Postresectional lung injury in thoracic surgery pre and intraoperative risk factors: a retrospective clinical study of a hundred forty-three cases

<p>Abstract</p> <p>Introduction</p> <p>Acute respiratory dysfunction syndrome (ARDS), defined as acute hypoxemia accompanied by radiographic pulmonary infiltrates without a clearly identifiable cause, is a major cause of morbidity and mortality after pulmonary resection. The aim of the study was to determine the pre and intraoperative factors associated with ARDS after pulmonary resection retrospectively.</p> <p>Methods</p> <p>Patients undergoing elective pulmonary resection at Adnan Menderes University Medical Faculty Thoracic Surgery Department from January 2005 to February 2010 were included in this retrospective study. The authors collected data on demographics, relevant co-morbidities, the American Society of Anesthesiologists (ASA) Physical Status classification score, pulmonary function tests, type of operation, duration of surgery and intraoperative fluid administration (fluid therapy and blood products). The primary outcome measure was postoperative ARDS, defined as the need for continuation of mechanical ventilation for greater than 48-hours postoperatively or the need for reinstitution of mechanical ventilation after extubation. Statistical analysis was performed with Fisher exact test for categorical variables and logistic regression analysis for continuous variables.</p> <p>Results</p> <p>Of one hundred forty-three pulmonary resection patients, 11 (7.5%) developed postoperative ARDS. Alcohol abuse (p = 0.01, OR = 39.6), ASA score (p = 0.001, OR: 1257.3), resection type (p = 0.032, OR = 28.6) and fresh frozen plasma (FFP)(p = 0.027, OR = 1.4) were the factors found to be statistically significant.</p> <p>Conclusion</p> <p>In the light of the current study, lung injury after lung resection has a high mortality. Preoperative and postoperative risk factor were significant predictors of postoperative lung injury.</p

Role of CMV pneumonia in the development of obliterative bronchiolitis in heart-lung and double-lung transplant recipients

Obliterative bronchiolitis (OB) is the main cause of late mortality after lung transplantation. Cytomegalovirus infection has been associated with late graft failure. The aim of this study was to determine whether the development of OB was related to CMV pretransplant serological status and to CMV infections. The study group comprised 36 lung transplant recipients (27 HLT and 9 DLT) who survived more than 4 months, of whom 47% developed OB (defined by the persistence of an unexplained obstructive disease: FEV1/VC &lt; 0.7). OB occurred more frequently: (1) in seronegative recipients with seropositive donors (8/9) than in seropositive recipients (7/19) or seronegative well-matched recipients (2/8); and (2) in patients who experienced CMV pneumonia (11/16) and CMV recurrence (11/16). Since matching seronegative recipients is the best way to prevent CMV infection, we believe that seronegative grafts must be reserved for seronegative recipients

Préparation des insuffisants respiratoires à la transplantation. Un état des lieux

RésuméIntroductionLa transplantation pulmonaire (TP) accroît le risque d’infection, de cancer, d’insuffisance rénale, de complication cardiovasculaire, d’ostéoporose, souvent en continuité avec la situation clinique pré-existante.Patients et méthodeLes comorbidités et leur prise en charge à la première consultation pré-TP ont été recensées chez 157 patients ayant subi une TP entre 2008 et 2011.RésultatsL’âge médian était de 37ans [25 ; 51]. L’index de masse corporel médian était inférieur à 19kg/m2 chez 56 % des patients. Parmi les bronchopneumopathies chroniques obstructives (BPCO), seulement 50 % avaient réalisé une réhabilitation respiratoire au cours des deux années précédentes. Une ostéoporose était présente chez 42 % des patients dont 36 % étaient traités par biphosphonates. Une carence en vitamine D était présente chez 65 % des patients. Au plan cardiovasculaire, le bilan d’évaluation pré-TP révélait une HTA méconnue dans un cas, une hypercholestérolémie méconnue chez 6 % des patients et un diabète méconnu chez 4 % des patients. Des soins dentaires étaient nécessaires chez 41 % des patients. Des taux protecteurs d’anticorps anti-HB étaient acquis chez 50 % des patients.Discussion et conclusionLa prise en charge des troubles nutritionnels, de l’ostéoporose, des facteurs de risque infectieux et des facteurs de risque cardiovasculaires est perfectible. Il serait bénéfique d’intégrer précocement la notion de TP ultérieure à la gestion des insuffisants respiratoires chroniques.SummaryIntroductionLung transplantation (LT) is associated with an increased risk of infection, cancer, chronic renal failure, cardiovascular disease and osteoporosis. Some risk factors precede transplantation and could benefit for early diagnosis and optimised care.MethodsThe incidence of comorbidities and their treatment before referral were assessed in 157 consecutive lung transplant candidates between 2008 and 2011.ResultsThe median age was 37years [25; 51]. Fifty-six percent had a body mass index below 19kg/m2. In the COPD group, only 50 % had undergone a pulmonary rehabilitation program in the preceding 2 years. Osteoporosis was present in 42 %, of whom 36 % were on bisphophonate therapy. Vitamin D deficiency was present in 65 %. Previously undiagnosed cardiovascular risk factors were discovered during LT assessment: hypertension in one patient, hypercholesterolemia in 6 % and diabetes in 4 %. Poor dental condition necessitating extractions were found in 41 % of patients. Protective anti-HBs antibodies levels were present in 50 % of the patients at the time of referral.ConclusionThe assessment and early treatment of nutritional disorders, osteoporosis and risk factors for infection as well as addressing associated cardiovascular risk factors should be optimised in the care of patients with chronic respiratory insufficiency. The potential for becoming a lung transplant candidate in the future should be kept in mind early in the global management of those patients

