Use of Methylene Blue to Treat Vasoplegia Syndrome in Cystic Fibrosis Patients Undergoing Lung Transplantation: A Case Series

Background: Several studies have demonstrated the utility of methylene blue (MB) to treat vasoplegic syndrome (VS), but some have cautioned against its routine use in lung transplantation with only two cases described in prominent literature. Cystic fibrosis patients commonly have chronic infections which predispose them to a systemic inflammatory syndrome-like vasoplegic response during lung transplantation. We present 13 cystic fibrosis patients who underwent lung transplantation and received MB for vasoplegic syndrome while on cardiopulmonary bypass, with or without inhaled pulmonary vasodilator therapy. Methods: Single?center, retrospective, case series analysis of cystic fibrosis patients who underwent lung transplant and received MB for vasoplegia. We defined the primary outcome as 30-day mortality, and secondary outcomes as primary graft failure, 1-year mortality, postoperative complications, and hemodynamic response to MB. Results: MB was associated with a significant increase in mean arterial pressure (MAP) (P < 0.001) in all patients, and 84.6% (11/13) of the patients had either a decrease or no change in vasopressor requirement. No patients developed acute primary graft dysfunction and there was 100% 30?day and 1?year survival. One patient required Extracorporeal membrane oxygenation (ECMO) for hypoxemia and 69% (9/13) of the patients had evidence of postoperative right ventricular dysfunction, but no patients required a right ventricular assist device. Conclusion: This case series demonstrates the effectiveness of MB in treating vasoplegia in cystic fibrosis patients during lung transplantation, without evidence of primary graft dysfunction, 30?day or 1?year mortality. The safety of MB regarding hypoxemia and increased pulmonary vascular resistance requires further investigation.

The prevalence of vascular and metabolic complications after lung transplant in people with cystic fibrosis in a Dutch cohort

Abstract Background With improvements in care for people with Cystic Fibrosis (pwCF), total survival after Lung Transplantation (LTx) will be longer. Therefore, this population's up-to-date analysis of late-onset post-transplant metabolic and vascular complications will be more relevant in current clinical practice. Methods We studied 100 pwCF who underwent an LTx between 2001 and 2020 at the University Medical Centre Utrecht, the Netherlands. The median age at transplant was 31 years and 55 percent was male. We assessed survival, the prevalence of metabolic complications (diabetes, renal damage, dyslipidemia, and metabolic syndrome), and vascular complications (hypertension, heart rhythm disease, micro-, and macrovascular disease). In addition, differences in risks for developing complications based on sex and overall survival were analyzed. Results The prevalence of macrovascular disease raised to 15.9 percent 15 years post-LTx. The prevalence of diabetes increased from 63 percent at LTx to over 90 percent 15 years post-LTx and the prevalence of dyslipidemia increased from 21 percent to over 80 percent. Survival 1-, 2-, 5-, and 10 years post-transplant were 84, 80, 76, and 58 percent respectively. No significant differences were found based on sex. Conclusion This study shows that the prevalence of cardiovascular risk factors increases after LTx for CF, potentially leading to major complications. These data emphasize the necessity of regular check-ups for metabolic and vascular complications after LTx with specific attention to renal damage. Early recognition of these complications is crucial and will lead to earlier intervention, which could lead to improved prognosis after lung transplantation.

Brazilian initial experience with lung transplantation due to irreversible lung fibrosis post-COVID-19 in a national reference center: a cohort study

ABSTRACT BACKGROUND: Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES: To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING: Cohort study conducted at a national reference center for lung transplantation. METHODS: Medical charts were reviewed regarding patients' demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS: Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. CONCLUSIONS: LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.

