of antibodies against capsid antigens (anti-CA antibodies), both in the IgG and IgM class, early antigens (anti-EA), nuclear antigens and the assessment of the avidity of anti-CA antibodies. The analysis of all diagnostically significant antibodies specific for EBV infections, including the avidity of anti-CA antibodies, increases the diagnostic accuracy in differentiating active and past infection with EBV. RESULTS: In the studied group it was shown that 58 had past EBV infection (80.6%). Twelve patients (16.6%) have anti-EA antibodies, which indicate that the virus is reactivated. Only 2 patients (2.8%) had no antibodies to EBV. CONCLUSIONS: Comprehensive assessment of antibodies against various EBV antigens in patients qualified for lung transplantation is important in the management and further diagnosis of this infection, especially after transplantation, due to the risk of developing post-transplant lymphoproliferative disease.

Influence of Bronchoscopic Interventions on Graft Function of Double Lung Transplant Recipients due to Cystic Fibrosis.

BACKGROUND: Healing of bronchial anastomoses may sometimes be complicated and require bronchoscopic intervention (BI). The main aim of the study was to assess whether patients who require BI present comparable lung function after reaching 1-year posttransplant survival to those who did not require any BI by means of spirometry and 6-minute walk test (6MWT). METHODS: This retrospective study included an analysis of 44 primary double lung transplant recipients who underwent transplant for end-stage respiratory failure in the course of cystic fibrosis transplanted in a single center between 2018 and 2021. Bronchoscopic intervention is defined as performing endoscopic bronchoplasty through balloon dilatation, cryoprobe, argon plasma, and/or laser treatment. Group 1 (25 patients who required at least 1 BI) presented similar spirometry parameters at qualification as group 2 (no BI). RESULTS: Statistically significant differences between the groups for the following parameters were reported: forced expiratory volume in 1 second (FEV1), FEV1 (%), Tiffeneau-Pinelli index (FEV1/forced vital capacity percentage of predicted value), oxygen saturation after conclusion of 6MWT (%) and oxygen saturation before 6MWT (%). In each case, the mean for the BI group in the first year was lower. All patients in this group received an average amount of 6.8 ± 4.9 bronchoscopic procedures during the first year (minimum = 1; maximum = 18). Strong negative correlations were observed between the number of balloons in the first year and the FEV1 (%) and FEV1/forced vital capacity percentage of predicted value indicators after the first year. CONCLUSIONS: Lung transplant recipients who underwent transplant because of cystic fibrosis and required at least 1 BI during the first posttransplant year presented inferior spirometry and 6MWT results in comparison with those who did not require any.

Interventional and Surgical Treatments for Pulmonary Arterial Hypertension.

Despite significant advancements in pharmacological treatment, interventional and surgical options are still viable treatments for patients with pulmonary arterial hypertension (PAH), particularly idiopathic PAH. Herein, we review the interventional and surgical treatments for PAH. Atrial septostomy and the Potts shunt can be useful bridging tools for lung transplantation (Ltx), which remains the final surgical treatment among patients who are refractory to any other kind of therapy. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the ultimate bridging therapy for patients with severe PAH. More importantly, VA-ECMO plays a crucial role during Ltx and provides necessary left ventricular conditioning during the initial postoperative period. Pulmonary denervation may potentially be a new way to ensure better transplant-free survival among patients with the aforementioned disease. However, high-quality randomized controlled trials are needed. As established, obtaining the Eisenmenger physiology among patients with severe pulmonary hypertension by creating artificial defects is associated with improved survival. However, right-to-left shunting may be harmful after Ltx. Closure of the artificially created defects may carry some risk associated with cardiac surgery, especially among patients with Potts shunts. In conclusion, PAH requires an interdisciplinary approach using pharmacological, interventional, and surgical modalities.

First lung transplantation as a treatment of a patient supported with extracorporeal membrane oxygenation (ECMO) after COVID-19 in Poland.

