ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics

Crespo, Maria; McCarthy, Daniel; Hopkins, Peter; Clark, Stephen; Budev, Marie; Bermúdez, C.; Benden, Christian; Eghtesady, Pirooz; Lease, Erika D.; Leard, Lorriana E.; D’Cunha, Jonathan; Wigfield, C.H.; Cypel, Marcelo; Diamond, Joshua M.; Yun, James; Yarmus, Lonny; Machuzak, Michael; Klepetko, Walter; Verleden, Geert; Höetzenecker, Konrad; Dellgren, Göran; Mulligan, Michael S.

doi:10.1016/j.healun.2018.01.1309

Cited by 137 publications

(162 citation statements)

References 90 publications

(253 reference statements)

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“…For example, graft hypoperfusion in the early-stage post-LTx can lead to the development of airway complications such as fibrinous bronchitis and bronchial stenosis, requiring repeated interventional bronchoscopy. 26 Likewise, the diagnosis of acute allograft rejection often requires bronchoscopic lung tissue biopsy. 15 Among clinically indicated OSV during the study period, the vast majority were for such endoscopic procedures.…”

Section: Discussionmentioning

confidence: 99%

Video Consultation During the COVID-19 Pandemic: A Single Center's Experience with Lung Transplant Recipients

Kayser

Valtin

Greer

et al. 2021

Telemedicine and e-Health

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Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. This is due to both to the reallocation of resources toward COVID-19 patients as well as concern for the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. The interruption of routine care is especially problematic for patients with chronic conditions requiring regular follow-up, such as lung transplant (LTx) recipients. Introduction: New methods such as telemedicine are needed to bridge the gap in follow-up care caused by the pandemic. Materials and Methods: A retrospective analysis of video consultations (VCs) in comparison with on-site visits (OSVs) was performed during a 6-week period in an LTx center in Germany. VC included a structured work-up questionnaire and vital sign documentation. Results: During the 6-week study period, 75 VCs were performed for 53 patients and 75 OSVs by 51 patients occurred. By the end of our study period, 77% of physician-patient contacts occurred through VC. Physician-patient consultations were reduced by 47% compared with the equivalent time frame in 2019. In 62% of cases, VC resulted in a concrete clinical decision. One COVID-19 patient in home quarantine was admitted due to respiratory failure detected by VC. Patient satisfaction with VC was high. Discussion: Implementation of VC helped to reduce the need for OSV and thus the risk of SARS-CoV-2 exposure in our patient cohort. This technology can be adopted to provide care for a wide range of chronic illnesses. Conclusions: VC can preserve access to specialist care while reducing SARS-CoV-2 exposure for patients with chronic illnesses during the pandemic.

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Section: Discussionmentioning

confidence: 99%

Video Consultation During the COVID-19 Pandemic: A Single Center's Experience with Lung Transplant Recipients

Kayser

Valtin

Greer

et al. 2021

Telemedicine and e-Health

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“…We investigated whether the degree of bronchial stenosis influenced pulmonary infection risk. Using the grading system devised by the IHSLT there was no significant increase in pneumonia or tracheobronchitis risk as stenosis degree increased from <25% to 25%‐50%, 51%‐99% and 100%. For example, the odds ratios for any pneumonia (using the <25% stenosis category as the baseline risk) were serially: 1.75, 1.25, and 0 ( P = 0.23).…”

Section: Resultsmentioning

confidence: 93%

“…Additional data recorded included recipient bronchial stenosis treatments, maximal degree of cellular rejection on lung biopsy (none, minimal, mild, or moderate to severe), and respiratory culture data. The degree of bronchial stenosis was measured during the bronchoscopy when the stenosis was first detected and categorized according to ISHLT consensus guidelines . Pseudomonas aeruginosa isolates that were resistant to at least three classes of antibiotics were categorized as multidrug‐resistant.…”

Section: Methodsmentioning

confidence: 99%

Infectious complications of bronchial stenosis in lung transplant recipients

Fallis

Jablonski²,

Moss

et al. 2019

Transplant Infectious Dis

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Background Bronchial stenosis is a known complication of lung transplantation, but there are limited data regarding whether transplant recipients with bronchial stenosis develop more infectious complications than those without bronchial stenosis. Methods We conducted a retrospective single‐center observational cohort study between January 1, 2011 and September 29, 2016 of 35 lung transplant recipients diagnosed with bronchial stenosis and a random sample of 35 lung transplant recipients without bronchial stenosis. Data collected included donor/recipient demographic and anatomic information, respiratory cultures, episodes of respiratory infections diagnosed using CDC‐NNIS criteria, hospitalizations, and 1‐year all‐cause mortality. Patients were followed up to 1 year after transplant. Results Bronchial stenosis occurred at a median of 54 days post‐transplant (range 5‐365 days). Bronchial stenosis patients spent more time in the hospital (87.4 vs 46.8 days, P = 0.011) and had more total hospitalizations (4.54 vs 2.37, P < 0.01) than their counterparts. The relative risk of pneumonia among cases vs controls was 4.0 (95% CI 2.2‐7.3, P < 0.01); for purulent tracheobronchitis the relative risk was 3.1 (95% CI 1.6‐6.1, P < 0.01). Patients with bronchial stenosis were significantly more likely to have respiratory cultures growing Staphylococcus aureus (RR 5.0; P = 0.001) and Pseudomonas aeruginosa (RR 2.1, P = 0.026). Mortality within the first year following transplant was equal in both the groups (14.3% vs 14.3%). Conclusions There was no significant increase in 1‐year mortality for lung transplant patients who developed bronchial stenosis. However, bronchial stenosis patients had significantly higher risks of pneumonia and tracheobronchitis, and spent more days in the hospital than those without bronchial stenosis.

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“…101,102 Anastomotic complications vary between centers, with rates as high as 18% being reported. 103 It is generally attributed to watershed ischemia of the donor bronchus due to their reliance on poorly oxygenated, low-pressure, retrograde flow via the pulmonary arterial system, rather than the usual bronchial arteries which are not rejoined. In 2018, an ISHLT consensus paper on airway complications after LTx was published.…”

Section: Anastomosis Dehiscence and Wound Infectionmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Lung Transplantation

Greer

Welte

2020

Semin Respir Crit Care Med

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Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first year post-LTx, infection and graft failure are the leading causes of death. Beyond this chronic graft rejection—currently referred to as chronic lung allograft dysfunction—represents the leading cause of death at all time points, with infection and over time malignancy also limiting survival. Referral of COPD patients to a lung transplant center should be considered in the presence of progressing disease despite maximal medical therapy. As a rule of thumb, a forced expiratory volume in 1 second < 25% predicted in the absence of exacerbation, hypoxia (PaO2 < 60 mm Hg/8 kPa), and/or hypercapnia (PaCO2 > 50 mm Hg/6.6 kPa) and satisfactory general clinical condition should be considered the basic prerequisites for timely referral. We also discuss salient issues post-LTx and factors that impact posttransplant survival and morbidity such as infections, malignancy, renal insufficiency, and complications associated with long-term immunosuppression.

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ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics

Cited by 137 publications

References 90 publications

Video Consultation During the COVID-19 Pandemic: A Single Center's Experience with Lung Transplant Recipients

Video Consultation During the COVID-19 Pandemic: A Single Center's Experience with Lung Transplant Recipients

Infectious complications of bronchial stenosis in lung transplant recipients

Chronic Obstructive Pulmonary Disease and Lung Transplantation

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