COVID-19 Among Lung Transplant Recipients: A Single Center Study.

BACKGROUND: When COVID-19 became a pandemic, it was difficult to predict how it would affect lung transplant recipients. The aim of this study was to assess the mortality, influence on graft function as well as attitude toward SARS-CoV-2 vaccination among lung transplant recipients from a single center. METHODS: We analyzed medical data pertaining to 124 recipients who received lung transplants between 2008-2021 from a single center and original questionnaire on the COVID-19 severity classification system and the patients' attitude toward SARS-CoV-2 vaccination. Graft function was assessed by spirometry and a 6-minute walk test (6MWT), at least at the first postCOVID-19 visit. RESULTS: Among 29 patients who were confirmed to have COVID-19, 6 people died during or directly after contracting this infectious disease. The significant decrease in spirometry and distance in a 6MWT has been rarely observed in COVID-19 survivors. After vaccination ( n=107 patients) , most patients reported mild symptoms with slight pain and discomfort at the injection site being the most common (51.4%). 67.7% of all studiedpatients did not have any fears regarding the vaccination. Others reported being significantly worried about its effects (19.4% agreed to receive a vaccination anyway and 12.9% refused to be vaccinated). CONCLUSIONS: COVID-19 may present significant mortality among lung transplant recipients. The short-term safety and outcomes of vaccinations among these patients seemed encouraging. We are aware of the small study group limitations and hope to research this issue further.

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.

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.

Various Aspects of Bacterial Infections in the Early Postoperative Stage Among Lung Transplant Recipients on Broad-Spectrum Antibiotics: A Single Center Study.

BACKGROUND: Life-long immunosuppression after lung transplantation increases the risk of bacterial infections, hence broad-spectrum antibiotics can be implemented after transplant. The aim of this study is to assess various aspects of bacterial infections in the early postoperative stage among lung transplant recipients on broad-spectrum antibiotics at a single center. METHODS: This retrospective study consists of 134 primary lung transplant recipients transplanted between 2014 and 2021 at a single center. Study analyzed the occurrence of de novo bacterium in bronchoalveolar lavage sampled 2 to3 weeks after lung transplantation, as well as survival and the occurrence of bacterial sepsis. Studied antibiotics include linezolid, meropenem, tobramycin, and cloxacillin. RESULTS: None of the patients from the broad-spectrum antibiotics developed bacterial sepsis within the first 30 postoperative days. In-hospital mortality due to bacterial sepsis among patients in the broad-spectrum group was 1.89%. The most common new pathogen in first couple of days after lung transplantation was Burkholderia multivorans (42%). After its occurrence, Ceftazidime was administered. It significantly reduced the occurrence of hospital-acquired B multivorans after 2 to 3 weeks post-transplant (χ2 = 8.01, P = .005). CONCLUSION: Broad-spectrum antibiotics seem to be an efficient approach against bacterial infections for lung transplant recipients in the early post-transplant period, as patients treated this way very rarely develop fatal bacterial infections in the studied period. Ceftazidime proved efficient for treatment for B multivorans among the studied group. Patients, who acquired new pathogen during post-transplant hospital stay presented comparable lung function at discharge in comparison to those who were not.

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.

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.

Colonoscopy: Preparation and Potential Complications.

Colonoscopy is a fairly common test that serves both diagnostic and therapeutic purposes. It has been considered the gold standard in colorectal cancer screening for several years. Due to the nature of the examination, various types of complications may occur. The purpose of this analysis is to describe the various complications related to the period of preparation for colonoscopy among hospitalized patients, including life-threatening ones, in order to know how to avoid complications while preparing for a colonoscopy. We analyzed the nursing and medical reports of 9962 patients who were prepared for colonoscopy between 2005 and 2016. The frequency of various side effects associated with intensive bowel cleansing prior to colonoscopy was assessed. In justified cases, additional medical data were collected from patients, their families or from other doctors providing advice to patients after complications. Out of 9962 patients prepared for colonoscopy, 180 procedures were discontinued due to complications and side effects, and in these cases no colonoscopy was performed. The most common complications were: vomiting; epistaxis; loss of consciousness with head injury; abdominal pain; acute diarrhea; symptoms of choking; heart rhythm disturbances; dyspnea; fractures of limbs and hands; acute coronary syndrome; hypotension; hypertension; cerebral ischemia; severe blood glucose fluctuations; increased muscle contraction and allergic reactions. In addition to the documentation of our own research, several works of other research groups were also analyzed. Currently, the literature does not provide data on the frequency and type of complications in the preparation period for colonoscopy. The advantage of our work is the awareness of the possibility of serious complications and postulating the necessary identification of threats. Individualization of the recommended procedures and increased supervision of patients undergoing bowel cleansing procedure, we hope, will reduce the occurrence of complications and side effects.

