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2.
J Comput Assist Tomogr ; 44(3): 314-327, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32176159

RESUMO

Airway complications (ACs) after lung transplant remain a challenge and include bronchial dehiscence, bronchial stenosis, tracheobronchomalacia, infections, and bronchial fistulas. The spectrum of complications may coexist along a continuum and can be classified as early (<1 month after transplant) or late (>1 month), and anastomotic or nonanastomotic. Bronchiolitis obliterans is the most common form of chronic lung allograft rejection. Airway compromise is seen in rare instances of lung torsion, and imaging may provide helpful diagnostic clues. Computed tomography (CT) and bronchoscopy play major roles in the diagnosis and treatment of ACs after lung transplant. Chest CT with advanced postprocessing techniques is a valuable tool in evaluating for airways complications, for initial bronchoscopic treatment planning and subsequent posttreatment assessment. Various bronchoscopic treatment options may be explored to maintain airway patency. The goal of this article is to review imaging findings of ACs after lung transplantation, with emphasis on chest CT and bronchoscopic correlation.


Assuntos
Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia Torácica , Doenças Respiratórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Humanos , Pulmão/diagnóstico por imagem , Deiscência da Ferida Operatória/diagnóstico por imagem
3.
J Thorac Cardiovasc Surg ; 159(3): 865-896, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31983522
4.
PLoS One ; 15(1): e0226488, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929536

RESUMO

KL-6 is an antigen produced mainly by damaged type II pneumocytes that is involved in interstitial lung disease. Chronic lung allograft dysfunction (CLAD) after lung transplantation (LT) is a major concern for LT clinicians, especially in patients with restrictive allograft syndrome (RAS). We investigated KL-6 levels in serum and bronchoalveolar lavage fluid (BALF) as a potential biomarker of the RAS phenotype. Levels of KL-6 in serum and BALF were measured in 73 bilateral LT recipients, and patients were categorized into 4 groups: stable (ST), infection (LTI), bronchiolitis obliterans syndrome (BOS), and RAS. We also studied a healthy cohort to determine reference values for serum KL-6. The highest levels of KL-6 were found in the serum of patients with RAS (918 [487.8-1638] U/mL). No differences were found for levels of KL-6 in BALF. Using a cut-off value of 465 U/mL serum KL-6 levels was able to differentiate RAS patients from BOS patients with a sensitivity of 100% and a specificity of 75%. Furthermore, higher serum KL-6 levels were associated with a decline in Forced Vital Capacity (FVC) at 6 months after sample collection. Therefore, KL-6 in serum may well be a potential biomarker for differentiating between the BOS and RAS phenotypes of CLAD in LT recipients.


Assuntos
Transplante de Pulmão/efeitos adversos , Mucina-1/sangue , Disfunção Primária do Enxerto/etiologia , Adulto , Idoso , Área Sob a Curva , Biomarcadores/sangue , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/etiologia , Líquido da Lavagem Broncoalveolar/química , Feminino , Humanos , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Mucina-1/análise , Fenótipo , Disfunção Primária do Enxerto/diagnóstico , Curva ROC , Sensibilidade e Especificidade , Transplante Homólogo , Capacidade Vital , Adulto Jovem
5.
Transplant Proc ; 51(9): 2981-2985, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611126

RESUMO

BACKGROUND: Despite significant improvements in lung transplantation procedures, the incidence of airway complications (ACs) remains high (2%-18%); these complications are associated with high costs, great morbidities, and a decreased quality of life. There is general disagreement over potential risk factors determining ACs, including graft cold ischemic time (CIT). The aim of this study was to evaluate the association between CIT and ACs. METHODS: All patients undergoing lung transplantation between January 2011 and December 2017 were evaluated. We excluded retransplantations and patients with 90-day mortality. Demographic and clinical data regarding donors, recipients, and surgical procedures were analyzed using propensity score weighted marginal Cox regression model. RESULTS: Out of the 161 lung transplantations performed in the study timeframe, 147 fulfilled the inclusion criteria and supplied complete data to be analyzed. Median follow-up was 25.5 months (interquartile range = 35.2). Ten patients (6.8%) had late ACs; out of the 260 anastomoses considered, 14 proved to be complicated (5.4%). Median time to event was 5.5 months (range, 3-15). ACs were classified as bronchial stenosis (12) and malacia (2). Mean CIT was 446.6 minutes (range, 117-1200). Without considering time-to-event data, CIT was significantly higher in complicated anastomoses (P = .002). The unweighted marginal univariate Cox model showed a significant association between ACs and CIT (P < .001). The propensity score weighted marginal univariable Cox model confirmed this significant association (P < .001). CONCLUSIONS: The prolonged CIT time seems to be a risk factor for the development of late ACs; we endorse any measure that could limit CIT within 600 minutes.


