The complications after lung transplantation

Jakubec, Petr; Žůrková, Monika; Hajdová, Lenka; Křenková, Aneta; Kolek, Vı́tězslav

doi:10.36290/vnl.2017.158

Cited by 4 publications

(4 citation statements)

References 73 publications

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“…However, it is difficult to reduce the occurrence of sternal dehiscence due to osteomalacia following a long preoperative treatment period, use of high doses of immunosuppressive drugs, and extensive surgical trauma accompanied by ligation of the bilateral mammary artery. 1 2 3 …”

Section: Discussionmentioning

confidence: 99%

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A Comparative Study of a Sternum-Sparing Procedure and Clamshell Incision in Bilateral Lung Transplantation

Park,

Son,

Kim

et al. 2023

Yonsei Med J

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Purpose Clamshell incision offers excellent exposure and access to the pleural spaces and is a standard incision for lung transplantation. However, due to its high sternal complication rate, the clamshell incision is considered a procedure that requires improvement. In this study, we aimed to investigate the outcomes of transverse sternotomy with clamshell incision in comparison to sternum-sparing bilateral anterolateral thoracotomy (BAT). Materials and Methods In total, 134 bilateral sequential lung transplants were performed from May 2013 to June 2022. The clamshell incision was used between May 2013 and December 2017, and the BAT was introduced in January 2018. Thirty-four patients underwent clamshell surgery, and 100 patients underwent BAT. We retrospectively compared patient characteristics and perioperative and postoperative outcomes between the two groups. Results The clamshell group required an operation time of 745.18±101.76 min, which was significantly longer than that of the BAT group at 669.90±134.09 min ( p =0.003). The mechanical ventilation period after surgery was 17.26±16.04 days in the clamshell group, significantly longer than the 11.35±12.42 days in the BAT group ( p =0.028). Intensive care unit stay was also significantly longer in the clamshell group (21.54±15.23 days vs. 15.03±14.28 days; p =0.033). In-hospital mortality rates were 26.5% in the clamshell group and 22.0% in the BAT group. Conclusion Less-invasive lung transplantation via sternum-sparing BAT is a safe procedure with low morbidity and favorable outcomes. Preventing sternal instability enables more stable breathing after surgery, earlier weaning from mechanical ventilation, and faster recovery to routine activities.

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Section: Discussionmentioning

confidence: 99%

“…Although various wiring and transverse sternotomy methods have been used to reduce the incidence of these complications, most of them are complicated and need to be more clearly advantageous, compared to conventional techniques. 1 2 3 …”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of a Sternum-Sparing Procedure and Clamshell Incision in Bilateral Lung Transplantation

Park,

Son,

Kim

et al. 2023

Yonsei Med J

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“…Despite the improvement in long‐term survival, complication rates remain high during the post‐transplant period, especially gastrointestinal (GI) complications. GI complications can occur during the immediate post‐operative period or years after and lead to significant morbidity, prolonged hospital stays and even mortality in severe cases 5 …”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal complications in pediatric lung transplant recipients: Incidence, risk factors, and effects on patient outcomes

Klouda,

Ryan E,

Leonard

et al. 2024

Pediatric Transplantation

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BackgroundGastrointestinal (GI) complications in lung transplant recipients can occur any time during the post‐operative period, leading to prolonged morbidity and mortality. Despite the negative association between GI complications and patient outcomes, little is known about their incidence and risk factors for their development in pediatric lung transplant recipients.MethodsWe performed a retrospective chart review at one pediatric tertiary center to describe the frequency of GI complications in lung transplant recipients. We identified potential risk factors for the diagnosis of gastroparesis, gastroesophageal reflux disease (GERD) and aspiration in the post‐transplant period. Lastly, we investigated the association of these complications with mortality and graft survival.Results84.3% of lung transplant recipients experienced at least one GI complication in the post‐transplant period. Gastroparesis (52.9%), GERD (41.2%), and oropharyngeal dysphagia/laryngeal penetration (33.3%) were the most common complications diagnosed. Post‐operative opioid exposure was a risk factor for gastroparesis, with the odds increasing 3.0% each day a patient was prescribed opioids (p = .021). The risk of death or retransplant in individuals who experienced gastroparesis was 2.7 times higher than those not diagnosed with gastroparesis (p = .027).ConclusionExposure to opioids in the post‐operative period is a risk factor for gastroparesis and a prolonged hospitalization placed patients at risk for aspiration. Gastroparesis was associated with increased patient mortality and graft failure, while aspiration and GERD had no effect on long term outcomes. Future prospective studies investigating the relationship between opioid use and the development of a gastroparesis are necessary to improve patient outcomes.

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“…The median survival after LTx is just 5.8 years, and this is the shortest survival compared with all other solid organ transplants, results primarily from chronic rejection . Several risk factors for AR or chronic rejection have been proposed, including immune responses to human leukocyte antigen (HLA), development of donor-specific antibody (DSA) against HLA, immune response to lung-associated self-antigens (SAgs), and respiratory viral infection (RVI). − The contribution and interplay of factors underlying each of these mechanisms in modulating the immune responses of LTx recipients (LTxRs) has not been fully characterized …”

Section: Introductionmentioning

confidence: 99%

Global Proteomics Analysis of Circulating Extracellular Vesicles Isolated from Lung Transplant Recipients

et al. 2020

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Lung transplant recipients (LTxRs) with acute rejection (AR) and chronic rejection (bronchiolitis obliterans syndrome [BOS]) induce circulating exosomes known to contain donor human leukocyte antigens and lung-associated self-antigens. Here, we sought to identify proteomic signatures in circulating extracellular vesicles (EVs) that differentiate LTxRs in 4 groups: stable, AR, BOS, or respiratory viral infection (RVI). EVs were isolated from plasma from patients in each group via ultracentrifugation. EV protein cargoes were prepared for shotgun proteomics using liquid chromatography−tandem mass spectrometry. We identified 2 unique proteins for AR, 4 for RVI, 24 for BOS, and 8 for stable LTxRs. Differential analysis of AR, BOS, RVI, and stable proteins identified significantly deregulated proteins (p < 0.05, log 2 (fold change) > ±1) in each condition (31, 2, and 2, respectively). EVs from LTxRs with AR contained proteins involved in immunoglobulin, complement regulation, coagulation, and innate and adaptive immune response pathways. EVs from LTxRs with BOS revealed enriched immunoglobulin receptors and a carboxypeptidase N catalytic chain. EVs from LTxRs with RVI had an enriched macrophage-stimulating factor. We found unique signatures in LTxRs with AR, BOS, and RVI, highlighting complex immune mechanisms underlying lung allograft rejection. Proteomic signatures in LTxRs' circulating EVs provided insights into immunological mechanisms of graft rejection and RVI.

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The complications after lung transplantation

Cited by 4 publications

References 73 publications

A Comparative Study of a Sternum-Sparing Procedure and Clamshell Incision in Bilateral Lung Transplantation

A Comparative Study of a Sternum-Sparing Procedure and Clamshell Incision in Bilateral Lung Transplantation

Gastrointestinal complications in pediatric lung transplant recipients: Incidence, risk factors, and effects on patient outcomes

Global Proteomics Analysis of Circulating Extracellular Vesicles Isolated from Lung Transplant Recipients

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