Evolution and Risk Factors for Early Mortality After Lung Transplantation for Idiopathic Pulmonary Fibrosis: An Experience of 20 Years.

High early mortality after lung transplantation (LT) for idiopathic pulmonary fibrosis (IPF) is still not well controlled, and some aspects remain debated. The aim of this study was to evaluate our experience to identify factors that might improve the early outcomes. Among the 427 patients transplanted from October 1993 to December 2014, 117 IPF patients underwent LT at our department. There was an increasing age of transplant recipients, and the overall early (1-mo_ mortality was 25/117 (21.4%) with a progressive decrease over the years. Logistic regression analysis for early mortality was performed, and multivariate analysis identified recipient age <55 years (P = .042; odds ratio [OR], 2.98), single-lung transplants (P = .001; OR, 5.226), and previous corticosteroid treatment (P = .05; OR, 5.128) as independent risk factors for development of early mortality. In conclusion, despite the increasing age of transplant recipients, we observed a decrease in mortality to almost one-half compared with our initial results. According to our results, the mortality risk in patients <55 years old is independent from the type of transplant (single or double), being higher with a single transplant. In addition, corticosteroid treatment should be reduced to achieve lower early mortality.

Reconstrucción de pared torácica con malla de titanio en paciente con tumor desmoide / Chest wall reconstruction with a titanium mesh in patient with desmoid tumour

Se presenta una paciente de 22 años con tumor desmoide de pared torácica y antecedente de cirugía de reconstrucción mamaria, que se sometió a resección de pared torácica y reconstrucción de esqueleto óseo empleando una malla de titanio como alternativa al metilmetacrilato. La prótesis se cubrió con epiplón mayor y el postoperatorio cursó sin complicaciones. El empleo de mallas de metilmetacrilato maleables proporciona estabilidad a los defectos de pared torácica, son fáciles de implantar y evitan las complicaciones inherentes al empleo de otras prótesis como el metilmetacrilato (AU)

We present a 22-year old patient with a desmoid tumour of chest wall and previous breast reconstructive surgery, who underwent a chest wall resection and reconstruction by using a titanium mesh, as an alternative to the conventional methyl metacrylate mesh. The titanium mesh was covered with omentum and the postoperative course was uneventful. The use of a malleable titanium mesh provides optimal stabilization for chest wall defects, they are easy to use, and avoid the potential complications inherent to the methylmetacrylate and other prosthetic material (AU)

Postoperative complications in the intensive care unit following lung transplantation in adults: results in University Hospital Reina Sofia.

The postoperative period following lung transplantation remains critical because of several complications. Infection, primary graft failure, acute rejection, and surgical complications are risk factors for mortality and morbidity. The recognition and early treatment of these complications is important to optimize outcomes. This article provides an overview of postoperative complications observed in our center during the last year. We were particularly interested in the influence of variables, such as inotrope usage and Acute Physiology and Chronic Health Evaluation (APACHE II) score, a well-known, and validated mortality prediction model for general intensive care unit (ICU) patients only infrequently reported in the transplantation literature. High APACHE II scores were significantly associated with prolonged mechanical ventilation (P = 0.041) and a tracheostomy requirement (P = .035). The factors significantly associated with an early postoperative death were older donor age (P = .005), prolonged donor ICU period (P = .004), need for cardiopulmonary bypass (CB; P = .005), and high inotrope requirements in the ICU (P = .034). CB data were biased because we selected the worst case patients. Donor age and high inotrope requirements in the ICU have been reported previously to be prognostic factors for poor graft function. We believe that control of these variables may improve outcomes.

Analisis secuencial y cronológico de la actividad de donación y trasplante pulmonar en Andalucía desde 1993 hasta 2007 / Sequential and chronological analysis of the activity of pulmonary donation and transplant in Andalusia between 1993 and 2007

Objetivo: la escasez de donantes pulmonares válidos es el principal factor que limita el desarrollo de un programa de trasplante pulmonar (TxP). Nuestra experiencia inicial analizando 280 donantes, demostró que solo el 54,7% eran válidos para trasplante. El presente trabajo pretende reexaminar el problema, analizando la evolución de las tasas de validez pulmonar con los años, identificando qué factores son susceptibles de mejorar para incrementar el número de donantes pulmonares, y determinando si el empleo de donantes subóptimos influye en los resultados del TxP a corto y largo plazo. Métodos: se revisaron todos los donantes ofertados a nuestra unidad desde octubre 1993 hasta diciembre 2007. La evaluación del donante pulmonar se dividió en tres fases: fase 1 (análisis de PaO2/FiO2, radiografía de tórax y hallazgos fibrobroncoscópicos); fase 2 (inspeccióny palpación pulmonar en campo operatorio); fase 3 (evaluación pulmonar después de la extracción donante). Se analizaron variables del donante y del receptor y se compararon entre dos periodos: donantes A (entre 1993 y 2001) y donantes B (entre 2002 y 2007). Se realizó un análisis adicional en un subgrupo de donantes con criterios de “subóptimo” (..) (AU)

Objective: The shortage of donors is a major problem limiting lung transplant programmes (LTx). Our early experience analysing 280 donors demonstrated that only 54.7% were (..) (AU)

Combined lung and liver transplantation-University Hospital Reina Sofia experience: two case reports.