Soporte ventilatorio no invasivo como puente hacia el trasplante pulmonar: reporte de un caso / Bridging to lung transplant using noninvasive ventilatory support: a case report

El soporte ventilatorio no invasivo es una herramienta que ha demostrado mejorar la sobrevida de pacientes con falla muscular de la bomba respiratoria y el manejo de enfermedades pulmonares crónicas, incluso la ventilación no invasiva nocturna ha servido de puente hacia el trasplante pulmonar. Se presenta el caso de una adolescente de 14 años con enfermedad pulmonar crónica hipoxémica severa y falla ventilatoria secundaria, que requirió ventilación prolongada y traqueostomía en espera de trasplante pulmonar. Luego de reevaluar indemnidad de la vía aérea fue decanulada a soporte ventilatorio no invasivo, con uso alternado de mascarilla nasal nocturna y pieza bucal diurna, permitiendo descanso muscular respiratorio eficiente, y mejoría de flujo de tos con técnicas de apilamiento de aire. Este plan permitió una decanulación segura y realizar soporte continuo ventilatorio no invasivo con un programa de rehabilitación cardiorrespiratorio. Generalmente, el soporte ventilatorio no invasivo se utiliza en trastornos primarios de la bomba respiratoria. En este caso, se indicó para enfermedad pulmonar crónica hipoxémica, mostrando claros beneficios con oxigenación adecuada, buen rendimiento cardiovascular con mejor tolerancia al ejercicio y entrenamiento en el escenario de preparación al trasplante pulmonar.

Noninvasive Ventilatory Support has demonstrated to improve survival of patients with ventilatory pump muscle failure and nocturnal noninvasive ventilation is useful in chronic lung disease, even bridging to lung transplant. We present a 14 years old girl with severe hypoxemic chronic lung disease and secondary ventilatory failure, who required continuous long-term ventilation and underwent a tracheostomy waiting for lung transplant. After reevaluated the airway patency the patient was decannulated to Noninvasive Ventilation Support, alternating nocturnal nasal mask with diurnal mouth piece in order to provide efficient respiratory muscle rest, made air stacking and improved cough flow. This plan allows safe decannulation to continuous Noninvasive Ventilatory Support tailoring a rehabilitation cardiorespiratory program. Usually, Noninvasive Ventilation Support is prescribed for primary respiratory pump muscles failure, but in this case, it was applied for a hypoxemic chronic lung disease. Clear benefits were observed leading to appropriate oxygenation, good cardiovascular performance with better tolerance to exercise for training in the preparatory scenario of a lung transplant.

Un caso exitoso de trasplante bipulmonar durante la pandemia por SARS CoV-2 en la Ciudad de Buenos Aires / A Successful Case of Double-Lung Transplant During the SARS CoV-2 Pandemic in the City of Buenos Aires

Paciente masculino portador de hipertesión pulmonar severa refractaria a tratamiento médico, sometido a trasplante bipulmonar durante la pandemia por SARS-CoV-2 en la ciudad de Buenos Aires. Para disminuir el riesgo de contagio se realizaron todas las medidas de prevención actualmente recomendadas, con especial énfasis en el uso del equipo de protección personal, contribuyendo de esta forma con el éxito terapéutico alcanzado.

Male patient with severe pulmonary hypertension refractory to medical treatment who underwent a double-lung transplant during the SARS-CoV-2 in the city of Buenos Aires. In order to reduce the risk of contagion all the currently recommended prevention measures were adopted, especially the use of personal protective equipment, thus contributing to the resultant therapeutic success.

Association Research between CYP3A5，CYP3A4，ABCB1 and POR*28 Genetic Polymorphisms and Individualized Use of Tacrolimus in Lung Transplant Recipients after One Year of Tacrolimus Administration / 中国药房

