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Rejection after lung transplantation, including acute rejection (AR) and chronic rejection manifested with chronic lung allograft dysfunction (CLAD), is the main factor affecting the long-term survival of allografts. Exosome, a type of extracellular nanovesicle for intercellular communication among eukaryotic cells, could carry complex biological information and participate in various physiological and pathological processes. Exosome has become a critical immune medium in rejection, regulates the incidence and development of rejection through multiple pathways, and also plays a key role in the monitoring and management of rejection. In this article, the type of rejection after lung transplantation, the mechanism underlying the role of exosome in regulating rejection, exosome acting as biomarkers and the application in rejection treatment were reviewed, aiming to provide a novel direction for comprehensive diagnosis and treatment of rejection following lung transplantation.
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Objective To improve the surgical efficacy of bilateral lung transplantation for pediatric cystic fibrosis through multi-disciplinary team (MDT). Methods Preoperative MDT consultation was delivered for a 10-year-old child with rare end-stage cystic fibrosis to establish the corresponding treatment protocol. Results The child was diagnosed with cystic fibrosis for 5 years, and the indication of lung transplantation were confirmed. After preoperative MDT consultation, bilateral lung transplantation via a Clam-shell incision was determined. The vital signs were maintained stable during operation. Postoperatively, ventilator-assisted ventilation, anti-infection, immunosuppression, acid suppression, prevention of stress ulceration and other treatments were delivered. Individualized treatment was given according to the characteristics of the child, and the child was well recovered. Conclusions Through preoperative MDT consultation, lung transplantation yields satisfactory surgical efficacy in treating pediatric cystic fibrosis and lowers the risk of postoperative complications, which deserves application in clinical practice.
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Cordyceps militaris exopolysaccharides (EPS) have many pharmacological activities such as boosting immunity and antifatigue. To obtain EPS efficiently, we added moderate Vernonia amygdalina leaf powder as inducer to the fermentation medium to promote the production of Cordyceps militaris EPS and studied the infrared absorption spectrum and antioxidant activities of the EPS after optimization. The optimum liquid fermentation conditions were as follows: addition of Vernonia amygdalina leaf powder of 8 g/L, fermentation duration of 9 d, initial pH of 6.5, inoculation quantity of 5.0 mL. Under such a condition, the yield of Cordyceps militaris EPS reached (5.24±0.28) mg/mL, increased by 205.20% compared to the control group without adding Vernonia amygdalina leaf powder. Results of infrared analysis and antioxidant activity showed that the Vernonia amygdalina leaves had little effect on the structure and activities of Cordyceps militaris EPS. The results of this research suggest that Vernonia amygdalina leaf can enhance the production of Cordyceps militaris EPS effectively, and provides a novel method for efficient production of EPS in Cordyceps militaris.
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Antioxidants , Cordyceps , Plant Leaves , Polysaccharides , VernoniaABSTRACT
Objective To investigate the selection of recipients,operative technique, and perioperative management of lung transplantation.Methods From June 2013 to September 2016, 9 patients with pulmonary lymphangioleiomyomatosis un-derwent lung transplantation at Affiliated Wuxi People's Hospital.There were 9 females aged from 23 to 52 years.Chest en-hancement of CT in 9 patients prior to transplantation suggests multiple different sized thin-walled cystic shadows in whole lung. Nine patients received bilateral sequence lung transplantation ( BSLT) .The pathological findings after the operation indicated that cells of the abnormal proliferation of smooth muscle diffused around the bronchi , vessels and lymphatics , and widened the alveolar septum, which was consistent with the pathological changes in the patients with PLAM .We analyzed the differences of oxygenation index, forcedexpiratory volume at 1 sec(FEV1), and DLCO％ pred.Using paired t test to compare these indica-tors, P<0.05 was considered statistically significant.Results The oxygenation index was increased from(210 ±55) mmHg (1 mmHg=0.133 kPa) to(400 ±80)mmHg after treatment, the difference was statistically significant(P<0.05).The FEV1 was increased from(1.0 ±0.2)L to(2.8 ±0.4)L, and the difference was statistically significant(P<0.05).The DLCO％pred was increased from(27.5 ±2.5)％ to(75.0 ±10.0)％, and the difference was statistically significant(P<0.05).Fi-nally, 8 patients were discharged from the hospital, and the pulmonary function was good.1 patients died of infection and acute rejection on the 13 day after operation.Conclusion Lung transplantation is effective in the treatment of chronic thromboem-bolic pulmonary hypertension , and long-term survival requires further investigations .Lung transplantation is the only effective means for the treatment of end-stage pulmonary lymphangioleiomyomatosis .Bilateral sequence lung transplantation is the first choice.
