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1.
Article in Chinese | WPRIM | ID: wpr-882777

ABSTRACT

Lung transplantation is an effective treatment for end-stage lung diseases in children, and the only treatment for children with no response to conservative treatment.However, merely a few transplantation centers at home and abroad can provide lung transplantation at present.The mortality of pediatric lung transplantation is high, and it is difficult for donor matching.Besides, it has many complications.In recent years, pediatric lung transplantation has made positive progress and technological breakthroughs in many aspects.In this article, research progress in pediatric lung transplantation at home and abroad was reviewed.

2.
Organ Transplantation ; (6): 421-2021.
Article in Chinese | WPRIM | ID: wpr-881526

ABSTRACT

Objective To evaluate the effect of interleukin (IL)-10 on donor lung function after ex vivo lung perfusion (EVLP) in rats of cardiac death. Methods Twenty adult male SD rats were randomly divided into the simple perfusion group (group A, n=10) and modified perfusion group (group B, n=10). Perfusate A (without IL-10) and perfusate B (supplemented with IL-10) was administered in group A and B, respectively. The EVLP rat models of cardiac death were established. The appearance of donor lung, dry-to-wet (D/W) ratio of donor lung tissues, the function and metabolism of donor lung, the morphology of donor lung and the levels of inflammatory markers of donor lung were statistically compared between two groups. Results After perfusion, evident edema of the whole donor lung, poor compliance and a large amount of edema fluid discharged from the airway were observed in group A, whereas no obvious edema and good compliance were found in group B. Compared with group A, the D/W ratio of lung tissues in group B was higher (P < 0.05). In both groups, the pulmonary vein partial pressure of oxygen reached the peak at 2 h after perfusion, which did not significantly differ between two groups (P > 0.05). In group B, the pulmonary artery pressure was increased at a lower speed and significantly lower after perfusion, and the lactic acid level in the perfusate was significantly lower than those in group A (all P < 0.05). In group A, the alveolar structure was largely destroyed and the cells was rare. In group B, the alveolar structure was relatively normal without evident cell edema. The incidence of cell apoptosis of donor lung was high in group A, whereas no obvious cell apoptosis of donor lung was noted in group B. After perfusion for 4 h, the levels of monocyte chemoattractant protein (MCP)-1 and IL-6 were significantly increased, the IL-4 levels were remarkably decreased (all P < 0.05), but the levels of tumor necrosis factor (TNF)-α, IL-1α and inducible nitric oxide synthase (iNOS) did not significantly change in both groups (all P > 0.05). Conclusions IL-10 may improve the function of donor lung after EVLP in rat of cardiac death by reducing cell apoptosis.

3.
Article in English | WPRIM | ID: wpr-880374

ABSTRACT

BACKGROUND@#The prevalence of obesity and overweight in childhood has increased dramatically over the past decades globally. Thus, the risk factors of overweight and obesity in children and adolescents must be studied.@*OBJECTIVES@#This study aimed to reveal the prevalence of childhood obesity and examine the relationship between socioeconomic status (SES) and z-body mass index (z-BMI) via parental obesity and dietary intake using path analysis.@*METHODS@#Stratified cluster sampling was used to select 17,007 participants aged 6-12 years on two avenues per region in urban, suburban, and rural areas. Path analysis was conducted to examine the mediators between SES and z-BMI.@*RESULTS@#The prevalence rates of overweight and obesity were 13.36% and 8.60%, respectively, and were positively correlated with the father's education level, family income, a birth weight > 3000g, a parental obesity history, vegetable intake and red meat intake (all P < 0.05). Four mediators (paternal obesity history, red meat intake, vegetable intake, and nutritional supplements) were observed, and the four path analyses were significant (all P < 0.05). The adjusted total effects on z-BMI were significant for income (β@*CONCLUSIONS@#The prevalence of overweight/obesity in children was notable, and the relationship between SES and z-BMI was mediated by paternal obesity history and dietary intake.