Assuntos
Isquemia Fria/efeitos adversos , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/métodos , Complicações Pós-Operatórias/etiologia , Adulto , Estudos de Coortes , Isquemia Fria/métodos , Feminino , Sobrevivência de Enxerto/fisiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Fatores de Risco , Fatores de Tempo
6.
Transplant Proc ; 51(9): 2991-2994, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611127

RESUMO

INTRODUCTION: Malignant diseases are well-known complications after lung transplantation (LT). Among these, inflammatory myofibroblastic tumor (IMT) is a rare neoplasm with a not well-known and often aggressive biological behavior. MATERIAL AND METHODS: We hereby describe 2 cases of cystic fibrosis patients who underwent bilateral sequential LT (BSLT) complicated by IMT. RESULTS: A 26-year-old man presented a right endobronchial lesion 6 months after BSLT. Two consecutive fiber bronchoscopic biopsies showed granulation tissue. For the persistent lesion growth, the patient underwent a transthoracic biopsy showing histologic diagnosis of IMT. Therefore, he underwent to right pneumonectomy that was unfortunately complicated after 6 months with a late bronchopleural fistula and empyema with exitus 6 months later. A 31-year-old woman 1 year after BSLT presented with a left voluminous pleural-parenchymal lesion; the histologic examination after biopsy revealed an IMT. She underwent a removal of the lesion with a macroscopic R0 resection. Histologic, immunophenotypic, and cytogenetic examinations showed a strong overexpression of anaplastic lymphoma kinase requiring biological adjuvant therapies; however, the patient refused it. Four years later, she presented a recurrence treated with debulking procedure and adjuvant radiotherapy. At last follow-up, the patient was alive with stable disease and optimal graft function. CONCLUSIONS: Although IMT is a rare complication after lung transplant, to obtain a careful diagnosis, an early and aggressive treatment is mandatory.


Assuntos
Hospedeiro Imunocomprometido , Transplante de Pulmão/efeitos adversos , Granuloma de Células Plasmáticas Pulmonar/imunologia , Adulto , Fibrose Cística/cirurgia , Feminino , Humanos , Masculino
7.
J Cardiothorac Surg ; 14(1): 181, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31661002

RESUMO

BACKGROUND: Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. METHODS: We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring < 30 days and ≥ 30 days post-transplant. The survival function was calculated through the Kaplan-Meier estimator. Variables were analyzed using univariate and multivariate analysis. Statistical significance was defined as p < 0.05. RESULTS: There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). CONCLUSIONS: SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.


Assuntos
Gastroenteropatias/mortalidade , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/mortalidade , Complicações Pós-Operatórias/mortalidade , Adulto , Idoso , Comorbidade , Feminino , Gastroenteropatias/etiologia , Humanos , Estimativa de Kaplan-Meier , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade , Análise Multivariada , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida
9.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(9): 694-699, 2019 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-31484244