A 44-year-old male with no history of underlying diseases was referred to academic hospital due to ARDS with confirmed SARSCoV-2 infection after 7 days of mechanical ventilation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was initiated as no improvement was noted in prone position. Mechanical ventilation was continued with TV of 3-4 mL/kg. A gradual decline of static lung compliance was observed from baseline 35 mL/cm H20 to 8 mL/cm H2O. The chest CT scan revealed extensive ground-glass areas with a significant amount of traction bronchiectasis after 3 weeks since admission. When the patient was negative for SARS-CoV-2 during the 4th week of ECMO, the decision to perform an emergency lung transplantation (LTx) was made based on the ongoing degradation of lung function and irreversible damage to lung structure. The patient was transferred to the transplant center where he was extubated, awaiting the transplant on passive oxygen therapy and ECMO. Double lung transplantation was performed on the day 30th of ECMO. Currently, the patient is self-reliant. He does not need oxygen therapy and continues physiotherapy. ECMO may be life-saving in severe cases of COVID-19 ARDS but some of these patients may require LTx, especially when weaning proves impossible. VV ECMO as a bridging method is more difficult but ultimately more beneficial due to insufficient number of donors, and consequently long waiting time in Poland.

Emphysema as a possible complication of infant respiratory distress syndrome leading to lung transplantation.

Infant respiratory distress syndrome (IRDS) develops among premature infants due to structural immaturity of the lungs and insufficient production of pulmonary surfactant. Nowadays, treatment takes place under conditions of intensive care and includes oxygen therapy, mechanical ventilation, exogenous supplementation of pulmonary surfactant and antenatal corticosteroid therapy. The treatment of IRDS, especially mechanical ventilation, may lead to complications which can contribute to developing a severe dysfunction of the respiratory system. Unavailability of pharmacological treatment of IRDS and development of pulmonary barotrauma due to mechanical ventilation in our patient led to the forming of severe pulmonary interstitial emphysema. In this case report, lung transplantation was performed as an only successful therapeutic option.

Number of Bronchoscopic Interventions in Lung Transplant Recipients Correlates with Respiratory Function Assessed by Pulmonary Function Tests.

BACKGROUND Lung transplant recipients may suffer from airway stenosis (AS). The aim of this study was to assess whether pulmonary function (as measured by spirometry and a 6-minute walk test [6MWT]) in patients with AS treated consistently with bronchoscopic interventions (BIs) was comparable to that in their AS-free counterparts at the 1-year follow-up visit. MATERIAL AND METHODS Fifty patients who underwent primary double-lung transplantation between January 2015 and March 2019 at a single center (23 who received BIs and 27 who did not) were enrolled in this retrospective study. Graft function was assessed with spirometry, based on forced expiratory volume (FEV1) and forced vital capacity (FVC), both measured in liters (L) and percentages (%), and the Tiffeneau-Pinelli index (FEV1/FVC), and a 6MWT and parameters such as oxygen saturation measured before and after the test. RESULTS Patients in need of BIs had significantly lower FEV1% compared with individuals who did not receive BIs during their first post-transplant year. Airway obstruction was present in 22% of patients who did not receive BIs and 65.23% of those who did receive the interventions. There were statistically significant, strong, negative correlations pertaining to the number of balloon BIs and 1-year FEV1% (rs=0.67) as well as the number of balloon BIs and 1-year FEV1/FVC (rs=0.72). A statistically significant, strong, negative correlation (rs=0.75) was found between the number of balloon bronchoplasty treatments and oxygen saturation after the 6WMT. CONCLUSIONS Despite receiving BIs, patients who experience bronchial stenosis may not obtain the expected ventilatory improvement at their 1-year follow-up visit. Their AS may recur or persist despite use of various procedures. Further study in that regard is required.

Assessment of Quality of Life Among Patients After Lung Transplantation: A Single-Center Study.

INTRODUCTION: Lung transplantation (LTx) is the only effective method of treatment to improve the health and quality of life (QoL) of patients with end-stage lung diseases. After LTx, medical examination accompanied by quality of life assessment should be performed on routine follow-up visits. The aim of the study was to assess the QoL of patients after LTx. MATERIAL AND METHODS: The study group consisted of 60 patients (29 women and 31 men); 20 patients received single lung transplantation (SLT), and 40 received double lung transplantation (DLT). To determine the patient's QoL, the General Health Questionnaire (GHQ), the World Health Organization Quality of Life Test-BREF (WHOQOL-BREF), and the Saint George Respiratory Questionnaire (SGRQ) were used. Spirometry and the 6-minute walk test were analyzed to examine efficiency of transplanted organs. RESULTS: In SGRQ there are differences between patients with cystic fibrosis and interstitial lung disease in symptom domain (20.28% vs 39.26%, P = .025) and total score (19.38% vs 32.47%, P = .028). As reported in the GHQ, men had worse overall results than women in sten scale (5.22 points vs 4.69 points). Patients after SLT achieved similar scores in every questionnaire. CONCLUSION: Studies assessing QoL should be an important addition to lung function tests and an integral part of control during postoperative follow-up visits. This study is one of the important contributions to understanding of how essential QoL is after LTx. The authors of this study realize that their work does not cover the whole issue, and further studies in this area are warranted.

