Long-term Prognosis After Lung Transplantation: A Monocentric Study in 510 Patients.

INTRODUCTION: Lung transplantation is the final treatment option in patients with respiratory failure. Morbidity and mortality rates associated with the management of complications is high despite advances. Postoperative complications include acute transplant rejection, bronchiolitis obliterans, and infections. Because of that, the success of this treatment option depends on the correct choice of donor and candidates to receive a transplant. OBJECTIVE: This study aims to perform a survival analysis of transplanted patients in our center and determine predictive variables of mortality. PATIENTS AND METHODS: This study is a retrospective assessment of data collected from 510 patients at the Hospital University Reina Sofía from October 1993 to December 31, 2016. Patients who were retransplanted were excluded. We collected data regarding basal characteristics of the donors and candidates to receive a transplant. We analyzed the impact in terms of future survival of basal variables from donor and donor recipients. RESULTS: Five hundred ten patients were included (average age 44 ± 17 years, 69% male), with a maximum follow-up period of 21.6 years (average follow-up 4.52 years, interquartile ratio: 0.13 to 6.97 years). Two hundred twenty-seven patients died (54.3% of the total amount). The influence of donor's basal characteristics on mortality was analyzed; moreover, the relationship between basal variables and survival were analyzed using univariate analysis. Available variables were analyzed through multivariate analysis. CONCLUSION: Lung transplantation is a treatment option with an acceptable risk of morbidity and mortality. Increased awareness of features of evolution could help to reduce postoperative complications.

Risk of tuberculosis after lung transplantation: the value of pretransplant chest computed tomography and the impact of mTOR inhibitors and azathioprine use.

BACKGROUND: It is necessary to determine the incidence and risk factors for tuberculosis (TB), as well as strategies to assess and treat latent tuberculosis infection (LTBI) in lung transplant recipients. METHODS: A retrospective cohort study of 398 lung transplant recipients was performed. Episodes of TB were studied and the incidence rate was calculated. Logistic regression analysis was used to analyze specific variables as potential risk factors for TB. RESULTS: Median follow-up was 558 days (range 1-6636). Six cases (1.5%) of TB were documented in 398 transplant patients. The incidence density of TB was 406.3 cases/10(5) patient-years (95% confidence interval [CI] 164.7-845), which is higher than in the general population (13.10 cases/10(5) person-years). All cases occurred in the period 1993-2006, when the tuberculin skin test (TST) and treatment of LTBI in positive TST patients were not part of the protocol. Pretransplant computed tomography (CT) showed residual lesions in 50% of patients who developed TB, although the TST was negative and the chest radiograph was inconclusive. Multivariate analysis identified the presence of residual lesions in the pretransplant chest CT (odds ratio [OR] 11.5, 95% CI 1.9-69.1, P = 0.008), use of azathioprine (OR 10.6, 95% CI 1.1-99.1, P = 0.038), and use of everolimus (OR 6.7, 95% CI 1.1-39.8, P = 0.036) as independent risk factors for TB. CONCLUSIONS: Residual lesions in the pretransplant chest CTs and the use of azathioprine and mTOR inhibitors are associated with the risk of TB.

Analysis of the Incidence of Noncutaneous Neoplasia After Lung Transplantation and Its Impact on Prognosis.

INTRODUCTION: Increased survival in lung transplant recipients, the need for immunosuppressive therapy, and many risk factors before and after transplantation enhance the development of malignancies. This study sought to analyze the incidence of noncutaneous tumors after lung transplantation in our hospital, the risk factors for malignancy, and its impact on prognosis. PATIENTS AND METHODS: A retrospective analysis of clinical records of patients after lung transplantation in our hospital from October 1993 to December 2014. RESULTS: The study population included 443 patients. In total, 35 neoplasia developed in 33 patients (9.6%). Twelve cases were posttransplant lymphoproliferative disorders (PTLDs), 7 localized in the native lung, 7 gynecologic neoplasia (2 in the breast, 4 in the vulva, and 1 in the cervix), 3 in the colon, 2 in the nervous system (one was an astrocytoma), 2 in the prostate, 1 in the kidney, and 1 in the esophagus. The average time between transplantation and malignancy detection was 52.7 ± 45.4 months, being earlier in patients with PTLDs than in non-PTLD. Eleven patients who developed malignancy (all patients with neoplasia in native lung and in cervix, 1 in the colon, 1 PTLD, and 1 in the nervous system) died as a result of it. The only factor associated with an increased risk of malignancy in our population was smoking history. CONCLUSIONS: Almost 10% of lung transplant recipients developed some type of noncutaneous neoplasia and the most frequently diagnosed were PTLDs. Lung neoplasia compromised most survival in these patients.

