Demographic and Psychosocial Characteristics of Lung Transplant Candidates: Single-Center Analysis.

BACKGROUND: Lung transplantation has changed the course of treatment of lung diseases for the better; however, there are various factors that should be considered to increase the probability of a better outcome. Factors such as the patient's background, level of education, and income could affect their perception and eventually the results of the procedure. METHODS: The present study involved patients who underwent the qualification process for lung transplant along with psychological and sociologic assessment at the Lung Transplant Unit in the Department of Cardiac Surgery and Vascular Surgery, Medical University of Gdansk. The following data were identified in the patients' medical history: marital status, size of the city, source of income, profession, voivodeship, and their Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) score for psychosocial prediction of the outcome. RESULTS: A group of 121 patients were included in the study: 77 (63.64%) men and 44 (36.36%) women. The average age of the patients was 55.4 ± 9.81 years. Eighty (66.12%) lived in the city, and 26 (21.49%) of patients were professionally active with a fixed salary as their source of income. One hundred two patients were married. The median SIPAT score was 10.0 ± 3.0 for men and 10.0 ± 2.75 for women (P = .0974). CONCLUSION: For optimum care and results of the lung transplant procedure, it is important to consider these background patient factors because they play a crucial role in determining the course of the surgery. The analysis of demographic data is undoubtedly one of the elements helpful in the further fate of the whole process.

Routine Coronary Angiography is Still the Key Test for Patients Eligible for Lung Transplantation Also for Those With No Symptoms and With High Risk of Coronary Artery Disease.

BACKGROUND: Coronary artery disease (CAD) has a considerable morbidity and mortality effect on the outcomes of a lung transplant. Currently, coronary angiography is performed as part of the pretransplant evaluation process. Unfortunately, there are no clear guidelines about performing cardiac angiography in lung transplant candidates. BACKGROUND: The aim of our work is to find a correlation between cardiovascular risk and coronary arterial status to optimize the selection of patients for coronary angiography prior transplantation. METHODS: We retrospectively analyzed 48 patients in whom coronary angiography and cardiac catheterization was performed during assessment for bilateral lung transplantation at the Medical University of Gdansk from 2018 to 2021. The coronary artery disease status was classified into 2 categories: without any stenosis and with stenosis. For each patient, the 10-year cardiovascular risk was estimated by using a Systematic COronary Risk Evaluation calculator modified for the Polish population. RESULTS: Coronary stenosis was detected in 15 patients during angiography (31%). The group with coronary stenosis had a median SCORE risk of 8%, which is considered as high risk, and in patients without stenosis it was 5%, which is also considered a high risk. Median mean pulmonary artery pressure in patients with stenosis was the same as that in patients without stenosis (23 mm Hg). CONCLUSIONS: CAD among lung transplant candidates cannot be predicted by risk factors, so coronary angiography is very important as a part of the evaluation process. Because pulmonary hypertension has a big impact on surveillance after transplantation, performing heart catheterization during the qualification process is crucial.

Lung Transplant in a Patient With Multifocal Langerhans Cell Histiocytosis After Chemotherapy With Cladribine: A Case Report.

Langerhans cell histiocytosis (LCH) is a rare inflammatory disorder of myeloid dendritic cells with mutations involving KRAS, BRAF and/or NRAS, and MAP2K1 genes. We describe the case of a 58-year-old female previous smoker with multifocal LCH involving the lungs, pituitary gland and mandibular bone. Initial treatment with 6 cycles of cladribine showed improvement in her extrapulmonary lesions, however, her lung disease progressed and after qualification and assessment tests she underwent uncomplicated double lung transplant surgery and was discharged home. We highlight that in select patients with well managed and controlled extrapulmonary LCH, such an invasive procedure as lung transplant is possible.

Anti-HLA immunization of patients qualified for lung transplantation - Single center study.

For lung transplantation, the presence of donor-specific anti-HLA antibodies (DSA) is an important factor of antibody-mediated rejection (AMR) in its hyperacute, acute or chronic form during long-term follow up. The aim of the study was to assess the allosensitization of Polish patients qualified for a lung transplantation in our center. A retrospective study of 161 potential lung allograft recipients, also of 31 patients transplanted in the University Hospital of Gdansk, between June 2018 and December 2020 were performed. 121 potential recipients were thoroughly tested for immunization status before eventual lung transplantation. SAB-testing, PRA-CDC and vPRA assessment, and HLA typing were performed to guide donor-recipient matching and risk stratification. Then 73 patients were separated and qualified for the list of patients awaiting lung transplantation. Then 31 patients were transplanted based on a negative biological crossmatch result. The patients were generally not sensitized, as the median PRA-CDC was 0% (min 0; max 53), and the vPRA, calculated according to HLA ABDR (>2000 cut-off MFI), was 8% (min 0; max 99). If the cut-off was split into 2000 MFI for HLA ABDR, 10,000 MFI for HLAC, and 7000 MFI for HLA-DQ, the vPRA increased to 20% (min 0; max 99). The immunization status was assessed with single antigen-SAB assays. For class I, the number of any detectable alloantibodies was 14 (11.6%) 21 (17.35%) 16 (13.22%) for locus HLA-A/B/C, and 28 (23.14%) 30 (24.8%) 24 (19.8%) for locus HLA-DR/DQ/DP, respectively. The immunization of the transplanted patients was then analyzed in detail. Summarizing, the study is an analysis of the degree of anti-HLA immunization in the population of patients eligible for lung transplantation, which showed that this degree is of low intensity and can be effectively and safely and very precisely diagnosed before transplantation.

Influence of polish national COVID-19 lockdown on the patient characteristics and outcomes of bariatric surgery at a high-volume center-A cohort study.

