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1.
Medicine (Baltimore) ; 99(46): e22427, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181640

RESUMO

There is paucity of data on the impact of surgical incision and analgesia on relevant outcomes.A retrospective STROBE-compliant cohort study was performed between July 2007 and August 2017 of patients undergoing lung transplantation. Gender, age, indication for lung transplantation, and the 3 types of surgical access (Thoracotomy (T), Sternotomy (S), and Clamshell (C)) were used, as well as 2 analgesic techniques: epidural and intravenous opioids. Outcome variables were: pain scores; postoperative hemorrhage in the first 24 hours, duration of mechanical ventilation, and length of stay at intensive care unit (ICU).Three hundred forty-one patients were identified. Thoracotomy was associated with higher pain scores than Sternotomy (OR 1.66, 95% CI: 1.01; 2.74, P: .045) and no differences were found between Clamshell and Sternotomy incision. The median blood loss was 800 mL [interquartile range (IQR): 500; 1238], thoracotomy patients had 500 mL [325; 818] (P < .001). Median durations of mechanical ventilation in Thoracotomy, Sternotomy, and Clamshell groups were 19 [11; 37] hours, 34 [IQR 16; 57.5] hours, and 27 [IQR 15; 50.5] hours respectively. Thoracotomy group were discharged earlier from ICU (P < .001).Thoracotomy access produces less postoperative hemorrhage, duration of mechanical ventilation, and lower length of stay in ICU, but higher pain scores and need for epidural analgesia.


Assuntos
Analgesia/normas , Transplante de Pulmão/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Esternotomia/efeitos adversos , Toracotomia/efeitos adversos , Administração Intravenosa/normas , Administração Intravenosa/estatística & dados numéricos , Adulto , Idoso , Analgesia/estatística & dados numéricos , Analgesia Epidural/normas , Analgesia Epidural/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Transplante de Pulmão/normas , Transplante de Pulmão/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Estatísticas não Paramétricas , Esternotomia/métodos , Esternotomia/estatística & dados numéricos , Toracotomia/métodos , Toracotomia/estatística & dados numéricos , Resultado do Tratamento
2.
BMC Infect Dis ; 20(1): 689, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32957986

RESUMO

BACKGROUND: The effect of donor lung colonized bacteria on the prognosis of lung transplantation is not clear. We used the technique of next-generation sequencing (NGS) to detect the colonized bacteria from the lower respiratory tract and analyzed whether the colonized bacteria of donor lung could affect the outcomes of lung transplantation. METHODS: Seventeen patients who underwent lung transplantation from March 2018 to June 2018 at Wuxi People's Hospital affiliated to Nanjing Medical University were included in this study. Twelve cases of donor lung were obtained, and 17 lung transplants were performed, including 12 single lung transplantation and 5 bilateral lung transplantation. The colonized bacteria in the lower lobe tissue of donor lung were detected by NGS, and the bacteria culture method was used to detect the bacteria in the airway secretion before and after the operation. The information of length of extracorporeal membrane oxygenation (ECMO) support, mechanical ventilation time, length of intensive care unit (ICU) stay, duration of fever and length of hospital stay were collected for prognostic analysis. RESULTS: Compared with bacterial culture methods, the positive rate by using NGS in the lungs were higher (52.9% vs 41.2%). Among the patients who were transplanted with donor lungs with detected bacteria by NGS before surgery, only one patient (1/9) developed the same bacteria after lung transplantation. Based on results of NGS and bacterial culture, there was no association between the colonized bacteria in donor lungs and the patients' outcomes of immediate posttransplant period. CONCLUSION: NGS showed more sensitive than bacterial culture for detection of bacteria. The colonized bacteria in different parts of the lung are inconsistent. There is no association between the colonized bacteria in donor lungs and short-term outcome of lung transplantation patients.


