Zmiany w sercu po przeszczepieniu płuc z powodu włóknienia z towarzyszącym nadciśnieniem płucnym

Chronic lung tissue disease leads to secondary pulmonary hypertension (PH). The conservative treatment has limitedpossibilities and lung transplantation (LuTx) remains the final treatment solution. This case report presents thenatural course of diagnostics and treatment of the patient with idiopatic pulmonary fibrosis and secondary PH, whounderwent LuTx.Echokardiografia w nadciśnieniu płucnym towarzyszącym chorobom płuc jest podstawowym, nieinwazyjnym narzędziem diagnostycznym, służącym do oceny występowania prawdopodobieństwa nadciśnienia płucnego (1). Jego obecność jest jednym z kryteriów kwalifikujących do przeszczepienia płuc LuTx (Lung Transplantation) (2) oraz decyduje, czy konieczne będzie użycie ECMO (Extracorporeal Membrane Oxygenation) w trakcie LuTx. Przedstawiony przypadek pokazuje szybkość zmian dokonujących się w strukturach i czynności prawego serca u chorego po LuTx

1,25-Dihydroxycholecalciferol with low-calcium diet reduces acute rejection in rat lung allotransplantation

OBJECTIVES The effect of 1,25-dihydroxycholecalciferol (calcitriol, vitamin D3) with a low-calcium diet on the acute lung allograft rejection in a rat unilateral left lung transplantation model was evaluated. METHODS Three transplantation groups were studied (n=5, male Brown-Norway to Fischer F344, 235±15g body weight): calcitriol and low-calcium diet, low-calcium diet and normal diet. Calcitriol (4μg/kg/day) was injected intraperitoneally for 5 days, starting from the day of transplantation. In addition, two non-transplantation groups were compared: (n=3, Brown-Norway) to measure the level of cytokines, and Fischer F344 receiving calcitriol and a low-calcium diet to measure the serum calcium level. The recipients of transplantation were killed on Day 5 post-transplant. The contralateral right main bronchus and the pulmonary artery were occluded for 5min and blood was drawn for the blood gas analysis, and the grafts were assessed for histology (International Society for Heart and Lung Transplantation 1996/rank scale). Lung levels of interleukin (IL)-2, IL-6, IL-12 and tumour necrosis factor-α (TNF-α) were assessed within the calcitriol and low-calcium diet, low-calcium diet and Brown-Norway groups. The serum calcium level was assessed in the Fischer F344 group. An analysis of variance with Tukey's post hoc test was used to compare the arterial blood oxygen pressure and the lung cytokine expression between groups. A non-parametric Kruskal-Wallis test followed by the Siegel and Castellan post hoc test was used to assess the differences between the groups according to the lung graft rejection grading. Student's paired t-test was used to compare the serum calcium level. RESULTS The arterial PaO2 was significantly higher in the calcitriol and the low-calcium diet groups when compared with low-calcium diet or normal diet groups (356±72mmHg; P<0.05 vs other groups). The arterial and bronchial rejection observed in calcitriol and low-calcium diet group was significantly milder than in the low-calcium diet or normal diet groups (A1-2, B1-2; P<0.05 vs other groups). IL-2 and IL-6 levels were significantly higher in low-calcium diet vs calcitriol and low-calcium diet and Brown-Norway groups. IL-12 and TNF-α did not differ among the groups. There was no significant difference in serum calcium level before and after the treatment in the Fischer F344 group. CONCLUSIONS Calcitriol with a low-calcium diet treatment improves lung function, reduces lung allograft acute rejection, decreases IL-2 and IL-6 allograft expression and does not change the serum calcium level significantl

Strong additive effect of 1,25-dihydroxycholecalciferol and cyclosporine A but not tacrolimus in rat lung allotransplantation