Utilidad del índice FRAX en la evaluación de osteoporosis en pacientes con EPOC candidatos a trasplante pulmonar / Invassive pulmonary aspergillosis with myocardial involvement

Introducción: La presencia de osteoporosis (OTP) añade comorbilidad al proceso del trasplante pulmonar (TxP). Su identificación y tratamiento disminuirá el riesgo de fracturas. Objetivos: Comparar la utilidad (..) (AU)

Introduction: The presence of osteoporosis (OTP) adds comorbidity to the lung transplant (LTx) process. Its identification and treatment (..) (AU)

Bone mineral density in patients with chronic obstructive pulmonary disease who are candidates for lung transplant.

UNLABELLED: INTRODUCTIóN: After cystic fibrosis, lung transplantation (LT) patients with prior chronic obstructive pulmonary disease (COPD) are most susceptible to loss of bone mineral density (BMD). OBJECTIVES: To determine the prevalence of BMD loss among COPD patients being evaluated as LT candidates, seeking to identify, their risk profile. PATIENTS AND METHODS: This cross-sectional study included COPD patients who were LT candidates evaluated from January 2007 to December 2009. To identify patients at risk of fracture, BMD at the femoral neck and lumbar spine was assessed by bone densitometry. For categorization, we followed the World Health Organization criteria. To evaluate the risk profile, we recorded data on age, sex, smoking, lung function forced expiratory volume in 1 second, distance covered in the 6-minute walk test, body mass index, and degree of dyspnea. We recorded individual data as well as grouped them the multidimensional BODE (Body mass index Obstruction Dyspnea Exercise capacity) index. RESULTS: The study cohort consisted of 64 patients (51 men and 13 women). The overall prevalence of low BMD in any of the explored territories was 84.4%, affecting 88.2% of men and 69.2% of women. Osteoporosis was identified in 56.2% of patients, reaching a serious degree in 11/64 (17.2%). No significant differences were observed in any evaluated parameter when patients were separated into those with normal versus pathological BMD. When patients with osteopenia and osteoporosis were compared, we observed that the former showed a lower exercise capacity (P=.023) and a higher BODE index (P=.002). CONCLUSIONS: The prevalence of a low BMD level was increased among male patients with a worse BODE index, especially due to a reduced exercise capacity.

Lung transplantation for bronchiolitis obliterans after allogenic bone marrow transplantation.

INTRODUCTION: Bronchiolitis obliterans (BO) occurring after allogeneic bone marrow transplant (ABMT) may be an expression of lung damage of multifactorial origins. At present, it is not a usual condition for lung transplant (LT), accounting for <1% of all indications in the international registry. We sought, to describe the clinical features and outcomes of patients undergoing LT for BO after ABMT in our group. PATIENTS AND METHODS: We undertook a cross-sectional study of patients with an indication for LT due to BO after ABMT from the beginning of our program. We recorded the type of transplant, patient age, clinical course, functional outcome, and survival. RESULTS: Among 313 LT, 13 cases (4.2%) were due to BO, including 3 after ABMT (0.96%). ABMT was indicated after bone marrow aplasia in 2 cases and acute myeloid leukemia in the other patient. The patients were 2 men (both 35 years old) and 1 woman, aged 25 years. All subjects received double elective LT at 24, 20, and 9 years post ABMT. At the time of LT, all displayed severe obstructive ventilatory defects with a forced expiratory volume in 1 second (FEV1)<30% and partial respiratory insufficiency. The initial immunosuppression was cyclosporine, mycophenolate mofetil, and steroids in all cases. Two of the subjects required changes in the immunosuppressive regimen: 1 due to chronic graft rejection with subsequent functional recovery and the other due to hematologic and neurologic toxicity. After 96, 37, and 9 months, all the patients were alive with baseline dyspnea of functional class 0 and a FEV1 of about 68%. CONCLUSION: LT is an effective therapy in terms of lung function and survival for patients with respiratory failure secondary to the development of BO after ABMT.

