Hyperammonemia in lung transplant patients and its management: a review

Kumar, Akshay; Advani, Shailesh; Kichloo, Asim; Mohamed, Mohamed A.; Wani, Farah; Singh, Jagmeet; Albosta, Michael; Shiwalkar, Nimisha; Keshavamurthy, Suresh

doi:10.1007/s12055-021-01319-6

Cited by 5 publications

(11 citation statements)

References 54 publications

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“…Hyperammonemia syndrome (HS) is an uncommon but fatal disorder that can affect up to 4% of lung transplant recipients. It is imperative that patients with this syndrome should be screened for ureaplasma species and treated with the appropriate antibiotics for this infection [64].…”

Section: Lung Microbiomementioning

confidence: 99%

Recent Advances and Outcomes in Heart and Lung Transplantation

Kumar¹,

Thite²,

Wazarkar³

et al. 2023

Current Challenges and Advances in Organ Donation and Transplantation

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Heart and lung transplantations are established treatments for patients with end-stage heart and lung failure, respectively. As mechanical circulatory devices, extracorporeal membrane oxygenation, organ perfusion, and transport systems advance, so do patient comorbidities and profiles of patients undergoing transplantation are becoming more complex. With the ever-increasing shortage of donor organs, marginal and high-risk donor utilization continues to rise. In this chapter, we attempt to elucidate the recent advances and outcomes in heart and lung transplantation. We also highlight how an ongoing COVID-19 pandemic affects the logistics of transplant programs.

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Section: Lung Microbiomementioning

confidence: 99%

Recent Advances and Outcomes in Heart and Lung Transplantation

Kumar¹,

Thite²,

Wazarkar³

et al. 2023

Current Challenges and Advances in Organ Donation and Transplantation

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“…The majority of natural ammonia production in the human body occurs in the gut after protein metabolism. These nitrogenous waste products are eliminated by conversion to urea through the urea cycle in the liver and subsequently excreted by the kidneys, or by conversion to glutamine in the liver, skeletal muscle, and central nervous system [2,4,5]. Acute hyperammonemia, most commonly presenting as encephalopathy, can result when mechanisms of elimination are disrupted or when there is excessive production.…”

Section: Pathophysiologymentioning

confidence: 99%

“…A prospective study of non-hepatic hyperammonemia in critically ill patients by Prado et al found those who developed hyperammonemia had received less calories per day (as a total of enteral nutrition or parenteral nutrition (PN)) and that hyperammonemia was statistically associated with prolonged fasting for 24 h or more (p < 0.05) [8]. Other possible mechanisms of decreased ammonia clearance post-transplant include immunosuppression and stress-induced loss of muscle mass as well as acute kidney injury [2,6,11].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Hyperammonemia syndrome is a complication that has been reported to occur in 1-4% of lung transplant patients with mortality rates as high as 60-80%, making detection and management crucial components of post-transplant care [1][2][3]. There is no standardized treatment algorithm, nor is there any research comparing the various options for this indication.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Hyperammonemia Syndrome in Lung Transplant Recipients

Yun,

Scalia,

Farghaly

2023

JCM

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Hyperammonemia syndrome is a complication that has been reported to occur in 1–4% of lung transplant patients with mortality rates as high as 60–80%, making detection and management crucial components of post-transplant care. Patients are treated with a multimodal strategy that may include renal replacement therapy, bowel decontamination, supplementation of urea cycle intermediates, nitrogen scavengers, antibiotics against Mollicutes, protein restriction, and restriction of parenteral nutrition. In this review we provide a framework of pharmacologic mechanisms, medication doses, adverse effects, and available evidence for commonly used treatments to consider when initiating therapy. In the absence of evidence for individual strategies and conclusive knowledge of the causes of hyperammonemia syndrome, clinicians should continue to design multimodal regimens based on suspected etiologies, institutional drug availability, patient ability to tolerate enteral medications and nutrition, and availability of intravenous access.

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“…Adults who underwent primary lung transplantation had a median survival of 6.7 years [ 1 ]. The double lung transplantation survival rate was 84% at 1 year, 63% at 3 years, 61% at 5 years, and 48% at 10 years [ 2 ]; compared with other solid organ transplants, the mortality rate continues to be high [ 3 ]. Physicians need to attach great importance to the cognitive management of perioperative infections in lung transplants that involve multiple sites, and adverse outcomes due to commensal bacteria in the urogenital tract have received increasing attention in recent years.…”

Section: Introductionmentioning

confidence: 99%

Fatal multiple organ dysfunction caused by commensal bacteria of urogenital tract infection in adult lung transplant recipients: two case reports

Tian

Han

et al. 2023

Virol J

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Background Infection following lung transplantation has been the focus of clinical concerns. The colonization rate of commensal bacteria of the urogenital tract, including Mycoplasma hominis, Ureaplasma urealyticum (UU), and herpes simplex virus type-2 (HSV-2), is high, which may cause secondary infection after transplantation. Case presentation Twenty-three-year-old and 67-year-old women underwent lung transplantation for different causes. Shortly after the operation, they developed perineal skin ulcers, hypoxia, and intractable epilepsy. Subsequent computed tomography (CT) of the chest showed lung consolidation, and cranial CT showed shallowing sulci and gyri. UU and HSV-2 were detected in bronchoalveolar lavage fluid by next-generation sequencing, and HSV-2 was shown in the cerebrospinal fluid of both patients. Despite active treatment, both suffered irreversible brain function damage within 72 h of the seizure. Conclusions Clinicians should know that commensal bacteria of urogenital tract infections can lead to fatal multiple organ dysfunction after lung transplantation.

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Hyperammonemia in lung transplant patients and its management: a review

Cited by 5 publications

References 54 publications

Recent Advances and Outcomes in Heart and Lung Transplantation

Recent Advances and Outcomes in Heart and Lung Transplantation

Treatment of Hyperammonemia Syndrome in Lung Transplant Recipients

Fatal multiple organ dysfunction caused by commensal bacteria of urogenital tract infection in adult lung transplant recipients: two case reports

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