RESUMO

Objective: To investigate the incidence of venous thromboembolism (VTE) in lung transplant (LT) recipients. Methods: The clinical data on 124 consecutive patients who underwent lung transplant at Lung Transplantation Center of China-Japan Friendship Hospital from March 2017 to September 2018 were retrospectively collected. Deep venous thrombosis (DVT) was ascertained by vascular ultrasound. Pulmonary embolism (PE) was diagnosed by either chest computed tomography pulmonary angiogram or ventilation/perfusion scan. The risk factors in those patients with postoperative VTE were studied. Results: A total of 124 lung transplant recipients including 78 single lung transplant recipients (62.9%) and 46 bilateral lung transplant recipients(37.1%) were enrolled. Preoperative and postoperative prophylactic anticoagulant was used in 52 patients(52/124, 41.9%) and 69 patients(69/124, 55.6%) respectively. Thirty-two patients developed postoperative VTE among 124 consecutive patients. The overall incidence rate of VTE among 124 LT recipients was 25.8%. The median time to VTE episode following lung transplant was 22.5 days (range 4-295 days). The percentage of DVT in VTE was 93.8%(30/32), involving 1-8 (2.83±1.86) veins. And 60.0% of DVT was from lower extremities and 56.7% located in upper extremities (P>0.05). Four patients (4/32,12.5%) had PE episodes, and half of them suffered from only PE without DVT. The use of extracorporeal membrane oxygenation (ECMO) in 32 patients with VTE was 90.6% (29/32), which was significantly higher than that without VTE (64/92,69.6%, P=0.033). However, there was no difference in the use of peripherally inserted central catheter (PICC) between two groups (96.9% vs 81.5%, P=0.067). Resolution of VTE was successfully accomplished by anticoagulant therapy with long-term use of low molecular weight heparin in 30 patients (93.7%) and followed by oral warfarin in 2 patients (6.3%). Three months follow-up data after anticoagulant therapy showed that total and partial vascular recanalization rate was 65.6%(21/32) and 34.4%(11/32), respectively. Despite anticoagulation-related bleeding complications in three patients, no serious consequences occurred. Conclusions: VTE was frequent in LT recipients. It was speculated that ECMO utilization may be a major risk factor for high incidence of VTE in LT recipients. Aggressive VTE screening/treatment protocols were suggested to be implemented in LT recipients.


Assuntos
Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias , Tromboembolia Venosa/epidemiologia , Adulto , Anticoagulantes/administração & dosagem , China/epidemiologia , Humanos , Incidência , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia
10.
Transpl Infect Dis ; 21(5): e13163, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472083

RESUMO

We report three cases of hospital-acquired mucormycosis in heart and lung transplant patients over a 6-month period. Traditional epidemiological investigation tools were used to look for a common link between patients to explain the outbreak. Genome sequencing of each fungal strain was used to supplement the investigation. By disproving a close genetic link between infecting strains of mucormycosis, we were able to conclude the outbreak investigation. Genome sequencing is a novel tool that can be used in addition to traditional epidemiologic investigations to help determine linkage of patients during outbreak investigations.


Assuntos
Infecção Hospitalar/microbiologia , Surtos de Doenças/estatística & dados numéricos , Genoma Fúngico , Mucorales/genética , Mucormicose/microbiologia , Transplantados , Idoso , DNA Fúngico/genética , Transplante de Coração/efeitos adversos , Humanos , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Mucorales/classificação , Mucormicose/diagnóstico , Análise de Sequência de DNA
12.
Transplant Proc ; 51(6): 2009-2013, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399181

RESUMO

BACKGROUND: The aim of the study was to investigate the serum concentration of cytokines and biochemical markers of malnutrition in correlation with frailty syndrome in patients qualified for lung transplantation (LTx). METHODS: The study population comprised 31 potential lung recipients, including 18 patients with idiopathic lung disease, 12 patients with chronic obstructive pulmonary disease, and 1 patient with bronchiectasis who qualified for a LTx. Cytokine serum levels were assessed using commercially available enzyme-linked immunosorbent assay kits and the Luminex 200 platform (ProcartaPlex Hu Cytokine/Chemokine Panel 1A 34plex, Invitrogen, Carlsbad, Calif., United States). The patients were also asked to complete a questionnaire, the Clinical Frailty Scale. RESULTS: All patients were found to have higher cytokine concentrations (IL6, IL 2,IL18, IL23, IL 12p70, IL 10, IL 7). No statistically significant differences in the analyzed cytokines were noted when the men's results were compared to those of the women. There were no significant differences between patients who scored 6 vs 7 points on the Canadian Study of Health and Aging Function Scale. In comparing chronic obstructive pulmonary disease to idiopathic lung disease patients, no significant differences were observed in the analyzed cytokine values. Significant correlations were observed between the analyzed cytokines and age of the patients, C-reactive protein, triglycerides, transferrin, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. CONCLUSIONS: Our findings indicate that cytokines may not have a statistically significant effect on the parameters of the frailty syndrome. The results require further investigations on larger study groups. The findings suggest that the analyzed cytokines may play a proinflammatory role in the end stages of lung diseases, but further studies are needed to evaluate whether these cytokines could be used as biomarkers in this group of patients.