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Objective To study the influence of pulmonary artery hypertension (PAH) on survival of patients with advanced chronic obstructive pulmonary disease (COPD) on the waiting list of lung transplantation.Methods The characteristics of 143 patients with COPD receiving lung transplantation evaluation from January 2014 to August 2016 were queried.Mild PAH was defined as mean pulmonary artery pressure (mPAP) ≥25 mmHg and severe ≥35 mrnHg by right heart catheterization measurements.The incidence of PAH was studied,and the patients were divided to different groups to determine the effect of PAH on survival prior to transplantation on the basis of different definitions of PAH.Kaplan Meier method was used to draw survival curves,and a log-rank test was used to analyze the effect of PAH on survival of COPD patients on the waiting list of pulmonary transplantation.Univariate and multivariate Cox proportional hazard models were performed to test the relationship between each main covariate and the hazard of mortality.The waiting time was tracked from wait list entry date until death or censoring,and the censoring issues were as follows:receiving lung transplantation,removing from the waiting list without transplant,and still wating for donor until the last follow-up day (2016-08-30).Results Of 143 COPD patients,there were 119 males and 24 males,with mean age of 61.73 years old;46 patients received lung transplantation,and the remaining 97 not;50 had mPAP ≥25 mmHg and 21 had mPAP ≥35 mmHg.A total of 23 cases (22.88％) died on the waiting list.Thirty-eight patients were removed from the list prior to transplantation,and 36 were still on the waiting list.Kaplan-Meier survival function showed suvival of patients with mild PAH or severe PAH was significantly shorter than that of patients without PAH (P＜0.001).Using Cox proportional hazards models,univariate analysis revealed significant differences in survival for mild PAH (HR =2.147,95％CI 1.429-3.157,P＜ 0.001) and severe PAH (HR =3.458,95 ％ CI 2.518-4.859,P＜0.001).Multivariate Cox models identified significant risk for death for mild PAH (HR=2.518,95％CI 1.728-3.364,P＜0.001) and severePAH HR=4.027,95％ CI 3.257-4.703,P＜0.001).Conclusion The incidence of PAH among COPD patients waiting for lung transplantation was high.PAH is associated with significantly increased risk of death among COPD patients waiting for lung transplantation.
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Objective To discuss the benefits of extracorporeal membrane oxygenation (ECMO) applied in the patients with idiopathic pulmonary arterial hypertension during the operation of bilateral sequential single lung transplantation.Methods Fifteen patients with idiopathic pulmonary arterial hypertension received lung transplantation supported with ECMO between Nov.2009 and Sep.2014.ECMO was removed after the transplantation if the oxygenation and hemodynamic were stable,otherwise,ECMO was applied continuously until the situation improved.Results All the operations of 15 patients were accomplished successfully and the ECMO was removed in 3 patients after the operation immediately,while in the other 12 patients,ECMO was applied continuously until the situation improved in ICU.ECMO was applied again in 3 patients when it was necessary.Deep venous thrombosis occurred in one patient.Three patients died after operation and the other 12 patients are alive till now.Conclusion ECMO can be applied safely and effectively in lung transplantations for idiopathic pulmonary arterial hypertension patients.