Objectives: 1,25-Dihydroxycholecalciferol (calcitriol, vitamin D3) has immunosuppressive properties. This study evaluates the effect of calcitriol in combination with either cyclosporine A or tacrolimus on acute lung allograft rejection in a rat model of unilateral left lung allotransplantation. Methods: Unilateral left lung transplantation was performed in male rats (Brown-Norway to Fischer F344, 200-250 g body weight). For immunosuppression, the following subtherapeutic doses were used: calcitriol 0.5 μg/kg/day, cyclosporine A 2.5 mg/kg/day i.p., and tacrolimus 40 μg/kg i.m. Five groups (n=5) were analyzed: cyclosporine A; cyclosporine A and calcitriol; calcitriol; tacrolimus and calcitriol; and tacrolimus. The injections were performed for 5 days starting from the day of transplantation. Recipients were sacrificed on day 5 post-transplant. The contralateral right main bronchus and pulmonary artery were occluded for 5 min and blood was drawn for blood gas analysis. The grafts were excised, fixed in formaline and embedded in paraffin. Histological evaluation was done in blinded fashion (ISHLT 1999/rank scale). The mean and standard error of the mean (PaO2) or the median and range (rejection grading) are given. ANOVA followed by planned comparison for the PaO2 and Kruskal-Wallis ANOVA for rejection grading were applied, p<0.05 considered significant. Results: Arterial PaO2 on day 5 was very low in animals treated with subtherapeutic dosages of either cyclosporine A (48±10 mmHg), calcitriol (51±3) or tacrolimus (86±22). Combined treatment with cyclosporine A and calcitriol revealed a significant improvement (248±78; p<0.05 vs. other groups), whereas the combination of tacrolimus with calcitriol did not reveal any benefit (65±9). Rejection grading with these subtherapeutic doses did not show any significant difference between groups. Conclusions: Our data indicate that cyclosporine A, but not tacrolimus, has a strong additive effect with calcitriol on acute rat lung allograft rejectio

Przydatność badań scyntygraficznych w diagnostyce autoprzeszczepów śledzionowych do płuc - opis przypadku

Thoracic splenosis of the left lung and upper abdominal area was described. Left minithoracotomy was performed due to unclear results from a fine needle biopsy and following the suggestion to obtain a tissue sample. Clinical findings were similar to neoplasmatic disease; intraoperative extension of the disease was larger than CT view and correlated with postoperative assessment with 99mTc sulphur colloid. This confirmed the usefulness of scintigraphic assessment in preoperative diagnosis in order to avoid thoracotomy in such cases.W pracy przedstawiono rzadki przypadek pourazowych autoprzeszczepów tkanki śledzionowej przebiegających pod postacią obwodowego cienia płuca lewego, którego obraz sugerował charakter nowotworowy. Wynik biopsji cienkoigłowej był niejednoznaczny i wymagał potwierdzenia otwartą biopsją płuca. Obraz śródoperacyjny wykazał większe rozprzestrzenienie zmian niż w tomografii komputerowej i korelował z wynikiem wykonanej w okresie późniejszym scyntygrafii z użyciem koloidu siarczkowego znakowanego 99mTc, potwierdzając jej przydatność, zwłaszcza w diagnostyce przedoperacyjnej

Primary pulmonary mucosa-associated lymphoid tissue lymphoma: a case report

Pierwotne chłoniaki płuc stanowią zaledwie 0,5% wszystkich nowotworów o lokalizacji płucnej. Chłoniak typu MALT jest pozawęzłowym, B-komórkowym chłoniakiem płuc o niskim stopniu złośliwości. Jest to jednostka chorobowa występująca sporadycznie, jednakże stanowi 72−90% wszystkich pierwotnych chłoniaków płuc. Przewlekła antygenowa stymulacja tkanki limfatycznej błony śluzowej drzewa oskrzelowego, palenie papierosów, stany zapalne czy choroby autoimmunologiczne wydają się być przyczyną chłoniaka typu MALT. Przedstawiamy przypadek chłoniaka typu MALT o lokalizacji płucnej. 76-letni chory palący papierosy od lat (22,5 paczkolat), został przyjęty do szpitala w celu dalszej diagnostyki zmiany w prawym płucu wykrytej w RTG klatki piersiowej. Diagnostyka nieinwazyjna nie pomogła ustalić etiologii zmiany. Po konsultacji torakochirurgicznej chory został zakwalifikowany do diagnostyki inwazyjnej. Badanie histologiczne potwierdziło chłoniaka typu MALT.Primary pulmonary lymphoma accounts only 0,5% of all primary lung neoplasms. Mucosa-associated lymphoid tissue (MALT) lymphoma is a low grade B-cell extranodal lymphoma. It is a quite infrequent entity, however it constitutes from 72% to 90% of all pulmonary lung lymphomas. Long-term stimulation of bronchus-associated lymphoid tissue by antigens, smoking, inflammatory disorders or autoimmune diseases are thought to be leading to the development of MALT lymphoma. We present the case of primary pulmonary mucosa-associated lymphoid tissue lymphoma. A 76-year-old man with a history of heavy smoking (22.5 pack years) was admitted to the hospital for a further diagnostics of an abnormal finding in the right lung visualized on the chest X-ray. The diagnostic process, including imagining studies did not reveal the etiology of a lesion in the right lung. The patient was qualified for surgical diagnostics. The histological finding confirmed extranodal marginal low-grade B-cell lymphoma of mucosa -associated lymphoid tissue