Approaches to the Management of Sensitized Lung Transplant Candidates: Findings from an International Survey

PURPOSE: Highly sensitized lung transplant candidates undergo transplant at a significantly lower rate than unsensitized candidates. We conducted a survey to understand the approach to waitlist and peri-operative management of these candidates across programs worldwide. METHODS: Lung transplant programs were invited to complete the survey either online or by telephone. Survey questions pertained to programs' method of human leukocyte antigen (HLA) antibody detection, characterization of HLA antibody risk, incorporation of virtual (VCM) and actual crossmatch (ACM) results in organ allocation decisions, and use of pre or peri-operative desensitization therapy between January 2018 and October 2019. RESULTS: 57 adult (39/57), pediatric (4/57), and combined (14/57) lung transplant programs were surveyed. Respondents were transplant physicians (46/57), surgeons (3/57), or several multi-disciplinary team members (8/57) from programs in North America (39/57), Europe (11/57), Asia (3/57), Australia (3/57), and Africa (1/57). Regarding organ allocation, 32/57 programs decline offers for candidates who are highly sensitized/critically ill on the basis of an unacceptable VCM. A high degree of sensitization is a contraindication to transplant at 12/57 programs, and a contraindication to using mechanical support as bridge-to-transplant at 19/57. At 19/57 programs, offers are accepted regardless of positive VCM results if the prospective flow crossmatch (4/19) or complement-dependent cytotoxicity crossmatch (15/19) is negative, either for all candidates (9/19) or only for those who are highly sensitized/critically ill (10/19). A minority of programs (8/57) accept offers regardless of positive VCM or ACM results, either for all candidates (1/8) or only for those who are highly sensitized/critically ill (7/8). All of these programs use plasmapheresis, intravenous immune globulin, thymoglobulin, and/or rituximab peri-operatively. Currently, 13/57 programs treat highly sensitized candidates on the waitlist with various desensitization therapies to improve their likelihood of receiving an acceptable offer. CONCLUSION: There is significant variation in the management of sensitized lung transplant candidates across programs. Further research and international consensus are needed to improve access to transplant for these patients

Donor‐specific HLA antibody‐mediated complement activation is a significant indicator of antibody‐mediated rejection and poor long‐term graft outcome during lung transplantation: a single center cohort study

Complement-mediated allograft injury, elicited by donor-specific HLA antibodies (DSA), is a defining pathophysiological characteristic of allograft damage. We aimed to study DSA-induced complement activation as a diagnostic marker of antibody-mediated rejection (AMR) and a risk stratification tool for graft loss in the context of lung transplantation (LT). We identified 38 DSA-positive patients whose serum samples were submitted for C3d deposition testing via the C3d assay. Among these 38 patients, 15 had AMR (DSAPos AMRPos ). Results were reported for each patient as the C3d ratio for each DSA, the immunodominant DSA, and the C3d ratio for all DSA present in a sample (C3d ratioSUM ). DSAPos AMRPos patients had higher C3d ratioSUM values (58.66 (-1.32 to 118.6) vs. 1.52 (0.30 to 2.74), P&nbsp;=&nbsp;0.0016) and increased immunodominant C3d ratios (41.87 (1.72 to 82.02) vs. 0.69 (0.21 to 1.19), P&nbsp;=&nbsp;0.001) when compared with DSAPos AMRNeg patients. Specificity and calculated positive predictive value of the immunodominant C3d ratio and BCMsum tests for AMR diagnosis were both 100% (CI&nbsp;=&nbsp;17.4-100) in this cohort. Worst graft survival was associated with both immunodominant C3d ratio ≥4 or C3d ratioSUM ≥10 or BCMsum &gt;7000, suggesting that the antibody composition and/or strength are the principal determinants of an HLA DSA's capacity to activate complement

Lung transplantation for COVID-19-associated acute respiratory distress syndrome: The first French patient

International audienc