ABSTRACT OBJECTIVE：To study the association between CYP3A5，CYP3A4，ABCB1 and POR*28 genetic polymorphisms and drug dosage（D）and steady blood concentration/dosage（c0/D）of tacrolimus in lung transplant recipients after one year of tacrolimus administration. METHODS：By retrospective analysis，a total of 46 recipients who underwent lung transplantation in China-Japan Friendship Hospital during May 2017-May 2018 were selected. The c0 and D of tacrolimus were measured and collected after one year of tacrolimus administration，and c0/D was calculated. Recipients’genotypes of CYP3A5（rs776746）， CYP3A4（rs2242480，rs28371759），ABCB1（rs1045642，rs2032582，rs1128503）and POR*28（rs1057868）were collected. The relationship between genetic polymorphism and D，c0/D was analyzed statistically. RESULTS：The genotype frequency in this study were all in accordance with Hardy-Weinberg equilibrium （P＞0.05）. While maintaining tacrolimus c0 within therapeutic range， genetic polymorphism of CYP3A5（rs776746）and CYP3A4（rs2242480）influenced D and c0/D of tacrolimus significantly（P＜ 0.05）. There was no statistical significance in D or c0/D among different genotypes of other sites（P＞0.05）. There was statistical significance in D or c0/D among extensive metabolism type recipients with CYP3A5（rs776746）*1 and CYP3A4（rs2242480）*1G alleles，normal metabolism type recipients with only CYP3A5 （rs776746） *1 or CYP3A4 （rs2242480） *1G alleles and poor metabolism type recipients without CYP3A5（rs776746）*1 and CYP3A4（rs2242480）* 1G alleles（P＜0.05）. D of tacrolimus was the highest in extensive metabolism type recipient and the lowest in poor metabolism type recipient. CONCLUSIONS：The detection of genetic polymorphism of CYP3A5（rs776746）and CYP3A4（rs2242480）has guiding significance for individualized medication of tacrolimus after one year of tacrolimus administration.

Bronchoscopic survillance during early postoperative period after lung transplantation

Background: Lung transplant has become an accepted modality of treatment of patients with end stage pulmonary disease, establishing protocols for improving survival in these patients is the need of the hour. The aim of this study was to assess the use of bronchoscopic surveillance during early post-operative period after lung transplantation.Methods: It is a hospital based retrospective study; the study was carried out in a lung transplant centre located in Chennai, India.  A total of eight cases of single lung transplantation were done during the period of one year. Six patients were selected based on the inclusion criteria and the use of bronchoscopy during the immediate post-operative period followed by bronchoscopy during the early hours of everyday for the first week and the success in reduction of immediate post-operative infection and observations has been analysed.Results: In analysis of all the six cases, the positive signs of early morning bronchoscopy done were identified, mucus plugs which contribute to significant hypoxemia and morbidity were not observed in any of the patients.  New patch was also not observed in any of these patients. Culture positivity from the donor lung carrying over to the recipient was observed in just one of these patients.Conclusions: This protocol based frequent bronchoscopy prevents ‘Surprise’ patches in the lungs. Performance of Broncho Alveolar Lavage on a regular basis avoided the possibility of infections developing by early screening and aided as a tool for identification of acute neo lung rejection.

Resección de nódulo pulmonar en pulmón trasplantado bajo asistencia con membrana de oxigenación extracorpórea / Resection of a pulmonary nodule in a transplanted lung under extracorporeal membrane oxygenation

La utilización de soporte perioperatorio con sistema de oxigenación a través de membrana extracorpórea (ECMO) es un concepto novedoso en cirugía torácica general. Se presenta el caso de un paciente con trasplante pulmonar derecho por fibrosis pulmonar idiopática (FPI) que requirió la resección de un nódulo pulmonar homolateral con soporte de ECMO veno-venoso (VV). El soporte a través de ECMO VV es una opción viable cuando se prevén dificultades con la ventilación unipulmonar en casos seleccionados.

The use of perioperative support with extracorporeal membrane oxygenation (ECMO) systems is a novel concept in general thoracic surgery We report the case of a male patient with a history of right lung transplant due to idiopathic pulmonary fibrosis (IPF) who required resection of a right pulmonary nodule under veno-venous (VV) ECMO support. The use of VV-ECMO is a feasible option in selected cases when complications are expected to occur with one lung ventilation.

