Incidence of Carcinoma in the Native Lung After Single Lung Transplantation.

BACKGROUND: This study aims to assess the incidence of primary lung cancer in the native lung and its impact on survival in patients undergoing single lung transplantation (SLT). METHODS: This study retrospectively analyzed 161 SLTs performed between June 2012 and June 2019. The incidence of carcinoma in the native lung and its influence on patient survival was determined. Recipient variables, tumor stage, and survival were analyzed and compared between patients with and without native lung cancer. The analysis was adjusted for transplant indication. Both univariable and multivariable analyses were performed. The present study followed the Declaration of Helsinki Ethical Principles for Medical Research involving human subjects. RESULTS: There were 161 patients (126 men/35 women; 57 ± 7 years) transplanted for chronic obstructive pulmonary disease (COPD) (n = 72), idiopathic pulmonary fibrosis (IPF) (n = 77), or other indications (n = 12). Eleven patients with COPD (7%) developed lung cancer in the native lung after SLT. Lung cancer did not appear in any of the SLTs for pulmonary fibrosis. Five participants were in stages I/II and underwent lung resection, and 6 participants were in stages III/IV and underwent chemotherapy/radiotherapy. Survival (1, 3, and 5 years) without vs with native lung carcinoma in patients with COPD was 89%, 86%, and 80% vs 86%, 71%, and 51% (P = .04). The occurrence of carcinoma in the native lung predicted survival in patients with COPD (odds ratio [OR]: 2.55; P = .07). CONCLUSIONS: Lung cancer in the native lung is a frequent and devastating complication after SLT in patients with COPD, which might negatively affect long-term survival. This should be considered when choosing the transplant procedure for patients with COPD.

The influence of the native lung on early outcomes and survival after single lung transplantation.

OBJECTIVE: To determine whether problems arising in the native lung may influence the short-term outcomes and survival after single lung transplantation (SLT), and therefore should be taken into consideration when selecting the transplant procedure. PATIENTS AND METHODS: Retrospective review of 258 lung transplants performed between June 2012 and June 2019. Among them, 161 SLT were selected for the analysis. Complications in the native lung were recorded and distributed into two groups: early and late complications (within 30 days or after 30 days post-transplant). Donor and recipient preoperative factors, 30-day mortality and survival were analysed and compared between groups by univariable and multivariable analyses, and adjusting for transplant indication. RESULTS: There were 161 patients (126M/35F; 57±7 years) transplanted for emphysema (COPD) (n = 72), pulmonary fibrosis (IPF) (n = 77), or other indications (n = 12). Forty-nine patients (30%) presented complications in the native lung. Thirty-day mortality did not differ between patients with or without early complications (6% vs. 12% respectively; p = 0.56). Twelve patients died due to a native lung complication (7.4% of patients; 24% of all deaths). Survival (1,3,5 years) without vs. with late complications: COPD (89%, 86%, 80% vs. 86%, 71%, 51%; p = 0.04); IPF (83%, 77%, 72% vs. 93%, 68%, 58%; p = 0.65). Among 30-day survivors: COPD (94%, 91%, 84% vs. 86%, 71%, 51%; p = 0.01); IPF (93%, 86%, 81% vs. 93%, 68%, 58%; p = 0.19). Native lung complications were associated to longer ICU stay (10±17 vs. 33±96 days; p<0.001), longer postoperative intubation (41±85 vs. 99±318 hours; p = 0.006), and longer hospital stay (30±24 vs. 45±34 days; p = 0.03). The presence of late native lung problems predicted survival in COPD patients (OR: 2.55; p = 0.07). CONCLUSION: The native lung is a source of morbidity in the short-term and mortality in the long-term after lung transplantation. This should be taken into consideration when choosing the transplant procedure, especially in COPD patients.

Orientacions per a l'alimentació dels nadonsnascuts prematurament durant els primers mesosdesprés de l'alta / No disponible

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Erythropoietin and prematurity--where do we stand?

Erythropoietin (EPO) treatment for anemia of prematurity is still controversial. Large multicentric trials demonstrate that administration of EPO+Fe cannot prevent early transfusions, particularly in very low birth weight newborns and in infants with severe neonatal diseases, but may have some beneficial effect to prevent late transfusions. Current treatment of anemia of prematurity should be multifactorial trying to minimize all causes that reduce erthrocytic mass (phlebotomies, use of noninvasive procedures) and promoting all factors that increase it (placental transfusion, adequate nutrition support). To evaluate the real impact of EPO treatment it is mandatory to follow similar transfusion protocols for preterm infants in all the studies. The aim of EPO+Fe administration should be to avoid new late transfusions in very low birth weight preterm infants or to prevent the first transfusion after the second week of life in less immature premature with the objective of reducing the number of donors rather than the number of transfusions. We have limited the use of EPO+Fe to infants <30 weeks gestational age and birth weight