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Objective To analyze the effect of traditional Chinese combined with Western medicine on the treatment of supracondylar fracture of humerus, and provide reference for clinical treatment.Methods122 patients with supracondylar fracture of humerus in hospital the affiliated hospital of traditional Chinese and western medicine;Zhejiang Chinese Medicine University from January 2015 to March 2016 were randomly divided into the observation group and the control group.The control group were given conventional fracture reduction, the observation group were given a new therapy of integrated traditional and western.Treatment outcome, quality of life changes and prognosis in the two groups were compared.ResultsThe excellent rate in the observation group (91.8%) was significantly higher than that in the control group (72.1%) (P<0.05).The fracture healing time in the observation group (4.1±1.1)months was significantly shorter than that in the control group (6.6±2.3) months (P<0.05).Before treatment, there was no significant difference in quality of life scores between the two groups;after treatment the overall health in the observation group (75.69±4.61), physiological function (77.62±4.19), pain (74.63±4.96), social function (76.84±4.28), mental health (76.12±4.18) scores were significantly higher than those overall health(62.74±4.36) in the control group, physiological function (64.51±4.12), pain (67.26±4.25), social function(68.72±4.13), mental health (65.97±4.23) (P<0.05).There were 2 cases with cubitus varus in the observation group, while 3 cases with elbow inversion in the control group.All patients were followed up for more than 6 months.There was no serious infection and abnormal bone development in the two groups.ConclusionIt can improve the treatment effect, reduce the pain of patients, promote the rapid recovery of the disease, improve the quality of life and prognosis, which traditional Chinese medicine combined with Western medicine was used in the treatment of humeral supracondylar fracture, it has the value of use.
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Objective To investigate the institution of extracorporeal membrane oxygenation(ECMO) for primary graft dysfunction( PGD) after lung transplantation and analysis its clinical outcome. Methods From September 2002 to December 2013, 286 patients with end-stage lung disease underwent lung transplantation(LTx) in Wuxi People's Hospital. Among them, there were 22 patients occured grade 3 PGD in early stage after LTx. In which there were 2 cases with chronic obstructive pulmonary disease, 12 with idiopathic pulmonary fibrosis, 4 case with primary pulmonary hypertension, 1 case with lung tuber-culosis, 1 case with silicosis, 2 cases with bronchiectasis. There were 7 patients with single LTx(3 cases with ECMO support) and 15 patients with bilateral LTx(2 cases with CPB support and 6 cases with ECMO support). According to the severity levels of PGD, different treatment measures were used, such as reinforce ventilatory support, negative fluid balance, extending the treatment time of the ventilator, the use of pulmonary vasodilators, such as prostaglandin E1 and ECMO. Results Six patients were treated by adjusting low volume, high frequency and high positive end expiratory pressure ventilation( PEEP) mode, and 2 cases reversed, 4 cases died of respiratory failure. 16 cases accepted ECMO support, among them 10 cases apply venous-ve-nous mode, 6 cases venous-artery mode, the average flow time was 5. 5 days. 10 cases dismantled from ECMO successly and 6 cases died of multiple organ failure, infection and cardiac arrest. 30-day, 1-year and 5-year survival of PGD recipients post-op-eratively were 55％, 40％, 25％, respectively. Conclusion The high incidence of PGD causes high mortality peri-operative-ly after LTx. Preventing PGD can improve the survival rate of the lung transplant patients. Once PGD happens, appropriate treatment should be given as soon as possible. ECMO can effectively promote the transplanted lung function recovery, reduce the perioperative mortality. If the indications of ECMO use was reached, the institution of ECMO should as soon as possible.
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Objective To investigate the selection of recipients,operative technique,and perioperative management of lung transplantation for chronic thromboembolic pulmonary hypertension.Methods This article reviews the clinical data of 6 patients with chronic thromboembolic pulmonary hypertension receiving lung transplantation from January 2012 to June 2016.From January 2012 to June 2016,6 patients with chronic thromboembolic pulmonary hypertension underwent lung transplantation at Department of Thoracic Surgery,Affiliated Wuxi People's Hospital,Nanjing Medical University.There were 4 male and 2 female patients aged from 34 to 59 years.Chest enhancement of CT or CTPA in 6 patients prior to transplantation suggests a different degree of pulmonary embolism.The mean pulmonary artery pressure (mPAP) was＞30 mmHg,NYHA 11Ⅰ or Ⅳ.Four patients received bilateral sequence lung transplantation (BSLT) under extracorporeal membrane oxygenation (ECMO) support.Two patients received single lung transplantation (SLT).We analyzed the differences of oxygenation index,pulmonary systolic pressure,pulmonary artery diastolic pressure,mean pulmonary arterial pressure,and central venous pressure before and after treatment.Using paired t test to compare these indicators,P＜0.05 was considered statistically significant.Results The oxygenation index increased from (195 ± 85) to (440 ± 140) mmHg after treatment,the difference was statistically significant (P＜0.05).the The systolic pressure of pulmonary artery was decreased from (108 ± 28) mmHg to (56 ± 16) mmHg,and the difference was statistically significant (P＜0.05).the The diastolic pressure of pulmonary artery was decreased from (72 ± 18) mmHg to (25 ± 10) mmHg,and the difference was statistically significant (P＜0.05).the The mean pulmonary artery pressure was decreased from (84 ± 27) mmHg to (36 ± 10) mmHg,and the difference was statistically significant (P＜0.05).the The central venous pressure was decreased from (17.5 ± 4.5) mmHg to (8.5 ± 1.5) mmHg,and the difference was statistically significant (P＜0.05).Finally,5 patients were discharged from the hospital,and the pulmonary valve? functioned? well.1 patients died of shock and systemic failure 3 days after operation.Conclusion Lung transplantation is effective in the treatment of chronic thromboembolic pulmonary hypertension,and long-term survival requires further investigations.
