Registry of the International Society for Heart and Lung Transplantation: Twenty-fourth Official Adult Lung and Heart–Lung Transplantation Report—2007

Trulock, Elbert P.; Christie, Jason D.; Edwards, Leah B.; Boucek, Mark M.; Aurora, Paul; Taylor, David O.; Dobbels, Fabienne; Rahmel, Axel; Keck, Berkeley M.; Hertz, Marshall I.

doi:10.1016/j.healun.2007.06.003

Cited by 434 publications

(357 citation statements)

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“…However the five-year survival is currently only around 60%, the worst of any solid organ transplant, with death beyond the acute phase being largely due to progressive and treatment refractory airway remodeling (obliterative bronchiolitis, OB) manifest clinically as bronchiolitis obliterans syndrome (BOS). BOS is thought to follow persistent alloreactive, infective, and non-specific epithelial injury with dysregulated epithelial repair 1 . Although the predominant histopathologic finding in patients with OB is of fibro-proliferative small airway obliteration, large airways are also affected with the eventual development of bronchiectasis, leading directly to patient morbidity and mortality.…”

Section: Resultsmentioning

confidence: 99%

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Decreased efferocytosis and mannose binding lectin in the airway in bronchiolitis obliterans syndrome

Hodge

Dean

Hodge

et al. 2011

The Journal of Heart and Lung Transplantation

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Short running title: Decreased efferocytosis and MBL in BOSwith BOS) and 14 healthy controls. Abstract & Manuscript 2Results: In plasma, MBL levels were highly variable (0-17.538 g/mL), but increased in infected subjects vs control (p=0.09) or stable groups (p=0.003). There was a similar increase in UC4 in infected patients and a significant correlation between MBL and UC4. There was no correlation between MBL and time post-transplant. In BAL, MBL levels were less variable (0-73.3 ng/mL) and significantly reduced in patients with BOS vs controls and stable groups. 3Lung transplantation is now recognized as an effective treatment option for a variety of end-stage lung diseases and is associated with improvements in life expectancy and quality of life. However the five-year survival is currently only around 60%, the worst of any solid organ transplant, with death beyond the acute phase being largely due to progressive and treatment refractory airway remodeling (obliterative bronchiolitis, OB) manifest clinically as bronchiolitis obliterans syndrome (BOS). BOS is thought to follow persistent alloreactive, infective, and non-specific epithelial injury with dysregulated epithelial repair 1 . Although the predominant histopathologic finding in patients with OB is of fibro-proliferative small airway obliteration, large airways are also affected with the eventual development of bronchiectasis, leading directly to patient morbidity and mortality.The well-ordered process of apoptosis is important for regulation and maintenance of normal tissue homeostasis. During resolution of airway inflammation, apoptotic epithelial cells are removed by phagocytosis by alveolar macrophages (a process termed 'efferocytosis'). The pathological concept of failed efferocytosis has been described in regard to a number of lung diseases including pulmonary fibrosis 2 , cystic fibrosis 3 chronic granulomatous disease 4 smokers and patients chronic obstructive pulmonary disease (COPD) 5-8 .It is considered that the failed efferocytosis results in a net increase in apoptotic material that may lead to secondary necrosis of this material resulting in increased tissue damage and chronic inflammation. This was clearly shown in our studies of COPD where we found evidence of secondary necrosis (increased lactate dehydrogenase in BAL) and that the increased numbers of apoptotic bronchial epithelial cells negatively correlated with efferocytosis 6,9 . In lung transplant recipients we have also described an accumulation of apoptotic material associated with an increase in the cytotoxic mediator granzyme b in the airways 10,11 .Mannose binding lectin (MBL) is a key mediator of both innate immunity and efferocytosis and is thus likely to be important in protecting against lung tissue damage. In other inflammatory chronic lung diseases including COPD, we have shown reduced levels of MBL that correlated with a defect in the 4 ability of alveolar macrophages to phagocytose apoptotic bronchial epithelial cells (efferocytosis) 8 . We further showed that treatm...

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Section: Resultsmentioning

confidence: 99%

“…The processes leading up to BOS are incompletely understood but are thought to include persistent alloreactive, infective, and non-specific epithelial injury with dysregulated epithelial repair 1 . These processes culminate in remodeling and fibrotic obstruction of the small airways.…”

Section: Discussionmentioning

confidence: 99%

Decreased efferocytosis and mannose binding lectin in the airway in bronchiolitis obliterans syndrome

Hodge

Dean

Hodge

et al. 2011

The Journal of Heart and Lung Transplantation

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“…A COPD patient may be considered for transplantation when FEV1 is ,25% pred and/or arterial carbon dioxide tension (Pa,CO 2 ) o7.2 kPa (o55 mmHg) [74]. Despite the progress since the early 1980s, the short-and long-term outcomes of lung recipients are not as good as those for other solid organs [75]. Pulmonary function improves, but exercise capacity may still be limited due to peripheral muscle dysfunction [76,77].…”

Section: Lung Transplantationmentioning

confidence: 99%

Nonpharmacological treatment and relief of symptoms in COPD: Table 1—

Clini

Ambrosino²

2008

Eur Respir J

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Evidence-based guidelines for chronic obstructive pulmonary disease (COPD) have recently been developed.Nonpharmacological treatments have evolved rapidly as an essential part of COPD therapy. They are especially important as complementary interventions in severe or very severe disease, when there is loss in function, a reduction in quality of life and when psychological impairments further complicate the disease.The present article discusses the most used nonpharmacological treatments for severe COPD patients (rehabilitation, long-term oxygen therapy, surgery, noninvasive positive pressure ventilation and supportive nutrition) and their evidence-based usefulness in promoting strategies that relieve symptoms.All of these interventions are used during end-stage disease, to promote self-efficacy, relieve symptoms and prevent further deterioration. These therapeutic options support physicians and allied professionals in improving symptom management for their patients.

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“…(Trulock et al 2007) Only recently has the mean survival time for transplant recipients risen to 5.7 years. (Ahmad, Shlobin, and Nathan 2011) There are four major causes of morbidity and mortality in all transplant recipients; primary allograft dysfunction, infection, acute rejection, and chronic rejection.…”

Section: Post Transplantation Complicationsmentioning

confidence: 99%