Long-Term Outcomes of Adult Lung Transplantation Recipients: A Single-Center Experience in South Korea / 결핵

BACKGROUND: Recently, the number of lung transplants in South Korea has increased. However, the long-term outcome data is limited. In this study, we aimed to investigate the long-term outcomes of adult lung transplantation recipients. METHODS: Among the patients that underwent lung transplantation at a tertiary referral center in South Korea between 2008 and 2017, adults patient who underwent deceased-donor lung transplantation with available follow-up data were enrolled. Their medical records were retrospectively reviewed. RESULTS: Through eligibility screening, we identified 60 adult patients that underwent lung (n=51) or heart-lung transplantation (n=9) during the observation period. Idiopathic pulmonary fibrosis (46.7%, 28/60) was the most frequent cause of lung transplantation. For all the 60 patients, the median follow-up duration for post-transplantation was 2.6 years (range, 0.01–7.6). During the post-transplantation follow-up period, 19 patients (31.7%) died at a median duration of 194 days. The survival rates were 75.5%, 67.6%, and 61.8% at 1 year, 3 years, and 5 years, respectively. Out of the 60 patients, 8 (13.3%) were diagnosed with chronic lung allograft dysfunction (CLAD), after a mean duration of 3.3±2.8 years post-transplantation. The CLAD development rate was 0%, 17.7%, and 25.8% at 1 year, 3 years, and 5 years, respectively. The most common newly developed post-transplantation comorbidity was the chronic kidney disease (CKD; 54.0%), followed by diabetes mellitus (25.9%). CONCLUSION: Among the adult lung transplantation recipients at a South Korea tertiary referral center, the long-term survival rates were favorable. The proportion of patients who developed CLAD was not substantial. CKD was the most common post-transplantation comorbidity.

Potts Anastomosis: Transthoracic Echocardiographic Features - Tetralogy of Fallot, Doubly Committed Sub-arterial Ventricular Septal Defect, Anomalous Left Anterior Descending Coronary Artery Crossing Right Ventricular Outflow Tract / Anastomosis de Potts: características ecocardiográficas transtorácicas - tetralogía de Fallot, defecto septal con compromiso doble subarterial ventricular, y arteria coronaria descendente anterior izquierda anómala a través del tracto de salida ventricular derecho

ABSTRACT Potts anastomosis is a central systemic-pulmonary surgical shunt between the descending aorta and the left pulmonary artery, developed and subsequently disbanded in the 1950s to provide pulmonary blood flow in patients with tetralogy of Fallot. Blalock-Taussig shunt is a peripheral systemic pulmonary communication which was varied to make the modified Blalock-Taussig shunt, which is now the standard of surgical care for temporary or permanent blood flow to the right or left pulmonary artery from the subclavian artery. The central shunts were disbanded in the 1950s as early development of pulmonary hypertension and its sequelae were the major prohibitive complications. This is a case report of a patient with tetralogy of Fallot with a rare combination of doubly committed sub-arterial ventricular septal defect, anomalous left anterior descending coronary artery crossing the right ventricular outflow tract and patent ductus arteriosus, who developed pulmonary hypertension within four years of Potts anastomosis and then required cardiac and lung transplantation. The transthoracic echocardiographic images are the focussed feature in this paper, confirming clearly defined structural anatomy in complex structural congenital heart disease.