Assuntos
Citocinas/sangue , Fragilidade/sangue , Pneumopatias/sangue , Transplante de Pulmão/efeitos adversos , Desnutrição/sangue , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Canadá , HDL-Colesterol , Contraindicações de Procedimentos , Ensaio de Imunoadsorção Enzimática , Feminino , Fragilidade/complicações , Fragilidade/cirurgia , Humanos , Interleucina-10/sangue , Pulmão/fisiopatologia , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Desnutrição/complicações , Desnutrição/cirurgia , Pessoa de Meia-Idade , Seleção de Pacientes , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/cirurgia , Triglicerídeos/sangue , Adulto Jovem
13.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466976

RESUMO

We present a case of a high cardiac output (CO) arteriovenous fistula (AVF) with pulmonary hypertension (PH) post-double lung transplant presenting for AVF occlusion. The patient presented with a CO of 9.83 L/min, pulmonary artery pressures of 64/16, inferior vena cava dilatation and an AVF between the left common iliac artery and vein. Given her anaesthetic considerations, we elected to proceed with local anaesthesia and sedation. Trial balloon occlusion resulted in an increase in blood pressure and a headache that resolved with balloon deflation. Successful final occlusion with an endovascular stent was completed without adverse events. PH is a complex pathophysiology with the potential for catastrophic decompensation. Anaesthesiologists must consider a patient's comorbidities and the procedure to safely administer anaesthesia without complications.


Assuntos
Fístula Arteriovenosa/complicações , Insuficiência Cardíaca/etiologia , Transplante de Pulmão/efeitos adversos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Adulto , Angiografia , Fístula Arteriovenosa/terapia , Oclusão com Balão/métodos , Débito Cardíaco/fisiologia , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/complicações , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Diálise Renal , Stents , Resultado do Tratamento
14.
Transpl Infect Dis ; 21(5): e13141, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31283872

RESUMO

BACKGROUND: Scedosporium species and Lomentospora prolificans (S/L) are the second most common causes of invasive mold infections following Aspergillus in lung transplant recipients. METHODS: We assessed the current practices on management of S/L colonization/infection of the lower respiratory tract before and after lung transplantation in a large number of lung transplant centers through an international practice survey from October 2016 to March 2017. RESULTS: A total of 51 respondents from 45 lung transplant centers (17 countries, 4 continents) answered the survey (response rate 58%). S/L colonization was estimated to be detected in candidates by 48% of centers. Only 18% of the centers used a specific medium to detect S/L colonization. Scedosporium spp. colonization was a contraindication to transplantation in 10% of centers whereas L prolificans was a contraindication in 31%; 22% of centers declared having had 1-5 recipients infected with S/L in the past 5 years. CONCLUSIONS: This survey gives an overview of the current practices regarding S/L colonization and infection in lung transplant centers worldwide and underscores the need of S/L culture procedure standardization before implementing prospective studies.


Assuntos
Ascomicetos/isolamento & purificação , Gerenciamento Clínico , Hospedeiro Imunocomprometido , Transplante de Pulmão/efeitos adversos , Micoses/epidemiologia , Scedosporium/isolamento & purificação , Humanos , Internacionalidade , Micoses/etiologia , Estudos Prospectivos , Infecções Respiratórias/etiologia , Infecções Respiratórias/microbiologia , Inquéritos e Questionários
15.
Intern Med ; 58(21): 3133-3137, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292405

RESUMO

Patients with end-stage lung disease can undergo living-donor lobar lung transplantation (LDLLT), with survival rates improving every year. We herein report the 20-year follow-up findings of the first patient who underwent LDLLT in Japan. A 24-year-old woman with primary ciliary dyskinesia became ventilator-dependent after severe respiratory failure and right-sided heart failure following repeated respiratory infections. In 1998, she underwent LDLLT and received her sister's right lower lobe and her mother's left lower lobe. Although the patient required 21 hospitalizations and developed unilateral bronchiolitis obliterans syndrome, she is in good physical condition and lives without restriction at 20 years after undergoing LDLLT.


