ABSTRACT
Background: The number of patients waiting for a lung transplant worldwide greatly exceeds the number of available donors. Ex vivo lung perfusion is a useful tool that allows marginal donor lungs to be evaluated and reconditioned for a successful lung transplantation. Aim: To describe the first Chilean and Latin American experience in ex vivo lung perfusion for marginal donor lungs before transplantation. Material and Methods: Descriptive analysis of all ex vivo lung perfusion conducted for marginal donor lungs at a private clinic, from April 2019 to October 2020. High risk donor lungs and rejected lungs from other transplantation centers were included. The "Toronto Protocol" was used for ex vivo lung perfusion. Donor lung characteristics and recipient outcomes were studied. Results: During the study period, five ex vivo lung perfusions were performed. All lungs were reconditioned and transplanted. No complications were associated. There were no primary graft dysfunctions and only one chronic allograft dysfunction. There was no mortality during the first year. The median arterial oxygen partial pressure/fractional inspired oxygen ratio increased from 266 mm Hg in the donor lung to 419 after 3 hours of ex vivo lung perfusion (p = 0.043). Conclusions: ex vivo lung perfusion is a safe and useful tool that allows marginal donor lungs to be reconditioned and successfully transplanted.
Subject(s)
Humans , Lung Transplantation , Perfusion , Tissue Donors , Extracorporeal Circulation , Latin America , Lung/surgeryABSTRACT
Pulmonary fibrosis is a progressive disease. Lung transplantation is the only effective therapy for a group of patients. Objective: To evaluate results of lung transplantation for fibrosis up to a 5 years of follow up. Methodology: Retrospective review of clinical records of patients subjected to lung transplantation from Clínica Las Condes and Instituto Nacional del Tórax. Demographic data, type of transplant, baseline and post-transplant spirometry and 6 min walked distance (6MWT), early and late complications and long-term survival rate were analyzed. Results: From 1999 to 2015, 87patients with pulmonary fibrosis were transplanted, in average they were 56 years old, 56% were male, 89% of patients were subjected to a single lung transplant. 16% of them were in urgency. Baseline and 1-3-5 years for FVC were 49-73-83 and 78% of the reference values and for 6MWT were 280, 485, 531 and 468 meters respectively. Predominant complications < 1 year post-transplant were: acute rejection (30%) and infections (42%). Complications after 1 year of transplantation were chronic graft dysfunction (DCI) 57% and neoplasms (15%). The main causes of mortality > 1 year were DCI (45%) and neoplasms (11%). The estimated 1, 3 and 5 year survival rate were 84, 71 and 58% respectively. Conclusions: Lung transplantation in patients with pulmonary fibrosis improves their quality of life and survival rate. The monopulmonary technique is efficient in the long term. Acute rejection and infection were the most common early complications and chronic graft dysfunction was the prevalent long-term complication.
La Fibrosis pulmonar es una enfermedad progresiva y el trasplante constituye una terapia efectiva para un grupo de pacientes. Objetivo: Evaluar los resultados del trasplante pulmonar por fibrosis a 5 años. Metodología: Revisión retrospectiva de registros de trasplante pulmonar de la Clínica Las Condes e Instituto Nacional del Tórax. Se analizaron datos demográficos, tipo de trasplante, función pulmonar basal y post-trasplante, complicaciones precoces y tardías y sobrevida a largo plazo. Resultados: Entre 1999 y 2015 ambos centros trasplantaron 87 pacientes por fibrosis pulmonar. Los pacientes tenían una edad promedio de 56 años, 56% eran del género masculino y se usó técnica monopulmonar en 89% de ellos. 16% de los pacientes se encontraba en urgencia. Los resultados espirométricos y la distancia caminada en 6 minutos (T6 min) basales y a 1- 3 - 5 años fueron: CVF 49- 73- 83 y 78% del valor teórico y T6 min fue 280, 485, 531 y 468 metros respectivamente. Complicaciones predominantes < 1 año fueron: rechazo agudo 30% e infecciones 42%. Complicaciones > 1 año fueron: disfunción crónica del injerto (DCI) 57% y neoplasias 15%. Las causas de mortalidad > 1 año fueron DCI 45% y neoplasias 11%. La sobrevida estimada a uno, 3 y 5 años fue 84, 71 y 58% respectivamente. Conclusiones: El trasplante en pacientes con fibrosis pulmonar, permite mejorar la calidad de vida y sobrevida de estos pacientes. La técnica monopulmonar es eficiente a largo plazo. En las complicaciones precoces predominaron el rechazo agudo e infecciones y a largo plazo la DCI.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Lung Transplantation/methods , Idiopathic Pulmonary Fibrosis/surgery , Idiopathic Pulmonary Fibrosis/complications , Spirometry , Exercise , Extracorporeal Membrane Oxygenation , Survival Analysis , Pulmonary Diffusing Capacity , Retrospective Studies , Walking , Statistical Data , Idiopathic Pulmonary Fibrosis/diagnosisABSTRACT
Introduction: In Chile, a number of criteria were agreed for emergency lung transplant in order to diminish the mortality of candidates on the waiting list. Objective: To evaluate short-term transplant patients in emergency condition. Methodology: Retrospective analysis of medical records of patients transplanted from January 2012 to July 2015 demographic data, underlying disease, early and late complication, and survival were recorded. Results: Out of 59 patients transplanted in this period, 18 have been in an emergency condition. Underlying pulmonary disease were: pulmonary fibrosis (n = 13), cystic fibrosis (n = 3), bronchiolitis obliterans (1) and pulmonary hypertension (1). The dependence of non invasive mechanical ventilation was the main reason for urgency (89%). 76% required intraoperative extracorporeal support. Survival at 30 days and 12 months was 94 and 87% respectively. Conclusion: Lung transplantation is a short-term emergency procedure with good results in survival.