Surgical treatment of malignant lung tumors in solid organ recipients

Powikłania płucne u biorców narządów cechują się trudnościami diagnostycznymi, poważnym rokowaniem i często słabą odpowiedzią na leczenie. Niektóre z nich wymagają diagnostyki inwazyjnej i leczenia operacyjnego, a inne długotrwałego leczenia farmakologicznego. Gruźlica, zakażenia Pneumocystis sp. i zakażenia grzybicze należą do grupy powikłań infekcyjnych. Pierwotne i wtórne nowotwory płuc powstające w niedalekim odstępie czasowym od transplantacji narządu litego noszą miano powikłań onkologicznych, a oba typy powikłań mają swoje podłoże w immunosupresji. Wymóg kontynuacji immunosupresji dotyczy także okresu leczenia wyżej wymienionych powikłań, stawiając podwyższone wymagania dla zespołów terapeutycznych. Przedstawiono grupę 5 chorych (2 kobiety i 3 mężczyzn) po przeszczepieniach narządów leczonych w ośrodku autorów z powodu nowotworów płuc. Czterech chorych przebyło transplantację wątroby, a jeden serca. Trzech chorych leczono z powodu pierwotnego raka płuca, z czego u 1 dodatkowo wystąpił przerzut raka płuca, u 2 chorych rozwinęły się zmiany przerzutowe raka wątrobowokomórkowego (HCC) z wszczepionej z tego powodu wątroby. Czterech chorych operowano. Wykonano 2 lobektomie i 1 segmentektomię, uzupełnione o limfadenektomię w grupie zmian pierwotnych, jedną obustronną resekcję przerzutów (HCC) i jedną resekcję przerzutu raka płuca wcześniej zoperowanego. Wszystkie przypadki pierwotnego raka płuca miały charakter raka płaskonabłonkowego. Opisano przebiegi okołooperacyjne, schematy immunosupresji oraz dodatkowe powikłania infekcyjne (gruźlica, zakażenie uogólnione i zakażenie dróg żółciowych, kandydoza przełyku), jakie miały miejsce w tej grupie chorych, choć powikłania te nie były związane z obecnym procesem leczenia. Podkreślono znaczenie nikotynizmu w tej grupie chorych, bowiem każdy z nich był palaczem tytoniu.Diagnostic difficulties, serious prognosis and often insufficient response to treatment are all common features of pulmonary complications in solid organ recipients. Some of these complications need invasive diagnostic procedures and surgical treatment or prolonged pharmacological treatment. Tuberculosis, Pneumocystis and fungal infections are examples of infectious complications. Primary lung cancer or metastasis to the lungs developed shortly after solid organ transplantation are oncological complications. Infectious and noninfectious complications are connected with immunosuppression. Treatment of pulmonary complications in solid organ recipients and continuation of immunosuppression therapy can be challenge for therapeutic team. This article presents five cases (2 women and 3 men) of solid organ recipients treated in department of the authors due to lung neoplasms. Four of them were liver recipients and one was recipient of heart. Three patients were treated due to primary lung cancer, additionally in one of them metastasis of lung cancer occurred, two suffered from metastasis of liver cancer (hepatocellular carcinoma) to the lungs. Four patients underwent 6 operation: 2 lobectomies with lymphadenectomy, 1 segmentectomy with lymphadenectomy, 1 bilateral metastasectomy of HCC and 1 metastasectomy of lung cancer. In all cases of primary lung cancer pathological examination revealed squamous cell carcinoma. Immunosuppression schedule, perioperative courses and infectious complications (tuberculosis, disseminated infection, infection of biliary tract, oesophageal candidiasis) in this group were described. All of them were smokers

Safety and Immunogenicity of the PRAME Cancer Immunotherapeutic in Patients with Resected Non–Small Cell Lung Cancer: A Phase I Dose Escalation Study

