Lung transplantation is a globally accepted treatment for some advanced lung diseases, giving the recipients longer survival and better quality of life. Since the first transplant successfully performed in 1983, more than 40 thousand transplants have been performed worldwide. Of these, about seven hundred were in Brazil. However, survival of the transplant is less than desired, with a high mortality rate related to primary graft dysfunction, infection, and chronic graft dysfunction, particularly in the form of bronchiolitis obliterans syndrome. New technologies have been developed to improve the various stages of lung transplant. To increase the supply of lungs, ex vivo lung reconditioning has been used in some countries, including Brazil. For advanced life support in the perioperative period, extracorporeal membrane oxygenation and hemodynamic support equipment have been used as a bridge to transplant in critically ill patients on the waiting list, and to keep patients alive until resolution of the primary dysfunction after graft transplant. There are patients requiring lung transplant in Brazil who do not even come to the point of being referred to a transplant center because there are only seven such centers active in the country. It is urgent to create new centers capable of performing lung transplantation to provide patients with some advanced forms of lung disease a chance to live longer and with better quality of life.

Introduction  The association between sinus and lung diseases is well known. However, there are scarce studies regarding the effects of sinus surgery on pulmonary function in lung transplant recipients. The present study describes our experience with sinus surgery in lung transplant recipients with chronic rhinosinusitis. Objectives  To assess the impact of sinus surgery for chronic rhinosinusitis on pulmonary function and on inpatient hospitalization days due to lower respiratory tract infection in lung transplant recipients. Methods  A retrospective study conducted between 2006 and 2012 on a sample of lung transplant recipients undergoing sinus surgery for chronic rhinosinusitis. Pulmonary function, measured by forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), as well as inpatient hospitalization days due to lower respiratory tract infection, were compared 6 months before and 6 months after sinus surgery. Results  The FEV1 values increased significantly, and the inpatient hospitalization days due to bronchopneumonia decreased significantly 6 months after sinus surgery. The preoperative and postoperative median FEV1 values were 2.35 and 2.68 respectively ( p  =  0.0056 ). The median number of inpatient hospitalization days due to bronchopneumonia 6 months before and 6 months after surgery were 32.82 and 5.41 respectively ( p  =  0.0013 ). Conclusion  In this sample of lung transplant recipients with chronic rhinosinusitis, sinus surgery led to an improvement in pulmonary function and a decrease in inpatient hospitalization days due to bronchopneumonia.

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Pego-Fernandes PM, Jatene FB. Lista de espera para tansplante pulmonar no Estado de São Paulo: características dos pacientes e preditores de mortalidade. Rev Med (São Paulo). 2009 jan.-mar.;88(1):20-35. RESUMO:Introdução: Atualmente, a alocação de pulmões no Brasil baseia-se, sobretudo, no tempo de espera em lista (Li) para transplante pulmonar (TxP). Objetivos: (1) Determinar o perfi l dos pacientes em Li, e (2) Identifi car preditores de mortalidade em lista (PMLi). Casuística e métodos: Analisamos os prontuários de 164 pacientes inscritos na Li por nosso serviço, de 2001 até 2008. Os PMLi foram obtidos por uma análise de riscos proporcionais de Cox. Resultados: Os pacientes foram inclusos na Li com 40,9 ± 15,7 anos, sobretudo por enfi sema (24,5%). Diagnóstico de enfi sema ou bronquiectasias (risco relativo [RR]=0,15; p=0,002), tempo de tromboplastina parcial ativada > 30 segundos (RR=3,28; p=0,002), albumina plasmática > 3,5 g/dl (RR=0,41; p=0,033) e saturação da hemoglobina > 85% (RR=0,44; p=0,031) foram identifi cados como PMLi. Conclusões: (1) Algumas variáveis podem predizer o risco de morte em Li para TxP; (2) Conhecer as características dos receptores de TxP é essencial para futuras medidas de aprimoramento dos critérios de alocação de TxP.

A hiperinsuflação do pulmão nativo é comum no pós-operatório de transplantes pulmonares unilaterais por enfisema. Quando progressiva, pode comprimir o pulmão transplantado, gerando balanço mediastinal, com prejuízo da ventilação. Nestas situações, o tratamento consiste na redução volumétrica do pulmão nativo. Relatamos dois casos de hiperinsuflação, uma aguda e outra tardia de pulmão nativo, após transplante pulmonar. Ambos evoluíram com disfunção progressiva e sem resposta ao tratamento clínico. No caso agudo, optamos por cirurgia de redução de volume pulmonar com uso de grampeadores e múltiplas ressecções em cunha, removendo 20% do parênquima. No caso crônico, optamos por realização de lobectomia inferior, devido ao resultado da cintilografia.