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1.
Praxis (Bern 1994) ; 109(13): 1050-1054, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33050816

RESUMO

Working After Lung Transplantation Abstract. Whether patients return to work after a successful lung transplant depends on various factors. The best predictive factor for employment after transplantation is the employment status before transplantation. Currently, there is no internationally standardized procedure regarding the questions of when and according to what criteria patients should be reintegrated into the working environment after lung transplantation. The risk of infection at the workplace/during the work activity should definitely be assessed before resuming work: a detailed work history is mandatory, an additional workplace inspection a further option. Advice should be based on the medical literature and general recommendations, and psychosocial factors must also be taken into account. In case of ambiguities, an interdisciplinary discussion is recommended.


Assuntos
Transplante de Pulmão , Retorno ao Trabalho , Emprego , Humanos
2.
Artigo em Alemão | MEDLINE | ID: mdl-32736384

RESUMO

The outcome after heart and lung transplantation has improved significantly. Consequently, many patients are admitted to the hospital for routine surgical interventions that are initially non-transplant-specific. Some disorders lead to hospital admissions that affect other organ systems due to late consequences of the underlying disease or can be seen as early and late complications of the transplantation itself. Many of these surgical interventions are certainly carried out in the responsible transplant centre. Some surgeries are also performed in hospitals that do not primarily transplant and do not regularly care for heart and lung transplant patients. In these situations, the understanding of the physiology of the transplanted heart and lung, the consequences of the underlying disease and the post-transplant treatment with its peculiarities and risks is paramount. The anaesthetic management of these patients requires preoperative risk stratification and perioperative anaesthetic planning, but also responsibility for a suitable post-operative monitoring. This review article deals with the special anaesthetic consideration in patients after heart and lung transplantation.


Assuntos
Anestésicos , Transplante de Coração , Transplante de Pulmão , Humanos
3.
BMC Infect Dis ; 20(1): 635, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847524

RESUMO

BACKGROUND: Data regarding the prevalence of metallo-ß-lactamases (MBLs) among Pseudomonas aeruginosa isolates in cystic fibrosis patients are scarce. Furthermore, there is limited knowledge on the effect of MBL production on patient outcomes. Here we describe a fatal respiratory infection due to P. aeruginosa producing VIM-type MBLs in a lung transplant recipient and the results of the subsequent epidemiological investigation. CASE PRESENTATION: P. aeruginosa isolates collected in the index patient and among patients temporally or spatially linked with the index patient were analyzed in terms of antibiotic susceptibility profile and MBL production. Whole-genome sequencing and phylogenetic reconstruction were also performed for all P. aeruginosa isolates producing VIM-type MBLs. A VIM-producing P. aeruginosa strain was identified in a lung biopsy of a lung transplant recipient with cystic fibrosis. The strain was VIM-1-producer and belonged to the ST308. Despite aggressive treatment, the transplant patient succumbed to the pulmonary infection due to the ST308 strain. A VIM-producing P. aeruginosa strain was also collected from the respiratory samples of a different cystic fibrosis patient attending the same cystic fibrosis center. This isolate harbored the blaVIM-2 gene and belonged to the clone ST175. This patient did not experience an adverse outcome. CONCLUSIONS: This is the first description of a fatal infection due to P. aeruginosa producing VIM-type MBLs in a lung transplant recipient. The circulation of P. aeruginosa isolates harboring MBLs pose a substantial risk to the cystic fibrosis population due to the limited therapeutic options available and their spreading potential.


