Trasplante pulmonar en pacientes con fibrosis pulmonar. Experiencia del Instituto Nacional del Tórax

Abstract

Pulmonary fibrosis is a progressive disease with a bad prognosis. This situation makes rise lung transplant as a therapeutic option among carefully selected patients. Objective: Evaluate the results and survival rates of patients with pulmonary fibrosis that were transplanted through an 8 years period of follow-up, from the beginning of our transplant program. Methods: Descriptive study of the transplanted patients diagnosed with pulmonary fibrosis from august 2010 to july 2018. Results: Out of 76 transplants, 68.4% were due to pulmonary fibrosis, among these, the main diagnosis was idiopathic pulmonary fibrosis (75%). The average lung allocation score (LAS) was 53 and 32% of them had urgency criteria. Patients' age averaged 55 years-old and 98% of them underwent a single lung transplant. Early medical complications were seen in 26 patients with infectious episodes and 6 with acute rejection. The main late complication was chronic allograft dysfunction. The main surgical complication was bronchial stenosis (7.6%). In comparison to its base line reference values FVC means pre transplant and 1 and 3 years post-transplant were 49%, 70% and 71% respectively. A 40% of patients died during follow up period. Infections were the main cause of mortality during the first year. Survival rates at 1 st 3 rd and 5 th year were 86,2%; 65.2% and 59.8% respectively. Conclusions: Single lung transplant is a therapeutic option for patients with interstitial lung disease with a 59% survival rate in 5 years, 1/3 fulfilled urgency criteria at the transplant time. The infections were the main early complication and chronic graft dysfunction was the main late complication.

Experiencia en trasplante pulmonar pediátrico en Chile

“…la indicación de trasplante se basó en el consenso de selección de candidatos a trasplante de pulmón de la de la ISHlt 5 . la inmunosupresión incluyó terapia de inducción con Basiliximab y metilprednisolona y la de mantención, prednisona, tacrolimus y micofenolato o azatioprina 6 . La profilaxis antibiótica post trasplante en pacientes en pacientes con FQ se basó en cultivos previos.…”

“…Hasta el año 2015 en receptores con serología con inmunoglobulina g positiva para citomegalovirus (Igg CMV+) dejábamos profilaxis con aciclovir por 4 meses y seguimiento con carga viral dejando valganciclovir a pacientes Igg CMV (-) o si presentaban viremia positiva en el seguimiento (> 2.000 copias) hasta negativización de ésta, itraconazol por un año y cotrimoxazol forte trisemanal de mantención. Desde el año 2016 usamos voriconazol por 3-4 meses y profilaxis universal con valganciclovir 6 . La FBC se realizó previo al alta y luego ante sospecha de rechazo o lesión de vía aérea.…”