Assuntos
Bactérias/genética , Transplante de Pulmão/efeitos adversos , Pulmão/microbiologia , Adulto , Idoso , Bactérias/isolamento & purificação , Oxigenação por Membrana Extracorpórea , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Transplante de Pulmão/métodos , Transplante de Pulmão/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Respiração Artificial , Doadores de Tecidos , Transplantados , Resultado do Tratamento
5.
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
6.
Transplantation ; 104(9): 1899-1905, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32502131

RESUMO

BACKGROUND: Primary graft dysfunction and allograft rejection represent major caveats to successful lung transplantation. Reducing inflammation in donor lungs before transplantation may improve outcomes. Evidence exists that ex vivo lung perfusion (EVLP) can alter the donor lung environment, although the mechanisms remain unclear. This study aimed to characterize the inflammatory signaling profile of the lung following standard and EVLP transplant and delineate the immediate impact on the recipient circulation. METHODS: Female recipient pigs (n = 12) were randomized to undergo left lung transplantation from male donors either using the gold standard protocol (static cold storage) or following 3 hours of EVLP. The relative phosphorylation of 44 phosphokinases and the relative expression of 35 apoptosis-related molecules were profiled within the donor lung 24 hours posttransplantation. RESULTS: A global profile of mitochondrial salvage and cell survival was observed in the EVLP lung tissue compared with lungs undergoing standard transplantation. This included increased phosphorylation of downstream prosignaling kinases, including ERK1/2 and FAK. In addition, there was upregulated expression of the antiapoptotic proteins Bcl-2, HSP-70, LIVIN, and PON2 with downregulation of apoptosis inducing mitochondrial associated molecules, including clusterin, cytochrome C, and HTRA2/OMI. In the early postoperative period, there were significantly lower levels of circulating mitochondrial DNA in recipients receiving EVLP lungs compared with a standard transplant (P = 0.016). Genomic DNA did not differ between groups, with donor DNA undetectable at all time points. CONCLUSIONS: EVLP alters the inflammatory signaling profile of the donor lung before transplantation, with a global cell survival and antiapoptotic signature.


Assuntos
Inflamação/prevenção & controle , Transplante de Pulmão/métodos , Pulmão/metabolismo , Preservação de Órgãos/métodos , Perfusão/métodos , Doadores de Tecidos , Animais , DNA Mitocondrial/sangue , Feminino , Masculino , Proteoma , Transdução de Sinais/fisiologia , Suínos
7.
Am J Respir Cell Mol Biol ; 63(4): 490-501, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32551854

RESUMO

Telomere dysfunction is associated with multiple fibrotic lung processes, including chronic lung allograft dysfunction (CLAD)-the major limitation to long-term survival following lung transplantation. Although shorter donor telomere lengths are associated with an increased risk of CLAD, it is unknown whether short telomeres are a cause or consequence of CLAD pathology. Our objective was to test whether telomere dysfunction contributes to the pathologic changes observed in CLAD. Histopathologic and molecular analysis of human CLAD lungs demonstrated shortened telomeres in lung epithelial cells quantified by teloFISH, increased numbers of surfactant protein C immunoreactive type II alveolar epithelial cells, and increased expression of senescence markers (ß-galactosidase, p16, p53, and p21) in lung epithelial cells. TRF1F/F (telomere repeat binding factor 1 flox/flox) mice were crossed with tamoxifen-inducible SCGB1a1-cre mice to generate SCGB1a1-creTRF1F/F mice. Following 9 months of tamoxifen-induced deletion of TRF1 in club cells, mice developed mixed obstructive and restrictive lung physiology, small airway obliteration on microcomputed tomography, a fourfold decrease in telomere length in airway epithelial cells, collagen deposition around bronchioles and adjacent lung parenchyma, increased type II aveolar epithelial cell numbers, expression of senescence-associated ß-galactosidase in epithelial cells, and decreased SCGB1a1 expression in airway epithelial cells. These findings demonstrate that telomere dysfunction isolated to airway epithelial cells leads to airway-centric lung remodeling and fibrosis similar to that observed in patients with CLAD and suggest that lung epithelial cell telomere dysfunction may be a molecular driver of CLAD.