OBJECTIVE: To analyze the results of combined lung and liver transplantation. METHODS: We performed two combined lung and liver transplantations for patients with cystic fibrosis with chronic respiratory failure accompanied by advanced liver disease. In each case, all thoracic and abdominal organs were obtained from a single donor by means of standard harvest techniques. In the recipient, a two-stage procedure was adopted with completion of the bilateral lung transplantation before the liver operation. Immunosuppression consisted of three-drug therapy used for isolated lung transplantation. RESULTS: The patients were both boys of 13 and 15 years old. Episodes of acute pulmonary rejection were successfully treated with intravenous steroids. Neither lung disorder was associated with a liver rejection episode. Airway complications that occurred in both cases were managed endoscopically. CONCLUSION: Combined transplantation of lung and liver is a feasible and therapeutically effective procedure for patients with cystic fibrosis complicated by advanced liver disease. Herein we have described our experience in two of the only three cases of combined liver and lung transplantation performed in Spain to date. Patient and graft survivals were comparable to isolated liver or isolated bilateral lung transplantations.

Cirugía broncoplástica en el tumor carcinoide bronquial típico. Descripción de tres casos en la infancia / Bronchoplastic surgery in typical bronchial carcinoid tumour

El tumor carcinoide bronquial típico (TCBT) asienta preferentemente en bronquios de grueso calibre produciendo fenómenos de obstrucción distal. Aunque la OMS lo clasifica dentro de las neoplasias malignas broncopulmonares, el TCBT se muestra poco agresivo y su pronóstico a largo plazo es bueno siempre que no exista diseminación linfática ni metástasis sistémicas. La mayoría de los autores son partidarios del tratamiento quirúrgico conservador, evitando la neumonectomía, siempre que este asegure la total resección del TCBT. Presentamos 3 casos de pacientes infantiles diagnosticados de TCBT en el eje bronquial principal con atelectasia de lóbulos inferiores en los que fue posible la resección con reimplante de lóbulos superiores en 2 casos, y un tercero con tumor en bronquio intermediario, resecándose el mismo con reimplante posterior de lóbulos medio e inferior

The typical bronchial carcinoid tumour (TBCT) is usually located in large bronchi, provoking distal obstruction. Although the WHO classifies it within the malignant bronco-pulmonary neoplasias, TBCT does not always present as very aggressive and its long-term prognosis is good, providing there are no lymphatic dissemination or distant metastasis. Most authors favour conservative surgical treatment, avoiding pneumonectomy, provided this assures the total resection of the TBCT. We present three cases of children diagnosed with TBCT in the main bronchi with atelectasis of the inferior lobes in which resection was possible, together with the re-implantation of the superior lobes in 2 cases. In the third case, the tumour in the intermediary bronchus was resected, with subsequent re-implantation of the midle and inferior lobes

Diagnóstico y manejo terapéutico del neumotórax / No disponible

No disponible

[Simultaneaous bilateral pulmonary metastasectomy of carcinoma of the sweat glands]. / Metastasectomía pulmonar bilateral simultánea de un carcinoma de glándulas sudoríparas.

A 51-year-old woman with carcinoma of the right axillary sweat glands was treated by radical surgery and radiotherapy. Six years later she developed multiple bilateral lung metastases. Nine nodes were resected from both lungs using a clamshell approach (bilateral transsternal, anterolateral thoracotomy). After surgery, the patient received 6 cycles of adjuvant chemotherapy with cisplatin and 5-fluoruracil. Three years after treatment, no intrathoracic recurrences had occurred and the patient was asymptomatic, with good quality of life.

[Spontaneous, massive primary pneumothorax in both lungs]. / Neumotórax espontáneo primario masivo bilateral simultáneo.

Primary spontaneous pneumothorax in both lungs simultaneously is rare. We report the case of a 22-year-old man with no relevant medical history who came to the emergency room in critical condition after suffering simultaneous massive pneumothorax in both lungs. After a pleural drain was inserted in each hemithorax, elective surgery was prescribed because of the bilaterality and severity of the pneumothorax. Sequential video thoracoscopic surgery was performed in a single session, during which small blebs were identified at both lung vertices. The blebs were resected and pleural abrasion performed. Postoperative recovery was unremarkable. The patient was discharged four days after surgery. Five years later, the patient was asymptomatic, having experienced no recurrences.

Metastasectomía pulmonar bilateral simultánea de un carcinoma de glándulas sudoríparas / Simultaneaous bilateral pulmonary metastasectomy of carcinoma of the sweat glands

Mujer de 51 años con un carcinoma de glándulas sudoríparas (CGS) en la axila derecha tratado mediante cirugía radical y radioterapia, que 6 años después presentó metástasis pulmonares bilaterales múltiples. Se resecaron nueve nódulos en ambos pulmones a través de una toracotomía anterolateral bilateral transesternal (clamshell). La paciente recibió seis ciclos de quimioterapia adyuvante postoperatoria con cisplatino y 5-fluorouracilo. En la actualidad, a los 3 años de seguimiento, no ha habido recidivas intratorácicas, y la paciente se encuentra asintomática y con buena calidad de vida (AU)

Neumotórax espontáneo primario masivo bilateral simultáneo / Spontaneous, massive primary pneumothorax in both lungs

El neumotórax espontáneo primario bilateral simultáneo es excepcional. Presentamos el caso de un paciente de 22 años, sin antecedentes de interés, que acudió a urgencias en situación crítica tras sufrir un episodio de neumotórax masivo bilateral simultáneo. Tras la inserción de un drenaje pleural en cada hemitórax, se indicó cirugía electiva definitiva, dada la bilateralidad y gravedad del neumotórax. El paciente fue intervenido mediante cirugía videotoracoscópica bilateral secuencial en la misma sesión operatoria, y se identificaron pequeños blebs en ambos vértices pulmonares. Se realizó una resección de los blebs y una abrasión pleural. El postoperatorio cursó sin incidencias y el enfermo fue dado de alta en el cuarto día postoperatorio. Cinco años después, el paciente se encuentra asintomático sin haber sufrido recurrencia del neumotórax (AU)