Survival in adult lung transplantation: where are we in 2020?

Bos, Saskia; Vos, Robin; Raemdonck, Dirk Van; Verleden, Geert M.

doi:10.1097/mot.0000000000000753

Cited by 184 publications

(144 citation statements)

References 47 publications

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“…Lung transplantation is the treatment option for patients with end-stage lung diseases [ 1 ]. Compared to other solid organ transplantation, the long-term outcomes of lung transplant remain poor, which is largely due to the chronic lung allograft dysfunction (CLAD) that usually develops in half of the recipients at 5 years post-lung transplant [ 2 ].…”

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confidence: 99%

New Clue: Prediction from Cell-Free DNA

Sanders

2020

JCM

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The main challenge for a positive long-term outcome in lung transplantation is the lack of early detection for chronic lung allograft dysfunction (CLAD). With advancements in technology, an increasing number of studies demonstrate that cell-free DNA (cfDNA) in body fluids could be used as a marker for disease diagnosis, prognosis or monitoring response to treatment. A previous report from this journal found the joint assessment of cfDNA and CXCL10 from brochoalveolar lavage (BAL) could determine the subphenotypes of CLAD and predict lung transplant survival. This is an exciting attempt in monitoring the progress for lung transplant recipients. More studies and better understanding of cfDNA are needed to develop an accessible and reliable biomarker to monitor the progress of CLAD to improve the long-term survival for lung transplant recipients.

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confidence: 99%

New Clue: Prediction from Cell-Free DNA

Sanders

2020

JCM

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“…This may be the result of peripheral blood reflecting more the general condition of the patient, while BAL reflects the status of the lungs. Therefore, high blood eosinophils may be related to other problems in addition to CLAD, such as pulmonary infections, one of the major complications post-LTx due to the continuous use of immunosuppressives [ 1 ]. Indeed, eosinophils are also involved in the host defense and immunologic reaction against respiratory fungal, bacterial and viral pathogens.…”

Section: Discussionmentioning

confidence: 99%

“…Long-term outcomes, however, are still lagging behind compared to the survival following other solid organ transplants. Complications hampering long-term survival after LTx are chronic lung allograft dysfunction (CLAD), cancer and side effects of the life-long necessary immunosuppression, e.g., infections and renal insufficiency [ 1 ]. CLAD is the major drawback, occurring in approximately 50% within five years after transplantation [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Peripheral Blood Eosinophilia Is Associated with Poor Outcome Post-Lung Transplantation

Kaes

Borght

Vanstapel

et al. 2020

Cells

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Eosinophils play a role in many chronic lung diseases. In lung transplantation (LTx), increased eosinophils in bronchoalveolar lavage (BAL) was associated with worse outcomes. However, the effect of peripheral blood eosinophilia after LTx has not been investigated thoroughly. A retrospective study was performed including all LTx patients between 2011–2016. Chronic lung allograft dysfunction (CLAD)-free and graft survival were compared between patients with high and low blood eosinophils using an 8% threshold ever during follow-up. A total of 102 patients (27.1%) had high blood eosinophils (≥8%) (45 before CLAD and 17 after, 40 had no CLAD) and 274 (72.9%) had low eosinophils (<8%). Patients with high blood eosinophils demonstrated worse graft survival (p = 0.0001) and CLAD-free survival (p = 0.003) compared to low eosinophils. Patients with both high blood and high BAL (≥2%) eosinophils ever during follow-up had the worst outcomes. Within the high blood eosinophil group, 23.5% had RAS compared to 3% in the group with low eosinophils (p < 0.0001). After multivariate analysis, the association between high blood eosinophils and graft and CLAD-free survival remained significant (p = 0.036, p = 0.013) independent of high BAL eosinophils and infection at peak blood eosinophilia, among others. LTx recipients with ever ≥8% blood eosinophils demonstrate inferior graft and CLAD-free survival, specifically RAS, which requires further prospective research.

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“…This has been our policy for many years and it did not impact our long-term outcomes, such as the 5-year survival rate (62%) which compares favorably to that of other major transplant programs or reports from the ISHLT registry. 10,11 This might encourage other groups to be more comfortable in using elderly donors and alleviate some of the unfounded concerns about organ function or recipient survival that sometimes leads surgeons to turn these lungs down. Finally, barriers such as regional variation in consenting practices for older donors should also be addressed.…”

Section: Extended Criteria For Neurologic Death and Cardiac Death Donor Lungs Donor Agementioning

confidence: 99%

Pushing the Envelope for Donor Lungs

Abdelnour‐Berchtold

Cypel

Keshavjee

2021

Semin Respir Crit Care Med

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The shortage of organ donors remains the major limiting factor in lung transplant, with the number of patients on the waiting list largely exceeding the number of available organ donors. Another issue is the low utilization rate seen in some types of donors. Therefore, novel strategies are continuously being explored to increase the donor pool. Advanced age, smoking history, positive serologies, and size mismatch are common criteria that decrease the rate of use when it comes to organ utilization. Questioning these limitations is one of the purposes of this review. Challenging these limitations by adapting novel donor management strategies could help to increase the rate of suitable lungs for transplantation while still maintaining good outcomes. A second goal is to present the latest advances in organ donation after controlled and uncontrolled cardiac death, and also on how to improve these lungs on ex vivo platforms for assessment and future specific therapies. Finally, pushing the limit of the donor envelope also means reviewing some of the recent improvements made in lung preservation itself, as well as upcoming experimental research fields. In summary, donor lung optimization refers to a global care strategy to increase the total numbers of available allografts, and preserve or improve organ quality without paying the price of early-, mid-, or long-term negative outcomes after transplantation.

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Survival in adult lung transplantation: where are we in 2020?

Cited by 184 publications

References 47 publications

New Clue: Prediction from Cell-Free DNA

New Clue: Prediction from Cell-Free DNA

Peripheral Blood Eosinophilia Is Associated with Poor Outcome Post-Lung Transplantation

Pushing the Envelope for Donor Lungs

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