Assuntos
Aloenxertos/patologia , Células Epiteliais Alveolares/patologia , Pulmão/fisiologia , Telômero/genética , Aloenxertos/metabolismo , Células Epiteliais Alveolares/metabolismo , Animais , Biomarcadores/metabolismo , Senescência Celular/genética , Humanos , Pulmão/metabolismo , Transplante de Pulmão/métodos , Camundongos , Fibrose Pulmonar/genética , Fibrose Pulmonar/metabolismo , Fibrose Pulmonar/patologia , Uteroglobina/genética , Uteroglobina/metabolismo
8.
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
9.
Surg Today ; 50(7): 633-643, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32363425

RESUMO

Lung transplantation is currently the only curative treatment for patients with end-stage lung disease; however, donor organ shortage and the need for intense immunosuppression limit its broad clinical application. Bioartificial lungs created by combining native matrix scaffolds with patient-derived cells might overcome these problems. Decellularization involves stripping away cells while leaving behind the extracellular matrix scaffold. Cadaveric lungs are decellularized by detergent perfusion, and histologic examination confirms the absence of cellular components but the preservation of matrix proteins. The resulting lung scaffolds are recellularized in a bioreactor that provides biomimetic conditions, including vascular perfusion and liquid ventilation. Cell seeding, engraftment, and tissue maturation are achieved in whole-organ culture. Bioartificial lungs are transplantable, similarly to donor lungs, because the scaffolds preserve the vascular and airway architecture. In rat and porcine transplantation models, successful anastomoses of the vasculature and the airway were achieved, and gas exchange was evident after reperfusion. However, long-term function has not been achieved because of the immaturity of the vascular bed and distal lung epithelia. The goal of this strategy is to create patient-specific transplantable lungs using induced pluripotent stem cell (iPSC)-derived cells. The repopulation of decellularized scaffolds to create transplantable organs is one of possible future clinical applications of iPSCs.


Assuntos
Órgãos Bioartificiais , Matriz Extracelular , Transplante de Pulmão/métodos , Pulmão/fisiologia , Células-Tronco Pluripotentes , Regeneração , Engenharia Tecidual/métodos , Tecidos Suporte , Animais , Humanos , Transplante de Pulmão/tendências , Modelos Animais , Perfusão , Ratos , Suínos
10.
Ann Thorac Surg ; 110(4): 1167-1174, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32380057

RESUMO

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is commonly used during double-lung transplantation. ECMO can be planned or unplanned, and used only during the procedure or extended postoperatively (intraoperative or extended). Our practice is to limit its use and duration as much as possible. We conducted this retrospective single-center study to assess prognoses of patients undergoing unplanned-intraoperative ECMO. METHODS: From among 436 patients who underwent double-lung transplantation from 2012 to 2018, we excluded those who underwent bridge-to-transplantation, multiorgan transplantation, repeated transplantation during the study period, and cardiopulmonary bypass. Unplanned-intraoperative ECMO group was compared with no-ECMO and planned-intraoperative ECMO groups. RESULTS: In our sample, 209 patients did not require ECMO, 77 underwent unplanned-intraoperative ECMO, and 14 underwent planned-intraoperative ECMO. One-year and 3-year survival were lower in unplanned-intraoperative ECMO group than in the no-ECMO group (P = .043 and P = .032, respectively). The only independent protective factor related to 1-year mortality was history of cystic fibrosis (P = .013). Lung allocation score (P = .001), grade 3 pulmonary graft dysfunction at end-surgery status (P = .014), and estimated intraoperative blood loss (P = .031) were risk factors. CONCLUSIONS: Patients who underwent unplanned-intraoperative ECMO showed poorer prognoses than patients who did not require ECMO. This finding may be explained by differences in initial condition severity, by long-term consequences of the intraoperative complications leading to ECMO pump implantation, or by flaws in our weaning protocol.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Cuidados Intraoperatórios/métodos , Transplante de Pulmão/métodos , Suspensão de Tratamento , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
11.
Ann Thorac Surg ; 110(4): 1175-1184, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32360877

