Influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation / 器官移植

Objective To analyze the influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation. Methods Clinical data of 66 patients with airway stenosis requiring clinical interventions after lung transplantation were retrospectively analyzed. Univariate and multivariate Cox’s regression models were adopted to analyze the influencing factors of survival of all patients with airway stenosis and those with early airway stenosis. Kaplan-Meier method was used to calculate the overall survival and delineate the survival curve. Results For 66 patients with airway stenosis, the median airway stenosis-free time was 72 (52,102) d, 27% (18/66) for central airway stenosis and 73% (48/66) for distal airway stenosis. Postoperative mechanical ventilation time [hazard ratio (HR) 1.037, 95% confidence interval (CI) 1.005-1.070, P=0.024] and type of surgery (HR 0.400, 95%CI 0.177-0.903, P=0.027) were correlated with the survival of patients with airway stenosis after lung transplantation. The longer the postoperative mechanical ventilation time, the higher the risk of mortality of the recipients. The overall survival of airway stenosis recipients undergoing bilateral lung transplantation was better than that of their counterparts after single lung transplantation. Subgroup analysis showed that grade 3 primary graft dysfunction (PGD) (HR 4.577, 95%CI 1.439-14.555, P=0.010) and immunosuppressive drugs (HR 0.079, 95%CI 0.022-0.287, P<0.001) were associated with the survival of patients with early airway stenosis after lung transplantation. The overall survival of patients with early airway stenosis after lung transplantation without grade 3 PGD was better compared with that of those with grade 3 PGD. The overall survival of patients with early airway stenosis after lung transplantation treated with tacrolimus was superior to that of their counterparts treated with cyclosporine. Conclusions Long postoperative mechanical ventilation time, single lung transplantation, grade 3 PGD and use of cyclosporine may affect the survival of patients with airway stenosis after lung transplantation.

Multi-disciplinary team of the treatment of bilateral lung transplantation for pediatric cystic fibrosis / 器官移植

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.

Perioperative anaesthetic management of bilateral lung transplantation for idiopathic pulmonary arterial hypertension / 临床麻醉学杂志

Objective To explore the key points of anaesthetic management of bilateral lung transplantation treating severe idiopathic pulmonary arterial hypertension.Methods Clinical data of 20 cases with severe IPAH treated by bilateral lung transplantation were analyzed retrospectively, 2 males and 18 females, ASA physical status Ⅲ or Ⅳ.The hemodynamic changes were observed at various points (30 min after double lung ventilation, 15 min after ECMO, during one-lung ventilation, 30 min after pulmonary artery block, at the opening of pulmonary artery and at the end of surgery) and pre-and post-operative changes of cardiovascular morphology were analyzed with heart ultrasound.Results Compared with 30 min after double lung ventilation, PaO2 and SVV were significantly increased and PAP, PAWP and PaCO2 were decreased 15 min after extracorporeal membrance oxygenation (ECMO) (P<0.05).PAP and PAWP were significant higher and SVV was lower 30 min after pulmonary artery block than 15 min after ECMO (P<0.05).Opening of pulmonary artery had significantly increased SVV and reduced PAP and PAWP compared with pulmonary artery block (P<0.05).ECMO was removed in 4 cases at end of the surgery.The remaining 16 cases assisted by ECMO were transferred to ICU, 3 cases underwent thoracotomy for exploration and hemostasis 1 day after the operation while 13 cases suffered from different degrees of left heart dysfunction postoperatively, 4 of which had acute heart failure.Of the 4 cases, 2 were treated by right femoral vein-right femoral artery bypass (V-A ECMO bypass) and 2 underwent right femoral vein-right internal jugular vein bypass (V-V ECMO bypass).Moreover, 3 cases performed tracheotomy 5 days, 6 days and 13 days day after the operation, respectively.All the patients were cured and discharged.Their cardiovascular morphology was improved.Conclusion The key successful factors of IPAH treated by bilateral lung transplantation are to improving perioperative heart function, keeping stable hemodynamics during induction of anesthesia and the operation and using ECMO properly and postoperative support.

