ABSTRACT
Background: Lung transplantation is a highly complex treatment method for selected patients with terminal lung disease. With the increase in the number of eligible candidates and the standardization of the technique, it was possible to set up a transplantation centre in University Medical Centre (UMC) Ljubljana in 2018. We report our initial experience. Method(s): We analysed the registry of patients with lung transplantation. Patients' characteristics were compared to the previous group referred to AKH Vienna for lung transplantation. Result(s): From 15 September 2018 to 15 September 2021, 37 lung transplantations (13 females) were done in UMC Ljubljana. Indications were COPD (n = 13, 35%), pulmonary fibrosis (n = 7, 19%), cystic fibrosis (n = 5, 14%), covid-19 pneumonia (n = 4, 11%), bronchiectasis (n = 3, 8%), pulmonary hypertension (n = 2, 5%), lymphangioleiomyomatosis (n = 1, 3%), al-pha-1-antitrypsin deficiency (n = 1, 3%) and bronchiolitis (n = 1, 3%). Compared to previous cohort referred for transplantation to AKH Vienna (71 patients, 35 females), there was higher proportion of patients with COPD (35% vs. 16%, p = 0.019) and the patients were older (median [range], 59 [14-68] vs. 43 [4-58] years, p = 0.001). 76% of donated lungs did not fit standard donor criteria (30% of donors were older than 55 years, 22% had infiltrates on chest radiographs, and 24% did not meet other criteria). Lung size reduction was required in 43%, which did not result in primary graft failure. Short-term survival was similar in both cohorts of patients (1-year survival in UMC Ljubljana vs. AKH Vienna, 89% [95% CI 78-99%] and 83% [95% CI 74-92%], respectively). Conclusion(s): Initial results show similar early lung transplantation outcomes between patients transplanted in UMC Ljubljana or in AKH Vienna. Copyright © 2022 Zdravniski Vestnik.
ABSTRACT
The COVID-19 pandemic is currently a challenge worldwide. In Austria, a crisis within the health care system has so far been avoided. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV-2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic. However, COVID-19-specific adjustments are useful. The treatment of patients with chronic lung diseases must be adapted during the pandemic, but must still be guaranteed.
ABSTRACT
Purpose Acute respiratory distress syndrome (ARDS) is a rapidly progressive lung disease with a high mortality rate. Although lung transplantation (LTx) is a well-established treatment for a variety of chronic pulmonary diseases, LTx for acute lung failure (due to ARDS) remains controversial. We retrospectively reviewed the post-transplant outcome of ARDS patients from three high-volume European transplant centers. Methods From August 1998 to May 2020, a total of 13 patients (mean age, 29.2 ±3.6 years) transplanted for ARDS, were identified. Demographics and clinical data of these patients were collected and analyzed. Results Viral infection (H1N1, cytomegalovirus, H3N1 and SARS-CoV-2) was the main reason (n=7/13, 53.8%) for ARDS. All patients were admitted to ICU, mechanical ventilated and 11/13 were supported with ECMO during listing, with a median LTx listing time of 3 days (IQR 1.5-14). Postoperatively, median length of mechanical ventilation after LTx was 33 days (IQR 17-52.5), ICU and hospital stay were respectively 39 days (IQR 19.5-58.5) and 54 days (IQR 43.5-127). Prolongation of peripheral postoperative ECMO was required in 7/13 (53.8%) patients with median duration of 2 days (IQR 2-7). The 30-day mortality was 7.7%, median survival 590 days, 1-year and 5-year survival rates were calculated as 71.6% and 54.2%, respectively. Median follow-up time was 536 (IQR 142-1524) days. Conclusion Given the lack of alternative treatment options the herein presented results support the concept of offering LTx to carefully selected ARDS patients.