RESUMO

BACKGROUND: No clinically validated tool exists to predict in-hospital mortality in patients requiring extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation. We generated a quantitative risk assessment tool for these patients. METHODS: Of 822 patients in the United Network for Organ Sharing (UNOS) database who required ECMO as bridge to lung transplant between 2004 and 2018, 630 were included in the analysis after exclusion for age <18 years, prior transplant, or treatment before 2004. Recipient-specific variables associated with posttransplant in-hospital mortality were incorporated into a multivariable logistic regression model in an automated stepwise fashion. Linear prediction was used to construct the Recipient Stratification Risk Analysis in Bridging Patients to Lung Transplant on ECMO (STABLE) score. K-fold cross-validation provided an unbiased estimate of out-of-sample performance. After further exclusion for University of Pennsylvania patients, the remaining cohort was used for external score validation. An iOS application was developed to aid clinical use. RESULTS: Six recipient-specific, pretransplant variables were translated into a 24-point score. STABLE scores in the United Network for Organ Sharing (UNOS) database ranged from 0 to 21, and each point increased the odds of in-hospital mortality by 22.0% (95% confidence interval, 1.14-1.29, P < .001). K-fold cross-validation yielded a receiver operating characteristic area under the curve of 86.2%. Validation of the STABLE score using our institutional database yielded an area under the curve of 89%. CONCLUSIONS: The STABLE score is a novel, internally cross-validated tool for risk stratification of patients on ECMO as a bridge to transplant. Its predictive power and accuracy may aid clinical decision-making and improve posttransplant outcomes.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Transplante de Pulmão/métodos , Medição de Risco/métodos , Adulto , Idoso , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Transplante de Pulmão/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Estados Unidos/epidemiologia
12.
Am J Respir Crit Care Med ; 202(6): 843-852, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32437637

RESUMO

Rationale: Pulmonary hypertension (PH) associated with neurofibromatosis type 1 (NF1) is a rare and largely unknown complication of NF1.Objectives: To describe characteristics and outcomes of PH-NF1.Methods: We reported the clinical, functional, radiologic, histologic, and hemodynamic characteristics, response to pulmonary arterial hypertension (PAH)-approved drugs, and transplant-free survival of patients with PH-NF1 from the French PH registry.Measurements and Main Results: We identified 49 PH-NF1 cases, characterized by a female/male ratio of 3.9 and a median (minimum-maximum) age at diagnosis of 62 (18-82) years. At diagnosis, 92% were in New York Heart Association functional class III or IV. The 6-minute-walk distance was 211 (0-460) m. Pulmonary function tests showed low DlCO (30% [12-79%]) and severe hypoxemia (PaO2 56 [38-99] mm Hg). Right heart catheterization showed severe precapillary PH with a mean pulmonary artery pressure of 45 (10) mm Hg and a pulmonary vascular resistance of 10.7 (4.2) Wood units. High-resolution computed tomography images revealed cysts (76%), ground-glass opacities (73%), emphysema (49%), and reticulations (39%). Forty patients received PAH-approved drugs with a significant improvement in functional class and hemodynamic parameters. Transplant-free survival at 1, 3, and 5 years was 87%, 54%, and 42%, respectively, and four patients were transplanted. Pathologic assessment showed nonspecific interstitial pneumonia and major pulmonary vascular remodeling.Conclusions: PH-NF1 is characterized by a female predominance, a low DlCO, and severe functional and hemodynamic impairment. Despite a potential benefit of PAH treatment, prognosis remains poor, and double-lung transplantation is an option for eligible patients.


Assuntos
Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/cirurgia , Neoplasias Pulmonares/fisiopatologia , Neurofibromatose 1/complicações , Neurofibromatose 1/genética , Neurofibromina 1/genética , Adolescente , Adulto , Feminino , França , Humanos , Hipertensão Pulmonar/etiologia , Transplante de Pulmão/métodos , Masculino , Pessoa de Meia-Idade , Fenótipo , Prognóstico , Adulto Jovem
13.
Am J Transplant ; 20(10): 2933-2937, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32400074

