A single-center experience of 1500 lung transplant patients

Balsara, Keki R.; Krupnick, Alexander S.; Bell, Jennifer M.; Khiabani, Ali J.; Scavuzzo, Masina; Hachem, Ramsey R.; Trulock, Elbert P.; Witt, Chad A.; Byers, Derek E.; Yusen, Roger D.; Meyers, Bryan F.; Kozower, Benjamin D.; Patterson, G. Alexander; Puri, Varun; Kreisel, Daniel

doi:10.1016/j.jtcvs.2018.03.112

Cited by 39 publications

(41 citation statements)

References 33 publications

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“…On the other hand, several transplant centres and social media platforms nowadays report LTx recipients surviving 20 years or more after transplantation , with 20‐year post‐LTx survival rates of 20–30% in experienced centres, again mainly patients who underwent bilateral LTx or were transplanted for cystic fibrosis . The longest surviving LTx recipient in our institution is currently a woman who underwent heart–lung transplantation for Eisenmenger's syndrome 28 years ago.…”

Section: Introductionmentioning

confidence: 93%

Mortality after lung transplantation: a single‐centre cohort analysis

Raskin¹,

Vanstapel

Verbeken

et al. 2019

Transpl Int

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Detailed data on postoperative death in lung transplant (LTx) recipients are lacking. Therefore, we investigated all deaths after LTx in a large, single-centre, 25-year follow-up cohort. Prevalence, time, place and cause of death (COD) were retrospectively analysed for all patients undergoing primary LTx between July 1991 and December 2015 in our centre. Over subsequent years, postoperative survival significantly improved, with proportionally more patients surviving to 1-year post-LTx (P < 0.0001). A total of 347 (38.9%) LTx recipients died, of which 53.6% expired within 3 years post-LTx [median time to death 910 (236-2447) days]. Autopsy was performed in 34.8% of deaths. COD included CLAD in 27.1% (BOS 63.8% vs. RAS 36.2%); infection (26.5%); malignancy (15.6%); postoperative complication (11.2%); cardiovascular disease (4.6%) or other causes (6.9%). In 8.1%, no clear COD could be determined. COD significantly differed between the various LTx indications (P = 0.047). With longer follow-up, infection becomes a less prevalent COD, but CLAD and malignancies a more important COD. The majority of patients died on the intensive care unit (40.6%) or hospital ward (29.1%), but place of death varied depending on the underlying COD. The current study provides insights into the postoperative deaths of LTx recipients.

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Section: Introductionmentioning

confidence: 93%

Mortality after lung transplantation: a single‐centre cohort analysis

Raskin¹,

Vanstapel

Verbeken

et al. 2019

Transpl Int

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“…With over 1650 transplants to date, Barnes Jewish Hospital (BJH) is the site of a well‐established, high‐volume LT program that supports clinical and laboratory research . Since the 14 busiest LT programs perform nearly 35% of LT in the United States, many aspects of the practice patterns and outcomes at BJH are reflective of national practice .…”

Section: Comparison Of Clinical Characteristics and Organ Costs For Lmentioning

confidence: 99%

Unintended consequences of changes to lung allocation policy

Puri

Hachem

Frye

et al. 2019

American Journal of Transplantation

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Organ allocation for transplantation aims to balance the principles of justice and medical utility to optimally utilize a scarce resource. To address practical considerations, the United States is divided into 58 donor service areas (DSA), each constituting the first unit of allocation. In November 2017, in response to a lawsuit in New York, an emergency action change to lung allocation policy replaced the DSA level of allocation for donor lungs with a 250 nautical mile circle around the donor hospital. Similar policy changes are being implemented for other organs including heart and liver. Findings from a recent US Department of Health and Human Services report, supplemented with data from our institution, suggest that the emergency policy has not resulted in a change in the type of patients undergoing lung transplantation (LT) or early postoperative outcomes. However, there has been a significant decline in local LT, where donor and recipient are in the same DSA. With procurement teams having to travel greater distances, organ ischemic time has increased and median organ cost has more than doubled. We propose potential solutions for consideration at this critical juncture in the field of transplantation. Policymakers should choose equitable and sustainable access for this lifesaving discipline.

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“…In addition, many lose their allograft 5-10 years postengraftment due to chronic rejection. 1 Standard of care management includes routine scheduled perioperative biopsies for the diagnosis of acute rejection, which is then treated with accentuation Abbreviations: O-AF, obliterative airway fibrosis; OB, obliterative bronchiolitis; OTU, operational taxonomic units; PBS, phosphate-buffered saline; rRNA, ribosomal ribonucleic acid; TGF-β, transforming growth factor beta; Tregs, regulatory T cell; VMNA, vancomycin, metronidazole, neomycin, and ampicillin. of immunosuppression in an attempt to offset chronic rejection-mediated graft loss.…”

Section: Introductionmentioning

confidence: 99%

Vendor-specific microbiome controls both acute and chronic murine lung allograft rejection by altering CD4+Foxp3+ regulatory T cell levels

Guo

Wang

et al. 2019

American Journal of Transplantation

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Despite standardized postoperative care, some lung transplant patients suffer multiple episodes of acute and chronic rejection while others avoid graft problems for reasons that are poorly understood. Using an established model of C57BL/10 to C57BL/6 minor antigen mismatched single lung transplantation, we now demonstrate that the recipient microbiota contributes to variability in the alloimmune response. Specifically, mice from the Envigo facility in Frederick, Maryland contain nearly double the number of CD4 + Foxp3 + regulatory T cells (T regs ) than mice from the Jackson facility in Bar Harbor, Maine or the Envigo facility in Indianapolis, Indiana (18 vs 9 vs 7%). Lung graft recipients from the Maryland facility thus do not develop acute or chronic rejection. Treatment with broad-spectrum antibiotics decreases T regs and increases both acute and chronic graft rejection in otherwise tolerant strains of mice. Constitutive depletion of regulatory T cells, using Foxp3-driven expression of diphtheria toxin receptor, leads to the development of chronic rejection and supports the role of T regs in both acute and chronic alloimmunity. Taken together, our data demonstrate that the microbiota of certain individuals may contribute to tolerance through T reg -dependent mechanisms and challenges the practice of indiscriminate broad-spectrum antibiotic use in the perioperative period. K E Y W O R D Sanimal models: murine, basic (laboratory) research/science, bronchiolitis obliterans (BOS), immunosuppression/immune modulation, lung disease: immune/inflammatory, lung transplantation/pulmonology, rejection: acute, rejection: chronic

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A single-center experience of 1500 lung transplant patients

Cited by 39 publications

References 33 publications

Mortality after lung transplantation: a single‐centre cohort analysis

Mortality after lung transplantation: a single‐centre cohort analysis

Unintended consequences of changes to lung allocation policy

Vendor-specific microbiome controls both acute and chronic murine lung allograft rejection by altering CD4+Foxp3+ regulatory T cell levels

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