Subject(s)
Child , China/epidemiology , Cross-Sectional Studies , Eating/psychology , Fathers/statistics & numerical data , Female , Humans , Male , Obesity/psychology , Pediatric Obesity/etiology , Social Class
4.
Organ Transplantation ; (6): 203-2021.
Article in Chinese | WPRIM | ID: wpr-873731

ABSTRACT

Objective To investigate the risk factors and clinical prognosis of massive blood transfusion during the perioperative period of lung transplantation. Methods Clinical data of 159 lung transplant recipients were retrospectively analyzed. According to the quantity of perioperative blood transfusion, all recipients were divided into the massive blood transfusion group (n=20) and non-massive blood transfusion group (n=139). Clinical data of lung transplant recipients were statistically compared between two groups. The risk factors of perioperative massive blood transfusion were analyzed. Clinical prognosis of the recipients was observed in two groups. Results There were significant differences between the two groups in preoperative data including anticoagulant therapy, hemoglobin content, the number of recipents with idiopathic pulmonary fibrosis or idiopathic pulmonary hypertension, and intraoperative data including the number of recipents presenting with intraoperative intrathoracic adhesion, operation time and the amount of various component transfusion(all P < 0.05). Preoperative anticoagulant therapy, incidence of intraoperative intrathoracic adhesion, use of extracorporeal membrane oxygenation (ECMO) and long operation time were the risk factors of massive blood transfusion during perioperative period of lung transplantation(all P < 0.05). In the massive blood transfusion group, the incidence rate of grade Ⅲ primary graft dysfunction (PGD) and the fatality within postoperative 30 d were higher compared with those in the non-massive blood transfusion group(both P < 0.01). Low body mass index (BMI) and massive blood transfusion were the risk factors for death within postoperative 30 d(P=0.048、P < 0.001). The 1-year survival rate in the massive blood transfusion group was lower than that in the non-massive blood transfusion group(P < 0.001). Conclusions Preoperative anticoagulant therapy, incidence of intraoperative intrathoracic adhesion, use of ECMO and long operation time are the risk factors for massive blood transfusion during perioperative period of lung transplantation. Massive blood transfusion negatively affects the clinical prognosis of the recipients undergoing lung transplantation.

5.
Organ Transplantation ; (6): 184-2021.
Article in Chinese | WPRIM | ID: wpr-873728

ABSTRACT

Objective To improve the surgical efficacy of bilateral lung transplantation for pediatric cystic fibrosis through multi-disciplinary team (MDT). Methods Preoperative MDT consultation was delivered for a 10-year-old child with rare end-stage cystic fibrosis to establish the corresponding treatment protocol. Results The child was diagnosed with cystic fibrosis for 5 years, and the indication of lung transplantation were confirmed. After preoperative MDT consultation, bilateral lung transplantation via a Clam-shell incision was determined. The vital signs were maintained stable during operation. Postoperatively, ventilator-assisted ventilation, anti-infection, immunosuppression, acid suppression, prevention of stress ulceration and other treatments were delivered. Individualized treatment was given according to the characteristics of the child, and the child was well recovered. Conclusions Through preoperative MDT consultation, lung transplantation yields satisfactory surgical efficacy in treating pediatric cystic fibrosis and lowers the risk of postoperative complications, which deserves application in clinical practice.