Assuntos
Antibacterianos/uso terapêutico , Transplante de Pulmão , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/enzimologia , Infecções Respiratórias/tratamento farmacológico , Transplantados , Adulto , Fibrose Cística/cirurgia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Evolução Fatal , Feminino , Humanos , Pulmão/microbiologia , Pulmão/patologia , Testes de Sensibilidade Microbiana , Filogenia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Infecções Respiratórias/microbiologia , beta-Lactamases/genética , beta-Lactamases/metabolismo
4.
Lancet Respir Med ; 8(8): 786-794, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32763205

RESUMO

BACKGROUND: Transbronchial lung cryobiopsy (TBLC) has been introduced recently in the diagnosis of interstitial lung diseases. We aimed to evaluate the prognostic significance of the distinction between idiopathic pulmonary fibrosis and other interstitial lung diseases with the use of TBLC data in multidisciplinary team (MDT) diagnosis. METHODS: In this single-centre, retrospective, investigator-initiated comparative study, we evaluated consecutive patients without a definite usual interstitial pneumonia pattern on high-resolution CT, who presented to the GB Morgagni Hospital (Forlì, Italy), and who underwent TBLC (Jan 1, 2011, to Dec 31, 2014) or surgical lung biopsy (SLB; Jan 1, 2002, to Dec 31, 2016). Three pathologists reviewed the specimens, masked to clinical information. MDT evaluation was done before and after biopsy. The primary endpoint was the prognostic significance of the MDT diagnostic separation between idiopathic pulmonary fibrosis and other interstitial lung diseases in patients undergoing TBLC. Mortality was evaluated by means of Cox regression analysis. FINDINGS: We evaluated 500 consecutive cases, 426 of which were included: 266 had TBLC and 160 had SLB. 189 patients had idiopathic pulmonary fibrosis, 143 had other fibrotic interstitial lung diseases, and 94 had non-fibrotic interstitial lung diseases. Patients undergoing TBLC had more comorbidities and better preserved lung function compared with those undergoing SLB; among patients with a final MDT diagnosis of idiopathic pulmonary fibrosis, patients undergoing TBLC were older, had more comorbidities, and had a different post-biopsy treatment profile than those who received SLB. The distinction between idiopathic pulmonary fibrosis and other interstitial lung diseases made by MDT diagnosis on the basis of TBLC biopsy had clear prognostic significance, with a 5-year transplant-free survival of 68% (95% CI 57-76) in patients with an MDT idiopathic pulmonary fibrosis diagnosis based on TBLC compared with 93% (87-96) in patients without an idiopathic pulmonary fibrosis diagnosis based on TBLC (hazard ratio 5·28, 95% CI 2·72-10·04; p<0·0001). This distinction remained statistically significant in a multivariate analysis controlling for age, sex, smoking status, comorbidities, pulmonary function, and high-resolution CT patterns (p=0·02). INTERPRETATION: TBLC makes an important diagnostic contribution in interstitial lung disease, on the basis of the prognostic distinction between idiopathic pulmonary fibrosis and other interstitial lung diseases when TBLC findings are included in multidisciplinary diagnosis. FUNDING: None.


Assuntos
Biópsia/métodos , Fibrose Pulmonar Idiopática/diagnóstico , Pulmão/patologia , Broncoscopia , Diagnóstico Diferencial , Feminino , Humanos , Fibrose Pulmonar Idiopática/mortalidade , Fibrose Pulmonar Idiopática/cirurgia , Doenças Pulmonares Intersticiais/diagnóstico , Transplante de Pulmão , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
5.
BMC Infect Dis ; 20(1): 600, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795251

RESUMO

BACKGROUND: BK virus-associated nephropathy (BKVAN) is a relatively common cause of renal dysfunction in the first six months after renal transplantation. It arises from reactivation of the latent and usually harmless BK virus (BK virus) due to immunosuppression and other factors including some that are unique to renal transplantation such as allograft injury. BKVAN is much rarer in non-renal solid organ transplantation, where data regarding diagnosis and management are extremely limited. CASE PRESENTATION: We report a case of a 58-year-old man found to have worsening renal dysfunction nine months after bilateral sequential lung transplantation for chronic obstructive pulmonary disease (COPD). He had required methylprednisolone for acute allograft rejection but achieved good graft function. Urine microscopy and culture and renal ultrasound were normal. BK virus PCR was positive at high levels in urine and blood. Renal biopsy subsequently confirmed BKVAN. The patient progressed to end-stage renal failure requiring haemodialysis despite reduction in immunosuppression, including switching mycophenolate for everolimus, and the administration of intravenous immunoglobulin (IVIG). CONCLUSIONS: This very rare case highlights the challenges presented by BK virus in the non-renal solid organ transplant population. Diagnosis can be difficult, especially given the heterogeneity with which BKV disease has been reported to present in such patients, and the optimal approach to management is unknown. Balancing reduction in immunosuppression against prevention of allograft rejection is delicate. Improved therapeutic options are clearly required.


