Transplant options for end stage chronic obstructive pulmonary disease in the context of multidisciplinary treatments

Santambrogio, Luigi; Tarsia, Paolo; Mendogni, Paolo; Tosi, Davide

doi:10.21037/jtd.2018.04.166

Cited by 5 publications

(4 citation statements)

References 79 publications

(68 reference statements)

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“…In the early 1980s, when lung transplantation was first carried out successfully, single lung transplantation was favored due to its lower surgical morbidity. However, today, double lung transplantation has gained preference owing to its superior long-term outcomes ( 12 , 13 ). Nevertheless, single lung transplantation remains a reasonable option in certain cases.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of lung transplantation for chronic obstructive pulmonary disease

Türkkan,

Çelik Başaran,

Şahin

et al. 2023

Tuberk Toraks

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Outcomes of lung transplantation for chronic obstructive pulmonary disease Introduction Chronic obstructive pulmonary disease is a progressive airway disease that can progress to the terminal stage requiring oxygen supply. In this period, lung volume reduction therapies and/or lung transplantation may be considered. Morbidity and mortality risks due to transplant surgery and posttransplant immunosuppressive therapy show the importance of selecting the best candidates who will benefit from transplantation. In this context, BODE index criteria serve as important markers. This study aimed to analyze the outcomes of lung transplantation in patients with chronic obstructive pulmonary disease and to identify variables that may affect post-transplant clinical outcomes. Materials and Methods Lung transplants diagnosed with chronic obstructive pulmonary disease performed in our center between March 2013 and January 2023 were included in the study. Demographic information and both pre-op and post-op clinical data of the transplant patients were collected. The effect of BODE index criteria and other pre-transplant clinical data on short- and long-term outcomes after transplantation were investigated. Results During the study period, 34 lung transplants were performed for chronic obstructive pulmonary disease. One patient died during the operation, three patients received single transplants, and 30 received double transplants. Post-operative primary graft dysfunction was more common in single transplant recipients. The results were comparable between single and double transplants in terms of post-transplant pulmonary function and the development of chronic lung allograft dysfunction. BODE index criteria had no effect on early and late post-operative clinical data, however intra-operative use of extracorporeal membrane oxygenation, primary graft dysfunction, and prolonged extubation were significantly higher in recipients younger than 60 years. Conclusion Our study suggests that prelisting demographic and clinical data of chronic obstructive pulmonary disease patients had no significant effect on post-operative outcomes, however, intra-operative ECMO use, prolonged extubation, primary graft dysfunction (p< 0.05 for each) and chronic rejection (p> 0.05) were more common in patients who are <60 years of age. These data need to be confirmed by larger studies.

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Section: Discussionmentioning

confidence: 99%

Outcomes of lung transplantation for chronic obstructive pulmonary disease

Türkkan,

Çelik Başaran,

Şahin

et al. 2023

Tuberk Toraks

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“…The choice of the transplant procedure depends on various factors, including whether it involves a single lung, bilateral lung, or multi-organ transplant [18]. Multi-organ transplants may occur in tandem or sequentially, depending on clinical need.…”

Section: Surgical Management Of Copdmentioning

confidence: 99%

Lung Transplantation as a treatment strategy for Pulmonary Emphysema

Ligia Cornea,

Linnane,

Riddell

et al. 2024

Pulmonary Emphysema - Recent Updates

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The role of lung transplantation is to provide survival and quality of life benefits to patients with advanced lung disease. In this chapter, focusing on chronic obstructive pulmonary disease (COPD), we provide a comprehensive discussion of key aspects involved in the assessment of recipient suitability for transplantation. We discuss key issues such as timing of referral, donor evaluation, and organ allocation. We provide a detailed evaluation of the technical aspects of transplant surgery, evaluating the relative merits of both single and bilateral lung transplantation. In addition, we highlight how the transplant field is addressing donor shortfall, with expansion of acceptable donor criteria and the use of ex vivo lung perfusion to improve donor evaluation. Finally, we examine post-operative morbidity and mortality, discussing both early and late surgical complications and the adverse effects of long-term immunosuppression.

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“…However, donor lung size should be smaller than the recipient TLC in order to optimize lung mechanics. 16 In patients with emphysema, in particular, size mismatch (actual TLC donor-to-recipient ratio of <0.67 and >1.03) has been associated with worse survival. 17 Relative undersizing of COPD lungs could lead to pleural effusions which accommodate the increased thoracic cavity space.…”

Section: As Shown Inmentioning

confidence: 99%

Pleural catheter placement and intrapleural fibrinolysis following lung transplantation

Kao

Cuevas

Tuthill

et al. 2019

Clinical Transplantation

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Lung transplantation is a treatment option for end-stage lung disease for which no other therapeutic options exist. Pleural space complications are common following lung transplantation, with a reported incidence of 22%-34%. 1 Pleural drains are placed surgically after lung transplantation to drain pleural fluid. The etiology of this pleural fluid may be multifactorial, and potential mechanisms for pleural fluid production include disruption of lymphatic drainage, increased alveolar-capillary permeability resulting from graft ischemia, denervation, and reperfusion, and overhydration. 2,3 In addition to expected post-operative pleural effusions, other pleural complications such as hemothorax, chylothorax, pneumothorax, empyema, trapped lung, and acute rejection may also occur.Typically, the amount of pleural fluid declines in the first week following transplant and resolves around day 9. 4 However, some patients may develop late pleural effusions (14-90 days following transplant) which may resolve with thoracentesis. 5 The use of smallbore drainage catheters to drain pleural effusions post-lung transplantation using ultrasound and CT guidance has also been reported in a small series of 31 patients up to 36 months after transplant. 6 In 9 of these patients, streptokinase was also administered when fluid increased despite catheter drainage or if the fluid was loculated. AbstractBackground: This study aimed to investigate the characteristics of lung transplant recipients requiring additional pleural drainage catheters early post-lung transplantation and to determine the safety and efficacy of intrapleural fibrinolytics in these patients. Methods:A retrospective review of lung transplant recipients at a single center was performed. Patient and transplant characteristics, placement of pleural drainage catheters within 90 days of transplant, and use of intrapleural fibrinolytics were determined.

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Transplant options for end stage chronic obstructive pulmonary disease in the context of multidisciplinary treatments

Cited by 5 publications

References 79 publications

Outcomes of lung transplantation for chronic obstructive pulmonary disease

Outcomes of lung transplantation for chronic obstructive pulmonary disease

Lung Transplantation as a treatment strategy for Pulmonary Emphysema

Pleural catheter placement and intrapleural fibrinolysis following lung transplantation

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