6.
Article in Chinese | WPRIM | ID: wpr-871728

ABSTRACT

Objective:To compare the function and action pathways of VEGFA, VEGFB and VEGFC in VEGF family of mouse eye.Methods:Using the BXD mouse gene data in Genenetwork database as template to compare and study the similarities and differences of VEGFA, VEGFB and VEGFC molecular pathways or potential functions in the whole genome expression spectrum of BXD recombinant mouse inbred line population, with multiple analytical methods and statistical strategies were used, such as gene expression level, target genes comparison, top genes comparison associated to target genes, expression Quantitative Trait Loci (eQTL).Results:Matrix comparison showed strong positive correlation between two probes of VEGFC ( r=0.732, P<0.01), weak correlation between VEGFA 1420909 and VEGFC 1440739, VEGFA 1451959 and VEGFC 1451803, VEGFC 1419417959 and VEGFC 1439766, VEGFC 1451803 and VEGFC 1439766 ( P<0.05); there was no correlation between VEGFA 1420909 and four other genes except VEGFC 1440739, VEGFA 1451959 and VEGFC 1440739, VEGFB 1451803 and VEGFA 1420909/VEGFC 1419417/VEGFC 1440739 ( P >0.05). In the comparative analysis of the relevant Top 50 genes of each VEGF gene, most of the genes in BXD mouse were not significantly correlated with VEGFA, VEGFB and VEGFC except for the weak association of individual related genes. The results of eQTL analysis showed that each probe of VEGF gene was located on different chromosomes. Conclusions:The expression levels and positive and negative correlations of VEGFA, VEGFB and VEGFC were different in the VEGF family of mouse eye, suggesting that these genes may play their role through different pathways.

7.
Article in Chinese | WPRIM | ID: wpr-870601

ABSTRACT

Objective:To explore the effects of secondary pulmonary hypertension(SPH)on postoperative outcomes of lung transplant recipients.Methods:The hospitalization data of 309 patients undergoing lung transplant were retrospectively analyzed. They were divided into normal(mPAP <25 mmHg, 56 cases), low-pressure(mPAP: 25 mmHg≤mPAP<40 mmHg, 155 cases)and high pressure(mPAP ≥40 mmHg, 98 cases)groups.Three groups were compared with regards to general profiles, intraoperative status, postoperative outcomes and survival rates. The postoperative patient survival was plotted by Kaplan-Meier curve and log-rank test performed. Multivariate Cox regression analysis was performed to explore the influencing factors of postoperative survival.Results:The distribution of chronic lung disease(CLD)was statistically different among 3 groups( χ2=30.837, P=0.001). Patients with different levels of pulmonary artery pressure had different decisions supported intraoperatively by extracorporeal membrane oxygenation(ECMO)( χ2=28.205, P<0.001). The 2-year survival rates of normal, low-pressure and high-pressure groups were 58.9 %, 63.9 % and 69.4 % respectively and there were no statistically significant differences( P=0.513). Multivariate Cox regression analysis indicated that preoperative cardiac function was an independent risk factor for postoperative survival. The postoperative risk of mortality was 1.796 (95 %CI: 1.078~2.991)folds higher in patients with cardiac function grade Ⅲ/Ⅳ than those with grade Ⅰ/Ⅱ( P=0.025). Conclusions:Preoperative classification of cardiac function should be emphasized in SPH patients. And surgery during early decompensated stage of cardiac function may confer a better survival.

8.
Article in Chinese | WPRIM | ID: wpr-870594

ABSTRACT

Objective:To explore the effect of extracorporeal membrane oxygenation(ECMO)upon supporting during bilateral lung transplantation(BLTx)for different primary diseases.Methods:The clinical data were retrospectively analyzed for 139 cases of BLTx. They were divided into non-ECMO and ECMO groups. The perieoperative data of two groups were compared.Results:BLTx was successfully performed in all patients. As compared with non-ECMO group, operative duration, mechanical ventilation time and ICU hospitalization time were significantly prolonged in ECMO group ( P<0.05). The proportion of patients with different primary diseases was statistically significant different between two groups( P<0.01). ECMO was employed intraoperatively in all IPAH patients. ECMO proportion was higher in idiopathic pulmonary fibrosis(IPF)patients but lower in chronic obstructive pulmonary disease(COPD)counterparts( P<0.05). In terms of cardiac function indices, patients with a moderate/severe elevation of pulmonary artery pressure had a higher proportion of ECMO application( P<0.001). Moreover, the application of ECMO increased with the severity of tricuspid regurgitation and pulmonary vascular resistance(PVR)( P<0.05). Conclusions:It is both safe and feasible to apply ECMO during BLTx. ECMO support should be given a high priority during BLTx for patients with primary diseases such as IPAH, IPF, severe preoperative PAP, tricuspid regurgitation and PVR. On the other hand, ECMO is sufficient as an alternative choice for COPD patients.

