Ventilation parameters and early graft function in double lung transplantation

Schwarz, Štefan; Benazzo, Alberto; Dunkler, Daniela; Muckenhuber, Moritz; Sorbo, Lorenzo Del; Nardo, Matteo Di; Sinn, Katharina; Moser, Bernhard; Matilla, José Ramon; Láng, György; Taghavi, Shahrokh; Vámos, Ferenc Rényi; Jaksch, Péter; Cypel, Marcelo; Keshavjee, S.; Klepetko, Walter; Höetzenecker, Konrad

doi:10.1016/j.healun.2020.10.003

Cited by 14 publications

(36 citation statements)

References 27 publications

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“…However, the definitional criteria may not fit all studies due to subject cohort variations. For lung transplantation, most patients undergo extubation within the first 72 h. Two previous studies defined PMV as mechanical ventilation > 72 h based on their finding that most patients (77.1% and 80.6%, respectively) were already extubated at T 72 [ 3 , 26 ]. They thus referred to > 72 h as the threshold to define PMV.…”

Section: Discussionmentioning

confidence: 99%

“…However, the mortality and morbidity of lung transplant remain at relatively high levels compared with other solid organ transplantations [ 2 ]. Prolonged mechanical ventilation (PMV) is a prognostic marker for short-term adverse outcomes in patients after lung transplantation [ 3 , 4 ]. Previous reports also show that PMV is associated with impaired long-term survival [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Instead, a model combing three ventilation parameters better predicted PMV. However, the predictive value of this model was still moderate, with an area under the curve (AUC) of 0.727 [ 3 ]. Thus, a more precise model is urgently required.…”

Section: Introductionmentioning

confidence: 99%

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Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study

Gao

et al. 2023

BMC Pulm Med

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Background Prolonged mechanical ventilation (PMV), mostly defined as mechanical ventilation > 72 h after lung transplantation with or without tracheostomy, is associated with increased mortality. Nevertheless, the predictive factors of PMV after lung transplant remain unclear. The present study aimed to develop a novel scoring system to identify PMV after lung transplantation. Methods A total of 141 patients who underwent lung transplantation were investigated in this study. The patients were divided into PMV and non-prolonged ventilation (NPMV) groups. Univariate and multivariate logistic regression analyses were performed to assess factors associated with PMV. A risk nomogram was then established based on the multivariate analysis, and model performance was further examined regarding its calibration, discrimination, and clinical usefulness. Results Eight factors were finally identified to be significantly associated with PMV by the multivariate analysis and therefore were included as risk factors in the nomogram as follows: the body mass index (BMI, P = 0.036); primary diagnosis as idiopathic pulmonary fibrosis (IPF, P = 0.038); pulmonary hypertension (PAH, P = 0.034); primary graft dysfunction grading (PGD, P = 0.011) at T0; cold ischemia time (CIT P = 0.012); and three ventilation parameters (peak inspiratory pressure [PIP, P < 0.001], dynamic compliance [Cdyn, P = 0.001], and P/F ratio [P = 0.015]) at T0. The nomogram exhibited superior discrimination ability with an area under the curve of 0.895. Furthermore, both calibration curve and decision-curve analysis indicated satisfactory performance. Conclusion A novel nomogram to predict individual risk of receiving PMV for patients after lung transplantation was established, which may guide preventative measures for tackling this adverse event. Graphic Abstract

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study

Gao

et al. 2023

BMC Pulm Med

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“…Experienced thoracic radiologists evaluated the chest radiographs. Extubated patients were not assigned to PGD grades but were listed separately [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Follistatin-like 1 and Biomarkers of Neutrophil Activation Are Associated with Poor Short-Term Outcome after Lung Transplantation on VA-ECMO

Veraar

Kirschner

Schwarz

et al. 2022

Biology

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The investigation of biomarkers associated with undesired outcome following lung transplantation (LuTX) is essential for a better understanding of the underlying pathophysiology, an earlier identification of susceptible recipients and the development of targeted therapeutic options. We therefore determined the longitudinal perioperative course of putative cytokines related to neutrophil activation (chemokine CC motif ligand 4 (CCL-4), interleukin (IL)-23 and Lipocalin 2 (LCN2)) and a cytokine that has been implicated in graft-versus-host disease (Follistatin-like 1 (FSTL1)) in 42 consecutive patients undergoing LuTX. We plotted receiver-operating curves (ROC) to assess the predictive power of the measured cytokines for short-term outcomes namely primary graft dysfunction (PGD), early complications requiring extracorporeal membrane oxygenation (ECMO), and a high postoperative sequential organ failure assessment (SOFA). All cytokines increased immediately after surgery. ROC analyses determined significant associations between CCL4 and a high SOFA score (area under the curve (AUC) 0.74 (95%CI:0.5–0.9; p < 0.05), between LCN2 and postoperative ECMO support (AUC 0.73 (95%CI:0.5–0.9; p < 0.05), and between FSTL1 and PGD (AUC 0.70 (95%CI:0.5–0.9; p < 0.05). The serum concentrations of the neutrophil-derived cytokines LCN2 and CCL4 as well as FSTL1 were all related to poor outcome after LuTX. The specific predictive power, however, still has to be assessed in larger trials. The potential role of FSTL1 as a biomarker in the development of PGD could be of great interest particularly since this protein appears to play a crucial role in allograft tolerance.

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“…Multicenter randomized controlled trials are warranted to identify ideal ventilator strategies after lung transplantation [50]. More recently, an international study found that three ventilation parameters (peak inspiratory pressure, PaO 2 /FiO 2 , and dynamic compliance) predict prolonged mechanical ventilation after lung transplantation [51]. Furthermore, venoarterial extracorporeal membrane oxygenation (ECMO) has recently been accepted by many institutions as the primary supportive treatment during lung transplantation [52,53]; however, prolonged use of ECMO after lung transplantation has been reported to yield better results when oxygenation is poor or pulmonary pressures are increased at the end of transplantation.…”

Section: Protection In Reperfusion and Ventilationmentioning

confidence: 99%

Ischemia–Reperfusion Injury in Lung Transplantation

Chen‐Yoshikawa

2021

Cells

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Lung transplantation has been established worldwide as the last treatment for end-stage respiratory failure. However, ischemia–reperfusion injury (IRI) inevitably occurs after lung transplantation. The most severe form of IRI leads to primary graft failure, which is an important cause of morbidity and mortality after lung transplantation. IRI may also induce rejection, which is the main cause of mortality in recipients. Despite advances in donor management and graft preservation, most donor grafts are still unsuitable for transplantation. Although the pulmonary endothelium is the primary target site of IRI, the pathophysiology of lung IRI remains incompletely understood. It is essential to understand the mechanism of pulmonary IRI to improve the outcomes of lung transplantation. Therefore, we reviewed the state-of-the-art in the management of pulmonary IRI after lung transplantation. Recently, the ex vivo lung perfusion (EVLP) system has been clinically introduced worldwide. Various promising therapeutic strategies for the protection of the endothelium against IRI, including EVLP, inhalation therapy with therapeutic gases and substances, fibrinolytic treatment, and mesenchymal stromal cell therapy, are awaiting clinical application. We herein review the latest advances in the field of pulmonary IRI in lung transplantation.

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Ventilation parameters and early graft function in double lung transplantation

Cited by 14 publications

References 27 publications

Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study

Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study

Follistatin-like 1 and Biomarkers of Neutrophil Activation Are Associated with Poor Short-Term Outcome after Lung Transplantation on VA-ECMO

Ischemia–Reperfusion Injury in Lung Transplantation

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