Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death.

We aimed to propose a simple and effective preservation method in lungs procured for transplantation from uncontrolled donation after circulatory death (uDCD) associated with excellent long-term results. Outcome measures for lung recipients were survival and primary graft dysfunction (PGD) grade 3. Survival was estimated using the Kaplan-Meier method. A total of 9 lung uDCDs were evaluated and 8 lung transplants were performed. Mean no-flow time was 9.8 minutes (standard deviation [SD] 8.6). Mean time from cardiac arrest to topical cooling was 96.8 minutes (SD 16.8). Preservation time was 159 minutes (SD 31). Ex vivo lung perfusion was used to assess lung function prior to transplantation in 2 cases. Mean recipient age was 60.8 years (SD 3.1), and mean total ischemic time was 678 minutes (SD 132). PGD grade 3 was observed in 2 cases (25%). The 1-month, 1-year, and 5-year survival rates were 100%, 87.5%, and 87.5%, respectively. Mean follow-up was 52 months. The logistic complexity of procuring lungs from uDCDs for transplantation requires the development of new strategies designed to facilitate this type of donation. A program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes.

Effect of an intensive lung donor-management protocol on lung transplantation outcomes.

BACKGROUND: An intensive lung donor-management protocol based on a strict protocol would increase the lung procurement rate. The aim of this study was to determine the effect of such a protocol on the rate of lung grafts available for transplant. METHODS: A lung-management protocol for donors after brain death (DBD) was implemented in 2009. Lung donors from 2009 to 2011 were the prospective cohort, and those from 2003 to 2008 formed the historical control. We analyzed the synergic effect of several measures, such as protective ventilation, ventilator recruitment maneuvers, high positive end-expiratory pressure, fluid restriction with reduced extravascular lung water values, and hormonal resuscitation therapy in multiorgan DBD. The number of lungs available for transplantation was the main outcome measure. For recipients, early survival and the rate of primary graft dysfunction (PGD) grade 3 were the main outcome measures. RESULTS: The DBD rate was more than 40 donors per 1 million population in both periods. The rate of lung donors increased from 20.1% to 50% (p < 0.001), quadrupling the number of lung donors (p < 0.001), grafts retrieved (p = 0.02), and patients who received a lung transplant (p < 0.01). No differences were observed in the survival of early recipients (p = 0.203) or in the rate of PGD grade 3 (p = 0.835). CONCLUSION: The management of multiorgan DBDs should be approached as a global treatment requiring attentive bedside management. Implementing an intensive lung donor-management protocol based on synergic measures increases lung procurement rates, negative effect on early survival of lung recipients or PGD grade 3.

Aspergillus endocarditis in lung transplant recipient: successful surgical treatment.

Solid organ transplantation can be followed by Aspergillus infection, implying high mortality rates. The highest infection rates are registered among lung transplant recipients. We present a recent case of an Aspergillus endocarditis in a young lung transplant recipient.

Registro Español de Trasplante Pulmonar: primer informe de resultados (2006-2010) / The Spanish Lung Transplant Registry: First Report of Results (2006-2010)

El Registro Español de Trasplante Pulmonar (RETP) inició su actividad en 2006, participando en él todos los equipos de trasplante pulmonar (TP) con un programa activo en España. Este informe presenta por primera vez de forma global la descripción y resultados de los pacientes trasplantados de pulmón en España entre los años 2006 y 2010. La actividad de TP ha ido en progresivo aumento, trasplantándose en este periodo 951 adultos y 31 niños. La media de edad del receptor fue de 48,2 años, siendo 41,7 años en el donante pulmonar. En el TP adulto, la causa más frecuente de trasplante fue el enfisema/EPOC, seguido de la fibrosis pulmonar idiopática, representando ambas más del 60% del total de las indicaciones. La probabilidad de supervivencia tras el TP adulto a uno y 3 años es del 72 y del 60%, respectivamente, si bien en los pacientes que sobreviven al tercer mes postrasplante estas supervivencias son del 89,7 y del 75,2%. Los factores que más claramente inciden en la supervivencia del paciente son la edad del receptor y el diagnóstico que indicó el trasplante. En los trasplantes pediátricos, la fibrosis quística es la principal causa de trasplante (68%), y la supervivencia al año es del 80, y del 70% a los 3 años. Tanto en el trasplante adulto como en el pediátrico, la causa más frecuente de fallecimiento es la infección. Estos datos confirman la consolidación del TP en España como una opción terapéutica para la enfermedad respiratoria crónica avanzada, tanto en niños como en adultos(AU)