Antifungal Prophylaxis and Treatment Among Lung Transplant Recipients in Early Postoperative Stage: A Single-Center Study.

BACKGROUND: Lung transplantation remains the only feasible option for certain patients with end-stage lung disease. Lifelong immunosuppression increases the risk of infection, including fungal infections. The aim of this study was to assess the effect of antifungal prophylaxis and treatment among lung transplant recipients in the early postoperative stage. METHODS: This retrospective analysis included 127 patients who underwent lung transplantation between 2014 and 2021 in the lung transplant ward, 65.35% of whom were males. The most common indication for lung transplantation was cystic fibrosis (n = 59; 46.46%). All of the patients were receiving inhaled amphotericin B. Within this group there were patients who also were treated with intravenous caspofungin, intravenous/oral voriconazole, or both. RESULTS: The difference in the efficacy against Candida spp. between caspofungin and voriconazole in the early post-transplant period was not statistically significant (χ2 = 0.5, P = .477). Moreover, the difference in the efficacy against Candida spp. between itraconazole and voriconazole during the first post-transplant year was not statistically significant (χ2 = 0.46, P = .496). CONCLUSION: Caspofungin and voriconazole are proper and relatively efficient antifungal prophylaxis and treatment options after lung transplantation. There was no significant difference between voriconazole and caspofungin as antifungal agents used in the early post-transplant stage. There was no significant difference between voriconazole and itraconazole as antifungal agents used during the first post-transplant year. Further research on this issue is required.

Lung Transplant as a Treatment for Patients with End-Stage Respiratory Failure Due to COVID-19.

BACKGROUND: COVID-19 may lead to development of irreversible acute respiratory distress syndrome. Some patients sustain severe respiratory failure after infection subsides. They may require lung transplant as a last resort treatment. The aim of the study is to assess the effect and feasibility of lung transplant as a treatment for patients with severe irreversible respiratory failure due to COVID-19. METHODS: This retrospective study pertains to analysis of 119 patients in critical condition who were referred to Lung Transplant Ward (Zabrze, Poland). between July 2020 and June 2021 after developing respiratory failure requiring extracorporeal membrane oxygenation, invasive ventilation, or both, as well as a few patients on high-flow oxygen therapy. Inclusion criteria for referral were confirmed lack of viral disease and exhaustion of other therapeutic options. RESULTS: Of the referred patients, 21.84% were disqualified from such treatment owing to existing contraindications. Among the suitable patients, 75.8% died without transplant. Among all patients who were qualified for lung transplant, only 9 patients became double lung transplant recipients. Intraoperative mortality for this procedure was 33%. Four patients were discharged after the procedure and are currently self-reliant with full respiratory capacity. CONCLUSIONS: Patients with severe irreversible respiratory failure after COVID-19 present significantly high mortality without lung transplant. This procedure may present satisfactory results but must be performed in a timely fashion owing to critical condition and scarcity of lung donors, only aggravated around the time of peak infection waves.

The Quality of Sex Life Among Patients Before and After Lung Transplantation: A Single-Center Study.

