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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 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 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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With basal medium, we studied the growth status, lipid droplet distribution, total lipid content of Chlorella protothecoides CS-41 treated with different concentrations of sodium chloride (0, 150, 300 and 600 mmol/L) by optical microscopy, electron microscopy, confocal laser focusing and Nile red staining. Results show that the addition of NaCl affected the growth of Chlorella protothecoides CS-41. With the increase of NaCl concentration, the growth rate of Chlorella was inhibited. Chlorella cell wall became thicker, and lipid droplets increased. At the early stage, the amount of lipid droplets in the 600 mmol/L NaCl culture was the highest, but at the late-log stage, the amount of lipid droplets increased with the increase of the biomass of culture in 150 and 300 mmol/L NaCl culture. At the stable stage, biomass (dry weight) in 300 mmol/L NaCl culture was 73.55% of that in the control, but the total lipid content was 2.22 times higher than that in the control. A certain concentration of sodium chloride treatment can significantly increase the lipid content of Chlorella protothecoides CS-41.
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Objective To explore the protective effect of Salvianolic acid B on isolated lung in rats.Method Twenty-four SD rats were randomly divided into 2 groups:control group and experimental group (n =12 each).The isolated lung in control group was perfused with raffinose-low potassium dextran (R-LPD),and that in experimental group was perfused with R-LPD and 800 mg/L of Salvianolic acid B.The model of isolated lung was established in all these rats.Wet/dry weight ratio (W/D),myeloperoxidase (MPO),malondialdehyde (MDA) and superoxide dismutase (SOD) were measured,and the pulmonary structures were observed by HE staining at different preservative periods of 6,9,12 and 24 h after infusion.Result Intragroup comparison was made in both groups:all parameters had no statistically significant difference before 12 h.However,W/D,MPO,MDA,and SOD at 24 h were higher than those at 12 h (P＜0.01).The result of interclass comparison showed that after 6,9 and 12 h preservation,all parameters of these two groups showed no significant difference.However,W/D,MDA and MPO were lower,and SOD was higher after 24 h preservation in control group (P＜0.05).Moreover,before 12 h preservation,the two groups did not show inflammatory injury,only manifested slight inflammatory reaction histologically.Destructive pulmonary structure,alveolar interstitial edema and inflammatory damage were seen more clearly in control group than in experimental group.Conclusion The perfusion with Salvianolic acid B had no apparent superiority before 12 h.However,after 12 h,it could ensure the quality and prolong the preservation time of the donor lungs more effectively.Salvianolic acid B might play an important role in donor lungs protection.
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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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ObjectiveTo evaluate the prevention and treatment of primary graft dysfunction (PGD) after lung transplantation (LTx).MethodsWe retrospectively analyzed clinical data of108 cases of lung transplantation from September 2002 to June 2011. All the recipients were given continuous monitoring of invasive arterial pressure,pulmonary artery pressure and (or) central venous pressure and artery blood gas analysis and chest X-ray examination postoperatively.The negative fluid balance of the recipients in the first 3 days was maintained.The inspired oxygen (FiO2) or ventilator parameters was adjusted according to the arterial oxygen tension (PaO2) and (or) oxygen saturation,to prevent the occurrence of PGD.Once PaO2/FiO2 sharp decline (less than 200),and chest X-ray showed higher density of the lower transplanted lung fields in the early postoperative period,PGD could be diagnosed when acute rejection,venous anastomotic obstruction,cardiogenic pulmonary edema and pulmonary infections were excluded.According to the standards set by the International Association of Heart and Lung Transplantation,PGD is divided as 0,1,2 and 3.Different levels of PGD were treated by ventilatory support,negative fluid balance,extending the treatment time of the ventilator,the use of pulmonary vasodilators,such as prostaglandin E1and the use of ECMO.Results PGD occurred in10 cases,and the incidence rate was 9.3％. 6 cases were given conventional ventilatory support for (285.8 + 238.6) h (Two cases obtained reversal of PGD,and four cases died) ; the rest four cases were given ECMO (Two cases were supported by ECMO in 24 h after the occurrence of PGD and had a long-term survival after a successful reversal of PGD,and the rest two cases died from acute renal failure and multiple organ failure induced by PGD on the 8th and11th day of the application of ECMO due to the late application of ECMO (after 24 h).ConclusionThe high incidence of PGD causes high mortality perioperatively after lung transplantation.Preventing PGD can improve the survival rate of the lung transplant patients.Once PGD happens,appropriate treatment should be given as soon as possible.