Characteristics of Lung Allocation and Outcomes of Lung Transplant according to the Korean Urgency Status

PURPOSE: We investigated the characteristics of lung allocation and outcomes of lung transplant (LTx) according to the Korean urgency status. MATERIALS AND METHODS: LTx registration in the Korean Organ Transplantation Registry (KOTRY) began in 2015. From 2015 to June 2017, 86 patients who received LTx were enrolled in KOTRY. After excluding one patient who received a heart-lung transplant, 85 were included. Subjects were analyzed according to the Korean urgency status. RESULTS: Except for Status 0, urgency status was classified based on partial pressure of oxygen in arterial blood gas analysis and functional status in 52 patients (93%). The wait time for lung allograft was well-stratified by urgency (Status 0, 46.5±59.2 days; Status 1, 104.4±98.2 days; Status 2 or 3, 132.2±118.4 days, p=0.009). Status 0 was associated with increased operative times and higher intraoperative blood transfusion. Status 0 was associated with prolonged extracorporeal membrane oxygenation use, postoperative bleeding, and longer mechanical ventilation after operation. Survival of Status 0 patients seemed worse than that of non-Status 0 patients, although differences were not significant. CONCLUSION: The Korean urgency classification for LTx is determined by using very limited parameters and may not be a true reflection of urgency. Status 0 patients seem to have poor outcomes compared to the other urgency status patients, despite having the highest priority for donor lungs. Further multi-center and nationwide studies are needed to revise the lung allocation system to reflect true urgency and provide the best benefit of lung transplantation.

Nutritional support for lung transplant over the perioperative period / 中华临床营养杂志

Objective To evaluate the effect of perioperative nutritional support on the prognosis of lung transplant.Methods Retrospective analysis was carried out on nutritional support for 6 lung transplant recipients in the Department of Thoracic Surgery in Henan Provincial People's Hospital between September 2015 and September 2016.The recipients were all males,with ages ranging from 28 to 60 (40± 12.1).The recipients' body mass index (BMI),serum albumin and pulmonary function at the first test after admission (t1),the last test before surgery (t2) and the last test after surgery (t3) were compared.The recipients' nutritional status was assessed with subjective global assessment.Results The 6 patients had successful single-lung transplant,without mortality or severe complications.At t3,all of them had increases in BMI by (2.4±1.4) kg/m2,weight by (3.2±1.2) kg,deltoid skin-fold thickness by (3.0±0.35) mm,prealbumin by (30±10.4) g/L,total protein (15.2±6.4) g/L,albumin by (6.4±4.1) g/L,triglyceride by (0.2± 1.4) mmoL/L,and total cholesterol by (1.4± 0.9) mmol/L (P＜0.01).The patients were followed up for 6 to 12 months.SGA results suggested no abnormality in their nutrition,and the patients were well able to function independently.Conclusion Nutritional support is vital for patients with severe malnutrition during the perioperative period of lung transplant,and can significantly improve the patient's quality of life.

Morfometria do osso esterno e sua correlação com o volume pulmonar / Sternum bone morphology and its correlation with lung volume

Este estudo teve por objetivo desenvolver um modelo matemático que a partir da extensão do osso esterno fornecesse o tamanho do pulmão compatível para o receptor. Foram coletadas as medidas antropométricas do tórax de 250 indivíduos, através de exame de tomografia computadorizada. Os resultados apontam que a medida do osso esterno (distância da incisura jugular até processo xifóide) apresenta correlação positiva com todas as outras medidas do tórax (medida ântero-posterior e látero-medial entre II e III costela, e ápice à base de ambos os pulmões). Entretanto, o volume pulmonar e sua relação com o osso esterno apresentam discrepâncias quando analisados sob a correlação de Pearson, pois a relação entre a medida da incisura jugular ao processo xifóide e a medida do ápice à base do pulmão direito e esquerdo, apresenta correlação positiva média (0,31-0,6). Já a medida da incisura jugular ao processo xifóide com a medida ântero-posterior e látero-medial do tórax, apresenta correlação significativa baixa (0-0,3). Então, a análise estatística da correlação de Pearson demonstrou ser inviável o desenvolvimento da fórmula, pois esta não seria confiável já que funcionaria para cerca de apenas 39% dos pacientes. Assim, o melhor método para determinar o doador para o transplante, continua sendo a análise de fatores de risco, a capacidade vital forçada do doador e receptor com estatura maior do que a do doador.

