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1.
Transplant Proc ; 49(4): 886-889, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28457418

RESUMEN

BACKGROUND: Gastro-esophageal reflux disease (GERD) and broncho-aspiration (BA) are known to increase the risk for chronic lung allograft dysfunction (CLAD). However, specific lung injury mechanisms are not clearly known. The objective of the study was to describe histopathological findings in surveillance lung transbronchial biopsies that can be correlated with episodes of BA in the lung allograft. METHODS: This retrospective analysis of surveillance transbronchial biopsies was performed in lung transplant recipients, with available data of broncho-alveolar fluid (cultures and cytology), lung function parameters, and esophageal functional tests. RESULTS: Were analyzed 11 patients, divided into 3 groups: (1) GERD group: 4 patients with GERD and CLAD diagnosis; (2) control group: 2 patients without GERD or CLAD; and (3) BA group: 5 patients with foreign material in lung biopsies. A histopathological pattern of neutrophilic bronchitis (NB) was present in 4 of 4 cases in the GERD group and in 1 of 5 cases in the BA group in 2 or more biopsy samples; culture samples were all negative; the 5 NB-positive patients developed CLAD and died (3/5) or needed re-transplantation (2/5). The other 3 patients in the BA group had GERD without NB or CLAD. Both patients in the control group had transient NB in biopsies with positive cultures but remained free of CLAD. CONCLUSIONS: Surveillance transbronchial biopsies may provide useful information other than the evaluation of acute cellular rejection and can help to identify high-risk patients for allograft dysfunction related to gastro-esophageal reflux.


Asunto(s)
Reflujo Gastroesofágico/patología , Trasplante de Pulmón/efectos adversos , Complicaciones Posoperatorias/patología , Aspiración Respiratoria de Contenidos Gástricos/patología , Adulto , Biopsia , Brasil , Femenino , Reflujo Gastroesofágico/etiología , Humanos , Pulmón/patología , Pulmón/fisiopatología , Trasplante de Pulmón/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Aspiración Respiratoria de Contenidos Gástricos/etiología , Estudios Retrospectivos , Trasplante Homólogo , Trasplantes/fisiopatología
2.
Transplant Proc ; 47(4): 1029-32, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-26036511

RESUMEN

BACKGROUND: Airway complications after lung transplantation are the major cause of morbidity, affecting up to 33% of all cases. Bronchial stenosis is the most common complication. The use of stents has been established as the most effective therapy; however, their removal is recommended after 3-6 months of use. We have been using self-expandable stents as a definitive treatment and remove them only if necessary. For this report, we evaluated the use of self-expandable stents as a definitive treatment for bronchial stenosis after lung transplantation. METHODS: We performed a retrospective cohort study to evaluate patients with bronchial stenosis from August 2003 to April 2014. Clinical and pulmonary function test data were collected. RESULTS: Two hundred lung transplants were performed, 156 of which were bilateral. Sixteen patients experienced airway complications: 4 had dehiscence, 2 necrosis, and 10 bronchial stenosis. Of these patients, 7 had undergone bilateral procedures, and 2 patients developed stenosis in both sides. Twelve anastomotic stenoses were observed. The follow-up after stenting ranged from 1 to 7 years. All patients had increased lung function, and 4 remained stable with sustained increase in pulmonary function without episodes of infection. Three patients required removal of their prosthesis 6 months to 1 year after implantation because of complications. Two patients died owing to unrelated causes. CONCLUSIONS: Definitive treatment of bronchial stenosis with self-expandable stents is a viable option. The 1st year seems to be the most crucial for determining definitive treatment, because no patients required removal of their stent after 1 year.


Asunto(s)
Obstrucción de las Vías Aéreas/prevención & control , Enfermedades Bronquiales/prevención & control , Toma de Decisiones , Remoción de Dispositivos , Trasplante de Pulmón/efectos adversos , Stents , Adulto , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Enfermedades Bronquiales/etiología , Enfermedades Bronquiales/cirugía , Constricción Patológica/etiología , Constricción Patológica/prevención & control , Constricción Patológica/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Adulto Joven
3.
Transplant Proc ; 46(6): 1845-8, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25131051

RESUMEN

Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiologic entity characterized by typical neurologic symptoms with characteristic cerebral image alterations. It has been reported in solid organ transplantations, especially related to the use of calcineurin inhibitors. The incidence of PRES in lung transplantation is unknown and probably under-reported in the literature. Here we describe 5 cases of PRES after bilateral lung transplantation. One of the reported cases was the first in the literature in which the neurologic onset precluded the introduction of calcineurin inhibitor. Therefore, although calcineurin inhibitors are known to play an important role in the development of PRES in the setting of lung transplantation, other causes seems to be involved in the physiopathology of this syndrome.


Asunto(s)
Fibrosis Quística/cirugía , Trasplante de Pulmón/efectos adversos , Síndrome de Leucoencefalopatía Posterior/etiología , Adolescente , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Síndrome de Leucoencefalopatía Posterior/diagnóstico , Adulto Joven
4.
Transplant Proc ; 46(6): 1849-51, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25131052

RESUMEN

Mucorales is a fungus that causes systemic, highly lethal infections in immunocompromised patients. The overall mortality of pulmonary mucormycosis can reach 95%. This work is a review of medical records of 200 lung transplant recipients between the years of 2003 and 2013, in order to identify the prevalence of Mucorales in the Lung Transplantation service of Heart Institute (InCor), Hospital das Clínicas da Universidade de São Paulo, Brazil, by culture results from bronchoalveolar lavage and necropsy findings. We report 4 cases found at this analyses: 3 in patients with cystic fibrosis and 1 in a patient with bronchiectasis due to Kartagener syndrome. There were 2 unfavorable outcomes related to the presence of Mucorales, 1 by reduction of immunosuppression, another by invasive infection. Another patient died from renal and septic complications from another etiology. One patient was diagnosed at autopsy just 5 days after lung transplantation, with the Mucor inside the pulmonary vein with a precise, well-defined involvement only of donor's segment, leading to previous colonization hypothesis. There are few case reports of Mucorales infection in lung transplantation in the literature. Surveillance for the presence of Mucor can lead to timely fungal treatment and reduce morbidity and mortality in the immunocompromised patients, especially lung transplant recipients.


Asunto(s)
Rechazo de Injerto/microbiología , Trasplante de Pulmón/efectos adversos , Mucorales/aislamiento & purificación , Mucormicosis/microbiología , Adulto , Fibrosis Quística/cirugía , Resultado Fatal , Femenino , Rechazo de Injerto/diagnóstico , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Mucormicosis/diagnóstico , Adulto Joven
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