Lung Transplantation: Current Status and Challenges

Pierson, Richard N.

doi:10.1097/01.tp.0000226058.05831.e5

Cited by 20 publications

(6 citation statements)

References 122 publications

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“…Solid organ transplantation (SOT) has become a reliable option for treating end-stage organ failure [1][2][3][4]. In transplant recipients, debilitating disease during end-stage organ failure, operative stress, and immunosuppressive therapy cause severe impairment of host defense mechanisms, while perioperative antibiotics disrupt the natural gut flora [5].…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile Colitis in Solid Organ Transplantation—A Single-Center Experience

et al. 2007

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Clostridium difficile (CD) is one of the most common causes of diarrhea in solid organ transplantation (SOT). Between 1996 and 2005, a total of 2474 solid organ transplants were performed at our institution, of which 43 patients developed CD-associated diarrhea. There were 3 lung, 3 heart, 20 liver, 8 kidney-pancreas, 6 kidney, 1 composite tissue, and 2 multivisceral recipients. Onset of CD infection ranged from 5 to 2453 days posttransplant. All patients presented with abdominal pain and watery diarrhea. Toxins A and B were detected using rapid immunoassay or enzyme immunoassay. Treatment consisted of reduction of immunosuppression, fluid and electrolyte replacement, metronidazole (n=20), oral vancomycin (n=20), and a combination of metronidazole and vancomycin (n=2). Toxic megacolon was seen in five patients. Two of them had colonoscopic decompression, and the remaining three required colonic resection. One of these patients died due to multiorgan failure after cured CD enteritis. The remaining patients were discharged with well-functioning grafts and all are currently alive. CD colitis was a rare complication prior to 2000; 38 of the 43 cases occurred thereafter. We conclude that CD colitis represents a severe complication following SOT. Recently, a dramatic increase in the incidence of this complication has been observed. The development of life-threatening toxic megacolon must be considered in solid organ recipients.

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Section: Introductionmentioning

confidence: 99%

Clostridium difficile Colitis in Solid Organ Transplantation—A Single-Center Experience

et al. 2007

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“…A COPD patient may be considered for transplantation when FEV1 is ,25% pred and/or arterial carbon dioxide tension (Pa,CO 2 ) o7.2 kPa (o55 mmHg) [74]. Despite the progress since the early 1980s, the short-and long-term outcomes of lung recipients are not as good as those for other solid organs [75].…”

Section: Lung Transplantationmentioning

confidence: 99%

Nonpharmacological treatment and relief of symptoms in COPD

Clini

Ambrosino²

2008

European Respiratory Journal

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Evidence-based guidelines for chronic obstructive pulmonary disease (COPD) have recently been developed.Nonpharmacological treatments have evolved rapidly as an essential part of COPD therapy. They are especially important as complementary interventions in severe or very severe disease, when there is loss in function, a reduction in quality of life and when psychological impairments further complicate the disease.The present article discusses the most used nonpharmacological treatments for severe COPD patients (rehabilitation, long-term oxygen therapy, surgery, noninvasive positive pressure ventilation and supportive nutrition) and their evidence-based usefulness in promoting strategies that relieve symptoms.All of these interventions are used during end-stage disease, to promote self-efficacy, relieve symptoms and prevent further deterioration. These therapeutic options support physicians and allied professionals in improving symptom management for their patients.

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“…These techniques have been shown to improve mean exercise capacity and reduce dynamic hyperinflation in a subgroup of patients with COPD. 61 Lung transplantation: Lung transplantation is an option for a more limited number of patients. A COPD patient can be considered an appropriate candidate for transplantation when the FEV 1 is below 25% predicted and/or the PaCO 2 is X ¼ 55 mmHg.…”

Section: Introductionmentioning

confidence: 99%

The clinical management in extremely severe COPD

Ambrosino

Simonds

2007

Respiratory Medicine

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Chronic obstructive pulmonary disease (COPD) affects 6% of the general population and is the fourth-leading cause of death in the United States with severe and very severe disease accounting for 15% and 3% of physician diagnoses of COPD. Guidelines make few recommendations regarding providing the provision of care for the most severe stages of disease, namely Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure. The effectiveness of inhaled drug therapy in very severe patients has not been assessed yet. Health care systems in many countries include public funding of long-term oxygen therapy for eligible candidates. Currently, there is little evidence for the use of mechanical ventilatory support in the routine management of hypercapnic patients. Pulmonary rehabilitation should be considered as a significant component of therapy, even in the most severe patients. Although Lung Volume Reduction Surgery has been shown to improve mortality, exercise capacity, and quality of life in selected patients, this modality is associated with significant morbidity and an early mortality rate in the most severe patients. Despite significant progress over the past 25 years, both short- and long-term outcomes remain significantly inferior for lung transplantation relative to other "solid" organ recipients. Nutritional assessment and management is an important therapeutic option in patients with chronic respiratory diseases. Morphine may significantly reduce dyspnoea and does not significantly accelerate death. No consistent improvement in dyspnoea over placebo has been shown with anxiolytics. Supplemental oxygen during exercise reduces exertional breathlessness and improves exercise tolerance of the hypoxaemic patient. Non-invasive ventilation has been used as a palliative treatment to reduce dyspnoea. Hypoxaemic COPD patients, on long-term oxygen therapy, may show reduced health-related quality of life, cognitive function, and depression. Only a small proportion of patients with severe COPD discuss end-of-life issues with their physicians.

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Lung Transplantation: Current Status and Challenges

Cited by 20 publications

References 122 publications

Clostridium difficile Colitis in Solid Organ Transplantation—A Single-Center Experience

Clostridium difficile Colitis in Solid Organ Transplantation—A Single-Center Experience

Nonpharmacological treatment and relief of symptoms in COPD

The clinical management in extremely severe COPD

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