RESUMO

Coronavirus disease 2019 (COVID-19) has been declared pandemic since March 2020. In Europe, Italy was the first nation affected by this infection. We report anamnestic data, clinical features, and therapeutic management of 2 lung transplant recipients with confirmed COVID-19 pneumonia. Both patients were in good clinical condition before the infection and were receiving immunosuppression with calcineurin inhibitors (CNI), mycophenolate mofetil, and corticosteroids. Whereas mycophenolate mofetil was withdrawn in both cases, CNI were suspended only in the second patient. The first patient always maintained excellent oxygen saturation throughout hospitalization with no need for additional oxygen therapy. He was discharged with a satisfactory pulmonary function and a complete resolution of radiological and clinical findings. However, at discharge SARS-CoV-2 RNA could still be detected in the nasopharyngeal swab and in the stools. The second patient required mechanical ventilation, had a progressive deterioration of his clinical conditions, and had a fatal outcome. Further insight into SARS-CoV-2 infection is eagerly awaited to improve the outcome of transplant recipients affected by COVID-19 pneumonia.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Transplante de Pulmão/métodos , Pneumonia Viral/diagnóstico , Transplantados , Idoso , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Fibrose Cística/cirurgia , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Período Pós-Operatório , Doença Pulmonar Obstrutiva Crônica/cirurgia , Respiração Artificial , Tomografia Computadorizada por Raios X
14.
Transplant Proc ; 52(5): 1384-1387, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32299703

RESUMO

Kartagener syndrome (KS) is a rare congenital disorder related to bronchiectasis, chronic sinusitis, and situs inversus, predisposing patients to recurrent respiratory infections that can evolve to end-stage lung disease; lung transplantation (LTx) is one of the therapeutic options. This study highlights some concerns in this group of patients, mainly related to the difficulty of performing the transplantation in recipients with suppurative disease and situs inversus. We conducted a retrospective analysis of all KS patients who underwent LTx at 2 national reference centers by the same LTx team. During 29 years of analysis, we performed 12 cases of bilateral sequential LTx in KS patients, representing 2.4% of all Ltx that we performed. Special perioperative care is needed, including vascular access sites and lung isolation techniques; operative concerns include the arteriotomy and bronchotomy during the back table preparation of the graft and concern about the length of the arterial and bronchial anastomosis. We found a higher incidence of bronchial complications is this group that had not been previously reported. Bilateral sequential orthotopic LTx is feasible in this group of patients, and more studies are needed to understand possible reasons for the apparent higher incidence of bronchial complications.


Assuntos
Síndrome de Kartagener/cirurgia , Transplante de Pulmão/métodos , Adulto , Feminino , Humanos , Síndrome de Kartagener/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Curr Opin Organ Transplant ; 25(3): 299-304, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32332198

RESUMO

PURPOSE OF REVIEW: The majority of lung transplants (LT) performed are in developed countries. In contrast, little is known about the status of LT in developing nations. The objective is to summarize the challenges, present solutions, and review outcomes of LT in developing countries. We hope this review will guide healthcare providers in such countries that are contemplating embarking on this journey. RECENT FINDINGS: The key challenges that programs in developing countries encountered included shortage and marginal quality of donated organs, lack of dedicated multi-disciplinary LT team, limited availability of advanced technology and high risk of post-transplant infections. Education and collaboration among government, public, and healthcare sectors was seen as fundamental to building and maintaining a successful program. Despite minimal resources and huge challenges, LT survival rates in developing countries improved and were comparable with outcomes reported by the International Society for Heart and Lung Transplantation (ISHLT) Registry. SUMMARY: Starting a new LT program is a daunting task that is complex and resource intensive, especially in developing countries. Improving outcomes indeed provide impetus to continue to persevere in this endeavor with support from all sectors. The findings presented here could help new programs to better anticipate and tackle challenges.


Assuntos
Transplante de Pulmão/métodos , Países em Desenvolvimento , Humanos , Sistema de Registros
17.
Ann Thorac Surg ; 110(4): e285-e287, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32224244

RESUMO

Use of prone positioning during ex vivo lung perfusion (EVLP) with the Toronto protocol reduced pulmonary edema in marginal human donor lungs. This report describes 2 cases in which prone positioning during EVLP significantly reduced lung weight. One of the 2 cases resulted in successful double-lung transplantation.