BACKGROUND: Lung transplantation (LTx) is the only effective method of treatment for patients with end-stage lung diseases; LTx prolongs and increases the quality of life (QoL). An important aspect of QoL that changes in the course of severe diseases is the quality of sex life. This aspect is yet to be discussed in relationship to LTx. We aim to compare patients' quality of sex life at the qualification process with patients' who underwent LTx. METHODS: The studied group consisted of 100 patients (24 women before and 16 after LTx, 39 men before and 21 after LTX) who were admitted to the lung transplantology department for qualification or to control the function after LTx. To assess the patients' quality of sex life, we used The Changes in Sexual Functioning Questionnaire (CSFQ) and World Health Organization (WHO) QoL-BREF. To assess lung function, patients underwent a 6-Minute-Walk-Test (6MWT). RESULTS: Patients after LTx obtained higher results-compared to patients qualified for LTx-in the WHO QoL-BREF in every domain (somatic, psychological, social, and environment). Men after LTx got more points in every domain and better total score (53 ± 5.62 vs 44.23 ± 10.28 point; P < .05) in CSFQ. Women before and after LTx obtained comparable results in CSFQ. Results of 6-Minute-Walk-Test were better among patients after LTx than in qualified patients (523.62 ± 95.71 vs 333.14 ± 145.38 and 524.12 ± 56.17 vs 317.20 ± 141.6, respectively for men and women). CONCLUSIONS: Patients after LTx show better pulmonary function and quality of sex life than qualified. Preliminary results encourage us to conduct research on a larger group.

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.

Novel Hybrid Treatment for Pulmonary Arterial Hypertension with or without Eisenmenger Syndrome: Double Lung Transplantation with Simultaneous Endovascular or Classic Surgical Closure of the Patent Ductus Arteriosus (PDA).

Patients with pulmonary arterial hypertension (PAH) become candidates for lung or lung and heart transplantation when the maximum specific therapy is no longer effective. The most difficult challenge is choosing one of the above options in the event of symptoms of right ventricular failure. Here, we present two female patients with PAH: (1) a 21-year-old patient with Eisenmenger syndrome, caused by a congenital defect-patent ductus arteriosus (PDA); and (2) a 39-year-old patient with idiopathic PAH and coexistent PDA. Their common denominator is PDA and the hybrid surgery performed: double lung transplantation with simultaneous PDA closure. The operation was performed after pharmacological bridging (conditioning) to transplantation that lasted for 33 and 70 days, respectively. In both cases, PDA closure effectiveness was 100%. Both patients survived the operation (100%); however, patient no. 1 died on the 2nd postoperative day due to multi-organ failure; while patient no. 2 was discharged home in full health. The authors did not find a similar description of the operation in the available literature and PubMed database. Hence, we propose this new treatment method for its effectiveness and applicability proven in our practice.

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.

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.

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.

Extracorporeal Membrane Oxygenation as a Postoperative Left Ventricle Conditioning Tool After Lung Transplantation in Patients With Primary Pulmonary Artery Hypertension: First Polish Experience.

BACKGROUND: Primary pulmonary hypertension can lead to hypertrophy of the right ventricle and ultimately to its insufficiency. Lung transplantation remains the only viable treatment for patients with certain forms of this disease. Usage of extracorporeal membrane oxygenation in veno-arterial form (VA-ECMO) after transplantation is both protective for left ventricle (enables adaptation to increased blood flow) and right ventricle (provides time to return to appropriate dimensions and in some cases to correct tricuspid regurgitaion). CASE PRESENTATION: The case study describes 4 patients who were treated with VA-ECMO as a perioperative support. Three patients were diagnosed with idiopathic form of precapillary primary pulmonary hypertension. A fourth patient was a 49-year old woman diagnosed with hypoplastic pulmonary veins representing the postcapillary form of pulmonary hypertension. In all of the cases, VA-ECMO was introduced during the surgery (femoral vein/internal jugular vein and femoral artery) and maintained for several days after the transplantation. Regular echocardiographic and biochemical assessment in postoperative course revealed that cardiac function improved during and after such treatment among all patients. They were successfully weaned off ECMO and finally surgically explanted without any local complications. One patient was treated with awake ECMO protocol. CONCLUSIONS: VA-ECMO was proved to be a useful tool during the transplantation and postoperative period. It helps to restore proper cardiac function, as well as prevent adverse effects of aforementioned pathologic changes of a heart.

Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: First Polish Experience.