Bilateral Lung Transplant Models in Lung Preservation with LPDG Solution / 대한이식학회지

PURPOSE: Canine left single lung allotransplantation has become a frequently used model, but has some limitation. The purpose of this study is to verify and compare canine sequential bilateral allotrasplant model with canine left single lung transplant model. We prepared LPDG (low potassium dextran glucose)solution for lung preservation study. In this study we examined the efficacy of LPDG solution in 24-hour lung preservation by using a sequential bilateral canine lung allotransplant model. METHODS: Seven bilateral lung transplant procedures were performed using adult mongrel dogs. Comparative group was 9 cases of left single lung. The donor lungs were flushed with LPDG solution and maintained hyperinflated with 100% oxygen at 10oC for a planned ischemic time of 24 hours. After sequential bilateral lung transplantation, dogs were maintained on ventilators for 3 hours: arterial resistance were determined and compared with donor values which were used as controls. After 2 hours of reperfusion, the chest X-ray, computed tomogram and lung perfusion scan were checked. Pathological examinations for ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery were performed. RESULTS: Five of seven experiments successfully finished the whole assessments after bilateral reperfusion for 3 hours. Arterial oxygen tension in the recipients was markedly decreased in immediate reperfusion period but gradually recovered after reperfusion for 3 hours. The pulmonary arterial pressure and pul-monary vascular resistance showed significant elevation (P<0.05 vs. control values) but also recovered after reperfusion for three hours (P<0.05 vs. immediate period value). The ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery showed reversible mild injury in 24 hours of lung perservation and reperfusion on both groups. CONCLUSION: The present study suggests that LPDG solution provide excellent preservation in a canine sequential bilateral lung transplant model in which the dog is completely dependent on the function of the transplanted lung and under physiologic condition. Sequential bilateral lung transplant model was more appropriate and accurate experimental model compared to single lung transplant model.

24-hour Lung Preservation Study in a Canine Sequential Bilateral Lung Tranplant Model / 대한이식학회지

BACKGROUND: Numerous studies on safe, long term preservation for lung transplantation has been performed for the purpose of developing ideal preservation solution with extracellular type or intracellular type solutions and overcoming the shortage of donors. We prepared LPDG (low potassium dextran glucose)solution for lung preservation study. In this study we examined the efficacy of LPDG solution in 24-hour lung preservation by using of a sequential bilateral canine lung allotransplant model. METHOD: Seven bilateral lung transplant procedures were performed using weight-matched pairs (23 to 26 Kg) of adult mongrel dogs. The donor lungs were flushed with LPDG solution and maintained hyperinflated with 100% oxygen at 10oC for a planned ischemic time of 24 hours for the lung implanted first. After sequential bilateral lung transplantation, dogs were maintained on a ventilator for 3 hours: arterial oxygen tension, pulmonary artery pressure, and pulmonary vascular resistance were determined in the recipients hourly after bilateral reperfusion and compared with pretransplant-recipient values, which used as controls. After 2 hours of reperfusion, the chest X-ray, computed tomogram and lung perfusion scan were performed for assessment of early graft lung function. And pathological examinations for ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery were performed. RESULTS: Five dogs of seven experiments had successfully finished the whole assessments after bilateral reperfusion for three hours. Arterial oxygen tension in the recipients was markedly decreased in immediate reperfusion period but gradually recovered after reperfusion for three hours. The pulmonary artery and pulmonary vascular resistance showed singificant elevation (p<0.05 versus control values) but also recovered after reperfusion for three hours (p<0.05 versus immediate period value). The ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery showed reversible mild injury in 24 hours of lung preservation and reperfusion. CONCLUSIONS: The present study suggests that LPDG solution provide excellent preservation and transplanted lung function after 24 hours of preservation in a canine model in which the dog is completely dependent on the fuction of transplanted lung.