Assuntos
Transplante de Pulmão/métodos , Pulmão/fisiologia , Pulmão/cirurgia , Perfusão/métodos , Cuidados Pré-Operatórios/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Decúbito Ventral , Resultado do Tratamento , Adulto Jovem
18.
Ann Palliat Med ; 9(2): 359-367, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32233631

RESUMO

BACKGROUND: To establish a stable ex vivo lung perfusion (EVLP) model and determine the preservation effect of the EVLP technique on donor lungs in vitro. METHODS: EVLP was performed on nonacceptable human donor and porcine lungs, and during perfusion, the oxygenation index was assessed and blood gas analysis was performed. RESULTS: After 4 h of EVLP of nonacceptable human donor and porcine lungs, lung function parameters remained stable, and lung energy metabolism was improved to a certain extent. CONCLUSIONS: EVLP can suitably maintain donor lungs in vitro for transplantation and is an effective method for ex vivo preservation of donor lungs.


Assuntos
Transplante de Pulmão/métodos , Perfusão/métodos , Obtenção de Tecidos e Órgãos/métodos , Animais , Humanos , Soluções para Preservação de Órgãos , Preservação Biológica , Suínos , Coleta de Tecidos e Órgãos/métodos
19.
Curr Opin Organ Transplant ; 25(3): 293-298, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32304424

RESUMO

PURPOSE OF REVIEW: Lung transplantation (LTx) is a worthwhile treatment for children with end-stage lung diseases who have no practicable medical or surgical solutions. But the long-term survival remains the lowest in all solid-organ transplant, with a median survival of 5.7 years, limited by the onset of chronic lung allograft dysfunction (CLAD). This reviews a recent publication in pediatric patients that focuses on translational regulation by microRNA. RECENT FINDINGS: The mechanisms that cause transplanted lung allografts have been difficult to identify. This review discusses pertinent findings in the first and largest observational prospective study of pediatric lung transplant recipients. The review discusses the relevance of microRNA that distinguish stable patients from those who can be predicted to display graft dysfunction on a molecular panel. SUMMARY: The article under review detected highly specific and sensitive markers of both acute rejection and CLAD in pediatric LTx recipients. With the use of next-generation sequencing techniques, biomarkers may soon provide the basis for earlier detection of graft function and stimulate development of therapeutic interventions to impact outcomes and survival. The review touches on the relevance of these findings and how future research can build on them.


Assuntos
Aloenxertos/transplante , Transplante de Pulmão/métodos , MicroRNAs/metabolismo , Transplantados/estatística & dados numéricos , Criança , Doença Crônica , Feminino , Humanos , Masculino , Estudos Prospectivos , Estudos Retrospectivos
20.
Curr Opin Organ Transplant ; 25(3): 280-284, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32304425

RESUMO

PURPOSE OF REVIEW: Despite an increase in lung transplantation globally, the waitlist mortality persists due to organ shortage. In order to keep up with the demand, the marginal lung donor criteria need to be revisited. The goal of this review is to redefine the lung donor criteria based on the most recent data. RECENT FINDINGS: Recent evidence indicates that lungs from donor with traditional extended criteria such as, age more than 55, PaO2/FiO2 threshold of less than 300, ischemia time more than 6 h, positive sputum microbiology, abnormal radiography no longer represent contraindications to lung transplantation by themselves. In addition, the introduction of new antiviral agents, organs from Hepatitis C positive donors, though not extended in the traditional sense, have shown positive outcomes. SUMMARY: The decision to use such organs, including those with smoking history, should be taken in totality weighing both donor and recipient characteristics. Hence, authors would advocate removing the term 'marginal' or 'extended' from lung donor criteria.


Assuntos
Transplante de Pulmão/métodos , Doadores de Tecidos/estatística & dados numéricos , Humanos , Transplante de Pulmão/mortalidade , Resultado do Tratamento
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