Characteristics of Lung Allocation and Outcomes of Lung Transplant according to the Korean Urgency Status

PURPOSE: We investigated the characteristics of lung allocation and outcomes of lung transplant (LTx) according to the Korean urgency status. MATERIALS AND METHODS: LTx registration in the Korean Organ Transplantation Registry (KOTRY) began in 2015. From 2015 to June 2017, 86 patients who received LTx were enrolled in KOTRY. After excluding one patient who received a heart-lung transplant, 85 were included. Subjects were analyzed according to the Korean urgency status. RESULTS: Except for Status 0, urgency status was classified based on partial pressure of oxygen in arterial blood gas analysis and functional status in 52 patients (93%). The wait time for lung allograft was well-stratified by urgency (Status 0, 46.5±59.2 days; Status 1, 104.4±98.2 days; Status 2 or 3, 132.2±118.4 days, p=0.009). Status 0 was associated with increased operative times and higher intraoperative blood transfusion. Status 0 was associated with prolonged extracorporeal membrane oxygenation use, postoperative bleeding, and longer mechanical ventilation after operation. Survival of Status 0 patients seemed worse than that of non-Status 0 patients, although differences were not significant. CONCLUSION: The Korean urgency classification for LTx is determined by using very limited parameters and may not be a true reflection of urgency. Status 0 patients seem to have poor outcomes compared to the other urgency status patients, despite having the highest priority for donor lungs. Further multi-center and nationwide studies are needed to revise the lung allocation system to reflect true urgency and provide the best benefit of lung transplantation.ope

Lung Cancer in the Explanted Lung of the Recipient in Lung Transplantation

Undetected lung cancer in the explanted lungs may significantly complicate the outcome of a patient following lung transplantation. The incidence and survival of undetected primary lung cancer in the explanted lungs have not been studied in a large cohort of patients. We have experienced a 63 year old male with a diagnosis of idiopathic pulmonary fibrosis who underwent bilateral sequential single lung transplantation in whom primary lung cancer was detected in the explanted lung of the recipient. A retrospective review of all radiological imaging study was correlated with the pathology of the explanted lung in order to localize the primary focus of the tumor. The patient was diagnosed as squamous cell carcinoma, stage IIIA (T1N2M0). This patient is currently under the close surveillance, and we recommend computerized tomograms of the chest immediately prior to lung transplantation in order to avoid the incidence of undetected primary lung cancer.ope

Current perspective of lung transplantation

Lung transplantation has become the standard of care for select patients with advanced lung diseases of various etiologies. A relatively scarce donor pool limits wider application of lung transplantation. Donor selection criteria, donor management protocols, and improvement in postoperative management have lead to improved overall survival with a median survival rate of 5.7 years. Bilateral lung transplantation has become the procedure of choice for most indications due to significantly better long term survival, especially in patients younger than 60 years. Proper management of donor organs may increase the utilization rate of scarce organs and through the increasing number of lung transplantation and improvement in postoperative management, many patients on the waiting list may achieve a new life after lung transplantation with excellent quality of life and long term survival.ope

고령의 식도암 환자에서 다빈치 S 로봇을 이용한 식도 절제술

The postoperative respiratory complications such as pneumonia and ARDS, are poor prognostic factors after esophagectomy in patients with esophageal cancer. To avoid these complications, there have been attempts to use minimally invasive approach. Recently introduced daVinciTM S surgical system is used in esophagectomy because of its advantages of minimal invasiveness, clear 3-dimensional imaging and precise handling of robotic arms. We report a 83-year-old esophageal cancer patient who underwent daVinciTMS robot-assisted esophagectomy, laparoscopic stomach mobilization followed by cervical esophagogastrostomy.ope

Design and Methods of the Korean Organ Transplantation Registry

BACKGROUND: Beneficial aspects of solid organ transplantation, which encompass survival benefit, improved quality of life, and cost efficacy, have been clearly demonstrated. However, regional and ethnic differences require further studies to identify prognostic factors and transplant outcomes against various backgrounds. After previous efforts of a nationwide, retrospective study on the kidney transplant outcomes in Korea, a new prospective-designed version of the Korean Organ Transplantation Registry (KOTRY) was launched in 2014. METHODS: Cohorts of kidney, liver, heart, lung, and pancreas transplantation were developed. Data on demographics, comorbid conditions, laboratory tests, including tissue typing and panel reactive antibody tests, immunosuppressive regimen followed, concentration and dosage of immunosuppressants, allograft rejection type, infectious events, cardiovascular outcomes, malignancies, donor comorbidity, and outcomes of living donors are collected. Longitudinal data collection is based on a regular annual interval, and blood samples are collected before organ transplantation and again at 1 and 3 years posttransplantation. To enhance data quality, a predefined data verification system operates on a Web-based database, and transplant center users receive regular education about updates. Data are cleansed thrice a year, and feedback given to centers about outlier values and missing data. Annual auditing is conducted. RESULTS: Currently, 59 centers are participating in KOTRY. The estimated annual enrollment is more than 2000 cases. CONCLUSIONS: KOTRY, as a systematic Korean transplant cohort, is expected to provide important information on Asian organ transplantation. The processes used to establish KOTRY provide a good model for launching new nationwide transplant cohort studies.ope