Introducción: En Chile se consensuaron una serie de criterios de urgencia para trasplante pulmonar con el fin de disminuir la mortalidad de candidatos en lista de espera. Objetivo: Evaluar la sobrevida a corto plazo de pacientes trasplantados en condición de urgencia. Metodología: Análisis retrospectivo de fichas clínicas de pacientes trasplantados desde enero del 2012 a julio del 2015. Se consignó datos demográficos, enfermedad de base, complicaciones precoces, tardías y sobrevida. Resultados: De 59 pacientes trasplantados en este período 18 han sido en urgencia. Enfermedad de base: fibrosis pulmonar (n = 13), fibrosis quística (n = 3), bronquiolitis obliterante (n = 1), hipertensión pulmonar (n = 1). La dependencia de ventilación mecánica no invasiva fue el principal motivo de urgencia (89%). Un 76% requirió de soporte extracorpóreo intraoperatorio. La sobrevida a 30 días y a 12 meses fue de 94 y 87% respectivamente. Conclusión: El trasplante pulmonar en situación de urgencia es un procedimiento con buenos resultados en sobrevida a corto plazo.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Lung Transplantation/mortality , Emergencies , Extracorporeal Membrane Oxygenation , Chile , Data Interpretation, Statistical , Survival Rate , Statistical Data , Health Records, Personal , Length of StayABSTRACT
Objective: To assess the outcome of patients ≤ 20 years old subjected to lung transplantation. Methods: Retrospective analysis of clinical records of these patients at Las Condes Clinic, Santiago de Chile. Results: Ten patients ≤ 20 years old have been subjected to lung transplantation. The median age at transplant was 15.8 years. The main indication was cystic fibrosis in 8 patients. The average baseline FEV1 was 31.3% of its reference value with progressive improvement in FEV1 being 76,3% after one year and 75,3% after two years, Early complications were infections and rejection. Late complications were mainly viral infections. Six patients achieved to continue their studies. Survival rate at 30 days, 1 and 5 years were 80, 70 and 58% respectively. Conclusion: Lung transplantation is an alternative for children and adolescents with advanced lung disease with acceptable results in long-term survival.
Sólo 45 centros en el mundo desarrollan trasplantes pulmonares en niños. Objetivo: Evaluar resultados de pacientes ≤ 20 años trasplantados de pulmón. Material y Método: Análisis retrospectivo de registros clínicos de estos pacientes en Clínica Las Condes. Resultados: Diez pacientes ≤ 20 años han sido trasplantados de pulmón. La edad promedio al momento del trasplante fue de 15,8 años. La principal indicación fue fibrosis quística en 8 pacientes. El VEF1 promedio basal fue de 31,3% de su valor de referencia, con mejoría progresiva post-trasplante siendo al año de 76,7% y a los 2 años de 75%, Complicaciones precoces fueron infecciones y rechazo. Complicaciones tardías fueron principalmente infecciones de origen viral. Seis pacientes lograron continuar sus estudios. La sobrevida a 30 días, al 1er y 5º año fue de 80%,70% y 58% respectivamente. Conclusión: El trasplante pulmonar es una alternativa válida en niños y adolescentes con enfermedades pulmonares avanzadas con resultados aceptables a largo plazo.