Early postoperative complications in lung transplant recipients

Soetanto, V.; Grewal, Udhayvir Singh; Mehta, Atul C.; Shah, Parth Ketankumar; Varma, Manu R.; Garg, Delyse; Majumdar, Tilottama; Dangayach, Neha; Grewal, Harpreet

doi:10.1007/s12055-021-01178-1

Cited by 10 publications

(5 citation statements)

References 113 publications

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“…The sponsor will report to the Swedish Medical Products Agency all of the following reportable events: (1) any SAE that has a causal relationship with the investigational device, the comparator or the investigation procedure, or where such causal relationship is reasonably possible; (2) any device deficiency that might have led to a SAE if appropriate action had not been taken, intervention had not occurred, or circumstances had been less fortunate; and (3) any new findings in relation to any event referred to above. Foreseeable adverse events related to LTx will not be reported [20][21][22][23][24][25][26].…”

Section: Safety Assessmentmentioning

confidence: 99%

Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial

Lindstedt,

Silverborn,

Lannemyr

et al. 2023

JMIR Res Protoc

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Background Lung transplantation (LTx) is the only treatment option for end-stage lung disease. Despite improvements, primary graft dysfunction (PGD) remains the leading cause of early mortality and precipitates chronic lung allograft dysfunction, the main factor in late mortality after LTx. PGD develops within the first 72 hours and impairs the oxygenation capacity of the lung, measured as partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2). Increasing the PaO2/FiO2 ratio is thus critical and has an impact on survival. There is a general lack of effective treatments for PGD. When a transplanted lung is not accepted by the immune system in the recipient, a systemic inflammatory response starts where cytokines play a critical role in initiating, amplifying, and maintaining the inflammation leading to PGD. Cytokine filtration can remove these cytokines from the circulation, thus reducing inflammation. In a proof-of-concept preclinical porcine model of LTx, cytokine filtration improved oxygenation and decreased PGD. In a feasibility study, we successfully treated patients undergoing LTx with cytokine filtration (ClinicalTrials.gov; NCT05242289). Objective The purpose of this clinical trial is to demonstrate the superiority of cytokine filtration in improving LTx outcome, based on its effects on oxygenation ratio, plasma levels of inflammatory markers, PGD incidence and severity, lung function, kidney function, survival, and quality of life compared with standard treatment with no cytokine filtration. Methods This study is a Swedish national interventional randomized controlled trial involving 116 patients. Its primary objective is to investigate the potential benefits of cytokine filtration when used in conjunction with LTx. Specifically, this study aims to determine whether the application of cytokine filtration, administered for a duration of 12 hours within the initial 24 hours following a LTx procedure, can lead to improved patient outcomes. This study seeks to assess various aspects of patient recovery and overall health to ascertain the potential positive impact of this intervention on the posttransplantation course. Results The process of patient recruitment for this study is scheduled to commence subsequent to a site initiation visit, which was slated to take place on August 28, 2023. The primary outcome measure that will be assessed in this research endeavor is the oxygenation ratio, a metric denoted as the highest PaO2/FiO2 ratio achieved by patients within a 72-hour timeframe following their LTx procedure. Conclusions We propose that cytokine filtration could enhance the overall outcomes of LTx. Our hypothesis suggests potential improvements in LTx outcome and patient care. Trial Registration ClinicalTrials.gov NCT05526950; https://www.clinicaltrials.gov/study/NCT05526950 International Registered Report Identifier (IRRID) PRR1-10.2196/52553

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Section: Safety Assessmentmentioning

confidence: 99%

Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial

Lindstedt,

Silverborn,

Lannemyr

et al. 2023

JMIR Res Protoc

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“…It is yet to be determined if this is a direct effect of ETI or, more likely, a reflection of poor culture sampling due to diminished sputum production in the majority of PwCF taking ETI [7]. Oftentimes, these bacteria are multi-drug resistant (MDR) given the history of frequent antibiotic treatments that most CF patients receive over the course of their lives for management of pulmonary exacerbations [38]. The PsA strain in CF also tends to be mucoid alginate-producing, which is responsible for the production of a protective biofilm for the bacteria against airway clearance and antibiotic penetrance [39].…”