9.
Article in Chinese | WPRIM | ID: wpr-870575

ABSTRACT

Objective:To explore the safety and nosocomial infection control measures of COVID-19 patients of end-stage respiratory failure after lung transplantation.Methods:Lung transplantation was performed for a COVID-19 patient with end-stage respiratory failure after a negative conversion of 2019-nCoV nucleic acid. Before operation, all medical staff received simulated training on nosocomial infection. The procedures were performed in an operation room with a negative pressure environment. The three-grade preventive strategy was implemented and wearing positive pressure protective mask of electric air supply required. During operation, the patient was managed according to the in-hospital protection process. The environment and medical instruments were disinfected after operation.Results:The operation was completed successfully. The 2019-nCoV nucleic acid test was negative for many times after operation. Participants were placed in medical isolation for 14 days after surgery. During the period, nucleic acid test was negative twice.Conclusions:As an exploratory treatment, lung transplantation is a safe option for end-stage respiratory failure in COVID-19 in operation room with a negative pressure environment and implementations of three-grade preventive strategy.

10.
Article in Chinese | WPRIM | ID: wpr-870572

ABSTRACT

Objective:To explore the indications of lung transplantation for pulmonary interstitial fibrosis after COVID-19 and the precautionary measures of medical staff during operation.Methods:Lung transplantation was performed for three cases of COVID-19 from February 15, 2020 to March 1, 2020. The course of disease, mechanical ventilation time, extra-corporeal membrane oxygenation (ECMO) support time, surgical procedures and precautionary measures of medical staff during operation were analyzed.Results:The course of disease were 40, 7, 39 days, the mechanical ventilation time 26, 22, 27 days and ECMO support time 16, 7, 14 days. The postoperative pathological results of three cases indicated pulmonary interstitial fibrosis. One case died on the operative day and two survivors stayed currently in rehabilitation. Thirty-nine medical staff had no symptoms of COVID-19 after 14 days of isolation. The detection of 2019-nCoV nucleic acid was negative for both nasal and pharyngeal swabs.Conclusions:Patients with pulmonary interstitial fibrosis after COVID-19 show no improvement after 1 month of active medical treatment. And the 1-month risk of mortality was over 50% and nucleic acid of 2019-nCoV turned negative. Lung transplantation might be considered. The triple precautionary levels of medical staff during operation prevented the transmission of 2019-nCoV.

11.
Article in Chinese | WPRIM | ID: wpr-870558

ABSTRACT

Objective:To assess the potentials for lung donation among 128 donors (deceased citizens) in 2017 from Beijing.Methods:Gender, age, blood type, duration of ventilation, oxygenation index (PaO 2/FiO 2), chest film and bronchoscopy were analyzed. Results:A total of 5135 deceased Chinese citizens were available for donation in 2017. The rate of donation per million population (PMP) was 3.71. And 463 donors from Beijing were recorded in 2017 and the rate of PMP was 21.05. In 2017, 299 lung transplantations were performed with an average rate of donor lung utility at 5.82%. Among 128 cases assessed for potential lung donors in Beijing, 72 were successfully procured with a percentage of lung utilization of 15.55%. There were 110 males (85.94%) and 18 females (14.06%) with an average age of (39.61±10.67) years. Mechanical ventilation duration was (7.59±2.93) days. The oxygenation rate (PaO 2/FiO 2) was (397.38±105.01) mmHg, (450±67.79) mmHg in procurement group and (338.89±116.15) mmHg in non-procurement group ( P=0.020). The median level of procalcitonin (PCT) was 0.195 ng/ml in procurement group versus 0.349 ng/ml in giving-up group ( P=0.042). Conclusions:Oxygenation rate and PCT level are the independent risk factors for reaching a procurement decision of donor lung. The actual PMP and lung procurement rate in Beijing were both higher than average domestic level (15.55% vs. 5.82%, P=0.000) because of excellent cooperation between Organ Procurement Organization (OPO) and lung transplantation centers. The evaluation of donor lungs and lung maintenance protocols from Beijing should be popularized nationwide.