Assuntos
Transplante de Pulmão , Infecções por Polyomavirus/diagnóstico , Infecções Tumorais por Vírus/diagnóstico , Vírus BK/genética , Vírus BK/isolamento & purificação , DNA Viral/metabolismo , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim , Transplante de Pulmão/efeitos adversos , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Infecções por Polyomavirus/virologia , Doença Pulmonar Obstrutiva Crônica/terapia , Infecções Tumorais por Vírus/virologia
6.
Pediatrics ; 146(Suppl 1): S48-S53, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737232

RESUMO

In this article, I review the ethical issues that arise in the allocation of deceased-donor organs to children and young adults. By analyzing the public media cases of Sarah Murnaghan, Amelia Rivera, and Riley Hancey, I assess whether public appeals to challenge inclusion and exclusion criteria for organ transplantation are ethical and under which circumstances. The issues of pediatric allocation with limited evidence and candidacy affected by factors such as intellectual disability and marijuana use are specifically discussed. Finally, I suggest that ethical public advocacy can coexist with well-evidenced transplant allocation if and when certain conditions (morally defensible criteria, expert evidence, nonprioritization of the poster child, and greater advocacy for organ transplantation in general) are met.


Assuntos
Doação Dirigida de Tecido/ética , Alocação de Recursos para a Atenção à Saúde/ética , Defesa do Paciente/ética , Alocação de Recursos/ética , Fatores Etários , Criança , Pré-Escolar , Fibrose Cística/cirurgia , Doação Dirigida de Tecido/legislação & jurisprudência , Feminino , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Alocação de Recursos para a Atenção à Saúde/organização & administração , História do Século XXI , Humanos , Deficiência Intelectual , Transplante de Rim , Transplante de Pulmão/ética , Transplante de Pulmão/legislação & jurisprudência , Masculino , Redes Sociais Online , Pais , Defesa do Paciente/legislação & jurisprudência , Pneumonia/cirurgia , Preconceito , Opinião Pública , Alocação de Recursos/legislação & jurisprudência , Alocação de Recursos/organização & administração , Transtornos Relacionados ao Uso de Substâncias , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/organização & administração , Listas de Espera , Síndrome de Wolf-Hirschhorn/cirurgia , Adulto Jovem
10.
Yonsei Med J ; 61(7): 606-613, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32608204

RESUMO

PURPOSE: Data on the distribution and impact of panel reactive antibodies (PRA) and donor specific antibodies (DSA) before lung transplantation in Asia, especially multi-center-based data, are limited. This study evaluated the prevalence of and effects of PRA and DSA levels before lung transplantations on outcomes in Korean patients using nationwide multicenter registry data. MATERIALS AND METHODS: This study included 103 patients who received a lung transplant at five tertiary hospitals in South Korea between March 2015 and December 2017. Mortality, primary graft dysfunction (PGD), and bronchiolitis obliterans syndrome (BOS) were evaluated. RESULTS: Sixteen patients had class I and/or class II PRAs exceeding 50%. Ten patients (9.7%) had DSAs with a mean fluorescence intensity (MFI) higher than 1000, six of whom had antibodies with a high MFI (≥2000). DSAs with high MFIs were more frequently observed in patients with high-grade PGD (≥2) than in those with no or low-grade (≤1) PGD. In the 47 patients who survived for longer than 9 months and were evaluated for BOS after the transplant, BOS was not related to DSA or PRA levels. One-year mortality was more strongly related to PRA class I exceeding 50% than that under 50% (0% vs. 16.7%, p=0.007). CONCLUSION: Preoperative DSAs and PRAs are related to worse outcomes after lung transplantation. DSAs and PRAs should be considered when selecting lung transplant recipients, and recipients who have preoperative DSAs with high MFI values and high PRA levels should be monitored closely after lung transplantation.