This study aimed at developing a mathematical model that can provide the compatible lung size for the recipient from the length of the sternum bone. Anthropometric chest measurements of 250 individuals were collected through a CT scan. The results indicate that the measurement of the sternum bone (distance from the jugular notch to the xiphoid process) shows a positive correlation with all other thorax measurements (antero-posterior and medial-posterior measurement between ribs II and III, and apex-to-base on both lungs). However, lung volume and its correlation to the sternal bone present discrepancies when analyzed under Pearson's correlation, since the relation between the jugular notch measurement and the apex measurement at the base of the right and left lungs shows a positive correlation mean (0.31-0.6). The measurement of the jugular notch in the xiphoid process with the anterior-posterior and medial-medial measurements, presents a low significant correlation (0-0.3). Therefore, the statistical analysis of the Pearson's correlation showed that the formula could not be applied since it would not be reliable since it would work for only 39% of the patients. Thus, the best method to determine the donor for transplantation remains the analysis of risk factors, the forced vital capacity of the donor, and the recipient being taller than the donor.

Rehabilitación respiratoria de larga duración en pacientes con enfermedad pulmonar intersticial difusa en lista de trasplante pulmonar: Serie de casos / Long Term Pulmonary Rehabilitation in Patients with Interstitial Lung Disease on Waiting list for Lu8ng Transplantation. A Case Series

En Argentina los pacientes esperan en lista de trasplante una media de 265 días, pudiendo experimentar cambios fisiológicos asociados a la severidad de la enfermedad. Múltiples estudios demuestran los beneficios de la Rehabilitación Respiratoria (RR). Los resultados del tratamiento son superiores a mayor duración del programa. Para nuestro conocimiento no hay estudios publicados que describan los beneficios de un programa de RR (PRR) de larga duración en esta población. Nuestro objetivo es describir los resultados de dos pacientes con enfermedad pulmonar intersticial difusa (EPID) en lista de trasplante pulmonar que realizan RR desde hace un año. Casos clínicos: CASO 1. Paciente masculino, 36 años, diagnóstico silicosis, patrón ventilatorio restrictivo muy severo y disminución severa de la difusión, oxígeno suplementario en el ejercicio. CASO 2. Paciente masculino, 61 años, diagnóstico fibrosis pulmonar idiopática e hipertensión pulmonar leve, patrón ventilatorio restrictivo leve, disminución moderada de la difusión y requerimiento de oxígeno crónico domiciliario. A los 12 meses del ingreso al PRR disminuyó la función pulmonar en ambos casos, mejoró la capacidad de ejercicio (Test de marcha de 6 minutos, Test incremental y Test a Carga Constante), la fuerza muscular y la calidad de vida. No se observaron cambios de la disnea en el primer caso y una disminución de la misma en el segundo. Observamos en dos pacientes con enfermedad intersticial en lista de trasplante que programas largos de RR proporcionaron beneficios que incluyen mejoría en la disnea, calidad de vida, fuerza muscular y tolerancia al ejercicio.

In Argentina, the average time a patient awaits lung transplantation is 265 days, during which, the patient may undergo physiological changes associated with end-stage lung disease. Many studies have shown the benefits of a Pulmonary Rehabilitation Program (PRP) with longer program duration correlating to more beneficial results. To our knowledge, there is currently no evidence that describes the benefits of a long term PRP among lung transplant candidates. Our goal is to give an account of the results of patients awaiting lung transplantation who have partaken in one year of PR. Case description: CASE 1. 36-year-old male, diagnosed with silicosis, presenting very severe restrictive ventilation patterns, decreased diffusion capacity and the use of supplemental oxygen during exercise. CASE 2. 61-year-old male, diagnosed with idiopathic pulmonary fibrosis, mild pulmonary hypertension, mild restrictive ventilation patterns, moderate decrease in diffusion capacity, and long term oxygen therapy. Twelve months after beginning the PRP, both patients presented a decline in pulmonary function and improvement in exercise capacity (6 minute walk test, incremental testing, and constant-load test), muscle strength, and quality of life. In the first case, changes in dyspnea symptoms were not observed and in the second case, a decrease was noted. In conclusion, we believe that long term PR may be beneficial in patients with interstitial lung disease awaiting lung transplantation in terms of improving dyspnea symptoms, muscle strength, exercise tolerance, and enhancing quality of life.

