Outcomes of lung transplantation for chronic obstructive pulmonary disease.

Introduction: Chronic obstructive pulmonary disease is a progressive airway disease that can progress to the terminal stage requiring oxygen supply. In this period, lung volume reduction therapies and/or lung transplantation may be considered. Morbidity and mortality risks due to transplant surgery and posttransplant immunosuppressive therapy show the importance of selecting the best candidates who will benefit from transplantation. In this context, BODE index criteria serve as important markers. This study aimed to analyze the outcomes of lung transplantation in patients with chronic obstructive pulmonary disease and to identify variables that may affect post-transplant clinical outcomes. Materials and Methods: Lung transplants diagnosed with chronic obstructive pulmonary disease performed in our center between March 2013 and January 2023 were included in the study. Demographic information and both pre-op and post-op clinical data of the transplant patients were collected. The effect of BODE index criteria and other pre-transplant clinical data on short- and long-term outcomes after transplantation were investigated. Results: During the study period, 34 lung transplants were performed for chronic obstructive pulmonary disease. One patient died during the operation, three patients received single transplants, and 30 received double transplants. Post-operative primary graft dysfunction was more common in single transplant recipients. The results were comparable between single and double transplants in terms of post-transplant pulmonary function and the development of chronic lung allograft dysfunction. BODE index criteria had no effect on early and late post-operative clinical data, however intra-operative use of extracorporeal membrane oxygenation, primary graft dysfunction, and prolonged extubation were significantly higher in recipients younger than 60 years. Conclusion: Our study suggests that prelisting demographic and clinical data of chronic obstructive pulmonary disease patients had no significant effect on post-operative outcomes, however, intra-operative ECMO use, prolonged extubation, primary graft dysfunction (p< 0.05 for each) and chronic rejection (p> 0.05) were more common in patients who are <60 years of age. These data need to be confirmed by larger studies.

The Effect of Ideal/Standard Donor and Marginal Donor Use on Primary Graft Dysfunction After Lung Transplantation in Turkey.

OBJECTIVE: The transplantation waiting list is getting longer day by day with the spread of lung transplantation and awareness of it. However, the donor pool cannot keep up with this rate. Therefore, nonstandard (marginal) donors are widely used. By studying the lung donors presented at our center, we aimed to raise awareness of the donor shortage and compare clinical outcomes in recipients with standard and marginal donors. MATERIALS AND METHODS: The data from recipients and donors of lung transplants performed at our center between March 2013 and November 2022 were retrospectively reviewed and recorded. Transplants with ideal and standard donors were classified as group 1, and those with marginal donors were classified as group 2. Primary graft dysfunction rates, intensive care unit, and hospital stay days were compared. RESULTS: Eighty-nine lung transplants were performed. A total of 46 recipients were in group 1 and 43 were in group 2. There were no differences between groups in the development of stage 3 primary graft dysfunction. However, a significant difference was found in the marginal group for developing any stage primary graft dysfunction. Donors were mostly from the western and southern regions of the country and from the education and research hospitals. CONCLUSION: Because of the donor shortage in lung transplantation, transplant teams tend to use marginal donors. Stimulating and supportive education for healthcare professionals to recognize brain death and public education to raise awareness about organ donation are necessary to spread organ donation throughout the country. Although our results using marginal donors are similar with the standard group, each recipient and donor should be assessed individually.

Effects of intraoperative fluid therapy on intensive care process, morbidity, and mortality after lung transplantation.

Background: This study aims to evaluate the effect of intraoperative fluid therapy on intensive care process and first 90-day morbidity and mortality in patients undergoing lung transplantation. Methods: Between March 2013 and December 2020, a total of 77 patients (64 males, 13 females; mean age: 47.6±13.0 years; range, 19 to 67 years) who underwent lung transplantation were retrospectively analyzed. The patients were divided into two groups according to the amount of fluid given intraoperatively: Group 1 (<15 mL/kg-1/h-1) and Group 2 (>15 mL/kg-1/h-1). Demographic, clinical, intra- and postoperative data of the patients were recorded. Results: Less than 15 mL/kg-1/h-1 f luid w as a dministered t o 75.3% (n=58) of the patients (Group 1) and 24.7% (n=19) were administered more than 15 mL/kg-1/h-1 (Group 2). In t erms of native disease, the rate of diagnosis of chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis was higher in Group 1, and the rate of other diagnoses was higher in Group 2 (p<0.01). The ratio of women in Group 2 was higher (p<0.05), while the body mass index values were significantly lower in this group (p<0.01). The erythrocyte, fresh frozen plasma, platelet, crystalloid and total fluid given in Group 2 were significantly higher (p<0.001). Inotropic/vasopressor agent use rates and extracorporeal membrane oxygenation requirement were significantly higher in Group 2 (p<0.01). Primary graft dysfunction, gastrointestinal complications, and mortality rates were also significantly higher in Group 2 (p<0.05). Conclusion: The increased intraoperative fluid volume in lung transplantation is associated with primary graft dysfunction, gastrointestinal complications, and mortality rates.