International audience; INTRODUCTION:Adjuvant platinum-based chemotherapy is standard treatment for surgically resected stage II to IIIA NSCLC, but the relapse rate is high. The preferentially expressed antigen of melanoma (PRAME) tumor antigen is expressed in two-thirds of NSCLC and offers an attractive target for antigen-specific immunization. A phase I dose escalation study assessed the safety and immunogenicity of a PRAME immunotherapeutic consisting of recombinant PRAME plus proprietary immunostimulant AS15 in patients with surgically resected NSCLC (NCT01159964).METHODS:Patients with PRAME-positive resected stage IB to IIIA NSCLC were enrolled in three consecutive cohorts to receive up to 13 injections of PRAME immunotherapeutic (recombinant PRAME protein dose of 20 μg, 100 μg, or 500 μg, with a fixed dose of AS15). Adverse events, predefined dose-limiting toxicity, and the anti-PRAME humoral response (measured by enzyme-linked immunosorbent assay) were coprimary end points. Anti-PRAME cellular responses were assessed.RESULTS:A total of 60 patients were treated (18 received 20 μg of PRAME, 18 received 100 μg of PRAME, and 24 received 500 μg of PRAME). No dose-limiting toxicity was reported. Adverse events considered by the investigator to be causally related to treatment were grade 1 or 2, and most were injection site reactions or fever. All patients had detectable anti-PRAME antibodies after four immunizations. The percentages of patients with PRAME-specific CD4-positive T cells were higher at the dose of 500 μg compared with lower doses. No predefined CD8-positive T-cell responses were detected.CONCLUSION:The PRAME immunotherapeutic had an acceptable safety profile. All patients had anti-PRAME humoral responses that were not dose related, and 80% of those treated at the highest dose showed a cellular immune response. The dose of 500 μg was selected. However, further development was stopped after negative results with a similar immunotherapeutic in patients with NSCLC

SARS-CoV-2 and lung transplantation. What do we know?

Introduction: In 2019, new Coronavirus (SARS-CoV-2) has spread around the globe. The virus can replicatein the cells of the lower respiratory tract, causing pneumonia, oedema and hypoxia. In some patients, thedisease will progress to acute respiratory distress syndrome (ARDS) which is a life-threatening condition.Lung transplantation (LuTx) might be the only rescue therapy for severe respiratory failure. Additionally,little is known about the impact of SARS-CoV-2 on lung transplant recipients. The purpose of this systematicreview is to present current knowledge about lung transplantation as a treatment method for ARDSassociated with COVID-19 infection and to summarize information regarding the management of COVIDinfection in lung transplant recipients. Materials and methods: Literature search through different databases was conducted. Only case report and case series were included. Results: Out of 525 initial results, 16 studies were included in this systematic review. 7 articles presentedpatients with LuTx as a treatment option for ARDS and 9 presented management of lung recipients infectedwith COVID-19. A total of 37 patients were included in this systematic review. Discussion: The course of reviewed patients with SARS-CoV-2 infection was similar and lung transplantationshould be considered as a treatment of last chance when extracorporeal life support cannot be withdrawn.Further research is still required to assess the impact of new coronavirus on graft function in lung transplantrecipients. Currently, the treatment strategy involves immunosuppression modification and supplementaloxygen therapy. However, some patients do not present clinical symptoms

Arterial sleeve lobectomy for lung cancer invading chest wall

Lung cancer is a leading cause of cancer-related deaths worldwide. Non-small cell lung cancer (NSCLC) is a predominant subtype and treatment may include immunotherapy, radiotherapy, chemotherapy, and surgery. Tumors of bigger size infiltrating large bronchi and vessels require more invasive resection such as pneumonectomy. To save lung parenchyma, sleeve lobectomy can be performed in certain patients. We report the case of a patient with NSCLC infiltrating the chest wall who underwent arterial sleeve lobectomy with rib resection. Furthermore, we discuss other surgical treatment strategies. A 58-year-old female patient was admitted to the hospital in 2020 with pain in her left posterolateral chest. Radiological imaging revealed a tumor (5.0×3.5×4.8 cm) in the top of the left lung, infiltrating pulmonary artery and ribs. Therefore, left upper sleeve lobectomy together with resection of rib blocks II to V was performed. The surgery was uncomplicated, but a few weeks postoperatively, the patient experienced repeated episodes of consciousness disturbances. Contrast CT revealed a cerebral malformation in the patient who died 3.5 months after surgery. Sleeve lobectomy can be safely performed in patients with lung tumors infiltrating larger bronchi and vessels who would not tolerate pneumonectomy