Effect of Voriconazole or Itraconazole on the Plasma Concentrations of Tacrolimus in Lung Transplant Recipients

OBJECTIVE: This study was performed to compare the changes in the blood concentrations of tacrolimus when either itraconazole or voriconazole is together with tacrolimus to prevent or treat invasive aspergillus pneumonia (IAP) in patients with lung transplants. Therefore we can compare the degree of drug-drug interactions between tacrolimus and itraconazole against tacrolimus and voriconazole. METHODS: Patients who were admitted and had lung transplants in a territory referral hospital from September 2012 to May 2015 were analyzed retrospectively. The effects of itraconazole and voriconazole on the plasma concentrations of tacrolimus were analyzed. RESULTS: Mean tacrolimus concentrations was 10.49±2.35 ng/mL vs. 10.95±2.98 ng/mL (p=0.722), and mean concentration of tacrolimus over the dose of tacrolimus per day was 8.510±5.890 (ng/mL)/(mg/d) vs. 15.45±28.47 (ng/mL)/(mg/d) (p=0.947) in itraconazole vs. voriconazole group each. The ratio of the number of the results out of target tacrolimus concentrations to the total number of tacrolimus concentration results was 18.0±13.3% vs. 24.4±18.5% (p=0.185). CONCLUSION: There were no significant differences between itraconzaole and voriconazole to have influences on mean concentrations of tacrolimus over tacrolimus dose per weight per day. However voriconazole tended to raise tacrolimus plasma concentrations more than itraconazole. Safer and more effective drug management to prevent and treat fungal infections should be done by therapeutic drug monitoring not only of tacrolimus but of itraconazole and voriconazole in lung transplant patients.

Resultados del trasplante pulmonar en pacientes en situación de urgencia / Results of lung transplant patients in emergency situation

Introduction: In Chile, a number of criteria were agreed for emergency lung transplant in order to diminish the mortality of candidates on the waiting list. Objective: To evaluate short-term transplant patients in emergency condition. Methodology: Retrospective analysis of medical records of patients transplanted from January 2012 to July 2015 demographic data, underlying disease, early and late complication, and survival were recorded. Results: Out of 59 patients transplanted in this period, 18 have been in an emergency condition. Underlying pulmonary disease were: pulmonary fibrosis (n = 13), cystic fibrosis (n = 3), bronchiolitis obliterans (1) and pulmonary hypertension (1). The dependence of non invasive mechanical ventilation was the main reason for urgency (89%). 76% required intraoperative extracorporeal support. Survival at 30 days and 12 months was 94 and 87% respectively. Conclusion: Lung transplantation is a short-term emergency procedure with good results in survival.

Introducción: En Chile se consensuaron una serie de criterios de urgencia para trasplante pulmonar con el fin de disminuir la mortalidad de candidatos en lista de espera. Objetivo: Evaluar la sobrevida a corto plazo de pacientes trasplantados en condición de urgencia. Metodología: Análisis retrospectivo de fichas clínicas de pacientes trasplantados desde enero del 2012 a julio del 2015. Se consignó datos demográficos, enfermedad de base, complicaciones precoces, tardías y sobrevida. Resultados: De 59 pacientes trasplantados en este período 18 han sido en urgencia. Enfermedad de base: fibrosis pulmonar (n = 13), fibrosis quística (n = 3), bronquiolitis obliterante (n = 1), hipertensión pulmonar (n = 1). La dependencia de ventilación mecánica no invasiva fue el principal motivo de urgencia (89%). Un 76% requirió de soporte extracorpóreo intraoperatorio. La sobrevida a 30 días y a 12 meses fue de 94 y 87% respectivamente. Conclusión: El trasplante pulmonar en situación de urgencia es un procedimiento con buenos resultados en sobrevida a corto plazo.