COVID-19 After Vaccination in Lung Transplant Recipients: Real-Life Data.

OBJECTIVES: The effectiveness of COVID-19 vaccines in lung transplant recipients is unclear. We retrospectively analyzed lung transplant recipients vaccinated with an inactivated virus vaccine (CoronaVac) and the mRNA vaccine BNT162b2 used against the SARS-CoV-2 virus in Turkey and shared their effects on COVID-19. MATERIALS AND METHODS: Demographic data of lung transplant recipients followed up for >3 months were collected, and vaccination dates and status against the SARS-CoV-2 virus were recorded. Recipients who received at least 3 doses of CoronaVac or 2 doses of BNT162b2, or 1 dose of CoronaVac plus 2 doses of BNT162b2, or 2 doses of CoronaVac plus 1 dose of BNT162b2 were considered fully vaccinated; those who were vaccinated less than this number were considered partially vaccinated. Patients with positive SARS-CoV-2 reverse transcription-polymerase chain reaction tests from respiratory tract samples were accepted as positive for COVID-19. Recipients were classified by number and type of vaccine, and groups were compared for infection, need for intensive care, and death as a result of COVID-19. RESULTS: Of the 53 lung transplant recipients, 51 were vaccinated (7 partially vaccinated, 44 fully vaccinated) and 2 were not vaccinated. Of fully vaccinated recipients, 13/44 received the inactivated vaccine, 5/44 received the mRNA vaccine, and 26/44 had a combination of the 2 vaccines. During the follow-up period, 13 patients (2/2 not vaccinated, 2/7 [28.5%] partially vaccinated, 9/44 [20.5%] fully vaccinated) were diagnosed with COVID-19. There was no significant difference in protection against infection between the inactivated, the mRNA, and combined vaccine groups. There was no significant association in cycle threshold values that determine the infection load and COVID-19 severity between transplant recipients who died and those who did not. CONCLUSIONS: In lung transplant recipients, 3 doses of inactivated vaccine, 2 doses of mRNA vaccine, or the combined heterologous vaccine provided similar protection. Prevention of exposure is one of the most crucial steps.

Everolimus Use in Lung Transplant Recipients.

BACKGROUND: Most lung transplantation centers prefer triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil, and corticosteroids. However, to prevent complications and comorbidities caused by tacrolimus, replacing the drug with everolimus has been considered. METHODS: This is a retrospective observational study investigating everolimus switch for different reasons. The population was divided into 3 groups: chronic lung allograft dysfunction (CLAD), kidney impairment, and malignant neoplasm groups. We investigated whether we achieved the goal of the switch and the frequency of rejection, cytomegalovirus and fungal infections, and everolimus adverse effects. RESULTS: Nineteen patients received everolimus therapy, and 5 of these were for CLAD, 7 for tacrolimus nephrotoxicity, and 7 for explant/de novo malignant neoplasm. The patients were followed up for a mean (SD) of 30 (16.7) months under the therapy. The number of acute cellular rejection, cytomegalovirus infection, and aspergillosis infection cases before switch were 7, 13, and 2, respectively, and 7, 2, and 3 after that. The mean values of creatinine and estimated glomerular filtration rate of the whole population after the switch improved with no statistical significance, whereas it was significant in tacrolimus nephrotoxicity group. Three patients in the CLAD group remained stable after switching, whereas 2 progressed. Only 1 of the 7 patients with malignant neoplasms had a recurrence during 31.1 (16.5) months of median follow-up. Eleven cases of everolimus adverse effects occurred in 9 patients (47.3%), with 2 (10.5%) withdrawal events. Kidney impairment (P = .02) and age (P = .05) stood out as significant risk factors for drug adverse effects. CONCLUSIONS: After lung transplant, everolimus can be a safe alternative for immunosuppression with acceptable adverse effects.