Pleuropneumonectomy in a Patient With Acquired Immune Deficiency Syndrome and Lung Abscess

A 54-year-old homosexual man was diagnosed as human immunodeficiency virus-1-positive in 1992. He was admitted to a tertiary hospital in March, 2000 because of right flank pain, fever and intermittent cough. A chest roentgenogram showed right-sided pleural effusion, and closed thoracostomy was performed for drainage Salmonella species and Escherichia coli were isolated from the pleural fluid. In spite of 6 weeks of antibiotic treatment, fever did not subside and the general condition gradually deteriorated, and under the diagnosis of lung abscess with empyema thoracis, right pleuropneumonectomy was performed. The general condition improved postoperatively until day 10 when he showed sudden change in mental status to stuporous and developed focal seizure. Brain CT showed multiple abscesses in right frontal and left frontotemporal lobes and he expired on postoperative day 14.ope

Thoracoscopic Sympathetic Nerve Reconstruction with using an Intercostal Nerve Graft after Thoracoscopic Sympathetic Clipping for Facial Hyperhidrosis

From October 2005 to August 2006, sympathetic nerve reconstruction with using the intercostal nerve was per- formed in 4 patients with severe compensatory hyperhidrosis following thoracoscopic sympathetic surgery for facial hyperhidrosis. The interval between the initial sympathetic clipping and the sympathetic nerve reconstruction was a median of 23.1 months. The compensatory sweating after sympathetic nerve reconstruction was improved for 2 pa- tients, but it was not improved for 2 patients. Thoracoscopic sympathetic nerve reconstruction may be one of the useful treatment methods for the patients with severe compensatory hyperhidrosis after they under go sympathetic nerve surgery for hyperhidrosis. (ope

Surgery for Lung Metastases from Colorectal Cancer

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Impact of idiopathic pulmonary fibrosis on recurrence after surgical treatment for stage I-III non-small cell lung cancer

Background: Idiopathic pulmonary fibrosis (IPF) is an independent risk factor for lung cancer (LC) development; however, its effect on recurrence after curative surgery remains unclear. Objectives: This study aimed to determine the impact of IPF on recurrence-free survival following curative surgical resection of stage I-III non-small cell lung cancer (NSCLC) and investigate the effects of patient and surgical factors on the risk of recurrence. Methods: We reviewed retrospectively collected data of patients with surgically resected stage I-III NSCLC from two tertiary care hospitals in South Korea. By propensity score matching, patients with IPF (LC with IPF) were matched to those without IPF (LC without IPF). Results: In total, 3416 patients underwent surgical resection, and 96 were diagnosed with underlying IPF. In the LC with IPF group, 89.6% patients were men, and the average age was 69.7 years. Sublobar resection was performed more frequently in the LC with IPF group than in the LC without IPF group, while the rate of mediastinal lymph node dissection and dissected node number were lower in the former group. The 5-year recurrence-free survival rate was significantly lower in the LC with IPF group (49.2%) than in the LC without IPF group (69.1%; P<0.001). Multivariable Cox regression analysis revealed that IPF and postoperative stage III were independent risk factors for recurrence. Conclusions: IPF may increase the risk of recurrence after curative surgical treatment for NSCLC. Close surveillance for recurrence is mandatory for patients with underlying IPF.ope

Extracorporeal membrane oxygenation as a bridge to lung transplantation: analysis of Korean organ transplantation registry (KOTRY) data

Background: The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation has greatly increased. However, data regarding the clinical outcomes of this approach are lacking. The objective of this multicenter prospective observational cohort study was to evaluate lung transplantation outcomes in Korean Organ Transplantation Registry (KOTRY) patients for whom ECMO was used as a bridge to transplantation. Methods: Between March 2015 and December 2017, a total of 112 patients received lung transplantation and were registered in the KOTRY, which is a prospective, multicenter cohort registry. The entire cohort was divided into two groups: the control group (n = 85, 75.9%) and bridge-ECMO group (n = 27, 24.1%). Results: There were no significant differences in pre-transplant and intraoperative characteristics except for poorer oxygenation, more ventilator use, and longer operation time in the bridge-ECMO group. The prevalence of primary graft dysfunction at 0, 24, 48, and 72 h after transplantation did not differ between the two groups. Although postoperative hospital stays were longer in the bridge-ECMO group than in the control group, hospital mortality did not differ between the two groups (25.9% vs. 13.3%, P = 0.212). The majority of patients (70.4% of the bridge-ECMO group and 77.6% of the control group) were discharged directly to their homes. Finally, the use of ECMO as a bridge to lung transplantation did not significantly affect overall survival and graft function. Conclusions: Short- and long-term post-transplant outcomes of bridge-ECMO patients were comparable to recipients who did not receive ECMO.ope