Lung Transplantation in Cystic Fibrosis: Trends and Controversies

Blatter, Joshua; Sweet, Stuart C.

doi:10.1089/ped.2015.0564

Cited by 7 publications

(4 citation statements)

References 37 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 Most potential lung grafts are turned down at the time of evaluation because of concerns about the health of the lungs related to donor history, chest trauma, pneumonia, aspiration, or various ICU complications. 4,[11][12][13] The problem of donor shortage appears to be worse in certain populations, specifically women (primarily thought to be because of shorter stature and a greater incidence of pretransplant allosensitization, making it more difficult to identify suitable donors), 10,[14][15][16] patients with cystic fibrosis (primarily thought to be because of shorter stature and a difference in allocation systems in patients < 12 years of age), 15,17 and patients with idiopathic pulmonary hypertension (primarily because of severity of disease not being captured by pulmonary function testing). 18,19 Four ways in which we think the problem of donor shortage may be improved are: (1) use of more donors after circulatory death to increase the total number of donors, (2) use of extended criteria for donor selection, (3) use of the relatively new technology of ex vivo lung perfusion (EVLP) to increase utilization rate, and (4) utilization of bioengineered lungs.…”

Section: Addressing the Donor Shortagementioning

confidence: 99%

The Future of Lung Transplantation

Young

Dilling

2019

Chest

View full text Add to dashboard Cite

The field of lung transplant has made significant advances over the last several decades. Despite these advances, morbidity and mortality remain high when compared with other solid organ transplants. As the field moves forward, the speed by which progress can be made will in part be determined by our ability to overcome several stumbling blocks, including donor shortage, proper selection of candidates, primary graft dysfunction, and chronic lung allograft dysfunction. The advances and developments surrounding these factors will have a significant impact on shaping the field within the coming years. In this review, we look at the current climate (ripe for expanding the donor pool), new technology (ex vivo lung perfusion and bioengineered lungs), cutting-edge innovation (novel biomarkers and new ways to treat infected donors), and evidence-based medicine to discuss current trends and predict future developments for what we hope is a bright future for the field of lung transplantation.

show abstract

Section: Addressing the Donor Shortagementioning

confidence: 99%

The Future of Lung Transplantation

Young

Dilling

2019

Chest

View full text Add to dashboard Cite

show abstract

“…While the management of CF is multimodal and multidisciplinary, lung transplantation remains an established intervention that confers survival benefits to CF patients in cases of lung failure and severely impaired lower‐airway function 8 . However, long‐term survival can be limited by allograft dysfunction 9 . Notably, lung transplant recipients with CF have a greater susceptibility to allograft recolonization with Pseudomonas compared with non‐CF transplant patients, which may underly graft rejection and accelerate transplant failure 10,11 .…”

Section: Introductionmentioning

confidence: 99%

“…8 However, long-term survival can be limited by allograft dysfunction. 9 Notably, lung transplant recipients with CF have a greater susceptibility to allograft recolonization with Pseudomonas compared with non-CF transplant patients, which may underly graft rejection and accelerate transplant failure. 10,11 As previous research has linked disease of the paranasal sinuses to disease of the lower respiratory tract, the sinuses and upper trachea have been proposed to serve as reservoirs for bacteria, which subsequently seed the transplanted lungs and diminish pulmonary function.…”

Section: Introductionmentioning

confidence: 99%

Comparison of endoscopic sinus surgery timing in lung transplant patients with cystic fibrosis