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Objective To summarize the lung transplant program using donation after death of citizens (DCD).Methods Retrospective characteristics of 242 patients with end-stage lung diseases receiving lung transplantation in our hospital were reviewed between January 2015 and December 2016.The data about evaluation and collection of all donors were analyzed.The survival rate,causes of deaths,and postoperative complications were reviewed.Kaplan Meier survival curves and a logrank test of differences in survival functions were used to assess the effect of lung transplant type and extracorporeal membrane oxygenation (ECMO) on survival post transplant.Results A total of 231 patients donated their lungs,including China type three (135 cases),China type two (19 cases),and China type one (77 cases).242 lung transplantations were successfully performed.The 3-month,6-month and 1-year survival rate after lung transplantation was 80.6％,80.6％,and 77.8％,respectively.There were 47 deaths during perioperative period,including 22 cases of primary graft dysfunction,14 cases of sepsis,6 cases of multiple organ failure,3 cases of heart failure,and 2 cases of stomal leak.One hundred and thirty-two patients received bilateral lung transplantation,with 3-month,6-month,and 1-year survival rate being 78.6％,78.6％,and 75.6％ respectively.110 underwent single lung transplantation with 3-month,6-month,and 1-year survival rate being 82.7 ％,82.7 ％,and 80.1％,respectively.No significant difference in survival rate was observed between single and bilateral lung transplantation (P＞0.05).One hundred and twenty-nine cases of lung transplants were conducted under ECMO support,with the 3-month,6-month and 1-year survival rate being 72.5％,72.5％,and 70.5％ respectively,which was significantly higher in those without ECMO with the 3-month,6-month and 1-year survival rate being 90.2％,90.2％ and 86.6％ respectively (n =113) (P ＜ 0.05).Conclusion DCD may facilitate the development of lung transplantation in China with long-term survival.
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Objective To investigate the institution of extracorporeal membrane oxygenation (ECMO) for primary graft dysfunction (PGD) after lung transplantation (LT) and analyze its clinical outcome.Method A retrospective analysis was performed on 22 patients with grade 3 PGD in early stage after LT from September 2002 to December 2013.There were 7 patients with single LT and 15 patients with bilateral LTx.Ventilatory support was used at early stage for 6 cases,and at later stage,ECMO assistant circulation was used for 16 cases.Result Of 6 patients treated by adjusting low volume,high frequency and high positive end expiratory pressure ventilation (PEEP) mode,2 cases reversed,and 4 cases died of respiratory failure.In 16 cases accepting ECMO support,10 cases were given venous-venous mode and 6 cases venous-artery mode.The average flow time was 5.5 days.ECMO was successfully withdrawn in 10 cases and 6 cases died of multiple organ failure,infection and cardiac arrest.Conclusion The high incidence of PGD causes high mortality peri-operatively after LT.Preventing ECMO can improve the survival rate of the lung transplant patients.Once PGD happens,appropriate treatment should be given as soon as possible.ECMO can effectively promote the transplanted lung function recovery,and reduce the perioperative mortality.If the indications of ECMO use was reached,the institution of ECMO should be used as soon as possible.