Assuntos
Transtornos da Motilidade Ciliar/cirurgia , Doadores Vivos , Transplante de Pulmão , Bronquiolite Obliterante/etiologia , Transtornos da Motilidade Ciliar/complicações , Feminino , Seguimentos , Volume Expiratório Forçado , Hospitalização/estatística & dados numéricos , Humanos , Japão , Pulmão/diagnóstico por imagem , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias , Radiografia Torácica , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , Resultado do Tratamento , Adulto Jovem
16.
Zhonghua Yi Xue Za Zhi ; 99(24): 1848-1852, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31269578

RESUMO

Objective: To analyze the incidence and influencing factors of venous thromboembolism (VTE) after lung transplantation. Methods: This study retrospectively analyzed the clinical data of 375 lung transplant patients from January 2015 to December 2017 in Wuxi People's Hospital. Every patient was classified into the VTE group or the non-VTE group according to whether the patient had VTE or not. Basic information like age, type of surgical procedure etc. was compared between two groups. The prevention and treatment of VTE between two groups were also compared. Furthermore, multivariate Logistic regression analysis was used to analyze the influence of related factors on the occurrence of postoperative VTE. Deep venous thrombosis (DVT) was diagnosed with vascular ultrasonography, and pulmonary thromboembolism (PTE) was diagnosed with CT pulmonary angiogram, nuclear ventilation/perfusion scanning, or pulmonary angiography. Results: This study included 316 lung transplant patients. VTE occurred in 19 patients (6.0%) during perioperative and follow-up period. The age of the VTE group was significantly higher than that of the non-VTE group (63.4±11.9 vs 54.3±13.0, P=0.003). The proportion of single lung transplantation in the VTE group was significantly higher than that in the non-VTE group (78.9% vs 48.5%, P=0.010). The incidence of VTE in patients without prevention was significantly higher than that in patients with prevention (15.0% vs 1.9%, P<0.001). Single lung transplantation (OR=4.425, P=0.018), duration in intensive care unit (ICU) (OR=1.396, P=0.001) and age (OR=1.080, P=0.005) were independent risk factors for VTE after lung transplantation. Conclusions: The incidence of VTE after lung transplantation is high. Single lung transplantation, prolonged duration of ICU stay and advanced age increase the risk of VTE after lung transplantation.


Assuntos
Transplante de Pulmão , Embolia Pulmonar , Tromboembolia Venosa , Humanos , Incidência , Transplante de Pulmão/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/etiologia
17.
Transpl Infect Dis ; 21(5): e13137, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267603

RESUMO

A 68-year-old man presented for outpatient evaluation of dyspnea and new-onset atrial fibrillation 9 months after undergoing bilateral lung transplantation. Echocardiography prior to cardioversion raised concern for tamponade. Therapeutic pericardiocentesis returned fluid containing 1875 wbc/mcl (68% pmn) and yielded Cryptococcus neoformans in culture. Cryptococcal antigen was detected in serum at a titer of 1:20. Cerebrospinal (CSF) fluid was without evidence of inflammation and without detectable cryptococcal antigen. There was no radiographic evidence of pulmonary cryptococcosis. Cultures of blood and CSF were without growth. Liposomal amphotericin B (3 mg/kg/day) was administered for 15 days. Oral fluconazole was added on day seven of amphotericin, and the patient was discharged to home 3 days later. Daily dosages of prednisone (10 mg), mycophenolate (500 mg), and tacrolimus (3 mg) at discharge were the same as at hospital admission. He was readmitted 12 days later with dyspnea and with re-accumulation and loculation of pericardial fluid. A pericardial window was created. Pericardial fluid contained 722 wbc/mcl (35% pmn); Cryptococcus was not identified on direct examinations or cultures of pericardial fluid or tissue. Cryptococcus antigen was present in serum at 1:160. Liposomal amphotericin B was resumed and continued for 2 weeks followed by resumption of fluconazole. Mycophenolate was stopped. Prednisone and tacrolimus were continued. Restrictive pericarditis was evident 3 weeks after window creation. Colchicine was initiated, prednisone increased to 15 mg daily and pericardiectomy planned. We aim to raise awareness to Cryptococcus as a potential etiology for pericarditis in solid organ transplant recipients.


