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After solid organ transplantation, signs and symptoms of the central nervous system may present a diagnostic challenge. A 43-year-old patient developed a decrease in vision 15 months after bilateral lung transplantation. The initial diagnosis was a left posterior cataract, but left eye cataract extraction did not improve his vision. Seizures led to investigation of a broader differential diagnosis (cyclosporine intoxication, post-transplant lymphoproliferative disorder, infectious disease, chronic lymphatic leukemia). The clinical diagnosis of progressive multifocal leukoencephalopathy (PML) was confirmed by demonstration of JC virus in the cerebrospinal fluid and by autopsy findings. Modulation of the immunosuppressive regimen was unsuccessful. This case illustrates that decreased vision in immunocompromised patients may be the first manifestation of PML.

Height is used in allocation of donor lungs as an indirect estimate of thoracic size. Total lung capacity (TLC), determined by both height and sex, could be a more accurate functional estimation of thoracic size. Size-matching criteria based on height versus predicted TLC was retrospectively evaluated, and, furthermore, whether a TLC mismatch was related to clinical and functional complications.The ratio of donor and recipient height, as well as the ratio of predicted TLC in donors and recipients, were calculated in 80 patients after bilateral lung transplantation. Complications evaluated included persistent atelectasis, persistent pneumothorax and increased number of days in intensive care, occurrence of bronchiolitis obliterans syndrome and limitation of exercise capacity.Median height donor/recipient ratio was 1.01 (0.93-1.12). Median predicted TLC donor/recipient ratio was 1.01 (with a clearly broader range 0.72-1.41). Neither sex mismatch nor TLC mismatch were related to clinical or functional complications.Allocation of donor lungs based upon height alone leads to a substantial mismatch in total lung capacity caused by sex mismatch. The absence of complications suggests that a greater height donor/recipient discrepancy can be accepted for allocation than previously assumed. Eur Respir J 2002; 20: 1419-1422. Size matching in lung transplantation (LT) has been performed in the past by measuring the submammary thoracic perimeter [1,2], by matching chest radiographs [3,4], anthropometry, weight [5], predicted lung size [6] and height. However, none of these methods guarantee an appropriate lung size with respect to the size of the thoracic cage. The best approach to donor/recipient (D/R) size matching has not been determined so far.In general, allocation of donor lungs is based primarily on blood group and height. Height mismatch may sometimes preclude allocation. The effect of the anatomical difference in shape of the thoracic cavity between males and females on the possible permitted height mismatch is unknown. Size matching based upon height alone may be associated with discrepancies in estimated thoracic size in case of a sex mismatch. A female recipient will receive a greater lung from a male donor although the height of donor and recipient is equal. Similarly, a male recipient will receive a smaller lung from a female donor although height of donor and recipient is equal. Total lung capacity (TLC) depends on height and sex and may thus be regarded as a more accurate, functional estimation of thoracic size.In the present study, size matching based on height versus size matching based on height and sex were retrospectively evaluated by calculating ratios of D/R height as well as ratios of predicted D/R TLC. Since an increased range of ratios of predicted TLC was expected, the authors investigated whether these size discrepancies led to clinical and/or functional complications. Methods PatientsNinety-six bilateral LT (BLT) were performed between November 1990 and September 1998 in the Groningen Un...

This study was performed to assess the main reasons for the unfavorable cost effectiveness of lung transplantation compared with that of heart and liver transplantation. Costs, effects, and cost-effectiveness ratios of Dutch lung, heart, and liver transplantation programs were compared. The data are based on three Dutch technology assessments of transplantation, with minor adjustments for time and methods. In result, mainly follow-up costs of lung transplantation are higher than costs of heart and liver transplantation -US $1 50,300, US $121,500, and US $95,300, respectively -in the first 3 years after transplantation. The survival gain realized by lung transplantation is small (4.4 years) compared with heart (8.8 years) and liver (14.7years) transplantation. Costs per life-year gained were US $77,000, US $38,000, and US $26,000 for lung, heart, and liver transplantation, respectively. The unfavorable cost effectiveness of lung transplantation is largely related to a relatively small survival gain and high follow-up costs.

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