BACKGROUND: Lung transplantation remains the only viable option for patients with end-stage lung diseases. However, due to an insufficient number of lung donors, many potential candidates die without undergoing the procedure. In the cases of some patients, bridges to transplantation can be implemented. One such method is extracorporeal membrane oxygenation (ECMO), which, depending on the type, has the ability to replace patients' circulatory and respiratory function. CASE PRESENTATION: This case study describes 4 cases of patients, who were successfully bridged to lung transplantation. The first patient developed respiratory failure as a result of acute pulmonary embolisms. His respiratory function was insufficient and he had ECMO implanted for 84 days until he was transplanted. Another patient presented respiratory failure due to massive bleeding, which occurred during transbronchial lung biopsy. Such event led to extensive exacerbation, which resulted in using ECMO as a bridge to recovery at first, but later a bridge to lung transplantation. The patient became a lung graft recipient after 14 days on ECMO. The third patient was a woman who developed severe respiratory failure during the course of the progression of her underlying disease. She was treated with ECMO for 14 days as well, and she also underwent lung transplantation. The fourth patient was qualified for retransplantation. She was bridged to retransplantation via veno-venous ECMO. CONCLUSION: ECMO can be used a bridge to lung transplantation for suitable patients even for a long period of time, given that it is maintained in accordance with the guidelines.

Retrospective cohort study of patients qualified for lung transplantation due to idiopathic pulmonary fibrosis - single-centre experience.

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disease. Pharmacological treatment can only slow its progression. However, lung transplantation (LTx) is the only treatment for patients with its end-stage form. This study analysed the long-term results of the qualification process of patients with IPF recruited for LTx in a single centre. MATERIAL AND METHODS: Retrospective analysis of 84 patients (56 patients who died while on the waiting list and 28 patients who underwent LTx) with end-stage IPF who were qualified for LTx between 2006 and 2017 at the Silesian Centre for Heart Diseases (Zabrze, Poland). RESULTS: Cox proportional hazard analysis showed that the only parameter was 6-minute walk test (6MWT) distance, which statistically significantly impacted the probability of receiving a graft (parameter assessment, 0.00523; p = 0.006; 95% confidence interval (CI): 0.0015-0.009; hazard ratio (HR) = 1.005) as well as that of death while on the waiting list (parameter assessment, -0.0054; p = 0.003; 95% CI: -0.009- (-0.0017); HR = 0.995). Patients with a 253-350-m 6MWT distance had 3 times greater risk of dying while on the waiting list than those who walked more than 350 m. Other factors, such as height, sex, and blood group, also influenced the outcome. CONCLUSIONS: The 6-minute walk test distance is an independent predictor of mortality on the lung transplant waiting list. Blood type and height also play a significant role in becoming a lung recipient.

Secondary Pulmonary Hypertension Among Patients Qualified for Lung Transplantation: Single-Center Study.

INTRODUCTION: Secondary pulmonary hypertension (PH) is a serious complication of end-stage lung disease and is associated with unfavorable prognosis. The aim of the study was to evaluate the incidence and severity of secondary PH among patients qualified for lung transplantation (LTx). MATERIAL AND METHODS: The study population consisted of 143 patients qualified for LTx between 2004 and 2019. Analyzed medical records included results collected during the qualification process (eg, echocardiography parameters, right heart catherization [RHC]). There were 37.8% (n = 54) of patients with chronic obstructive pulmonary disease (COPD), 58.7% (n = 84) of patients with interstitial lung diseases (ILDs), and 3.5% (n = 5) of patients with combined pulmonary fibrosis and emphysema (CPFE). The inclusion criteria were ILDs, COPD or CPFE diagnosis, and the presence of RHC data preformed during qualification for LTx. The exclusion criteria were lack of RHC results and diagnosis of idiopathic pulmonary artery hypertension, pulmonary artery hypertension associated with connective tissue disease, cystic fibrosis, or bronchiectasis. RESULTS: PH was detected among 60.1% (n = 86) of patients qualified for LTx. The prevalence of PH was 39% (n = 18) vs 76.19% (n = 64) in the COPD vs ILDs groups, respectively. Both ILDs and COPD patients presented with similar mean artery pulmonary pressure (36.3 ± 9.61 vs 34.78 ± 11.47 mm Hg; not statistically significant). Severe PH was more frequent in the ILDs group than in the COPD group (60.94% vs 38.89%). CONCLUSIONS: PH is commonly diagnosed in patients with chronic lung diseases qualified for LTx and more often observed among patients qualified because of ILDs. It is important to assess the pulmonary pressure because of frequent occurrence of PH among patients referred for LTx.