Trasplante pulmonar en niños y adolescentes: Experiencia Clínica Las Condes / Lung transplantation in children and adolescents: Experience at Clinica Las Condes

Objective: To assess the outcome of patients ≤ 20 years old subjected to lung transplantation. Methods: Retrospective analysis of clinical records of these patients at Las Condes Clinic, Santiago de Chile. Results: Ten patients ≤ 20 years old have been subjected to lung transplantation. The median age at transplant was 15.8 years. The main indication was cystic fibrosis in 8 patients. The average baseline FEV1 was 31.3% of its reference value with progressive improvement in FEV1 being 76,3% after one year and 75,3% after two years, Early complications were infections and rejection. Late complications were mainly viral infections. Six patients achieved to continue their studies. Survival rate at 30 days, 1 and 5 years were 80, 70 and 58% respectively. Conclusion: Lung transplantation is an alternative for children and adolescents with advanced lung disease with acceptable results in long-term survival.

Sólo 45 centros en el mundo desarrollan trasplantes pulmonares en niños. Objetivo: Evaluar resultados de pacientes ≤ 20 años trasplantados de pulmón. Material y Método: Análisis retrospectivo de registros clínicos de estos pacientes en Clínica Las Condes. Resultados: Diez pacientes ≤ 20 años han sido trasplantados de pulmón. La edad promedio al momento del trasplante fue de 15,8 años. La principal indicación fue fibrosis quística en 8 pacientes. El VEF1 promedio basal fue de 31,3% de su valor de referencia, con mejoría progresiva post-trasplante siendo al año de 76,7% y a los 2 años de 75%, Complicaciones precoces fueron infecciones y rechazo. Complicaciones tardías fueron principalmente infecciones de origen viral. Seis pacientes lograron continuar sus estudios. La sobrevida a 30 días, al 1er y 5º año fue de 80%,70% y 58% respectivamente. Conclusión: El trasplante pulmonar es una alternativa válida en niños y adolescentes con enfermedades pulmonares avanzadas con resultados aceptables a largo plazo.

Veinte años de experiencia en trasplante pulmonar: Complicaciones de la vía aérea: Rol de la tomografía computada multidetector / Twenty-Year Experience in Lung Transplantation: Complications of the Airways. The Role of Multidetector Computed Tomography

Introducción: Las complicaciones de la vía aérea (CVA) en pacientes trasplantados pulmonares ocupan una causa importante de morbimortalidad; llegan a presentarse (hasta en el 18% de los mismos). Se incluyen la dehiscencia, la estenosis y la malasia. Objetivo: Demostrar nuestra experiencia en pacientes con CVA sometidos a trasplante pulmonar. Objetivo secundario: Demostrar la utilidad de la tomografía computada multidetector (TCMD) para el diagnóstico y control post tratamiento de las CVA. Materiales y métodos: Se analizaron las historias clínicas de pacientes trasplantados pulmonares con diagnóstico broncográfico de CVA. Además se compararon los hallazgos tomográficos de estos pacientes con el de las FBC. Resultados: De 325 trasplantes realizados en 20 años, 65 (20%) de ellos presentaron alguna CVA. Se reportó estenosis en 51 pacientes (78,5%); malasia en un 15% y dehiscencia en un 13,5%. Los pacientes con estenosis o malasia recibieron dilatación endoscópica; 33 de ellos presentaron re estenosis, por lo que a 30 se les implantó un stent. Las dehiscencias fueron tratadas con corrección quirúrgica, stents o cierre con Histoacryl. De los 30 pacientes con sospecha de CVA a los que se les realizó TCMD, esta demostró ser diagnóstica en el 100% de los casos. Conclusión: Las CVA deben sospecharse en caso de disnea, fiebre o empeoramiento de la clase funcional con caída del volumen espiratorio forzado en 1 segundo (VEF1). La TCMD con reconstrucciones multiplanares o 3D demostró alta certeza para el diagnóstico de las CVA, planeamiento de su terapéutica y control posterior de la misma.