Assuntos
Criptococose/diagnóstico , Transplante de Pulmão/efeitos adversos , Pericardite/microbiologia , Transplantados , Idoso , Antifúngicos/uso terapêutico , Antígenos de Fungos/líquido cefalorraquidiano , Criptococose/tratamento farmacológico , Cryptococcus neoformans/isolamento & purificação , Ecocardiografia , Humanos , Masculino , Pericardite/diagnóstico , Resultado do Tratamento
18.
J Thorac Cardiovasc Surg ; 157(5): 2096-2106, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31288367

RESUMO

OBJECTIVE: Lung transplantation is therapeutic for end-stage lung disease, but survival is limited due to bronchiolitis obliterans syndrome and restrictive chronic lung allograft dysfunction. We sought a common denominator in lung transplant recipients, analyzing risk factors that trigger immune responses that lead to bronchiolitis obliterans syndrome. METHODS: We collected blood from patients who underwent lung transplant at our institution. Exosomes were isolated from the sera of recipients with risk factors for chronic rejection and from stable recipients. Exosomes were analyzed with western blot, using antibodies to lung self-antigens K alpha 1 tubulin and collagen-V, costimulatory molecules (costimulatory molecule 80, costimulatory molecule 86), transcription factors (nuclear factor kappa-light-chain-enhancer of activated B cells, hypoxia-inducible factor 1α, Class II Major Histocompatibility Complex Transactivator), and 20S proteasome. RESULTS: Of the 90 patients included, we identified 5 with grade 3 primary graft dysfunction, 5 without, 15 with respiratory viral infection, 10 with acute rejection, 10 with donor-specific antibodies (DSA), 5 without DSA, and 10 who were stable for exosome isolation. Recipients with grade 3 primary graft dysfunction, respiratory viral infection, acute rejection, and DSA had exosomes containing self-antigens; exosomes from stable recipients did not. Exosomes from recipients with grade 3 primary graft dysfunction, acute rejection, and DSA also demonstrated costimulatory molecule 80, costimulatory molecule 86, major histocompatibility complex class II, transcription factor, and 20S proteasome. CONCLUSIONS: Transplanted lungs with grade 3 primary graft dysfunction, symptomatic respiratory viral infection, acute rejection, and immune responses induce exosomes that contain self-antigens, costimulatory molecules, major histocompatibility complex class II, transcription factors, and 20S proteasome. Release of circulating exosomes post-transplant from the aforementioned stress-inducing insults augment immunity and may play an important role in the pathogenesis of bronchiolitis obliterans syndrome.


Assuntos
Bronquiolite Obliterante/imunologia , Exossomos/imunologia , Rejeição de Enxerto/imunologia , Transplante de Pulmão/efeitos adversos , Disfunção Primária do Enxerto/imunologia , Infecções Respiratórias/imunologia , Doença Aguda , Adulto , Idoso , Autoantígenos/sangue , Autoantígenos/imunologia , Antígenos B7/sangue , Antígenos B7/imunologia , Biomarcadores/sangue , Bronquiolite Obliterante/sangue , Bronquiolite Obliterante/diagnóstico , Estudos de Casos e Controles , Linhagem Celular , Feminino , Rejeição de Enxerto/sangue , Rejeição de Enxerto/diagnóstico , Antígenos de Histocompatibilidade Classe II/sangue , Antígenos de Histocompatibilidade Classe II/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Primária do Enxerto/sangue , Disfunção Primária do Enxerto/diagnóstico , Complexo de Endopeptidases do Proteassoma/sangue , Complexo de Endopeptidases do Proteassoma/imunologia , Infecções Respiratórias/sangue , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia , Fatores de Risco , Fatores de Tempo , Fatores de Transcrição/sangue , Fatores de Transcrição/imunologia , Resultado do Tratamento
19.
BMC Gastroenterol ; 19(1): 137, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357954