INTRODUCTION: As a result of the COVID-19 pandemic, the health care systems around the world have been overburdened resulting in significant reduction of planned surgical procedures such as bariatric surgeries. The primary aim of this study is to assess the influence of the COVID-19 national lockdown in Poland on the short-term outcomes and intraoperative course of bariatric patients in a high volume IFSO certified bariatric center. MATERIAL & METHODS: This is a retrospective analysis of 158 bariatric surgery patients, who underwent bariatric procedures either prior to or after the first national lockdown in Poland. The patients were categorized as pre-lockdown group and the post-lockdown group, each comprising of 79 patients. RESULTS: The post-lockdown group had significantly lower operative weight (105.76 vs 114.25, p = 0.012) and BMI (36.99 vs 39.93, p = 0.005) compared to pre-lockdown group. The primary length of stay was significantly longer in the post-lockdown group (3.04 vs 2.44, p = 0.001). The post-lockdown group had significantly lower mean CCI score (1.90 vs 6.67, p = 0.046) and less short-term readmissions post-discharge (0 vs 8.86, p = 0.007) than pre-lockdown group. CONCLUSION: The post-lockdown group was found to have lower body weight and BMI on the day of the operation than those operated prior to the lockdown. These findings are conflicting to previous research assessing weight changes during lockdowns. Since the qualification criteria and order of operations were similar and pre-defined for both groups, possible explanations for these findings are higher patient motivation due to COVID-19 fears and longer preparation period due to elective surgery postponement. We encourage bariatric centers globally to assess the effect of national lockdowns on the patient profiles as well as the psychological and behavioral impact on the bariatric cohort.

A Single-Center Experience with Lung Transplants During the COVID-19 Pandemic.

BACKGROUND This single-center study analyzed distinctions between lung transplants performed in the Department of Cardiac and Vascular surgery of the University Clinical Center in Gdansk, Poland before and during the COVID-19 pandemic. MATERIAL AND METHODS There were 189 patients who underwent the qualification procedure to lung transplantation in the Department of Cardiac and Vascular Surgery of the University Clinical Center in Gdansk, Poland in the years 2019 and 2020. The control group consisted of 12 patients transplanted in 2019, and the study group consisted of 16 patients transplanted in 2020. RESULTS During 2019, the qualification process was performed in 102 patients with pulmonary end-stage diseases. In 2020, despite the 3-month lockdown related to organizational changes in the hospital, 87 qualification processes were performed. The mortality rate of patients on the waiting list in 2020 was 14.3% (6 patients died), and during 2019 the rate was also 14.3% (4 patients died). Donor qualifications were according to ISHLT criteria. The distribution of donors in both years was similar. There was no relationship between the geographic area of residence and source of donors. In 2019, all 12 patients had double-lung transplant. In 2020, 11 patients had double-lung transplant and 5 patients had single-lung transplant. There was no difference in ventilation time and PGD aside from a shorter ICU stay in 2020. CONCLUSIONS Lung transplants were relatively well-conducted despite the continued obstacles of the COVID-19 pandemic.

Clinical presentation and outcomes of cholecystectomy for acute cholecystitis in patients with diabetes - A matched pair analysis. A pilot study.

PURPOSE: The primary aim of this study is to compare the clinical course and laboratory parameters of acute cholecystitis in patients with diabetes vs. patients without diabetes. MATERIALS AND METHODS: The study involved patients who underwent emergency cholecystectomy in the Department of General, Endocrine and Transplant Surgery of University Clinical Center in Gdansk (Poland) between 2007 and 2017. There were 267 patients included in the study. The control group of 197 patients was age and sex matched at a 3:1 ratio. The following was compared between the groups: symptoms at admission, course of surgery, postoperative course, length of hospitalization, total costs of hospitalization and antibiotic therapy, other than routine perioperative prophylaxis. RESULTS: There was no significant difference between the patients with and without diabetes regarding symptoms at admission. Operative and postoperative complication rates were significantly higher in the patients with diabetes. The operative time and length of hospitalization were significantly longer in the study group. The conversion rate was not higher in the study group, but classic surgery was performed significantly more often. The patients without diabetes had less pronounced symptoms with more locally advanced disease. CONCLUSIONS: Our study demonstrates that patients with diabetes have a significantly more eventful course of acute cholecystitis than patients without diabetes. Patients with diabetes should therefore be qualified for cholecystectomy early in the course of acute cholecystitis.

Partial pancreatic resection along the embryological fusion plane - no longer a fantasy.

BACKGROUND: The embryological connection between the dorsal and ventral pancreatic regions divides the pancreas into two segments. This anatomical dependence allows segmental pancreatic resection through the embryological fusion plane (EFP). The advantages of limited pancreatic resection are the preservation of the natural continuity and function of the gastrointestinal tract and the avoidance of the metabolic and endocrine consequences of total resection of the pancreas and the duodenum. MATERIALS AND METHODS: Two patients are described who underwent anatomicalsegmentectomyof the pancreatic head along the EFP for the treatment of pancreatic cystic tumor and main duct IPMN. The authors suggested diagnostic and intraoperative management leading to qualification for pancreatic resection along the EFP. RESULTS: Pancreas and duodenum sparing surgery is an opportunity for patients in terms of the post-operative quality of life. Indications for this kind of surgery are limited and case selection is very difficult. The procedure for embryological bud resection is highly complicated includes a high rate of possible complications. On the other hand high volume centers may offer this procedure at an acceptable rate of complications in selected cases. CONCLUSIONS: Accurate diagnosis with a vascular anatomy and biliary and pancreatic duct configuration give grounds to analyze pancreas-sparing surgery. The operation plan requires careful 3D planning and an experienced team. Bipolar electrocautery, micro surgical tools and intraoperative cholangiography and pancreatography are helpful.