Single-lung transplantation can be performed with acceptable outcomes using selected donors with heavy smoking history

Taghavi, Sharven; Jayarajan, Senthil N.; Komaroff, Eugene; Horai, Tetsuya; Brann, Stacey; Patel, Namrata; Cordova, Francis; Criner, Gerard J.; Guy, T. Sloane; Toyoda, Yoshiya

doi:10.1016/j.healun.2013.05.018

Cited by 21 publications

(12 citation statements)

References 27 publications

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“…Factors most strongly associated with mortality included the requirement for mechanical ventilation as a bridge to transplantation and transplantation at a lower-volume transplantation center. These findings are consistent with previous studies (1)(2)(3)(4)(18)(19)(20). Contrary to prior studies, in our analysis the use of ECMO as a bridge to transplantation was not associated with mortality.…”

Section: Discussionsupporting

confidence: 91%

“…In recent years, the field of lung transplantation has seen an increase in survival compared with prior eras, which may be related to improvements in donor selection and posttransplantation care (1)(2)(3)(4). This progression may, further, be related to advances in induction agents as part of the lung transplantation immunosuppression regimen.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Alemtuzumab and Basiliximab Induction on Patient Survival and Time to Bronchiolitis Obliterans Syndrome in Double Lung Transplantation Recipients

Furuya

Jayarajan

Taghavi

et al. 2016

American Journal of Transplantation

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We examined the effect of alemtuzumab and basiliximab induction therapy on patient survival and freedom from bronchiolitis obliterans syndrome (BOS) in double lung transplantation. The United Network for Organ Sharing database was reviewed for adult double lung transplant recipients from 2006 to 2013. The primary outcome was risk-adjusted all-cause mortality. Secondary outcomes included time to BOS. There were 6117 patients were identified, of whom 738 received alemtuzumab, 2804 received basiliximab, and 2575 received no induction. Alemtuzumab recipients had higher lung allocation scores compared with basiliximab and no-induction recipients (41.4 versus 37.9 versus 40.7, p < 0.001) and were more likely to require mechanical ventilation before to transplantation (21.7% versus 6.5% versus 6.2%, p < 0.001). Median survival was longer for alemtuzumab and basiliximab recipients compared with patients who received no induction (2321 versus 2352 versus 1967 days, p = 0.001). Alemtuzumab (hazard ratio 0.80, 95% confidence interval 0.67-0.95, p = 0.009) and basiliximab induction (0.88, 0.80-0.98, p = 0.015) were independently associated with survival on multivariate analysis. At 5 years, alemtuzumab recipients had a lower incidence of BOS (22.7% versus 55.4 versus 55.9%), and its use was independently associated with lower risk of developing BOS on multivariate analysis. While both induction therapies were associated with improved survival, patients who received alemtuzumab had greater median freedom from BOS.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The Impact of Alemtuzumab and Basiliximab Induction on Patient Survival and Time to Bronchiolitis Obliterans Syndrome in Double Lung Transplantation Recipients

Furuya

Jayarajan

Taghavi

et al. 2016

American Journal of Transplantation

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“…Although it has been demonstrated that lung transplantation may be safely performed using donors with a smoking history, we have demonstrated that these donors might serve as an independent risk factor for the need for retransplantation at a later stage [16][17][18]. Taghavi and colleagues [16] evaluated 5,900 double-lung transplant recipients, 766 of whom received organs from donors with a heavy smoking history.…”

Section: Commentmentioning

confidence: 92%

Risk Factors Associated With Lung Retransplantation: Evaluation of a Nationwide Registry Over a Quarter Century

Hayanga

Yang

Aboagye

et al. 2014

The Annals of Thoracic Surgery

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“…Abnormal and suspicious nodules or infiltrates should be biopsied and analyzed with frozen section. The risk of transplanting cancer cells form donor to recipient may rise in the future with the increasing use of extendedcriteria donor lungs including older donors >55 years (73,74) and donors with more extensive smoking history (75,76). The current evidence in the literature suggests that lungs from carefully selected older donors and smokers can be safely used for transplantation.…”

Section: Primary Lung Cancer In the Allograftmentioning

confidence: 99%

Lung cancer: a rare indication for, but frequent complication after lung transplantation

Raemdonck¹,

Vos²,

Yserbyt³

et al. 2016

J. Thorac. Dis.

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Lung transplantation is an effective and safe therapy for carefully selected patients suffering from a variety of end-stage pulmonary diseases. Lung cancer negatively affects prognosis, particularly in patients who are no longer candidates for complete resection. Lung transplantation can be considered for carefully selected and well staged lung cancer patients with proven, lung-limited, multifocal, (minimally invasive) adenocarcinoma in situ (AIS) (previously called bronchioloalveolar cell carcinoma) causing respiratory failure. Despite a substantial risk of tumour recurrence (33-75%), lung transplantation may offer a survival benefit (50% at 5 years) with best palliation of their disease. Reports on lung transplantation for other low-grade malignancies are rare. Lung transplant candidates at higher risk for developing lung cancer [mainly previous smokers with chronic obstructive lung disease (COPD) and idiopathic pulmonary fibrosis (IPF) or older patients] should be thoroughly and repeatedly screened for lung cancer prior to listing, and preferably also during waiting list time if longer than 1 year, including the use of PET-CT scan and EBUS-assisted bronchoscopy in case of undefined, but suspicious pulmonary abnormalities. Double-lung transplantation should now replace single-lung transplantation in these high-risk patients because of a 6-9% prevalence of lung cancer developing in the remaining native lung. Patients with unexpected, early stage bronchial carcinoma in the explanted lung may have favourable survival without recurrence. Early PET-CT (at 3-6 months) following lung transplantation is advisable to detect early, subclinical disease progression. Donor lungs from (former) smokers should be well examined at retrieval. Suspicious nodules should be biopsied to avoid grafting cancer in the recipient. Close follow-up with regular visits and screening test in all recipients is needed because of the increased risk of developing a primary or secondary cancer in the allograft from either donor or recipient origin.

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Single-lung transplantation can be performed with acceptable outcomes using selected donors with heavy smoking history

Cited by 21 publications

References 27 publications

The Impact of Alemtuzumab and Basiliximab Induction on Patient Survival and Time to Bronchiolitis Obliterans Syndrome in Double Lung Transplantation Recipients

The Impact of Alemtuzumab and Basiliximab Induction on Patient Survival and Time to Bronchiolitis Obliterans Syndrome in Double Lung Transplantation Recipients

Risk Factors Associated With Lung Retransplantation: Evaluation of a Nationwide Registry Over a Quarter Century

Lung cancer: a rare indication for, but frequent complication after lung transplantation

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