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Objective To investigate the influence of perioperative administration of Ambroxol on pulmonary function, postoperative complications, postoperative hospital-stay and cost in elderly lung cancer patients after thoracic lobectomy surgery.Methods One hundred and forty consecutive elderly patients who underwent thoracic lobectomy surgery for lung cancer were randomly assigned into 2 groups: control group (n=70) and Ambroxol group (n=70).In control group, subjects were given the standardized treatment.In the Ambroxol group, patients were given the standardized treatment plus Ambroxol (90 mg/q, 8 h/d) from the day of operation to postoperative 5 days.The preoperative general information, intraoperative conditions, pulmonary function tests, arterial blood gases, incidence of perioperative morbidity, duration of ICU stay, length and costs of postoperative hospital-stay were collected and compared between the 2 groups.Results The 2 groups were well matched for demographics and operative variables.The forced expiratory volume in 1 second (FEV1),the forced vital capacity (FVC), peak expiratory flow rate (PEF) and arterial oxygen pressure were reduced in the 2 groups after operation as compared with before treatment, while the decreases of the above indexes were more significant in the control group than in the Ambroxol group (P＜0.05).Compared with the control group, the postoperative pulmonary complications declined, oxygenation index improved, the postoperative ICU occupancy rate and the length and costs of postoperative hospital-stay were decreased in the ambroxol group (all P＜ 0.05).Conclusions Perioperative administration of Ambroxol could reduce the incidence of pulmonary complications, improve the lung function, decrease the total hospitalization cost, shorten the length of hospital-stay, promote a rapid recovery after surgery, which is worthy of clinical application.
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Objective To investigate the effectiveness and safety of bilateral lobar lung transplantations (LLTx) in thoracic cavity size mismatching patients with end-stage lung diseases and analyze its prognosis.Method Clinical data of 34 patients receiving LLTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2012.LLTx were performed on 14 male and 20 female patients,with a mean age of 37.0 ± 6.3 years (ranging from 15 to 56 years).Indications for LLTx were idiopathic pulmonary fibrosis (n =24),idiopathic pulmonary hypertension (n =2),Eisenmenger syndrome (n =3),bronchiectasis (n =2) and lymphangiomyomatosis (n =3).Amongst them 26 patients received LLTx under extracorporeal membrane oxygenation (ECMO) support and 3 on ECMO as a bridge to transplantation.Twenty-four middle/lower right lobes with left lower LLT,4 bilateral lower LLT,2 bilateral superior LLT and 4 split left lung LLT were performed.Ischemic time was 4.4± 1.2 h for the first lobe and 6.3 ± 1.4 h for the second.Result The mortality in postoperative prophase (30 days) was 23.5％.The 1-,2-,3-and 5-year survival rate after LLTx was 70.9％,60.8％,50.6％ and 36.2％ respectively.The main causes of mortality included primary graft dysfunction,acute rejection,multiple organ failure,bronchiolitis obliterans and sepsis.Lung function test was performed on 23 cases after transplantation and forced expiratory volume in first second,maximal voluntary ventilation accounting for the predicted value was (74.23 ± 4.86)％ and (72.0 ± 3.64)％,respectively.Conclusion This study demonstrates that for thoracic cavity size mismatching patients,LLTx are safe and effective in the treatment of end-stage lung diseases,which can ameliorate the lung function and prognosis.
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Objective To explore the feasibility of ultra-long distance transport of lung from donation after cardiac death (DCD)or donation after brain death (DBD)by civil aviation for lung transplantation.Methods Clinical data of 6 cases with lung transplantation through ultra-long distance transport of lung from donors by civil aviation in Wuxi People's Hospital Affiliated to Nanjing Medical University from February to March in 201 5 were analyzed retrospectively.Results There were 6 donors who were DBD or DCD.It spent 5.0 ~8.5 h from lung removal,transport to lung transplantation in the operation room,including 2.0 ~3.0 h (mileage > 1 500 km)for flight.Five cases received sequential double lung transplantation.One case received right single lung transplantation.The operation was conducted successfully,with the lung's cold ischemia time of 7-1 2 h.After operation,all patients received ventilator assisted breathing,and suspended after 2-4 d.As of the date of submission,6 cases recovered well.Conclusions Long distance transport is feasible in the case of conducting sequential double lung transplantation with donor lung from DCD or DBD,if there are direct flights between the two cities of the donor and recipient,and the flight time is within 3 h.
