Pediatric lung transplantation and end of life care in cystic fibrosis: Barriers and successful strategies

Dellon, Elisabeth P.; Goldfarb, Samuel; Hayes, Don; Sawicki, Gregory S.; Wolfe, Joanne; Boyer, Debra

doi:10.1002/ppul.23748

Cited by 10 publications

(8 citation statements)

References 65 publications

(130 reference statements)

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“…Although this review included provider perspectives on patient perspectives on palliative care usage in solid organ transplant, no articles described patient perspectives or patient self-reported barriers to palliative care in solid organ transplant. Although research exists on the experiences and perspectives of cystic fibrosis patients regarding palliative care, 30,31 those studies were not include in this review because they were not targeting specifically patients awaiting lung transplant or posttransplant.…”

Section: Discussionmentioning

confidence: 99%

State of the Science of Palliative Care in Solid Organ Transplantation

Gustafson

Song

2020

Prog Transpl

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Introduction: Both solid organ transplant candidates and recipients and their family caregivers have complex care needs and may benefit from palliative care. But palliative care is not often considered as part of transplant care despite palliative care being promoted as an important component of transplant care both before and after solid organ transplantation. Further, the current state of the science of palliative care in solid organ transplantation has not been well-documented. Objective: To describe the state of the science of palliative care in solid organ transplant and identify gaps in the literature. Methods: Four electronic databases were searched using controlled vocabulary words and synonymous free text to find articles on palliative care and solid organ transplant. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist were also used. Results: Twenty articles were included in the final review for synthesis, 18 of which involved transplants for adults only. Twelve articles described palliative care for patients before transplant, four articles examined palliative care for patients after transplant, primarily at the end-of-life, and four articles described transplant provider perspectives on palliative care. The reviewed evidence suggested that patients could be benefited by palliative care both pre and posttransplant, particularly for symptom management and advance care planning and that transplant providers faced many barriers to implementing palliative care in practice. Discussion: There is limited research on palliative care following solid organ transplantation, particularly outside of hospice care. Much of the prior research on this topic has described adult patients.

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Section: Discussionmentioning

confidence: 99%

State of the Science of Palliative Care in Solid Organ Transplantation

Gustafson

Song

2020

Prog Transpl

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“…We conducted a retrospective cohort study of patients <22 years of age admitted to TCH for lung transplantation. Patient with other organ involvement such as renal, liver, and heart failure might not be suitable candidates for lung transplantation as previously described by Dellon et al 16 Our transplant candidates are carefully selected and screened for any potential organ failure. Cystic fibrosis patients, at the time of transplantation, already suffer from substantial toxicities including renal disease from chronic antibiotic exposure.…”

Section: Methodsmentioning

confidence: 99%

Influence of early extubation on post‐operative outcomes after pediatric lung transplantation

Labarinas

Coss‐Bu

Onyearugbulem

et al. 2020

Pediatric Transplantation

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Lung transplantation has become an accepted therapeutic option for a select group of children with end‐stage lung disease. We evaluated the impact of early extubation in a pediatric lung transplant population and its post‐operative outcomes. Single‐center retrospective study. PICU within a tertiary academic pediatric hospital. Patients <22 years after pulmonary transplant between January 2011 and December 2016. A total of 74 patients underwent lung transplantation. The primary pretransplantation diagnoses included cystic fibrosis (58%), pulmonary fibrosis (9%), and surfactant dysfunction disorders (10%). Of 60 patients, 36 (60%) were extubated within 24 hours and 24 patients after 24 hours (40%). A total of seven patients (11.6%) required reintubation within 24 hours. Median length of stay for the early extubation group was shorter at 3 days ([(IQR) 2.2‐4.7]) compared to 5 days (IQR, 3‐7) (P = .02) in the late extubation group. Median costs were lower for the early extubation group with 13,833 US dollars (IQR, 9980‐22,822) vs 23 671 US dollars (IQR, 16 673‐39 267) (P = .043). Fourteen patients were in the PICU prior to their transplantation; this did not affect their early extubation success. Neither did the fact of requiring invasive or non‐invasive mechanical ventilation before transplantation. Early extubation appears to be safe in a pediatric population after lung transplantation and is associated with a shorter LOS and decreased hospital costs. It may prevent known complications associated with mechanical ventilation.

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“…Chronic graft dysfunction, with its multifaceted determinants, necessitates a collaborative effort to unravel its underlying pathophysiology and devise targeted interventions. Geographic disparities in the adoption of technologies like EVLP beckon for a collective commitment to bridge gaps and ensure that advancements benefit all, regardless of where they are on the map (Dellon et al 2017). These challenges are not roadblocks but rather waypoints in a journey that calls for perseverance, innovation, and a shared commitment to advancing the frontiers of medical science.…”

Section: Navigating Challenges: a Call For Resiliencementioning

confidence: 99%

Lung Transplant: Navigating Challenges and Advancements in Pulmonary Medicine

Alrashdaa,

Alanazi,

Muqbil Alanazi

et al. 2023

IJEAST

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Lung transplantation, a complex and lifealtering medical intervention, serves as a beacon of hope for individuals grappling with end-stage pulmonary diseases. This research embarks on a comprehensive exploration of the dynamic landscape of lung transplantation, unraveling the challenges faced by both medical practitioners and recipients while spotlighting recent advancements that have reshaped the field. The introduction sets the stage by delineating the critical importance of lung transplantation in the context of organ transplants. The unique challenges inherent in lung transplantation, distinct from other organ transplants, are highlighted. The literature review critically examines existing studies, revealing gaps and limitations that this research seeks to address, adding depth to our understanding of this intricate medical procedure. Methodologically, a meticulous approach is adopted, encompassing a retrospective analysis of diverse lung transplant cases. The research design, selection criteria, and ethical considerations are transparently outlined, ensuring the robustness and reliability of the study. This section serves as the groundwork for unraveling the nuances of lung transplantation. Results are presented with clarity, offering insights into post-transplant complications, patient outcomes, and factors influencing long-term success. Visual aids, including graphs and tables, complement the narrative, providing a comprehensive visual representation of the data. This section aims to contribute valuable empirical evidence to the growing body of knowledge in lung transplantation. The discussion section delves into the implications of the findings, addressing challenges in post-transplant care such as rejection episodes and infectious complications. Simultaneously, it explores the impact of technological advancements and evolving immunosuppressive strategies in mitigating these challenges. This dynamic analysis underscores the adaptability of pulmonary medicine in the face of an ever-evolving medical landscape. In conclusion, this research synthesizes key findings, emphasizing their implications for the future of lung transplantation. By bridging gaps in the current literature, it contributes to the ongoing dialogue in pulmonary medicine, offering a nuanced perspective that combines empirical evidence with a deep understanding of the challenges and advancements in lung transplantation. The abstract invites readers on a journey through the intricacies of lung transplantation, providing a comprehensive overview that balances challenges with the potential for medical advancements. As the demand for lung transplantation continues to rise, this research endeavors to inform and guide future practices, fostering a more effective and personalized approach to enhance the success and sustainability of this life-saving procedure.

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Pediatric lung transplantation and end of life care in cystic fibrosis: Barriers and successful strategies

Cited by 10 publications

References 65 publications

State of the Science of Palliative Care in Solid Organ Transplantation

State of the Science of Palliative Care in Solid Organ Transplantation

Influence of early extubation on post‐operative outcomes after pediatric lung transplantation

Lung Transplant: Navigating Challenges and Advancements in Pulmonary Medicine

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