Bone mineral density in lung transplant candidates.

INTRODUCTION: The loss of bone mineral density (BMD) affects more than half of the patients on the waiting list for lung transplantation (LT), increasing their disease burden. OBJECTIVE: To describe the prevalence of BMD loss among patients evaluated as candidates for LT. PATIENTS AND METHODS: We included all hospitalized patients evaluated as LT candidates over the last 3 years, excluding pediatric subjects under 17 years of age. We estimated BMD in the femoral neck and lumbar spine. Categorization used the World Health Organization criteria. RESULTS: Among 156 patients, 64 (41%) had chronic obstructive pulmonary disease (COPD) with only 2 (3.1%) having densitometry before referral; 55 (35.3%), interstitial lung disease (ILD) with 9 (16.4%) BMD values; and 21 (13.5%) cystic fibrosis (CF) with only 3 (14.3%) with BMD screening. The 116 patients (74.4%) who had BMD below normal values included 84.4% of COPD, 67.3% of the ILD, and 81% of the CF patients. The detection of these patients allowed us to initiate preventive treatment depending on the degree of risk of bone fracture. Half of the patients evaluated were eventually included on the LT waiting list, with 70% of them finally receiving a transplant. CONCLUSIONS: Bone mineral loss was highly prevalent among this population but its investigation before referral for LT was scarce. Its identification allows primary or secondary prophylaxis to be started, seeking to reduce the risk of bone fracture after transplantation.

El trasplante pulmonar en enfermedades raras / Lung transplant in rare diseases

La indicación de trasplante pulmonar (TxP) en las enfermedades poco prevalentes es escasa, siendo desconocido el impacto en su historia natural (..) (AU)

The indications for lung transplant (TxP) in uncommon diseases is scarce and undocumented (..) (AU)

Estenosis traqueal postintubación / No disponible

No disponible

[A lung transplant in a woman with bronchiolitis obliterans following an allogenic bone marrow transplant]. / Trasplante pulmonar por bronquiolitis obliterante tras trasplante alogénico de médula ósea.

Graft-versus-host disease is a major complication for bone marrow transplant recipients and is often a cause of late mortality. It can affect any tissue, and involvement of the lungs--target organs of particular importance--can lead to chronic respiratory failure due to bronchiolitis obliterans. We report the case of a lung transplant in a woman who developed bronchiolitis obliterans after receiving a marrow transplant to treat bone marrow aplasia. Three years later, clinical course was satisfactory, with full functional recovery.

Trasplante pulmonar por bronquiolitis obliterante tras trasplante alogénico de médula ósea / A lung transplant in a woman with bronchiolitis obliterans following an allogenic bone marrow transplant

La enfermedad del injerto contra el huésped es una complicación importante de los pacientes sometidos a trasplante de médula ósea, en quienes es causa de una elevada mortalidad tardía. Puede afectar a cualquier tejido y, cuando afecta a los pulmones, que son órganos diana de particular relevancia, acarrea insuficiencia respiratoria crónica secundaria al desarrollo de bronquiolitis obliterante. Presentamos el caso de una paciente con trasplante pulmonar por bronquiolitis obliterante tras haber recibido un trasplante de médula ósea por aplasia medular. La evolución tras el trasplante pulmonar, a los 3 años de seguimiento, es favorable, con recuperación clínica y funcional completa

Graft-versus-host disease is a major complication for bone marrow transplant recipients and is often a cause of late mortality. It can affect any tissue, and involvement of the lungs --target organs of particular importance-- can lead to chronic respiratory failure due to bronchiolitis obliterans. We report the case of a lung transplant in a woman who developed bronchiolitis obliterans after receiving a marrow transplant to treat bone marrow aplasia. Three years later, clinical course was satisfactory, with full functional recovery

Poligrafía domiciliaria. ¿es una técnica válida para el diagnóstico del síndrome de apneas obstructivas del sueño? / Home polygrafhy. Is it a valid technique for the diagnosis of obstructive sleep apnoea syndrome?