RESUMEN La anastomosis de Potts - desarrollada y disuelta posteriormente en los años 50 - es una derivación quirúrgica sistémico-pulmonar central entre la aorta descendente y la arteria pulmonar izquierda, cuyo fin es proporcionar flujo de sangre pulmonar en pacientes con la tetralogía de Fallot. La derivación de Blalock-Taussig es una comunicación pulmonar sistémica periférica. Este procedimiento sufrió cambios que condujeron a la derivación modificada de Blalock-Taussig, que es ahora el procedimiento quirúrgico estándar para tratar el flujo de sangre temporal o permanente hacia la arteria pulmonar derecha o izquierda desde la arteria subclavia. Las derivaciones centrales fueron disueltas en los años 50, cuando el desarrollo temprano de la hipertensión pulmonar y sus secuelas eran las complicaciones prohibitivas principales. Éste es un reporte de caso de un paciente con la tetralogía de Fallot con una rara combinación de defecto septal con compromiso doble subarterial ventricular, arteria coronaria descendente anterior izquierda anómala a través del tracto de salida ventricular derecho, y conducto arterioso persistente. El paciente desarrollo hipertensión pulmonar a los cuatro años de una anastomosis de Potts, y requirió entonces trasplante cardíaco y pulmonar. Las imágenes ecocardiografias transtorácicas constituyen el aspecto central de este trabajo, que confirma la anatomía estructural claramente definida de la enfermedad cardíaca congénita, estructuralmente compleja.

Clinical Outcomes of Heart-Lung Transplantation: Review of 10 Single-Center Consecutive Patients

BACKGROUND: Heart-lung transplantation (HLT) has provided hope to patients with end-stage lung disease and irreversible heart dysfunction. We reviewed the clinical outcomes of 10 patients who underwent heart-lung transplantation at Asan Medical Center. METHODS: Between July 2010 and August 2014, a total of 11 patients underwent HLT at Asan Medical Center. After excluding one patient who underwent concomitant liver transplantation, 10 patients were enrolled in our study. We reviewed the demographics of the donors and the recipients' baseline information, survival rate, cause of death, and postoperative complications. All patients underwent follow-up, with a mean duration of 26.1±16.7 months. RESULTS: Early death occurred in two patients (20%) due to septic shock. Late death occurred in three patients (38%) due to bronchiolitis obliterans (n=2) and septic shock (n=1), although these patients survived for 22, 28, and 42 months, respectively. The actuarial survival rates at one year, two years, and three years after HLT were 80%, 67%, and 53%, respectively. CONCLUSION: HLT is a procedure that is rarely performed in Korea, even in medical centers with large heart and lung transplant programs. In order to achieve acceptable clinical outcomes, it is critical to carefully choose the donor and the recipient and to be certain that all aspects of the transplant procedure are planned in advance with the greatest care.

Infections after lung transplantation: time of occurrence, sites, and microbiologic etiologies

BACKGROUND/AIMS: Infections are major causes of both early and late death after lung transplantation (LT). The development of prophylaxis strategies has altered the epidemiology of post-LT infections; however, recent epidemiological data are limited. We evaluated infections after LT at our institution by time of occurrence, site of infections, and microbiologic etiologies. METHODS: All consecutive patients undergoing lung or heart-lung transplantation between October 2008 and August 2014 at our institution were enrolled. Cases of infections after LT were initially identified from the prospective registry database, which was followed by a detailed review of the patients' medical records. RESULTS: A total of 108 episodes of post-LT infections (56 bacterial, 43 viral, and nine fungal infections) were observed in 34 LT recipients. Within 1 month after LT, the most common bacterial infections were catheter-related bloodstream infections (42%). Pneumonia was the most common site of bacterial infection in the 2- to 6-month period (28%) and after 6 months (47%). Cytomegalovirus was the most common viral infection within 1 month (75%) and in the 2- to 6-month period (80%). Respiratory viruses were the most common viruses after 6 months (48%). Catheter-related candidemia was the most common fungal infection. Invasive pulmonary aspergillosis developed after 6 months. Survival rates at the first and third years were 79% and 73%, respectively. CONCLUSIONS: Although this study was performed in a single center, we provide valuable and recent detailed epidemiology data for post-LT infections. A further multicenter study is required to properly evaluate the epidemiology of post-LT infections in Korea.