Johnson

Hwang

Nayak

et al. 2022

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

Background: No studies have investigated when endoscopic sinus surgery (ESS) is best performed in lung transplant patients with cystic fibrosis (CF). We sought to examine the effects of ESS timing on pulmonary health in this population. Methods: A retrospective review of all adult lung transplant patients with CF who underwent ESS at our academic medical center over a near 25-year period was performed. Patients were split into two groups based on median time from lung transplantation to ESS. Twenty-three patients were included (12 ESS early and 11 ESS delayed). Outcomes included changes in pulmonary function tests (PFTs) from baseline, preoperative to postoperative measurements, the number and duration of hospitalizations for pulmonary exacerbations, and the number of antibiotic courses used specifically to treat pulmonary exacerbations during the 12 months before and after ESS. Results: Baseline demographics, operative history, and pulmonary function characteristics were similar between groups. While the ESS early group saw significant improvement from preoperative percent-predicted FEV 1 (ppFEV 1 ) at 12 months postoperatively (confidence interval [CI]: 0.729-11.452, p = 0.030), there were no significant postoperative PFT changes for the ESS delayed group. Postoperative improvement in FEV 1 and ppFEV 1 at 12 months was significantly higher for the ESS early group relative to the ESS delayed group (CI: 0.010-0.583, p = 0.043; CI: 1.240-16.692, p = 0.025; respectively). The ESS early group had a significant reduction in the need for total antibiotic courses compared with the ESS delayed group (ESS early median: -1, interquartile range [IQR]: -1.5 to -0.5 vs.ESS delayed median: 0, IQR: 0 to 0; p = 0.027). Conclusion: Earlier ESS interventions following lung transplantation mayimprove pulmonary function and attenuate pulmonary exacerbations in CF patients.

show abstract

“…These CLAD stages can occur post-LTX in patients with different pre-LTX lung diseases such as alpha-1-antitrypsin deficiency disease (AATD), cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis (PF) [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Bronchoalveolar lavage metabolome dynamics reflect underlying disease and chronic lung allograft dysfunction

H¹,

Mahan

Wiggen

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Progression of chronic lung disease often leads to the requirement for a lung transplant (LTX). Despite improvements in short-term survival after LTX, chronic lung allograft dysfunction (CLAD) remains a critical challenge for long-term survival. This study investigates the relationship between the metabolome of bronchoalveolar lavage fluid (BALF) collected longitudinally from subjects post-LTX with underlying chronic lung diseases and its association with CLAD severity. Methods Untargeted LC-MS/MS metabolomics was performed on 960 BALF samples collected over 10 years from LTX recipients with alpha-1-antitrypsin disease (AATD, n = 22), cystic fibrosis (CF, n = 46), chronic obstructive pulmonary disease (COPD, n = 79) or pulmonary fibrosis (PF, n = 47). Datasets were analyzed using machine learning and multivariate statistics for associations with underlying disease and final CLAD severity. Results. BALF metabolomes varied by underlying disease state, with AATD LT recipients being particularly distinctive (PERMANOVA, p = 0.001). We also found significant associations of the metabolome with a subjects final CLAD severity score (PERMANOVA, p = 0.001), especially those with underlying CF. Association with CLAD severity was driven by changes in phosphoethanolamine (PE) and phosphocholine lipids that increased and decreased, respectively, and metabolites from the bacterial pathogen Pseudomonas aeruginosa. P. aeruginosa siderophores, quorum-sensing quinolones, and phenazines were detected in BALF, and 4-hydroxy-2-heptylquinoline (HHQ) was predictive of the final CLAD stage in samples from CF patients (R = 0.34; p ≤ 0.01). Relationships between CLAD stage and P. aeruginosa metabolites were especially marked in those with CF, where 61% of subjects had at least one of these metabolites in their first BALF sample after transplant. These molecules also correlated with the relative abundance of P. aeruginosa from microbiome sequence data. Conclusions: BALF metabolomes after LTX are distinctive based on the underlying disease. Metabolomic data also reflected measures of the final CLAD stage, which was driven by a lipid transition from mostly PC to predominantly PE phospholipids, and metabolites from P. aeruginosa. The association of P. aeruginosa metabolites with CLAD stages in LTX recipients indicates this bacterium and its associated metabolites may be drivers of allograft dysfunction.

show abstract

Lung Transplantation in Cystic Fibrosis: Trends and Controversies

Cited by 7 publications

References 37 publications

The Future of Lung Transplantation

The Future of Lung Transplantation

Comparison of endoscopic sinus surgery timing in lung transplant patients with cystic fibrosis

Bronchoalveolar lavage metabolome dynamics reflect underlying disease and chronic lung allograft dysfunction

Contact Info

Product

Resources

About