Assuntos
Anticorpos/imunologia , Bronquiolite Obliterante/etiologia , Transplante de Pulmão/efeitos adversos , Disfunção Primária do Enxerto/imunologia , Doadores de Tecidos , Adulto , Idoso , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/mortalidade , Feminino , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Prevalência , República da Coreia/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Sobrevida
16.
Nat Med ; 26(7): 1102-1113, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32661401

RESUMO

Patients awaiting lung transplantation face high wait-list mortality, as injury precludes the use of most donor lungs. Although ex vivo lung perfusion (EVLP) is able to recover marginal quality donor lungs, extension of normothermic support beyond 6 h has been challenging. Here we demonstrate that acutely injured human lungs declined for transplantation, including a lung that failed to recover on EVLP, can be recovered by cross-circulation of whole blood between explanted human lungs and a Yorkshire swine. This xenogeneic platform provided explanted human lungs a supportive, physiologic milieu and systemic regulation that resulted in functional and histological recovery after 24 h of normothermic support. Our findings suggest that cross-circulation can serve as a complementary approach to clinical EVLP to recover injured donor lungs that could not otherwise be utilized for transplantation, as well as a translational research platform for immunomodulation and advanced organ bioengineering.


Assuntos
Lesão Pulmonar Aguda/terapia , Transplante de Pulmão/métodos , Pulmão/irrigação sanguínea , Preservação de Órgãos/métodos , Lesão Pulmonar Aguda/sangue , Lesão Pulmonar Aguda/fisiopatologia , Animais , Circulação Extracorpórea/métodos , Humanos , Pulmão/fisiopatologia , Perfusão/métodos , Suínos , Doadores de Tecidos
19.
Clinics (Sao Paulo) ; 75: e1698, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32556057

RESUMO

OBJECTIVE: To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS: Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS: A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION: Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Pneumopatias/terapia , Transplante de Pulmão/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Bronquiectasia/epidemiologia , Bronquiectasia/terapia , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Hipertensão Arterial Pulmonar/epidemiologia , Hipertensão Arterial Pulmonar/terapia , Enfisema Pulmonar/epidemiologia , Enfisema Pulmonar/terapia , Fibrose Pulmonar/epidemiologia , Fibrose Pulmonar/terapia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
20.
J Anesth Hist ; 6(2): 70-73, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32593379

RESUMO

Leo Fabian played a role in many anesthesia firsts: the first halothane anesthetics in the United States, the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. As was common for men of his generation, Fabian's first taste of medicine came during World War II, as a pharmacist's mate aboard the U.S.S. Bountiful. Afterward, he pursued his medical education before joining Dr. C. Ronald Stephen and the anesthesiology department at Duke. There he helped to create one of the first inhalers for halothane, the Fabian Newton Stephen (F-N-S) Fluothane Vaporizer. Fabian left Duke for the University of Mississippi Medical Center, where he consistently worked with the chair of surgery, Dr. James Hardy. Together they performed the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. By the end of his time at Mississippi, Fabian and Hardy had several philosophical disagreements, and Fabian ultimately left for Washington University in St. Louis, where he rejoined Dr. Stephen. He served as Stephen's right-hand man and would oversee the department when Stephen was away. Fabian spent the final years of his career as chair of the department before his own health forced him to step down.


Assuntos
Anestesia/história , Anestesiologia/história , Anestesia/métodos , Anestesiologia/instrumentação , Animais , Eletricidade/história , Transplante de Coração/história , História do Século XX , Experimentação Humana/história , Humanos , Transplante de Pulmão/história , Pan troglodytes , Transplante Heterólogo/ética , Transplante Heterólogo/história , Estados Unidos
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