Delirium Development After Lung Transplantation: An Intraoperative Assessment.

BACKGROUND: This study aimed to evaluate the relationship between intraoperative hemodynamic and laboratory parameters with postoperative delirium development after lung transplantation. METHODS: A total of 77 patients who underwent lung transplantation in a single center were included in the study. Demographic and clinical data recorded at critical intraoperative stages (after induction [T1], after bilateral lungs are dissected [T2], while the patient is ventilated for 1 lung [T3], while the unilateral transplanted lung is ventilated [T4], while bilateral transplanted lungs are ventilated [T5], and after the thorax is closed [T6]), postoperative complications, mechanical ventilation duration, intensive care, and hospitalization durations and mortality rates were recorded. RESULTS: A total of 83.1% of the 77 patients were male, and the mean (SD) age was 47.56 (12.95) years. The mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 23.30 (3.99), and the median Charles Comorbidity Index (CCI) was 1. The diagnosis of 36.4% of the patients was chronic obstructive pulmonary disease. Delirium was seen in 51.9% of the patients. Age, CCI, intraoperative mean arterial pressure changes, lactate levels, mechanical ventilation duration, and hospital stay were all associated with delirium development. CONCLUSION: Age, CCI, duration of mechanical ventilation, and hospital stay were independent predictors of postoperative delirium development. We believe that our study will be a guide for future prospective randomized controlled studies.

Comparison of new generation baska mask with i-gel and classical laryngeal mask in outpatient urological interventions.

OBJECTIVES: To compare the clinical performance of the baska mask (PTY Ltd, Australia), i-gel (Intersurgical Ltd, UK) and classic laryngeal mask airway (cLMA) in adult patients undergoing outpatient urologic interventions. METHODS: One hundred fifty patients with American Society of Anesthesiologists I-III physical status were enrolled between January 2017 and September 2017 in Yuksek Ihtisas Research and Educational Hospital, Ankara, Turkey for elective urological surgery for this prospective randomized controlled trial. There were 50 patients in each of the following groups: baska mask, i-gel, and cLMA. In each group, the insertion times, ventilation times, 'first attempt' success rates, airway dynamics-complications and hemodynamic variables were evaluated. RESULTS: No statistically significant values were observed in means of demographic data, airway dynamics, complications, and hemodynamic variables. Insertion and ventilation times were different between groups (p less than 0.001 for each). In cLMA group, insertion and ventilation times were found to be shorter than others (insertion times 5.78±1.72 seconds and ventilation times 11.72±4.72 seconds). The longest insertion and ventilation times were observed in baska mask with 12.04±6.25 and 21.26±8.53 seconds. The 'first attempt' success rates were 98% for cLMA, 92% for i-gel, and 88% for baska mask. The addition maneuvering requirements in baska mask group was  20% (40/10). Conclusion: When cLMA, i-gel and baska mask are compared regarding insertion and ventilating times, first attempt success rates, and additional maneuvers, cLMA and i-gel are superior to baska mask in urological ambulatory surgical cases.

Intraoperative 16-Channel Electroencephalography and Bilateral Near Infrared Spectroscopy Monitorization in Aortic Surgery.

Transient neurologic dysfunction is common after aortic surgery. Major causes of postoperative complications followed by cardiac surgery are due to hypoperfusion states such as selective cerebral perfusion, embolic debris during cardiopulmonary bypass and ulcerated plaque emboli originated from carotid arteries. Neurologic complications prolong periods of intensive care unit and hospital stay, worsens quality of life and unfortunately they are an important cause of morbidity. Anaesthesia during a carotid and aortic surgery constitutes of providing adequate brain perfusion pressure, attenuating cerebral metabolism by anaesthetic agents and monitoring the cerebral metabolic supply and demand relationship during the intraoperative period. We present a monitoring approach with an intraoperative 16-channel electroencephalography and bilateral near infrared spectroscopy during redo aneurysm of the sinus of Valsalva surgery.