Donor-related Risk Factors Associated With Increased Mortality After Lung Transplant.

BACKGROUND: Lung transplant is a surgical procedure for end-stage lung disease. Many factors related to lung donors influence the outcome of transplant. The main aim of this single-center study was to assess which donor-related and procedure-related factors would influence the 30-day or hospital mortality of the recipients. METHODS: This retrospective study group consisted of 110 donor-recipient pairs undergoing lung transplant between 2012 and 2017 (group 1) and 2018 and 2019 (group 2) in Silesian Center for Heart Diseases. Both groups of donor- and procedure-related factors were included in the analysis: oxygenation index at reporting of the donor, time donor spent in the intensive care unit (ICU), presence of cardiac arrest while being in the ICU, donor age, type of transplant, cumulative ischemia time, duration of the operation, and time of mechanical ventilation. RESULTS: The type of surgery was significantly associated with an increase in the chance of death within 30 days. Patients who underwent single lung transplant had a 20.217 times greater chance of dying within 30 days than patients after double lung transplant (interquartile range, 2.116-193.125). CONCLUSIONS: Single lung transplant increases the risk of death during the first 30 days after lung transplant, and using lungs from older donors may increase the rate of hospital mortality. Oxygenation index, sudden cardiac arrest of the donors, and donor time spent in the ICU do not impact the short-term mortality of lung graft recipients.

The Impact of Airway Complications on Survival Among Lung Transplant Recipients.

INTRODUCTION: Long-term outcomes of airway complications (AC) after lung transplantation are unknown. The incidence of AC varies from 1.6% to 32% with the related mortality rate of 2% to 4%. The management of most AC is based on endobronchial methods, including balloon bronchoplasty, endobronchial stent placement, and ablative techniques. The aim of the study was to assess the connection between airway complications treated by bronchial intervention (BI) and the survival of lung transplant recipients. MATERIALS AND METHODS: The single-center retrospective study reviewed the cases of 165 patients (63 women [38.18%], 103 men [61, 82%]; median age at referral for lung transplantations (LTx), 41 years [range, 15-68 years]). The cohort was stratified into 2 groups comprising those whose procedures were complicated by ACs and those without. The primary outcome measured was mortality, with survival endpoints calculated at 6 months. RESULTS: The comparison of the survival of recipients regarding underlying disease (cystic fibrosis [CF], chronic obstructive pulmonary disease [COPD], idiopathic pulmonary artery hypertension [IPAH], and others) with the use of the Kaplan-Meier estimator indicated that the only statistically significant (P = .0194) differences between patients who underwent BI and patients without BI performed were observed in CF patients (Fig 1). In any other diagnosis, the results were not statistically significant (P > .05). CONCLUSIONS: Bronchoscopic intervention because of airway complications after lung transplantation are often-used procedures, but they have no impact on the survival of patients with cystic fibrosis.

Single Lung Transplantation With Concomitant Cardiac Surgery in a Patient With Cystic Fibrosis: A Case Report.

BACKGROUND: Cystic fibrosis is a congenital, progressive disease affecting many organs. It frequently leads to severe respiratory failure, which can be treated by means of a double lung transplantation. Single lung transplantation is justified only in certain cases. CASE REPORT: This is a case report describing a 20-year-old female patient who became the recipient of a single lung transplant as a result of cystic fibrosis. The transplant was performed during cardiothoracic surgery, which included an intervention in the right atrium. At the age of 14, the patient underwent left pneumonectomy. In addition, the patient had a percutaneous endoscopic gastrostomy placed and a vascular port implanted. During preoperative evaluation, she presented with clinical symptoms of chronic respiratory failure. The patient was approved for lung transplantation at the age of 16. After 2 years on the national lung transplant waiting list, in 2018, the patient underwent right lung transplantation and removal of numerous thrombi in the right atrium during 1 procedure. This surgery was accomplished with the use of extracorporeal circulation, which is an extracorporeal membrane oxygenator combined with cardiopulmonary bypass. The patient was discharged 3 weeks after the procedure in good general condition. Presently, her pulmonary function is excellent and she presents with normal respiratory capacity. CONCLUSIONS: Patients with cystic fibrosis often require double lung transplantation. Under normal circumstances, performing only a single lung transplantation would be considered medical malpractice. However, in certain cases, a single lung transplant is a life-saving procedure.

