Pneumonia<i>versus</i>graft dysfunction as the cause of acute respiratory failure after lung transplant: a 4-year multicentre prospective study in 153 adults requiring intensive care admission

Mazo, Cristopher; Pont, Teresa; Ballesteros, M.Á.; López, E.; Rellán, Luzdivina; Robles, Juan Carlos; Rello, Jordi

doi:10.1183/13993003.01512-2018

Cited by 8 publications

(9 citation statements)

References 40 publications

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“…Moreover, for LTRs, it has been described that pneumonia is a main and independent predictor of mortality upon ICU admission. 27 Our study has some limitations that need to be addressed. First, data regarding the outcome of some patients are lacking because they were still hospitalized at the time of last follow-up.…”

Section: Ta B L E 3 Treatment and Outcomesmentioning

confidence: 94%

COVID-19 in lung transplant recipients: A multicenter study

Sáez-Giménez¹,

Berastegui²,

Barrecheguren³

et al. 2021

American Journal of Transplantation

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This study describes the clinical presentation, treatment, and outcomes of SARS-CoV-2 infection in lung transplant recipients (LTRs). This is a multicenter, retrospective study of all adult LTRs with confirmed SARS-CoV-2 infection from March 4 until April 28, 2020 in six Spanish reference hospitals for lung transplantation. Clinical and radiological data, treatment characteristics, and outcomes were reviewed. Forty-four cases were identified in that period. The median time from transplantation was 4.2 (interquartile range: 1.11-7.3) years. Chest radiography showed acute parenchymal abnormalities in 32 (73%) cases. Hydroxychloroquine was prescribed in 41 (93%), lopinavir/ritonavir (LPV/r) in 14 (32%), and tocilizumab in 19 (43%) patients. There was a strong interaction between tacrolimus and LPV/r in all cases. Thirty-seven (84%) patients required some degree of respiratory support and/or oxygen therapy, and 13 (30%) were admitted to intermediate or intensive critical care units. Seventeen (39%) patients had died and 20 (45%) had been discharged at the time of the last follow-up.Deceased patients had a worse respiratory status and chest X-ray on admission and presented with higher D-dimer, interleukin-6, and lactate dehydrogenase levels. In this multicenter LTR cohort, SARS-CoV-2 presented with high mortality. Additionally, the severity of disease on presentation predicted subsequent mortality.

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Section: Ta B L E 3 Treatment and Outcomesmentioning

confidence: 94%

COVID-19 in lung transplant recipients: A multicenter study

Sáez-Giménez¹,

Berastegui²,

Barrecheguren³

et al. 2021

American Journal of Transplantation

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“…In these cases, bronchoscopy to rule out infection is usually performed before commencing empirical medical therapy for infection or rejection. 81,82 Transbronchial biopsies can also be considered to confirm the diagnosis of rejection or infection; however, caution should be used in ventilated patients for the high risk of bleeding (greater than 20%) and pneumothorax (6 to 10%). 83 Although the immunosuppressive drug regimens have not changed significantly over recent years, the understanding of how to optimize immunosuppression has improved.…”

Section: Current Trends and Future Insights On Immunosuppressive Ther...mentioning

confidence: 99%

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

et al. 2021

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The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome of lung transplantation recipients is critically affected by a complex interplay of particular pathophysiologic conditions and risk factors, knowledge of which is fundamental to appropriately manage these patients during the early postoperative course. As high-grade evidence-based guidelines are not available, the authors aimed to provide an updated review of the postoperative management of lung transplantation recipients in the intensive care unit, which addresses six main areas: (1) management of mechanical ventilation, (2) fluid and hemodynamic management, (3) immunosuppressive therapies, (4) prevention and management of neurologic complications, (5) antimicrobial therapy, and (6) management of nutritional support and abdominal complications. The integrated care provided by a dedicated multidisciplinary team is key to optimize the complex postoperative management of lung transplantation recipients in the intensive care unit.

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“…4 Study variables were reported elsewhere. 4 PCT plasma levels samples were obtained within 24 hours after ICU-A. Patients were followed until hospital discharge or death.…”

Section: Methodsmentioning

confidence: 99%

“…All clinical data were collected prospectively by the investigators, as part of a multicenter study reported elsewhere 4 . Study variables were reported elsewhere 4 . PCT plasma levels samples were obtained within 24 hours after ICU‐A.…”

Section: Methodsmentioning

confidence: 99%

Acute respiratory failure among lung transplant adults requiring intensive care: Changing spectrum of causative organisms and impact of procalcitonin test in the diagnostic workup

Campogiani

Mazo

Romero

et al. 2020

Transplant Infectious Dis

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Background: The aim was to identify the causing organisms and assess the association of procalcitonin (PCT) with bacterial pneumonia within 24 hours of intensive care unit admission (ICU-A) among lung transplant (LT) adult recipients. Methods: Secondary analysis from a prospective cohort study. All LT adults admitted to ICU for acute respiratory failure (ARF) over 5 years were included. Patients were followed until hospital discharge or death. Results: Fifty-eight consecutive LT patients were enrolled. The most important cause of ICU-A due to ARF was pneumonia 29 (50%) followed by acute rejection 3 (5.2%) and bronchiolitis obliterans syndrome exacerbation 3 (5.2%). Microorganisms were isolated from 22/29 cases with pneumonia (75.9%): 17 (77.2%) bacterial, 4 (18.2%) viral, 1 (4.5%) Aspergillus fumigates, with Pseudomonas aeruginosa being the most common cause (45.5%) of pneumonia, with 10 patients presenting chronic colonization by P aeruginosa. Median [Interquartile range (IQR)] PCT levels within 24 hours after admission were higher in pneumonia (1.5 µg/L; IQR:0.3-22.0), than in non-pneumonia cases (0.2 µg/L; IQR:0.1-0.7) (P = .019) and PCT levels within 24 hours helped to discriminate bacterial pneumonia (8.2 µg/L; IQR:0.2-43.0) from viral pneumonia and non-pneumonia cases (0.2 µg/L; IQR:0.1-0.7). The overall negative predictive value for bacterial pneumonia was 85.1%, increasing to 91.6% among episodes after 6 months of LT. Conclusions: Causes of severe pneumonia in LT are changing, with predominant role of P aeruginosa and respiratory viruses. PCT ≤ 0.5 μg/L within 24 hours helps to exclude bacterial pneumonia diagnosis in LT adults requiring ICU-A. A negative PCT test allows antimicrobial de-escalation and requires an alternative diagnostic to bacterial pneumonia.

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Pneumoniaversusgraft dysfunction as the cause of acute respiratory failure after lung transplant: a 4-year multicentre prospective study in 153 adults requiring intensive care admission

Cited by 8 publications

References 40 publications

COVID-19 in lung transplant recipients: A multicenter study

COVID-19 in lung transplant recipients: A multicenter study

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

Acute respiratory failure among lung transplant adults requiring intensive care: Changing spectrum of causative organisms and impact of procalcitonin test in the diagnostic workup

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