Dual Extracorporeal Membrane Oxygenation Support for Bridging Lung Transplantation in Acute Exacerbation of Idiopathic Pulmonary Fibrosis / 대한구급학회지

When patients with severe respiratory failure are treated with venovenous extracorporeal membrane oxygenation (VV-ECMO), severe pulmonary hypertension due to right ventricular (RV) failure is possible. This is a serious complication that requires immediate therapeutic intervention. We report an extraordinary experience of additional venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for RV failure in a patient who was being treated with VV-ECMO as a bridge to lung transplantation. A 61-year-old man was diagnosed with acute exacerbation of idiopathic pulmonary fibrosis. While waiting for lung transplantation, he was placed on VV-ECMO and developed RV failure. After insertion of additional VA ECMO, RV dysfunction was dramatically improved. He underwent heart-lung transplantation after 23 days of dual ECMO support.

Anesthesia for non-pulmonary surgical intervention following lung transplantation: two cases report / 대한마취과학회지

The survival rate after lung transplantation has increased in recent years, leading to an increase in non-pulmonary conditions that require surgical intervention. These post-transplant surgical procedures, however, are associated with high mortality and morbidity rates. Intra-abdominal conditions are the most common reasons for surgical intervention. We describe here two patients who underwent abdominal surgery under general anesthesia following lung transplantation. One patient underwent cholecystectomy due to cholecystitis after heart-lung transplantation, and the other patient had an exploratory laparotomy for duodenal ulcer perforation after double lung transplantation. Depending on the type of transplant intervention, the physiology of the transplanted lung must be considered for general anesthesia. Knowledge of underlying conditions and immunosuppressive therapy following transplantation are important for safe and effective general anesthesia.

8.5 year-follow-up of combined heart-lung transplantation in a patient / 中南大学学报(医学版)

To summarize the case of combined heart-lung transplantation for a patient who survived for 8.5 years. On September 20, 2003, at Second Xiangya Hospital of Central South University, homologous heartlung transplantation was performed on a male patient who was diagnosed with cardiopulmonary failure secondary to congenital ventricular septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1500 mL modified St.Thomas solution and 3000 mL modified LPD solution. Postoperative immunosuppressive therapies included: methylprednisolone and human anti-lymphocyte globulin protein in the induction period; and combination of ciclosporin A, CellCept and prednisolone in the stable period. In 2007, the treatment was changed to CellCept mg, twice a day+FK506 4 mg, twice a day. The patient lived 8.5 years of normal life with cardiac function of NYHA I-II. Echocardiogram showed left ventricular ejection fraction of 61% to 74%. Heart-lung transplantation proved reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation and proper perioperative treatment are key factors for long-term survival after heart-lung transplantation.

Early Postoperative Complications after Heart Transplantation in Adult Recipients: Asan Medical Center Experience

BACKGROUND: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. METHODS: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of 58.4+/-43.6 months. RESULTS: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). CONCLUSION: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.

Anesthetic considerations during heart-lung transplantation in a patient with an unresectable pulmonary artery sarcoma / 대한마취과학회지

No abstract available.

Gastrointestinal Complications after Lung Transplantation / 대한흉부외과학회지

BACKGROUND: The postoperative management following lung transplantation has dramatically improved in the recent decade. However, some complications still remain as troublesome problems. We retrospectively reviewed the gastrointestinal complications and their management after lung transplantation. MATERIAL AND METHOD: We performed a retrospective review of the medical records of 25 cases in 23 patients who underwent lung and heart-lung transplantations from July 1996 to March 2009. The definition of gastrointestinal complication was the gastrointestinal tract-related disease that occurred after lung transplantation. There were eight postoperative deaths (within postoperative 30 days) that were excluded from the analysis. RESULT: Twenty three gastrointestinal complications occurred in 11 (64.7%) of the 17 cases. The median follow-up period was 6.9 months (range: 2 months to 111 months), and chronic gastritis (23.5%, 4 of 17 cases) was the most common complication. Severe, prolonged (more than 2 weeks) diarrhea occurred in 3 cases. Three patients had gastric ulcer with one case requiring gastric primary closure for gastric ulcer perforation. This patient had gastric bleeding due to recurrent gastric ulcer 2 months after laparotomy. Cytomegalovirus gastritis and esophagitis occurred in 2 cases and 1 case, respectively, and esophageal ulcer occurred in 2 cases. There were esophageal strictures in 2 patients who underwent esophageal stent insertion. Other complications were one case each of ileus, early gastric cancer requiring endoscopic mucosal resection, gall bladder stone accompanied with jaundice, and pseudomembranous colitis. CONCLUSION: The incidence of gastrointestinal complication is relatively high in patients after they undergo lung transplantation. Since gastrointestinal complications can induce malnutrition, which might be related to considerable morbidity and mortality, close follow-up is necessary for the early detection and proper management of gastrointestinal complications.