12.
Article in Chinese | WPRIM | ID: wpr-867103

ABSTRACT

Objective:To investigate the effect and mechanisms of lateral ventricular injection of interferon-alpha (IFN-α) on electrophysiological activity in central nervous system.Methods:Twenty male Kunming mice were selected and subjected to auditory cortical electrode implantation and lateral ventricle intubation under general anesthesia. After one week of recovery, all mice were randomly divided into IFN-α group ( n=10) and normal saline group ( n=10). IFN-α and saline were administered by lateral ventricle injection for 7 consecutive days, and the auditory steady-state response(ASSR) in auditory cortex were recorded. Then the brain tissue was perfused, and the changes of microglia and astrocytes in the hippocampus were observed by immunohistochemical staining. Results:There was no significant difference in the average intensity of ASSR between the saline group and the IFN-α group((3.22±0.87)dB vs (3.49±0.56)dB; t=0.84, P=0.41) before administration.After administration, the average intensity of ASSR in IFN-α group was significantly lower than that before administration ((3.22±0.87)dB vs (1.59±0.44)dB, t=5.27, P<0.01), while the ASSR in saline group did not change before and after administration((3.49±0.56)dB, (3.46±0.61)dB; t=0.12, P=0.90). Immunohistochemistry revealed that the number of astrocytes and microglia in hippocampal CA1, CA3, and DG regions in the IFN-α group was higher than that of the saline group. Obvious morphological changes were also observed in the astrocytes and microglia. Conclusion:IFN-α can induce the activation of glial cells in the hippocampus and lead to the abnormal electrophysiological activity in the cortex. ASSR can reflect IFN-α induced brain dysfunction, which may be a potential indicator for early diagnosis.

13.
Organ Transplantation ; (6): 497-2020.
Article in Chinese | WPRIM | ID: wpr-822931

ABSTRACT

This paper summarized the operation cooperation and management of the first case of bilateral lung transplantation assisted with double extracorporeal membrane oxygenation (ECMO) for the recipient with novel coronavirus pneumonia (COVID-19) in the world. The bilateral lung transplantation assisted by double ECMO had been accomplished successfully on a recipient with COVID-19, who was supported by ventilator and ECMO, with other organs function basically normal. The operation took 405 min and went smoothly. The cooperation and management guidelines of the operation room included the following: setting up of COVID-19 emergency operation group quickly; listing and preparing of the detailed operation supplies; transferring of the whole system of lung transplantation operating room in Wuxi People's Hospital to the Wuxi No.5 People's Hospital (isolation hospital); reconstruction of a negative pressure operating room for lung transplantation; formulating and strictly implementing the guidelines and management process for the operation of patient with COVID-19.

14.
Organ Transplantation ; (6): 737-2020.
Article in Chinese | WPRIM | ID: wpr-829689

ABSTRACT

In recent years, organ donation has developed rapidly in China, whereas the brain death criteria have not been confirmed by relevant legislation. In this article, the current legislation situation of brain death criteria at home and abroad, and the current criteria for determination of death for organ donation after citizen's death in China were introduced. The necessity of legislation of brain death criteria in China was discussed from the perspective of organ donation, and suggestions on the form and content of brain death criteria legislation were proposed based on the actual national conditions, aiming to provide reference for the legislation of brain death criteria.

