Prolonged Lung Allograft Ischemia and Posttransplant Outcome

Bharat, Ankit

doi:10.1001/jamasurg.2015.0416

Cited by 3 publications

(2 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The authors of that study recommended extending the acceptable ischemia time in certain patient populations to expand organ availability (8). Bharat (14) urged caution in moving forward with this recommendation because of limited data on potential confounding factors in the UNOS registry and potential risk due to prolonged ischemia in certain cases, such as bilateral LTx. We have argued that differences in the case mix between small and large transplant programs strongly confound the association between ischemic time and survival, as shown by the fact that large programs tend to perform LTx involving longer ischemia but achieve better patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality

Hayes

Hartwig

Tobias

et al. 2017

American Journal of Transplantation

View full text Add to dashboard Cite

The influence of prolonged ischemic time on outcomes after lung transplant is controversial, but no research has investigated ischemic time in the context of center volume. We used data from the United Network for Organ Sharing to estimate the influence of ischemic time on patient survival conditional on center volume in the post–lung allocation score era (2005–2015). The analytic sample included 14 877 adult lung transplant recipients, of whom 12 447 were included in multivariable survival analysis. Patient survival was improved in high-volume centers compared with low-volume centers (log-rank test p = 0.001), although mean ischemic times were longer at high-volume centers (5.16 ± 1.70 h vs. 4.83 ± 1.63 h, p < 0.001). Multivariable Cox proportional hazards regression stratified by transplant center found an adverse influence of longer ischemic time at low-volume centers but not at high-volume centers. At centers performing 50 transplants in the period 2005–2015, for example, 8 versus 6 h of ischemia were associated with an 18.9% (95% confidence interval 6.5–32.7%; p < 0.001) greater mortality hazard, whereas at centers performing 350 transplants in this period, no differences in survival by ischemic time were predicted. Despite longer mean ischemic time at high-volume transplant centers, these centers had favorable patient outcomes and no adverse survival implications of prolonged ischemia.

show abstract

Section: Discussionmentioning

confidence: 99%

Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality

Hayes

Hartwig

Tobias

et al. 2017

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…We have previously demonstrated that PGD is associated with a robust inflammatory response that promotes development of alloimmunity, autoimmunity, and chronic rejection [3, 11]. PGD has been thought to be the result of ischemia-reperfusion injury [58, 59], but this hypothesis conflicts with the recent observation that ischemic time may not correlate with PGD development [60, 61]. In other words, it is not uncommon to observe high-grade PGD development in lung allografts with very short ischemic times, or grafts with more than 8 hours of ischemia that do not develop PGD.…”

Section: Role Of Tissue-restricted Abs In Organ Transplantationmentioning

confidence: 99%

Immune Responses to Tissue-Restricted Nonmajor Histocompatibility Complex Antigens in Allograft Rejection

Bharat

Mohanakumar

2017

Journal of Immunology Research

Self Cite

View full text Add to dashboard Cite

Chronic diseases that result in end-stage organ damage cause inflammation, which can reveal sequestered self-antigens (SAgs) in that organ and trigger autoimmunity. The thymus gland deletes self-reactive T-cells against ubiquitously expressed SAgs, while regulatory mechanisms in the periphery control immune responses to tissue-restricted SAgs. It is now established that T-cells reactive to SAgs present in certain organs (e.g., lungs, pancreas, and intestine) are incompletely eliminated, and the dysregulation of peripheral immuneregulation can generate immune responses to SAgs. Therefore, chronic diseases can activate self-reactive lymphocytes, inducing tissue-restricted autoimmunity. During organ transplantation, donor lymphocytes are tested against recipient serum (i.e., cross-matching) to detect antibodies (Abs) against donor human leukocyte antigens, which has been shown to reduce Ab-mediated hyperacute rejection. However, primary allograft dysfunction and rejection still occur frequently. Because donor lymphocytes do not express tissue-restricted SAgs, preexisting Abs against SAgs are undetectable during conventional cross-matching. Preexisting and de novo immune responses to tissue-restricted SAgs (i.e., autoimmunity) play a major role in rejection. In this review, we discuss the evidence that supports autoimmunity as a contributor to rejection. Testing for preexisting and de novo immune responses to tissue-restricted SAgs and treatment based on immune responses after organ transplantation may improve short- and long-term outcomes after transplantation.

show abstract

Research Progress on Factors Related to Primary Graft Dysfunction after Lung Trans-plantation

陈¹

2023

ACM

View full text Add to dashboard Cite

Prolonged Lung Allograft Ischemia and Posttransplant Outcome

Cited by 3 publications

References 5 publications

Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality

Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality

Immune Responses to Tissue-Restricted Nonmajor Histocompatibility Complex Antigens in Allograft Rejection

Research Progress on Factors Related to Primary Graft Dysfunction after Lung Trans-plantation

Contact Info

Product

Resources

About