Section: Pseudomonas Aeruginosamentioning

confidence: 99%

Lung Transplantation in a New Era in the Field of Cystic Fibrosis

Huang

Smith

Korotun

et al. 2023

Life

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Lung transplantation for people with cystic fibrosis (PwCF) is a critical therapeutic option, in a disease without a cure to this day, and its overall success in this population is evident. The medical advancements in knowledge, treatment, and clinical care in the field of cystic fibrosis (CF) rapidly expanded and improved over the last several decades, starting from early pathology reports of CF organ involvement in 1938, to the identification of the CF gene in 1989. Lung transplantation for CF has been performed since 1983, and CF now accounts for about 17% of pre-transplantation diagnoses in lung transplantation recipients. Cystic fibrosis transmembrane conductance regulator (CFTR) modulators have been the latest new therapeutic modality addressing the underlying CF protein defect with the first modulator, ivacaftor, approved in 2012. Fast forward to today, and we now have a growing CF population. More than half of PwCF are now adults, and younger patients face a better life expectancy than they ever did before. Unfortunately, CFTR modulator therapy is not effective in all patients, and efficacy varies among patients; it is not a cure, and CF remains a progressive disease that leads predominantly to respiratory failure. Lung transplantation remains a lifesaving treatment for this disease. Here, we reviewed the current knowledge of lung transplantation in PwCF, the challenges associated with its implementation, and the ongoing changes to the field as we enter a new era in the care of PwCF. Improved life expectancy in PwCF will surely influence the role of transplantation in patient care and may even lead to a change in the demographics of which people benefit most from transplantation.

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“…Perioperative ECMO support itself did not increase the risk for TE in our cohort, however, this may be due to the large time span of observation and the fact that 30-daysmortality in patients on ECMO support as 'bridge to transplant' was much higher in the earlier years compared to the last decade. There are some reports describing thrombi arising from the surgical suture lines, which is a possible, although rare source for TE [29,30]. The venous and pulmonary arterial anastomoses are checked for patency and flow pattern intra-and, if needed, also postoperatively by transesophageal echography.…”

Section: Risk Factors and Distribution Of Tementioning

confidence: 99%

Independent risk factors for an increased incidence of thromboembolism after lung transplantation

Moneke

Ögütür

Kalbhenn

et al. 2022

J Thromb Thrombolysis

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Background Thromboembolism (TE) after lung transplantation (LTX) is associated with increased morbidity and mortality. The aim of this study is to analyze the incidence and outcome of venous and arterial thromboembolic complications and to identify independent risk factors. Patients and methods We retrospectively analyzed the medical records of 221 patients who underwent LTX at our institution between 2002 and 2021. Statistical analysis was performed using SPSS and GraphPad software. Results 74 LTX recipients (33%) developed TE. The 30-days incidence and 12-months incidence were 12% and 23%, respectively. Nearly half of the patients (48%) developed pulmonary embolism, 10% ischemic stroke. Arterial hypertension (p = 0.006), a body mass index (BMI) > 30 (p = 0.006) and diabetes mellitus (p = 0.041) were independent predictors for TE. Moreover, a BMI of > 25 at the time of transplantation was associated with an increased risk for TE (43% vs. 32%, p = 0.035). At the time of LTX, 65% of the patients were older than 55 years. An age > 55 years also correlated with the incidence of TE (p = 0.037) and these patients had reduced overall post-transplant survival when the event occurred within the first postoperative year (59% vs. 72%, p = 0.028). Conclusions The incidence of TE after LTX is high, especially in lung transplant recipients with a BMI > 25 and an age > 55 years as well as cardiovascular risk factors closely associated with the metabolic syndrome. As these patients comprise a growing recipient fraction, intensified research should focus on the risks and benefits of regular screening or a prolonged TE prophylaxis in these patients. Trial registration number DKRS: 00021501.

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Early postoperative complications in lung transplant recipients

Cited by 10 publications

References 113 publications

Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial

Design and Rationale of Cytokine Filtration in Lung Transplantation (GLUSorb): Protocol for a Multicenter Clinical Randomized Controlled Trial

Lung Transplantation in a New Era in the Field of Cystic Fibrosis

Independent risk factors for an increased incidence of thromboembolism after lung transplantation

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