15.
Organ Transplantation ; (6): 204-2020.
Article in Chinese | WPRIM | ID: wpr-817595

ABSTRACT

As one of the four major types of organ transplantation, lung transplantation has been developed rapidly in recent years. With the establishment of Quality Management and Control Center for Lung Transplantation of National Health Commission, the formulation of Technical Management Specifications for Lung Transplantation and Standard Procedures and Technical Specifications for Lung Transplantation and the implementation of a series of measures, the quality and quantity of lung transplantation have been steadily increased in China. It will provide a guarantee for further promoting the development of lung transplantation in China by the establishment and improvement of scientific quality control parameters for clinical application of lung transplantation technology, the formulation of standard procedures and technical specifications for lung transplantation, strengthening the management of standardized training bases for lung transplantation, building up a multidisciplinary lung transplantation team and constructing a complete lung transplantation database.

16.
Article in Chinese | WPRIM | ID: wpr-735043

ABSTRACT

Objective To investigate the selection of recipients,operative technique, and perioperative management of lung transplantation.Methods From June 2013 to September 2016, 9 patients with pulmonary lymphangioleiomyomatosis un-derwent lung transplantation at Affiliated Wuxi People's Hospital.There were 9 females aged from 23 to 52 years.Chest en-hancement of CT in 9 patients prior to transplantation suggests multiple different sized thin-walled cystic shadows in whole lung. Nine patients received bilateral sequence lung transplantation ( BSLT) .The pathological findings after the operation indicated that cells of the abnormal proliferation of smooth muscle diffused around the bronchi , vessels and lymphatics , and widened the alveolar septum, which was consistent with the pathological changes in the patients with PLAM .We analyzed the differences of oxygenation index, forcedexpiratory volume at 1 sec(FEV1), and DLCO% pred.Using paired t test to compare these indica-tors, P<0.05 was considered statistically significant.Results The oxygenation index was increased from(210 ±55) mmHg (1 mmHg=0.133 kPa) to(400 ±80)mmHg after treatment, the difference was statistically significant(P<0.05).The FEV1 was increased from(1.0 ±0.2)L to(2.8 ±0.4)L, and the difference was statistically significant(P<0.05).The DLCO%pred was increased from(27.5 ±2.5)% to(75.0 ±10.0)%, and the difference was statistically significant(P<0.05).Fi-nally, 8 patients were discharged from the hospital, and the pulmonary function was good.1 patients died of infection and acute rejection on the 13 day after operation.Conclusion Lung transplantation is effective in the treatment of chronic thromboem-bolic pulmonary hypertension , and long-term survival requires further investigations .Lung transplantation is the only effective means for the treatment of end-stage pulmonary lymphangioleiomyomatosis .Bilateral sequence lung transplantation is the first choice.