Effectiveness of Lung Transplantation in Patients With Interstitial Lung Diseases.

BACKGROUND: Interstitial lung diseases (ILDs) are a heterogeneous group of more than 200 diseases manifested by progressive exercise dyspnea, radiological lung changes, and ventilation restrictive disorders. ILDs are the second most common indication for lung transplantation (LTx). Our study group consisted of 139 patients who qualified for LTx at the Silesian Center for Heart Diseases between 2004 and 2018. Of the 139, 92 patients died while on the waiting list, and 47 patients underwent LTx. Medical records including laboratory test results, spirometry, and the 6-minute walk test (6MWT) were analyzed to determine eligibility for LTx. We also assessed quality of life post-LTx. RESULTS: Patients who qualified for LTx showed decreased values of parameters measured by spirometry (43.69 ± 19.05% of forced expiratory volume in the first second [FEV1] and 43.07 ± 20.55% of forced vital capacity [FVC] and severe desaturation during the 6MWT (SpO2 = 88.78% before 6-minute walk test and 73.23% after the test). After LTx, longer distances were achieved in the 6MWT (235.47 ± 159.57 m during qualification vs 533.2 ± 34.15 m 12 months after LTx) and increased values of spirometry. On average, patients had stopped working 6 years prior to LTx. CONCLUSION: There is no effective medical treatment for patients with end-stage ILDs. Therefore, lung transplantation is a lifesaving procedure for patients that also extends patients' lives and improves their quality of life.

Model for End-Stage Liver Disease (MELD) Score Among Patients Qualified For Lung Transplantation With End-Stage Lung Diseases With Particular Consideration of Median Pulmonary Artery Pressure.

BACKGROUND: Model for End-Stage Liver Disease (MELD) score is used to assess the severity of chronic liver disease. It is implemented in transplantology in the process of qualification for urgent liver transplant. The aim of our study was to assess the liver function of patients qualified for lung transplant using MELD score, taking under consideration mean pulmonary artery pressure as an important risk factor of death. METHODS: The study group consisted of 123 patients qualified for lung transplant in Silesian Center for Heart Diseases between 2004 and 2017. Data relevant for MELD score calculations and medial pulmonary artery pressure were acquired from medical records. RESULTS: The average MELD score among patients qualified for lung transplant was 8.24 points, and mean pulmonary pressure (mPAP) was 35.02 mm Hg. Patients with idiopathic pulmonary artery hypertension acquired the highest MELD and highest mPAP results (13.1 points and 57.7 mm Hg, respectively). Patients with idiopathic pulmonary fibrosis presented higher mean MELD-Na score among those with pulmonary arterial hypertension than those without pulmonary arterial hypertension (36.59 mm Hg; 7.74 points vs 18 mm Hg; 6.5 points). There is strong positive correlation between MELD-Na and mPAP among patients who underwent lung transplant because of idiopathic pulmonary fibrosis. CONCLUSIONS: This is the first study in the worldwide literature assessing MELD-Na as a predictor of survival among patients qualified for lung transplant and those who already are recipients. Further studies regarding this issue are required as authors will explore this issue in the future.

Bronchoscopic Interventions as a Management of Airway Complications After Lung Transplant Including Assessment of Risk Factors With Special Consideration for Pretransplant Pulmonary Hypertension.