RESUMO

BACKGROUND: The increasing life expectancy of individuals with Cystic Fibrosis (CF) is likely to be associated with new age-related challenges, colorectal cancer (CRC) most notably; recent consensus recommendations for CRC screening published in 2018 represent an important early step in addressing the emerging awareness of CF as a gastrointestinal cancer syndrome. These recommendations, however, need to be further refined based on more systematic data. We discuss an illustrative first-ever case of synchronous CRC arising in a post-lung transplant individual with CF within the recommended surveillance interval after a well-documented prior normal colonoscopy. CASE PRESENTATION: A 51-year-old female individual with homozygous F508del CF, presents to clinic with abdominal discomfort and intermittent blood in stools. She had previously undergone bilateral lung transplantation 18 years earlier, as well as two kidney transplants related to immunosuppression-related nephrotoxicity. A diagnostic colonoscopy was performed which revealed the presence of two separate synchronous colon cancers in the cecum and transverse colon; she had undergone a colonoscopy three years prior to this exam which was structurally normal. Endoscopic quality indicators, including a good quality bowel preparation, colonoscopic withdrawal time > 12 min, and quarterly Adenoma Detection Rate (ADR) ranging from 50 to 70% for both male and female patients for the endoscopist from both colonoscopic exams, as well as secondary retrospective comparative review of the pertinent case images, diminish the risk for a "missed" cancer or advanced lesion on the index exam. These cancers did not demonstrate any immunohistochemical features suggestive of Lynch Syndrome, though the rapid progression to cancer within the surveillance interval (possibly non-polypoid in nature) is similar. This cancer presentation within the newly-established recommended colon cancer screening interval warrants concern. CONCLUSIONS: This case prompts serious discussion regarding the length of surveillance intervals in the post-transplant CF population (a population at 20-30 times greater risk for CRC compared to the general non-CF population), as well as the importance of documenting endoscopic quality benchmarks, particularly if a narrative of interval CRC development continues to develop with further prospective monitoring and multi-center experience.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Colo/diagnóstico , Fibrose Cística/cirurgia , Detecção Precoce de Câncer/métodos , Transplante de Pulmão/efeitos adversos , Neoplasias Primárias Múltiplas/diagnóstico , Colonoscopia , Fibrose Cística/complicações , Feminino , Humanos , Pessoa de Meia-Idade
20.
Transplant Proc ; 51(6): 2035-2042, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303416

RESUMO

BACKGROUND: Mycobacterium abscessus (M abscessus) infection is a serious complication post-lung transplant (LTx). We examined determinants of outcomes in LTx recipients infected with M abscessus. METHODS: Electronic records of all patients who underwent LTx in a single transplant center between 2000 and 2015 were screened for isolation of M abscessus before or after LTx. RESULTS: Twenty-six cases of M abscessus isolation were identified. Twenty-four had M abscessus isolation post-LTx. Two had M abscessus isolated from a surgical site, while the others were pulmonary isolates. Out of these 22 with pulmonary isolates, 12 had clinical disease. In 73% of patients, treatment had to be temporarily held or switched due to intolerance and toxicity. There was a statistically significant worsening in survival in those who developed clinical disease compared to matched controls. Among the 12 patients with clinical pulmonary disease, use of clofazimine was significantly associated with a favorable outcome. Six patients had M abscessus isolation pretransplant. Four developed M abscessus recurrence at a median of 2 months post-LTx. Two recurrences were surgical site infections, and 2 were pulmonary infections. CONCLUSION: M abscessus infection is difficult to treat as tolerance to medications used is poor. M abscessus pneumonia is associated with worse survival post-LTx. Use of clofazimine is associated with 1-year infection-free survival.


Assuntos
Transplante de Pulmão/efeitos adversos , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/etiologia , Adulto , Antibacterianos/uso terapêutico , Clofazimina/uso terapêutico , Feminino , Humanos , Transplante de Pulmão/mortalidade , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Mycobacterium abscessus , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Infecções Respiratórias/microbiologia , Centros de Atenção Terciária , Transplantados
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