17.
Article in Chinese | WPRIM | ID: wpr-734820

ABSTRACT

Objective To study the influence of pulmonary artery hypertension (PAH) on survival of patients with advanced chronic obstructive pulmonary disease (COPD) on the waiting list of lung transplantation.Methods The characteristics of 143 patients with COPD receiving lung transplantation evaluation from January 2014 to August 2016 were queried.Mild PAH was defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg and severe ≥35 mrnHg by right heart catheterization measurements.The incidence of PAH was studied,and the patients were divided to different groups to determine the effect of PAH on survival prior to transplantation on the basis of different definitions of PAH.Kaplan Meier method was used to draw survival curves,and a log-rank test was used to analyze the effect of PAH on survival of COPD patients on the waiting list of pulmonary transplantation.Univariate and multivariate Cox proportional hazard models were performed to test the relationship between each main covariate and the hazard of mortality.The waiting time was tracked from wait list entry date until death or censoring,and the censoring issues were as follows:receiving lung transplantation,removing from the waiting list without transplant,and still wating for donor until the last follow-up day (2016-08-30).Results Of 143 COPD patients,there were 119 males and 24 males,with mean age of 61.73 years old;46 patients received lung transplantation,and the remaining 97 not;50 had mPAP ≥25 mmHg and 21 had mPAP ≥35 mmHg.A total of 23 cases (22.88%) died on the waiting list.Thirty-eight patients were removed from the list prior to transplantation,and 36 were still on the waiting list.Kaplan-Meier survival function showed suvival of patients with mild PAH or severe PAH was significantly shorter than that of patients without PAH (P<0.001).Using Cox proportional hazards models,univariate analysis revealed significant differences in survival for mild PAH (HR =2.147,95%CI 1.429-3.157,P< 0.001) and severe PAH (HR =3.458,95 % CI 2.518-4.859,P<0.001).Multivariate Cox models identified significant risk for death for mild PAH (HR=2.518,95%CI 1.728-3.364,P<0.001) and severePAH HR=4.027,95% CI 3.257-4.703,P<0.001).Conclusion The incidence of PAH among COPD patients waiting for lung transplantation was high.PAH is associated with significantly increased risk of death among COPD patients waiting for lung transplantation.

18.
Chinese Critical Care Medicine ; (12): 1167-1172, 2018.
Article in Chinese | WPRIM | ID: wpr-733977

ABSTRACT

Objective To evaluate the effect of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LTx). Methods The clinical data of 18 patients with end-stage lung diseases was retrospectively reviewed, using ECMO as a bridge to LTx in intensive care unit of Affiliated Wuxi People's Hospital from January 2015 to December 2017. Clinical parameters were obtained from these patients, including gender, age, primary disease, preoperative lactate level, preoperative leukocyte, operation modality (unilateral or bilateral), type of ECMO, ECMO support time as a bridge to LTx, ECMO support time after operation, total usage time of ECMO, ECMO associated complications, primary graft dysfunction (PGD), successful ECMO weaning, and survival. Patients were divided according to type of ECMO, whether successfully weaned from ECMO or not, and primary disease. Clinical data was compared, and the Kaplan-Meier survival of 180-day was studied. Results ① The overall situation showed: A total of 18 patients were enrolled, with 14 males and 4 females, age ranged from 23 to 78 years old. Primary disease included 6 cases of idiopathic pulmonary fibrosis (IPF), 3 cases of idiopathic pulmonary hypertension (IPAH), 8 cases of interstitial pneumonia and 1 case of silicosis. Nine patients received venous-venous (V-V) ECMO and 9 venous-artery (V-A) ECMO as a bridge to LTx; 15 patients received LTx successfully, and failed in 3 cases. The average bridge time was 57.5 (14.5, 116.5) hours. ECMO associated complications included 6 cases with bleeding, 12 cases with renal failure, 2 cases with thrombosis, 2 cases with oxygenator leak, and 1 case with leg ischemia. There were 7 unilateral (5 right lungs and 2 left lungs) and 8 bilateral LTx. Three patients died before LTx due to septic shock. Nine patients died after LTx, 4 for septic shock, 4 for multiple organ failure, and 1 for sudden cardiac death. Six patients survived after LTx.② Group comparison showed: There was no significant difference in gender, age, ECMO support time as a bridge to LTx, ECMO support time after operation, total ECMO usage time, incidence of PGD, successful weaning from ECMO, and 180-day survival rate between V-V ECMO group (n = 7) and V-A ECMO group (n = 8). There was no significant difference in gender, age, primary disease, type of ECMO, operation modality, preoperative leukocyte count between groups of successfully weaned from ECMO (n = 11) and the failed (n = 7). Lower level of preoperative lactate acid (mmol/L: 3.01±1.51 vs. 8.27±3.49, t = -3.770, P = 0.006), shorter total ECMO usage time (hours: 72.82±40.53 vs. 210.71±107.10, t = -3.907, P = 0.001), and higher 180-day survival rate (54.5% vs. 0, P = 0.038) were found in the group of successfully weaned from ECMO, when compared with the failed group. ③ Kaplan-Meier survival analysis showed that postoperative survival rates of 7, 30, 60, and 180 days of 18 patients was 72.2%, 38.9%, 33.3%, and 33.3%, respectively. Among them, the postoperative survival rates of 7, 30, 60, and 180 days in the group of successfully weaned from ECMO (n = 11) were higher than those in group of failed (n = 7; 81.8% vs. 57.1%, 63.6 % vs. 0, 54.5% vs. 0, 54.5% vs. 0, respectively; log-rank test: χ2= 8.009, P = 0.005). The postoperative survival rates of 7, 30, 60, and 180 days in IPF group (n = 6) were lower than those in non-IPF group (n = 12; 33.3% vs. 83.3%, 16.7% vs. 50.0%, 16.7% vs. 41.7%, 16.7% vs. 41.7%; log-rank test: χ2= 4.161, P = 0.041). Conclusions The use of ECMO as a bridge to LTx may provide survival benefit for LTx recipients. V-V ECMO provides effective life support for patients without severe heart failure, and V-A ECMO for patients with unstable hemodynamics. Preoperative lactate level and total ECMO duration time were closely related to ECMO weaning rate. Primary diagnosis may affect prognosis.