BACKGROUND: Lung transplant (LTx) is a procedure associated with risk of complications related to airway stenosis that can be treated with bronchoscopic interventions (BIs). The aim of the study was to assess the frequency and risk factors associated with increased need of bronchial interventions in the post-transplant period. METHODS: The retrospective study reviewed cases of 165 patients (63 women) who underwent LTx from April 2013 to June 2019. For dichotomous discrete variables (occurrence or lack of intervention) multivariate logistic regression analysis was performed to assess the aforementioned risk factors. RESULTS: BIs were required among 38.55% of lung recipients (n = 65). The number of interventions/patient/y decreases between years 1 and 2 (P < .001), 2 and 3 (P = .013), and 3 and 4 (P < .001); after the fourth year post LTx the differences are not statistically significant. Each 1 mm Hg above 25 mm Hg of mean pulmonary arterial pressure causes statistically significant elevation in the number of interventions by 0.7% in the first year after the procedure. The number of BIs per patient among lung recipients who received a transplant because of idiopathic pulmonary arterial hypertension was statistically significantly higher compared with patients with another underlying lung disease. CONCLUSIONS: Airway complications developed in the post-transplant period caused a significant number of patients to be in need of BI, especially balloon bronchoplasty. The highest number of interventions occurred within the first year after LTx, and BI decreases over time. Mean pulmonary arterial pressure measured during qualification may have the ability to predict whether the patient would require BI after LTx.

Suboptimal Donors Do Not Mean Worse Results: A Single-Center Study of Extending Donor Criteria for Lung Transplant.

BACKGROUND: Lung transplant remains the only viable treatment for most of the end-stage lung diseases. It is believed that extending criteria for donor lungs would increase the number of lung transplants. The aim of the study was to compare the graft function by means of oxygenation index among recipients who received the lungs from donors of extended criteria with those whose received lungs from donors who met the standard criteria. METHODS: This retrospective study analyzed 71 donors whose lungs where transplanted into 71 first-time double lung recipients of 2 groups: patients who received transplants before and after 2018. The objective was to assess whether there is a significant difference in quality of the donor pool after applying extended criteria. The second objective was to compare results of recipients with lungs from donors of oxygenation index > 400 mm Hg with those obtained among recipients with this parameter < 400 mm Hg. RESULTS: In the case of transplants performed in 2018 to 2019, oxygenation indices were significantly lower in donors but significantly higher in recipients on the first day than those observed in 2015 to 2017. The number of transplants increased from 9 per year to 22 per year. Irrespective of whether the donor had PaO2/fraction of inspired oxygen above or below 400 mm Hg, recipients showed similar oxygenation index values after transplant (mean oxygenation index, 462 vs 412 mm Hg, respectively). Short-term mortality did not differ either. CONCLUSIONS: Extended criteria of lungs suitability as a potential grafts not only increases the donor pool but also proves that suboptimal donors are not associated with producing inferior results of the recipients.

Single Lung Transplant vs Double Lung Transplant: A Single-Center Experience With Particular Consideration for Idiopathic Pulmonary Arterial Hypertension.

BACKGROUND: Lung transplant remains the only viable treatment for certain patients with end-stage lung diseases. Such patients can become either single or double lung recipients. The 2 procedures are associated with specific risks and benefits. The aim of the study was to assess the survival of patients after lung transplant in a single center. METHODS: The retrospective study consists of 128 lung transplant recipients. Patients underwent transplant between 2004 and 2017 because of following diseases: chronic obstructive pulmonary disease (28.2%), cystic fibrosis (26.5%), and primary pulmonary hypertension (12.3%), including idiopathic pulmonary arterial hypertension and interstitial lung diseases (33%). Patients with idiopathic pulmonary arterial hypertension were not treated with postoperative extracorporeal membrane oxygenation as left heart conditioning. RESULTS: Regardless of underlying disease, 75% of DLT recipients and 51% of SLT recipients reached 5-year survival (P = .0066). A total of 87% of lung transplant recipients with cystic fibrosis reached 1-year survival. Among lung recipients with primary pulmonary hypertension who underwent DLT and SLT, 5-year survival was reached by 84% and 51%, respectively (P = .025). Among patients with chronic obstructive pulmonary disease, 82% of DLT recipients and 62% of SLT recipients reached 1-year survival (P = .22). Patients who received transplants because of primary pulmonary hypertension presented the worst short-term survival among all SLT recipients. CONCLUSIONS: Patients with CF have the best overall survival among all lung transplant recipients. Double lung transplant provides statistically significantly better outcomes than single lung transplant. This observation is also present among recipients who underwent transplant because of primary pulmonary hypertension, as single lung transplant is not recommended among such patients in particular.