Introduction: The complications of airways in lung transplant recipients are an important cause of morbidity and mortality, reaching up to 18% of patients according to various reports. Dehiscence, stenosis and malacia are included. Objective: Describe our experience in patients with complications of airways after lung transplantation. Secondary Objective: Demonstrate the usefulness of multidetector computed tomography for the diagnosis, treatment and monitoring of airways complications in lungs transplanted patients. Materials and Methods: The medical records of lungs transplanted patients with bronchographic diagnosis of the airways complications were reviewed and analyzed. Furthermore CT findings of these patients were compared with the bronchoscopy diagnosis to determine their utility. Results: Among 325 lung transplants performed in 20 years, 65 (20%) showed airways complications. The most frequently reported complications were stenosis in 51 patients (78.5%), malacia (15%) and dehiscence (13.5%). All patients with stenosis or malacia received first a therapeutic endoscopic dilatation; 33 of them had re-stenosis and in 30 patients a stent was implanted. Dehiscences were treated with surgical intervention, stenting or closing with Histoacryl. In 30 patients with clinical suspicion of significant airways complications, MDCT proved to be diagnostic in 100% of cases. Conclusion: The airways complications should always be suspected in cases of dyspnea, fever or worsening functional class associated with spirometry forced expiratory volume decline in one second. Also, MDCT with multiplanar and 3D reconstructions showed high accuracy for diagnosis, therapy planning and subsequent control.

Transplante de pulmão: Indicações atuais / Lung Transplantation: Current Indications

A doença pulmonar obstrutiva crônica representa cerca de 40% de todos os transplantes de pulmão. A fibrose pulmonar, idiopática ou secundária, caracteriza a indicação básica de transplante unilateral. A fibrose cística é a principal indicação de transplante em doenças supurativas. Há uma crescente tendência a aumentar as indicações de transplante bilateral. O transplante bilobar com doadores vivos representa a melhor opção para os receptores pediátricos e adolescentes. A terapia vasodilatadora modificou substancialmente a indicação de transplante em hipertensão pulmonar, primária e secundária. É intransferível a necessidade de divulgação dos critérios de inclusão em lista de espera, demovendo o equivocado conceito de que transplante é a terapia de desespero e, com isso, prevenindo mortes evitáveis.

Single lung transplantation in India an initial experience.

The science of lung transplantation has evolved from an experimental procedure, to be accepted as a legitimate mainstream therapy for patients with end-stage pulmonary disease. Now lung transplantation offers patients with end-stage lung disease acceptable quality of life and matches a 5-year survival rate of other solid organ transplants. In the present report, we present our initial experience in performing two single lung transplantations done in our centre.

Programa de trasplante pulmonar en Uruguay: Nuestra experiencia con un centro regional de referencia / Lung transplant program in Uruguay: our experience with a regional reference center

El Uruguay es un país con 3 millones de habitantes que no cuenta con un programa de trasplante pulmonar propio. En este contexto se ha optado por generar un acuerdo para su realización en un centro de referencia regional como la Fundación Favaloro de la República Argentina. En este trabajo se muestra la experiencia de este programa durante 4 años. Hasta el momento se han trasplantado 20% de los pacientes alistados y la mortalidaden lista de espera ha sido elevada. La principal limitante ha sido la dificultad para obtener donantes pulmonares óptimos para el implante. La flexibilización en la selección, con la utilización de donantes marginales o la utilización de donantes en asistolia pueden en el futuro mejorar esta situación.

Uruguay, a country with three million- inhabitants does not have its own lung transplant program. Therefore an agreement has been reached for transplants, to be performed in the regional reference center called Favaloro Foundation in Argentine. The experience of the program for the first four years is presented in this paper. Twenty percent of the waiting list patients have been transplanted so far; the mortality of the patients on the waiting list was high. The main limitation of the program has been the difficulty to get optimal lung donors.The selection of donors who either meet marginally the transplant requirements or are in asystolic arrest will make the program more flexible and may improve current results.