19.
Organ Transplantation ; (6): 268-271,277, 2018.
Article in Chinese | WPRIM | ID: wpr-731738

ABSTRACT

Objective To evaluate the clinical efficacy of bilateral lung transplantation combined with Nuss operation on the treatment of bronchiolitis obliterans syndrome (BOS) complicated with pectus excavatum after hematopoietic stem cell transplantation. Methods On March 24, 2015, one patient presenting with BOS complicated with pectus excavatum after hematopoietic stem cell transplantation underwent extracorporeal membrane oxygenation (ECMO)-assisted bilateral lung transplantation in the Department of Thoracic Surgery and Lung Transplantation Center of Wuxi People's Hospital affiliated to Nanjing Medical University. Simutaneously, Nuss operation was successfully performed to treat pectus excavatum. After anti-inflammation and anti-fungal treatment, a triple immunosuppressive regimen consisting of tacrolimus + mycophenolate mofetil + adrenocortical hormone was implemented. Results The patient was properly recovered and discharged on 25 d after operation. The Nuss steel plate was removed from the chest at postoperative 2 years. The thoracic deformity was corrected. The patient received long-term postoperative follow-up. Until submission date, the patient survived for more than 3 years. The lung function was well restored and the quality of life was satisfactory. Conclusions Bilateral lung transplantation combined with Nuss operation is an effective approach in the treatment of end-stage BOS complicated thoracic deformity.

20.
Organ Transplantation ; (6): 58-62, 2018.
Article in Chinese | WPRIM | ID: wpr-731712

ABSTRACT

Objective To explore the efficacy and prognosis of lung transplantation from donors combined with pulmonary contusion on the treatment of patients with end-stage lung disease. Methods Clinical data of 73 cases of donors and recipients were collected. The donors and recipients were divided into contusion group (23 cases of donors and recipients, with a maximum diameter of contusion in 5-8 cm) and standard group (50 cases of donors and recipients) depending on combined pulmonary contusion. Major clinical indicators [postoperative oxygenation index, duration of mechanical ventilation and chest tube drainage and incidence of primary graft dysfunction (PGD)] and prognosis of the recipients in both groups were compared. Results The recipients in both groups presented no significant difference in postoperative oxygenation index, duration of mechanical ventilation and chest tube drainage and incidence of PGD (all P>0.05). The postoperative 1-year survival of the recipients in standard group and contusion group was 74% and 83%, which presented no statistically significant difference (P>0.05). Conclusions The efficacy and prognosis of lung transplantation from donors combined with pulmonary contusion (with a maximum diameter of 5-8 cm) are comparable to those of lung transplantation from standard donors.

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