Bacterial meningitis as a cause of death in lung transplant donors: Early outcomes in recipients.

BACKGROUND: Lung transplant remains an established treatment for end-stage lung disease, but limited organ availability remains a major barrier and contributor to waitlist mortality.1 Only 20% of available organs are considered suitable for lung transplantation (Am J Transplant, 16, 2016 and 141; Thorac Surg Clin, 25, 2015 and 35). Successful lung transplantation has been reported from donors infected with bacterial or fungal organisms, but there is a paucity of evidence regarding the use of donors with bacterial meningitis (Transplant Proc, 32, 2000 and 75; Transplantation, 64, 1997 and 365; Ann Thorac Surg, 86, 2008 and 1554). METHOD: The Cleveland Clinic lung transplant database was retrospectively reviewed for patients between January 1998 and December 2014. Post-transplantation outcomes collected included graft dysfunction, infectious complications, and survival. RESULTS: The recipients were identified as having lungs from donors with bacterial meningitis. All recipients remained free of infectious organisms responsible for bacterial meningitis related in the donor. Severe primary graft dysfunction (PGD) was not seen in these recipients. CONCLUSION: In our study, lung transplantation from increased risk donors with bacterial meningitis was not associated with an increased risk of early infectious complications in recipients. Donors with bacterial meningitis should be considered for lung donation and may expand the donor pool safely.

Teaching conventional transbronchial needle aspiration. A continuum.

Proponents of the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) propose that in this era of EBUS-TBNA, training for conventional transbronchial needle aspiration (C-TBNA) should be abandoned. The authors of this editorial provide the opposing view. C-TBNA has a short and a steep learning curve and adds to the diagnostic yield of flexible bronchoscopy in a cost-effective fashion. Considering its simplicity, availability, affordability, safety, and several unique indications, C-TBNA continues to contribute to the welfare of patients worldwide. It should remain as an integral part of pulmonary fellowship training programs.

The debate on CXR utilization and interpretation is only just beginning: a Pro/Con debate.

The CXR is the most commonly performed radiographic examination worldwide. Its ease of performance, apparent ease of interpretation and low radiation dose, alongside its great spatial resolution would suggest that it should be the first investigation performed in all patients presenting with thoracic disease. But, the advent of ever-improving multislice CT and increasing scanner availability has resulted in some patients being referred directly for scanning, bypassing the CXR. This has resulted in an inexorable rise in the number of scans performed, with an increase in patient radiation exposure and concerns among legislators and physicians that the number of scans needs to be regulated. A key role in the reduction of unnecessary scanning in patients with thoracic disease is the understanding of the place of the CXR, its ability to help in disease detection and monitoring, and its limitations.

Matching donor to recipient in lung transplantation: How much does size matter?

OBJECTIVE: The impact of size matching between donor and recipient is unclear in lung transplantation. Therefore, we determined the relation of donor lung size to 1) posttransplant survival and 2) pulmonary function as measured by forced expiratory volume in 1 second. METHODS: From 1990 to 2006, 469 adults underwent lung transplantation with lungs from donors aged 7 to 70 years. Donor and recipient total lung capacities were calculated using established formulae (predicted total lung capacity), and actual recipient lung size was measured in the pulmonary function laboratory. Disparity between donor and recipient lung size was expressed as a ratio of donor predicted total lung capacity to recipient predicted total lung capacity-the predicted total lung capacity ratio-and predicted donor total lung capacity to actual recipient total lung capacity-the actual total lung capacity ratio. Survival was measured by multiphase hazard methodology and repeated measures of National Health and Nutrition Examination Survey-normalized forced expiratory volume in 1 second analyzed by temporal decomposition. RESULTS: Predicted total lung capacity ratio and actual total lung capacity ratio ranged widely, from 0.55 to 1.59 and 0.52 to 4.20, respectively. Overall survival was unaffected by predicted total lung capacity ratio (P = .3) or actual total lung capacity ratio (P = .5). Patients with emphysema and an actual total lung capacity ratio of 0.67 or less or 1.03 or greater had higher predicted mortality (P = .01). During the first posttransplant year, forced expiratory volume in 1 second increased and then gradually declined. Predicted total lung capacity ratio and actual total lung capacity ratio had a small impact on forced expiratory volume in 1 second, primarily in the late phase after transplant in a disease-specific manner. CONCLUSION: Size matching between donor and recipient using predicted total lung capacity ratio and actual total lung capacity ratio is an effective technique. Wide discrepancies in lung sizing do not affect overall posttransplant survival or pulmonary function. Therefore, a greater degree of lung size mismatch can likely be accepted, thereby improving patients' odds of undergoing transplantation.

AERO self-expanding hybrid stent for airway stenosis.

Self-expanding metal, as well as silicon, stents have long been available for use in the airway. Metal stents can be placed using a flexible bronchoscope and are less readily removed. Silicone stents require rigid bronchoscopy and general anesthesia for placement but are removable. Both technologies are prone to complications on a long-term basis. A new self-expanding hybrid stent, the AERO stent (Alveolus, Inc., NC, USA), combines the best features of metal and silicone stents with a completely covered nitinol framework. The potential advantages of a self-expanding hybrid stent include placement using flexible bronchoscopy under conscious sedation, easy removability and a potential reduction in common long-term stent implant complications. This article profiles the AERO device and evaluates stent technology in general.