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Objective To investigate the effectiveness and safety of bilateral lung transplantation with simultaneous lung volume reduction surgery in the treatment on end-stage lung disease and analysis its prognosis.Methods Clinical data of 79 patients with end-stage 1ung diseases receiving BLTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2012.Bilateral lung transplantations were performed on 48 male and 31 female patients, with a mean age of(57.0 ± 6.3) years (ranging from 15 to 75 years).Amongst them 56 patients received LTx under circulation support,including 1 cases of cardiopulmonary bypass(CPB) support and 55 cases of extracorporeal membrane oxygenation(ECMO) support.34 patients accepted lung volume reduction surgery, other 45 patients receive standard BLTx.The Patients were divided into lung volume reduction group(group Ⅰ)and control group(group Ⅱ).Differences in various clinical parameters such as Pulmonary function, postoperative complications, and prognosis between the two groups were compared.Results The 1、2、3 and 5-year survival rate after LTx was 80.5％ 、71.4％ 、58.2％ and 43.5％.The mean survival time post-transplant in size reduction group and control group were(38.54 ±4.72) months and(42.19 ±6.64) months repectively.The main causes of mortality included primary graft dysfunction(PGD) ,acute rejection(AR) , multiple organ failure(MOF) , bronchiolitis obliterans(BOS) and sepsis.No tendency of increase in mechanical ventilation, chest tube drainage time, volume of chest drainage were observed.Compared clinical parameters between the two groups, none had significant differences(P ＞0.05).Lung function test was performed on 63 cases after transplantation.There was no significant difference in FEV1 improvement after lung transplantation between the two groups[(74.23 ±4.86)％, (72.0 ±3.64)％, P ＞0.05].Conclusion This study demonstrates that BLTx with simultaneous lung volume reduction surgery is safe and effective, which have the same outcome and prognosis compare with standardbilateral lung transplantation.
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Objective To estimate the effects of risk factors on early survuval (90 days) after lung transplantation for idiopathic pulmonary fibrosis (IPF).Method We reviewed 49 cases of lung tansplant male patients which suffered from IPF.Two groups were set up according to the early survival.The early outcomes (90 days) were compared between two groups by multiple logistic regression analysis.Result The early survival rate was 81.6％.Multivariate analysis confirmed that mean pulmonary artery pressure and bilateral lung transplantation (BLTx) were risk factors after adjustment for potential confounders.Recipients' age,lung volume reduction on donors,and use of extracorporeal membrane oxygenation (ECMO) were not risk factors for early mortality.Conclusion The increased pulmonary artery pressure and BLTx are risk factors for death after lung transplantation in IPF.Preoperative evaluation of mean pulmonary artery pressure and choosing suitable operative method could improve the surgical outcomes of lung transplantation.
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Objective To observe the effects of extracorporeal membrane oxygenation (ECMO) on coagulation during lung trangplantation.Method Forty cases of end stage lung diseases received bilateral sequential single lung transplantation during July 2007 and Mar.2012.The patients were divided into two groups in terms of ECMO.ECMO was applied before lung transplantation if needed.The amount of bleeding during surgery was recorded.The venous blood samples were collected during and after operation for the measurements of the following parameters:activated whole blood clot time (ACT),prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT) and plasma fibrinogen (Fg).Result The coagulation and the amount of bleeding showed no significant difference between the two groups.Wound infection occurred in 2 patients where the ECMO tube was inserted and femoral arterial thrombosis in one patient.All of the three patients were cured and discharged.Conclusion ECMO didn't cause excessive bleeding or coagulation dysfunction during lung transplantation,yet it maybe increase the occurrence of local thrombosis.
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Objective To determine the changes of heart structure and function in early stage after lung transplant and to study the relationship between decreased pulmonary artery pressure and changes of heart structure and function.Methods 45 cases of lung transplant recipients were included in the study,their preoperative and postoperative echocardiography data were reviewed,and the postoperative early changes of cardiac structure and function were analysed.Then,the Pearson correlation analysis was used to compare the relationships between the decrease of pulmonary artery pressure and the changes of cardiac structure and function.Results After lung transplant,pulmonary artery systolic pressure(PASP) decreased significantly [(62.3 ± 27.2) vs (36.20 ± 7.8)mm Hg,P ＜0.01],and right ventricular dimensions zoomed down,tricuspid valve and pulmonary valve regurgitation reduced,left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVDD) were enlarged,stroke volume (SV) increased [(43.85 ± 14.78) vs (58.68 ± 13.85)],but left ventricular ejection fraction (LVEF) was decreased [(69.31 ± 7.50)％ vs (62.82 ± 8.12) ％],those differences above were statistically significant (P ＜ 0.05) compared with preoperative echocardiography date.Pearson linear correlation analysis show that after lung transplantation the more decreased PASP,the more increased LAD and LVDD,and the more decreased LVEF (P ＜0.05).Conclusions In early stage after lung transplant,the structure of right ventricular was quickly normalized,the function of right ventricular improved,LAD enlarged,SV increased,but left ventricular function reduced,there were a linear correlation between those changes and PASP reduced.Echocardiography has good reference value for early lung transplant patient.
