Acute Rejection in the Modern Lung Transplant Era

Renaud-Picard, B.; Koutsokera, Angela; Cabanero, Michael; Martinu, T.

doi:10.1055/s-0041-1729542

Cited by 14 publications

(9 citation statements)

References 187 publications

(222 reference statements)

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“…This is a potentially mechanistic outcome as acute rejection is a leading risk factor for chronic rejection which in turn is a leading cause of LT mortality. 18 Identifying risk…”

Section: Discussionmentioning

confidence: 99%

“…To ensure equal time risk, this was assessed for the subset of patients who were followed for at least 1‐year post‐LT. Treated lung rejection during the LT admission or first year of LT (within the subset of subjects followed at least 1‐year post‐ LT to ensure equal time risk). This is a potentially mechanistic outcome as acute rejection is a leading risk factor for chronic rejection which in turn is a leading cause of LT mortality 18 . Identifying risk factors for acute rejection opens opportunities for earlier detection and intervention which could slow the progression toward worse outcomes. Posttransplant graft survival, defined as the time from LT until death or retransplant.…”

Section: Methodsmentioning

confidence: 99%

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Place-based heterogeneity in lung transplant recipient outcomes

Tsuang

López

Tang

et al. 2022

American Journal of Transplantation

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Lung transplant (LT) is the definitive, life-saving intervention for patients with end-stage lung diseases and leads to a survival benefit. 1 While there have been many advances in clinical care, a gap in knowledge exists between LT outcomes and place-defined as a social or environmental area with meaning to a patient. LT recipients may be particularly vulnerable to place-based effects as lungs are directly and continuously exposed and susceptible to infection, pollution, and the environment. This vulnerability is exacerbated by lifelong immunosuppression where adherence and regular access to these medications can be disrupted by social stressors. [2][3][4] The association between place and transplant outcomes has been rigorously investigated in kidney transplantation which has

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“…This is a potentially mechanistic outcome as acute rejection is a leading risk factor for chronic rejection which in turn is a leading cause of LT mortality. 18 Identifying risk…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Place-based heterogeneity in lung transplant recipient outcomes

Tsuang

López

Tang

et al. 2022

American Journal of Transplantation

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“…CLAD is the most common cause of death within I year after LT [ 54 ]. External exposure and infection increase the risk of rejection after LT [ 55 ]. Acute rejection can be mediated by either acute cellular rejection (ACR) involving T cells or antibody-mediated rejection (AMR) involving B cells.…”

Section: Pulmonary Complicationsmentioning

confidence: 99%

Medical Complications of Lung Transplantation

Park

2022

J Chest Surg

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Lung transplantation (LT) is now considered as an effective treatment option for end-stage lung diseases that improves the short and long-term survival rates and quality of life. As increasingly many LT procedures are being performed, the medical complications of LT are also increasing in frequency and emerging as a very important issue for transplant clinicians. Although chronic lung allograft dysfunction and infection are major causes of death after LT, many medical complications, several of which result from immunosuppressive treatment, contribute to increased mortality and morbidity. This article reviews the most frequent and important medical complications of LT, accompanied by a review of the literature and studies from South Korea, including lung allograft rejection, infection, and non-allograft organ systemic complications.

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“…Primary lung transplantation (LTx) offers definitive treatment for patients who have advanced pulmonary disease, with longer survival for patients with many causes of end-stage, life-threatening lung disease and improved quality of life in carefully selected candidates ( 1 , 2 ). However, early graft failure due to primary graft dysfunction ( 3 ) or acute cellular rejection ( 4 ) and late graft failure due to chronic lung allograft dysfunction ( 5 ) both lead to significant morbidity and mortality after LTx. While medical interventions for both early and late lung allograft failure may have limited efficacy, lung re-transplantation is one potential therapy that could definitively treat end-stage lung allograft failure for the appropriate candidates.…”

Section: Introductionmentioning

confidence: 99%

Time since primary transplant and poor functional status predict survival after redo lung transplant

Aggarwal¹,

Jackson²,

Lemke³

et al. 2022

J Thorac Dis

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Background: In previous studies, lower functional status measured by Karnofsky Performance Status (KPS) correlated with worse survival after redo lung transplant. We hypothesize that combining reduced functional status and time from primary lung transplant will correlate with the etiology of lung allograft failure after primary lung transplant and more accurately predict survival after redo lung transplant.Methods: This retrospective study was approved by University of Minnesota Institutional Review Board. From the Scientific Registry of Transplant Recipients (SRTR) database, 739 patients underwent redo lung transplant (01/01/2005-8/30/2019). Pre-lung transplant characteristics, KPS, time between primary and redo lung transplant, outcomes, overall survival were evaluated. Paired comparisons were used to compare pre-transplant variables. A Cox regression model was fit to examine re-transplant survival. Due to nonproportional hazards, time between transplants was split into <1-year vs. 1+ years and analyzed with timedependent coefficients, with follow-up time considered in three segments (0-6, 6-24, 24+ months).Results: After KPS grouping (10-40%, 50-70%, 80-100%), KPS 10-40% were less likely to be discharged after primary transplant and more likely required mechanical ventilation or extracorporeal membrane oxygenation (ECMO) bridging (P<0.001). Redo lung transplant survival was worse in the KPS 10-40% group who more likely underwent lung transplant <1 year after primary lung transplant. Mortality was significantly higher for patients who underwent redo lung transplant within one year of primary transplant when KPS was 10-40% (P<0.001). These patients were more likely to require redo lung transplant due to primary graft failure or acute cellular rejection.Conclusions: Functional status and time from primary lung transplant are strong predictors of outcome after redo lung transplant. We categorized redo lung transplant recipients in two distinct groups. One group has early allograft failure and poor functional status with a very poor prognosis after redo lung transplant. The other group has chronic allograft failure and overall better functional status with relatively better survival after redo lung transplant. Salvage redo lung transplant for primary allograft failure or acute rejection is associated with low one year survival.

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Acute Rejection in the Modern Lung Transplant Era

Cited by 14 publications

References 187 publications

Place-based heterogeneity in lung transplant recipient outcomes

Place-based heterogeneity in lung transplant recipient outcomes

Medical Complications of Lung Transplantation

Time since primary transplant and poor functional status predict survival after redo lung transplant

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