Abertura do sulco interatrial na retirada de enxertos múltiplos para transplante de coração e pulmões: estudo anatômico / Interatrial sulcus opening during multiple grafts harvesting for heart and lung tranplantation: anatomical study

OBJETIVO: Avaliar o impacto que a abertura do sulco interatrial representa em termos de ganho de parede de átrio esquerdo quando da retirada de coração e pulmões para transplante. MÉTODOS: Foi estudada a medida do átrio esquerdo, pela face mediastinal direita, obtida após dissecção do sulco interatrial em 50 cadáveres humanos. O ganho em extensão de parede do átrio esquerdo após a abertura do sulco interatrial foi correlacionado com as variáveis sexo, idade e grupo étnico. RESULTADOS: O ganho obtido através da abertura do sulco interatrial à direita foi, na média, de 1,31 cm (variação de 0,3 cm a 2,5 cm). Quando esse valor foi relacionado à variável sexo, observou-se que nos 27 (54 por cento) casos do sexo masculino o ganho foi de 1,19 cm ± 0,6 cm e, nos 23 (46 por cento) do sexo feminino, o ganho foi de 1,21 cm ± 0,5 cm (p = 0,895). Em relação à idade, observou-se que nos 24 (48 por cento) casos com idade menor do que 50 anos o valor foi de 1,08 cm ± 0,6 cm e, nos 26 (52 por cento) com idade maior ou igual a 50 anos, 1,36 cm ± 0,6 cm (p = 0,088). Em relação ao grupo étnico, observou-se que o valor do ganho nos 31 (62 por cento) casos de brancos foi de 1,34 cm ± 0,5 cm e, nos 19 (38 por cento) de pacientes não-brancos, 1,27 cm ± 0,4 cm (p =0,589). CONCLUSÃO: Embora não haja correlação entre o ganho obtido com o sulco interatrial dissecado e as variáveis sexo, idade e grupo étnico, nossos resultados confirmam que a abertura do sulco interatrial pode propiciar acesso a uma extensão significativa de parede atrial esquerda na separação do coração dos pulmões.

OBJECTIVE: To evaluate the impact of the interatrial sulcus opening regarding of left atrium gain when harvesting heart and lungs for transplantation. METHODS: It was evaluated the left atrium dimension, from the right mediastinal side, after the interatrial sulcus dissection in fifty human cadaver. The interatrial sulcus gain was related with gender, age and ethnic group. RESULTS: The gain observed through right interatrial opening was, in media, 1.31cm (0.3 cm to 2.5cm). When that value was related to the variable gender it was observed that in the 27 (54 percent) cases of the male the earnings was 1.19 cm ± 0.6 cm and, in the 23 (46 percent) female, 1.21 cm ± 0.5 cm (p = 0.895). In relation to age, it was observed that, in the 24 (48 percent) cases with smaller age than 50 years, the value was 1.08 cm +0.6 cm and, in the 26 (52 percent) with larger age or same to 50 years, 1.36 cm ± 0.6cm (p = 0.088). In relation to ethnic group, it was observed that the value of the earnings in the 31 (62 percent) cases of whites it was 1.34 cm ± 0.5 cm and, in the 19 (38 percent) non white, 1.27 cm ± 0.4 cm (p = 0.589). CONCLUSION: Heart grafts and lung grafts must be harvested maintaining adequate segments of left atrium near the heart and the pulmonary veins of the lungs that will be transplanted. Although there is no correlation between the observed gain in the interatrial sulcus dissection and the variables gender, age and ethnic group, our results confirm that the interatrial sulcus opening can give access to significant extension of left atrium wall when separating heart and lungs.