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Objective To evaluate the safety and effectiveness of immunosuppression regimens,postoperative complications,dead causes and risk factors of lung transplantation (LTx).Methods The immunosuppression regimens and clinical data of 100 patients with end-stage lung diseases receiving LTx in our hospital were retrospectively analyzed between Sept.2002 to Dec.2010.There were 72 patients subject to single LTx and 28 patients to bilateral LTx,amongst them 61 patients received LTx under circulation support,including 5 cases of cardopulmonary bypass (CPB) support and 56 cases of extracorporeal membrane oxygenation (ECMO) support.The immunosuppression regimens including Cyclosporin,mycophemolate Mofeil and corticosteroids were utilized in 53 recipients before the year of 2007,and Cyclosporin was switched to Tacrolimus in 47 patients after 2007.All the patients received Daclizumab or Basiliximab as immunosuppression induction regimens.Results The 1-,2-,3-and 5-year survival rate after LTx was 73.3％,61.6％,53.5％ and 40.7％ respectively.The mean survival time post-transplant in the patients who received Cyclosporin-based regimens and Tacrolimus-based regimens were (36.57 ± 3.44) months and (35.00 ± 2.33) months,repectively,with no significant differences (P＞0.05).The main causes of mortality included primary graft dysfunction (PGD),acute rejection (AR),bronchiolitis obliterans (BOS) and sepsis.The incidence of AR and BOS in Tacrolimus group was significantly lower than that in Cyclosporin grou (P ＜0.05),but the incidence of diabetes mellitus was significantly higher in Tacrolimus group.Analysis of Spearman rank correlation revealed that there was a direct correlation between the incidence of AR and BOS (r =0.340,P＜0.01).The use of circulation support,diagnosis of IPF,postoperative complications such as AR,BOS and infection were associated with decreased survival time postoperatively,in both univariate and multivariate proportional hazards regression models (P＜0.05).Conclusion Cyclosporin-and Tacrolimus-based regimens were both effective immunosuppression strategies postoperatively,Consummate follow-up surveillance and prompt treatment of complications were the key points in prolongation of survival time and improving quality of life after LTx.
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Objective To summarize the clinical experience ot harvesting and using the lungs from donation after brain death (DBD) and donation after cardiac death (DCD,Maastricht category Ⅳ) in China.Methods Eleven potential DBDs and DCDs were evaluated by our transplant group preoperatively,including 6 cases of DCDs and 5 cases of DBDs,and all of them received the tests of sputum culture bedside bronchoscopy,chest X rays,and blood gas analysis.After clear evaluation,1 case of DCD and 2 cases of DBD were discharged from the group for bilateral inflammatory infiltration and poor oxygenation index,and one case of DCD was precluded due to long warm ischemic time (＞60min).The donor lungs from remaining 7 cases were harvested successfully after the declaration of brain death or cardiac death.The preoperative lymphocytotoxic cross match test was negative,ABO blood types were compatible,and the donors were all suitable for the transplant procedure.Results Seven lung transplants were performed successfully under ECMO support,including 5 cases of bilateral lung transplantation and 2 cases of single lung transplantation.One patient was complicated with severe infection and died of sepsis on postoperative day (POD) 39,and one was succumbed to multiple organ failure.Two patients suffered of acute rejection on POD 30 and POD 19,respectively,and obtained improvements by bolus steroid therapy.The remaining 3 patients all recovered uneventfully.During a follow up period,all the patients lived an active life style with high quality of life.The mean survival time was 23.3 months (3-51 months).Conclusion The DCD and DBD may be one of the available donor resources for lung transplantation after efficient management of the potential donors and detailed preoperative evaluation in China.