Posttransplantation chronic renal damage in nonrenal transplant recipients

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Lung function in relation to six-minute walk test in pulmonary hypertension

Background: Pulmonary hypertension (PH) is a progressive disorder of the pulmonary circulation,associated with diverse medical conditions. Exercise limitation is the most prominent symptom inPH. Exercise capacity, commonly assessed through a six-minute walk test (6MWT), correlates withboth functional status and survival in PH. Few studies have analysed the relation betweenrespiratory function and exercise limitation. Therefore, we investigated the relationship betweenresting pulmonary function, exercise capacity, and exertional desaturation, assessed through the6MWT, in unselected PH patients.Methods: Fifty consecutive patients with PH diagnosis, referred for pulmonary function testing(lung volume, spirometry, and diffusing capacity for carbon monoxide (DLCO)) and 6MWT, wererecruited at Molinette University Hospital, Turin.Results: The majority of the patients (54%) had PH due to left heart disease. Airway obstruction(FEV1/VC-ratio < 0.7) was found in 46% of the patients and they performed significantly worse inthe 6MWT than unobstructed patients (307 m vs. 377 m). Patients with PH due to left heartdisease also performed significantly poorer 6MWT when airway obstruction was present (305 mvs. 389 m). Twenty-two patients (44%) presented exertional desaturation upon 6MWT. LowerDLCO divided by the alveolar volume (DLCO/VA), FEV1/VC-ratios and resting PaO2-values weresignificantly correlated with exertional desaturation after adjustments for age, sex, BMI, andsmoking habits. DLCO/VA was the main determinant of exertional desaturation in a stepwiseregression model.Conclusions: Spirometric parameters of airway obstruction were related to walk distance andexercise-induced desaturation in PH patients. This suggests a place for spirometry in clinicalmonitoring of PH patients

Prevalence and clinical role of Human Bocavirus in bronchoalveolar lavages of adult patients

Introduction. Human Bocavirus (HBov) is a ubiquitous parvovirus predominantly associated with respiratory tract infections in pediatric patients.The results of the few studies conducted in adult patients are conflicting, with data of prevalence around 0.8%, thus making difficult to evaluate the HBOV clinical role. In this study the prevalence and clinical role of HBoV in adult hospitalized patients were evaluated. Methods. The presence of HBoV was evaluated in 514 bronchoalveolar lavages (BAL), obtained over a period of 24 months from 341 adult patients (mean age, 56.5 ± 16.2 years, range 19-85), by real-time TaqMan PCR.The BAL was performed for the presence of symptoms/signs of suspected infection of the lower airways or for surveillance in the transplanted lung patients (month 1 and every 3 months). Results. 12/341 patients (3.5%) were positive for HBoV; in particular: 1/45 (2.2%) lung transplanted, 1/20 (5%) liver transplanted and 2/26 (7.7%) bone marrow transplanted, while no kidney (n=19) or heart (n=13) transplant patients resulted positive. 8/218 (3.6%) not transplantpatient were positive, in particular 1.8% patients with haematological cancers and 1.8% with other disease.The prevalence of HBoV did not differ between transplanted and not transplanted patients, depending on the type of transplant, and between immunocompetent and immunocompromised individuals. Conclusions. HBoV can be detected at low frequency in BAL of adult patients with acute lower respiratory tract, further studies would show whether the virus plays a role as a single pathogen or whether the altered lung background could help the viral infection

CMV management in lung transplant recipients

Human cytomegalovirus (HCMV) is a member of the Betaherpesvirinae subfamily (Herpesviridae family), that, following primary infection, is able to establish latency in host tissues and may reactivate in conditions of immunosuppression. In solid organ transplant recipients, the incidence of CMV infection and disease varies according to the transplanted organ and is particularly high in lung transplantation (LT), reaching 40-50% incidence. Lung is a CMV latency site and in LT, viral reactivation has been associated with direct (i.e. organ and systemic infection/disease) and indirect effects (including acute rejection and chronic allograft dysfunction). The clinical importance of CMV has grown in parallel with the increasing number of solid organ transplant recipients. Symptoms related to CMV disease and the prevention of CMV infection show variation among different patient populations, depending on the type of transplant and the intensity of immunosuppression. Treatment and prevention of CMV infection have assumed increasing importance in lung transplant recipients management relative to the mortality and morbidity and, on the other hand, to the availability of effective antiviral agents as well as new diagnostic techniques and the prophylaxis, diagnosis, and treatment of CMV infections. In lung transplant recipients management is evolving with experience and we are living the sunrise of a new personalized or tailored management era matching, almost in real time, infection, diagnosis, immunity status and therapy

Choosing the best first line oral drug agent in patients with pulmonary hypertension: Evidence from a network meta-analysis

[No abstract available

Sildenafil in severe pulmonary hypertension associated with chronic obstructive pulmonary disease: A randomized controlled multicenter clinical trial

Background Pulmonary hypertension (PH) is a well-known independent prognostic factor in chronic obstructive pulmonary disease (COPD) and a sufficient criterion for lung transplant candidacy. Limited data are currently available on the hemodynamic and clinical effect of phosphodiesterase 5 inhibitors in patients with severe PH associated with COPD. This study assessed the effect of sildenafil on pulmonary hemodynamics and gas exchange in severe PH associated with COPD. Methods After screening, this multicenter, randomized, placebo-controlled double-blind trial randomized patients to receive 20 mg sildenafil or placebo 3 times a day (ratio 2:1) for 16 weeks. The primary end point was the reduction in pulmonary vascular resistance. Secondary end points included BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index, 6-minute walk test, and quality of life questionnaire. Changes in the partial pressure of arterial oxygen were evaluated as a safety parameter. Results The final population included 28 patients, 18 in the sildenafil group and 10 in the placebo group. At 16 week, patients treated with sildenafil had a decrease in pulmonary vascular resistance (mean difference with placebo –1.4 WU; 95% confidence interval, ≤ –0.05; p = 0.04). Sildenafil also improved the BODE index, diffusion capacity of the lung for carbon monoxide percentage, and quality of life. Change from baseline in the partial pressure of arterial oxygen was not significantly different between the sildenafil and placebo groups. Conclusions This pilot study found that treatment with sildenafil reduced pulmonary vascular resistance and improved the BODE index and quality of life, without a significant effect on gas exchange

AISF position paper on HCV in immunocompromised patients

This report summarizes the clinical features and the indications for treating HCV infection in immunocompromised and transplanted patients in the Direct Acting Antiviral drugs era. (C) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved

AISF position paper on HCV in immunocompromised patients

This report summarizes the clinical features and the indications for treating HCV infection in immunocompromised and transplanted patients in the Direct Acting Antiviral drugs era