FUNDAMENTO: En el síndrome de apnea obstructiva delsueño (SAOS), la poligrafía es una alternativa diagnóstica, aunqueson infrecuentes los estudios realizados en el domicilio del paciente.El objetivo de este estudio es comparar la validez diagnóstica de lapoligrafía domiciliaria respecto a la polisomnografía convencional,en pacientes con moderada y alta sospecha clínica de SAOS, ademásde valorar el grado de satisfacción.PACIENTES Y METODOS: En una muestra seleccionada, serealizó un estudio aleatorio y ciego analizando el grado de satisfaccióndel paciente mediante una escala visual analógica y la utilidadde la poligrafía domiciliaria frente a la polisomnografía estándarcomparando el IAH (índice de apnea-hipopnea) obtenido enambas pruebas.RESULTADOS: Se estudian 33 enfermos (25 hombres y 8mujeres), edad media (± DE) de 53,4 ± 11 años y un índice de masacorporal de 33 ± 5 kg/m2.Para un IAH ≥ 10 obtenido en la polisomnografía, la poligrafíapresenta una sensibilidad del 90,3%, una especificidad del 50%,un valor predictivo positivo del 96,5% y un valor predictivo negativodel 25%, encontrándose un área bajo la curva ROC de 0,863.En un SAOS grave (IAH >30) la poligrafía obtiene una sensibilidaddel 88,2% (72,9-100) y una especificidad del 100% con un áreabajo la curva ROC de 1.El IAH obtenido en la poligrafía comparado con el de la polisomnografía(33,70 ±22,38 y 36,36 ±22,09, respectivamente) muestrauna alta correlación con un valor de r:0,975 (p<0,0001) y unaelevada concordancia con un coeficiente de correlación intraclasede 0,968. La puntuación de la polisomnografía fue de 7,5 y de 9para la poligrafía, al expresar el grado de satisfacción los pacientes(p<0,0001).CONCLUSIONES: En una muestra seleccionada, la poligrafíadomiciliaria muestra una alta correlación y concordancia con lapolisomnografía, siendo una prueba válida para el diagnóstico conun mayor grado de satisfacción para el paciente

BACKGROUND: Polygraphy is an alternative diagnoses techniquein the sleep apnea syndrome (SAS), although is infrequent toperform the studies at patients home. This study aims to comparethe diagnoses validity of home polygraphy with conventional polysomnographyin patients with moderate and high clinical suspicionof SAS, as well as valorating the grade of satisfaction.PATIENTS AND METHODS: On a selected sample, a randomizedblinded study was performed analizing the degree of satisfactionof the patient by an analogic visual scale and the diagnosticvalidity of home polygraphy versus standard polysomnographycomparing the apnea hypopnea index (AHI) obtained from bothtests.RESULTS: Thirty four patients are studied (25 men and 8women), middle age (±SD) of 53,4± 11 years old and a body massindex of 33± 5 kg/m2.For an AHI ≥10 obtained after polysomnography, polygraphyrepresents a sensitivity of 90,3%, especificity of 50%, a positivepredictive value of 96,5% and a negative predictive value of 25%,finding an area under the ROC curve of 0,863. In a severe SAS(AHI≥30) polygraphy obtains a sensitivity of 88,2% (72,9-100) anda especificity of 100% with an area under the ROC curve of 1.AHI obtained after polygraphy compared with polysomnography(33,70±22,38 and 36,36±22,09 respectively) shows a highcorrelation with a value of r:0,975 (p<0,0001) and a high concordancewith a coefficient of correlation intraclass of 0,968. Scoreafter polysomnography was 7,5 and 9 after polygraphy, whenexpressing the patients satisfaction grade (p<0,0001).CONCLUSIONS: On a selected sample, home polygraphyshows a high correlation and concordance with polysomnography,being a valid technique for the diagnoses with a higher patientsatisfaction grade