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Objective To evaluate the clinical effect of lung transplantation for pediatric pulmonary artery hypertension (PAH).Methods The recepter 1 and 2 with idiopathic pulmonary artery hypertension (IPAH) were diagnosed by right catheterization.The heart fuction was NYHA IV.The pulmonary artery pressure and mean pulmonary artery pressure were 110/70mmHg and 148/72 mmHg respectively.They underwent bilateral sequential lung transplantation with extracorporeal membrane oxygenation (ECMO) support.During operation,the ECMO support time was 550 min and 450 min and the blood loss was 3000 ml and 1200 ml respectively.The recepter 3 with end-stage congenital ventricular septal defect with Eisenmenger syndrome (ES) who had received open heart exploration underwent right single lung transplantation and ventricular septal defect repair under cardiopulmoanry bypass(CPB).There were ventricular septal defect and bidirectional shunt through UCG assessment The pulmonary artery pressure and mean pulmonary artery pressure were 110/60 mmHg.CPB time was 244 min.The three recepters had the same ABO blood group and the similar body type with the three donors.Results The recepter 1 and 2 was sustained by ECMO after operation for 16 h and 13h respectively.But unstable hemadynamics and acute left heart failure occured on 3rd and 4th day after the operation respectively.We treated them with ventilate support and tracheotomy on 3rd and 6th day respectively.They were also treated with cardiotonic; dieresis and the patients were weaned away from the ventilation on 33rd and 12ed day after the operation respectively.The transplanted lung of the receptor 3 had pneumochysis in the first 3 days.The patient was treated with ventilate support and tracheotomy on 7th day and was weaned from the ventilation on 12ed day after the operation.An acute rejection episode occurred on 14th day.The cordioform and heart function of the three cases improved and especially the receptor 3 had intact repaired of ventricular septal defect.They were discharged from the hospital on 93rd,32ed and 62ed day afer the operation.The heart function all reached NYHA I and the pulmonary artery pressure and mean pulmonary artery pressure was reduced to 54/32 mmHg,60/36 mmHg and 53/39 mmHg respectively.The three cases have been followed up for 41 months,21 months,and 82 months.They are having an excellent quality life.Conclusion Lung transplantation is effective to improve the quality of life for end-stage pediatric pulmonary artery hypertension even with slight right ventricular dysfunction with satisfying short-term results.
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Objective To evaluate the effects of ambroxol on prevention of bronchopulmonary complications after thoracotomy in patients with chronic obstructive pulmonary disease(COPD).MethodsTotal 161 elderly patients aged ≥70 years with COPD undergoing thoracotomy were randomly allocated to two groups:ambroxol group (300 mg/d,6 d) and placebo group as control.Pulmonary complications were evaluated by clinical symptoms,radiographic changes,and blood gas analysis. Results The incidence rates of atelectasis were 8.6％ in ambroxol group and 28.8％ in placebo group,respectively.The PaO2 values after surgery in ambroxol group decreased more than in placebo group (P＜0.05) compared with the preoperative values.Side effects were not found in all patients.Conclusions Ambroxol should be considered as an alternative pharmacologic approach for the prevention of post-thoracotomy pulmonary complications in the elderly patients with COPD.
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Objective To explore the perioperative application of extracorporeal membrane oxygenation (ECMO) in lung transplantation. Methods Thirty patients with primary and end-stage pulmonary disease accompanied by pulmonary hypertension were subjected to operation under the accessory of ECMO. Eighteen patients received single-lung transplantation and 12 patients bilateral sequential lung transplantation without sternal division in our hospital from November 2005 to July 2009. In 2 patients ECMO was given before operation and maintained for 19 days and 6 days respectively. In the remaining patients, ECMO pipeline was placed after anesthesia. After lung trarnsplantation,ECMO was removed after the recipients' oxygen saturation and hemodynamics were stable. Results In all recipients lung transplantation was successfully done. ECOM was removed in 27recipients after operation, and the rest 3 recipients were supported by ECMO after operation: the ECMO was removed at 36th h and 7th day after lung transplantation in two patients respectively,and another one was supported by ECMO for 5 days after operation and suffered acute kidney failure, and died of multiple organ failure 2 weeks post-transplantation. Two recipients were infected in thigh arteriovenous cut and one suffered femoral artery thrombosis, but all of them got better and discharged from hospital after treatment. Conclusion ECMO can be used for lung transplantation on patients with primary and secondary pulmonary hypertension. The complications may be associated with patients'serious condition and unstable hemodynamics. Early detection and active and effective treatment can improve patient's prognosis.