Estado actual del trasplante pulmonar / Lung transplantation: state of the art

Actualmente el trasplante pulmonar es considerado como tratamiento definitivo para algunas enfermedades pulmonares avanzadas. Los primeros trasplantes pulmonares experimentales en animales fueron realizados en los años 1940’s por el soviético Vladimir P. Demikhov. Sin embargo, pasaron aproximadamente dos décadas antes de que se realizara el primer trasplante pulmonar en humanos por el doctor James Hardy. Desafortunadamente los inicios clínicos del trasplante pulmonar no fueron muy exitosos debido a complicaciones quirúrgicas y efectos secundarios de los fármacos inmunosupresores. Gracias al mejoramiento de la técnica quirúrgica y al desarrollo de fármacos inmunosupresores más efectivos y menos tóxicos, la morbimortalidad ha disminuido significativamente. La selección y el cuidado del donador antes de la procuración de los órganos juegan un papel primordial en los resultados en el receptor. Debido a la escasez de donadores, algunas instituciones están utilizando criterios de selección más liberales con resultados satisfactorios. El manejo del paciente con trasplante pulmonar o del bloque cardiopulmonar requiere de un enfoque multidisciplinario que incluye al cirujano de trasplantes cardiotorácicos, al neumólogo, al anestesiólogo y al intensivista entre otros. En este artículo revisamos aspectos históricos y avances recientes en el manejo de estos pacientes incluyendo indicaciones y contraindicaciones, evaluación y cuidado del donador y del receptor, técnica quirúrgica y manejo peri- y posoperatorio.

Lung transplantation is currently considered an established treatment for some advanced lung diseases. The beginning of experimental lung transplantation dates back to the 1940's when the Soviet Vladimir P. Demikhov performed the first lung transplants in animals. Two decades later, James Hardy performed the first lung transplant in humans. Unfortunately, the beginning of clinical lung transplantation was hampered by technical complications and the excessive toxicity of immunosuppressive drugs. Improvement in the surgical technique along with the development of more effective and less toxic immunosuppressive drugs has led to a better outcome in lunt transplant recipients. Donor selection and management before organ procurement play a key role in the receptor's outcome. Due to the shortage of donors, some institutions are using more liberal selection criteria, reporting satisfactory outcomes. The approach of the lung and heart-lung transplant patient is multidisciplinary and includes the cardiothoracic transplant surgeon, pulmonologist, anesthesiologist, and intensivist, among others. Herein, we review some relevant historical aspects and recent advances in the management of lung transplant recipients, including indications and contraindications, evaluation of donors and recipients, surgical techniques and peripost-operative care.

The 10 Years Experience of Lung Transplantation / 대한흉부외과학회지

BACKGROUND: Lung transplantation is a definitive therapy for a variety of end stage lung diseases. Since 1996, we have performed thirteen cases of lung transplantation including two retransplantations, and we analyzed the outcomes, complications, and survivals of these patients. MATERIAL AND METHOD: We retrospectively analyzed the medical records of thirteen cases from July, 1996 to July, 2005. RESULT: During the period, 11 patients had undergone 13 lung and heart-lung transplantations, and two patients had retransplantation due to allograft failure. Mean age of recipients were 45.2+/-10.7 years (range, 25~59). Early complications were bleeding, reperfusion injury, and infection and late complications were mainly infection and post-transplantation lymphoproliferative disease. Excluding the operative mortality, the mean survival period was 16.5 months (2~60 months). Two retransplantations had been performed 2 weeks and 13 months after single lung transplantations. CONCLUSION: In order to achieve long term survival, early detection of complications and proper treatment in addition to surgical skills are necessary, and these efforts can promote better lung transplantation programs in the near future.