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Objective To discuss the benefits of extracorporeal membrane oxygenation (ECMO) applied in the patients with primary or secondary pulmonary hypertension during the operation of lung transplantation. Methods Thirty cases of end stage lung disease subject to primary or secondary pulmonary hypertension received lung transplantation supported with ECMO between Nov. 2005 and July 2009. The single lung transplantation was performed on 18 cases and bilateral sequential single lung transplantation on 12 cases. ECMO was used in 2 patients as a bridge to the lung transplantation to maintain 19 and 6 days respectively, and ECMO support was given during lung transplantation. ECMO was removed after the transplantation if the oxygenation and hemodynamics were stable, otherwise, ECMO was applied continuously until the situation improved. Results All the operations of these patients were accomplished successfully and the ECMO was removed in 27 patients after the operation immediately. The average time with ECMO was 6. 81 + 0. 95 h, and pulmonary artery systolic pressure after lung transplantation was 31.67 + 8. 42 mmHg. The ECMO was continuously used after lung transplantation in three patients until the hemodynamics was stable, and ECMO in 2 of them was removed at 36th h and 6th day respectively after the operation, and one,receiving postoperative ECMO for 5 days, died of acute renal failure 2 weeks after the operation.Conclusion ECMO can replace CPB safely and effectively in lung transplantations for primary or secondary pulmonary hypertension patients. As a respiratory and circulatory support it can control pulmonary hypertension during operative period and can decrease the complications of lung transplantation.
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Objective To evaluate the operative technique, perioperative management and outcomes of bilateral lung transplantation for idiopathic pulmonary artery hypertension. Methods There were 2 cases of idiopathic pulmonary hypertension subject to bilateral sequential lung transplantation with ECMO support (16, 17 years old, respectively). The pulmonary artery pressure was 10/70 and 148/72 mm Hg respectively. The heart function was NYHA Ⅳ, the operative procedure was right lung first, then left lung, and the cold ischemia time was 230 min/430 min and 185 min/300 min respectively. The ECMO support time was 550 min and 450 min respectively. The blood loss during the operation was 3000 and 1200 ml, respectively. Resuits The ECMO was withdrawn 16 and 13 h postoperation respectively. There was unstable hemadynamics and acute left heart failure on the 3rd and 4th day after the operation. The patients were treated with ventilate support and tracheotomy on 3rd and 6th day respectively. Additionally, the patients were given cardiotonic, dieresis and the ventilation was withdrawn on 33rd and 12th day after the operation respectively. They were discharged from the hospital on 93rd and 32nd day after the operation. The heart function both reached NYHA I, two cases were followed up for 25 and 10 months respectively.Both of them had an excellent quality life. Conclusion Bilateral lung transplantation is effective for end-stage idiopathic pulmonary artery hypertension even with slight right ventricular dysfunction with satisfactory short-term outcome. A limited operative time, an ECMO support for heart and lung during the peri-operative period and a perfect management for the left ventricular dysfunction after surgery are key roles for the success. Closed follow-up and surveillance are needed for long-term outcomes.
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Objective To observe the therapeutic effects of lung transplantation for diffuse pulmonary disease. Methods From September 2002 to April 2009, lung transplantation was performed on 72 cases in our hospital. Thirty-seven cases of these recipients were suffered from diffuse pulmonary disease, including idiopathic pulmonary fibrosis (30/37), pneumosilicosis (4/37), vascular leiomyoma (2/37) ,diffuse panbronchiolitis (1/37),30 males and 7 females with age ranging from 22 to 73 years old (mean 52.9 ± 13.2). All the patients received pulmonary function test and echocardiography (ECHO) to test the pulmonary artery systolic pressure before transplantation and artery blood gas to calculate the oxygenation index (PaO2/FiO2 ). Results The systolic pulmonary artery pressure (Ppa,syst) was monitored by Swan-Gans catheterization one week post-transplant, and decreased significantly from 54. 30 ± 17. 41 to 41.52 ± 9. 36 mm Hg (P＜0. 05). Simultaneously, oxygenation index was improved from 185. 89 ± 77. 25 to 392. 12 ± 98. 23 (P＜0. 05). The pulmonary function was also improved significanzly one month post-operation. The volume in the first second was improved from (1.33 ± 0. 64) to (1.81 ± 0. 57) L, and the diffusion capacity of carbonmonoxide was increased from (2. 87 ± 1.26) to (4. 22 ± 2. 05) L. Conclusion Lung transplantation is feasible and efficient to deal with diffuse pulmonary disease.