The Spanish Lung Transplant Registry (SLTR) began its activities in 2006 with the participation of all the lung transplantation (LT) groups with active programs in Spain. This report presents for the first time an overall description and results of the patients who received lung transplants in Spain from 2006 to 2010. LT activity has grown progressively, and in this time period 951 adults and 31 children underwent lung transplantation. The mean age of the recipients was 48.2, while the mean age among the lung donors was 41.7. In adult LT, the most frequent cause for lung transplantation was emphysema/COPD, followed by idiopathic pulmonary fibrosis, both representing more than 60% the total number of indications. The probability for survival after adult LT to one and three years was 72% and 60%, respectively, although in patients who survived until the third month post-transplantation, these survival rates reached 89.7% and 75.2%. The factors that most clearly influenced patient survival were the age of the recipient and the diagnosis that indicated the transplantation. Among the pediatric transplantations, cystic fibrosis was the main cause for transplantation (68%), with a one-year survival of 80% and a three-year survival of 70%. In adult as well as pediatric transplantations, the most frequent cause of death was infection. These data confirm the consolidated situation of LT in Spain as a therapeutic option for advanced chronic respiratory disease, both in children as well as in adults(AU)

The Spanish Lung Transplant Registry: first report of results (2006-2010).

The Spanish Lung Transplant Registry (SLTR) began its activities in 2006 with the participation of all the lung transplantation (LT) groups with active programs in Spain. This report presents for the first time an overall description and results of the patients who received lung transplants in Spain from 2006 to 2010. LT activity has grown progressively, and in this time period 951 adults and 31 children underwent lung transplantation. The mean age of the recipients was 48.2, while the mean age among the lung donors was 41.7. In adult LT, the most frequent cause for lung transplantation was emphysema/COPD, followed by idiopathic pulmonary fibrosis, both representing more than 60% the total number of indications. The probability for survival after adult LT to one and three years was 72% and 60%, respectively, although in patients who survived until the third month post-transplantation, these survival rates reached 89.7% and 75.2%. The factors that most clearly influenced patient survival were the age of the recipient and the diagnosis that indicated the transplantation. Among the pediatric transplantations, cystic fibrosis was the main cause for transplantation (68%), with a one-year survival of 80% and a three-year survival of 70%. In adult as well as pediatric transplantations, the most frequent cause of death was infection. These data confirm the consolidated situation of LT in Spain as a therapeutic option for advanced chronic respiratory disease, both in children as well as in adults.

Nosocomial infection following video-assisted thoracoscopic surgery.

OBJECTIVES: To assess the incidence and risk factors for nosocomial infection after video-assisted thoracic surgery (VATS). METHODS: Prospective cohort study of all consecutive patients who underwent VATS surgery during 20 months. Patients were visited on a daily basis and followed up until they were discharged from the hospital. RESULTS: During the study period 217 patients (70.1% men; mean age, 50.9 years, range 15-85 years) underwent VATS. Fourteen (6%) episodes of postoperative infection were diagnosed in 13 patients, including pneumonia (n = 2), lower respiratory tract infection (n = 9), surgical site infection (n = 2), and urinary tract infection (n = 1). Prior inmunosupresion (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52-4.84), prior infections (OR, 14.9; 95% CI 1.91-116.5), preoperative stay > 2 days (OR, 3.37; 95% CI 1.00-11.40), neoplasia (OR, 3.69; 95% CI, 1.94-7.06) duration of surgery > 45 minutes (OR, 5.91; 95% CI, 1.00-36.40) and presence of central venous catheter (OR, 16.40; 95% CI, 2.29-117.20), were independent risk factors for nosocomial infection. CONCLUSIONS: Nosocomial infection rate after VATS was low. Respiratory infection was the most common infection. Factors which affect patient immunity, preoperative stay and perioperative-related variables were independently associated with infection.

Nosocomial infection following video-assisted thoracoscopic surgery

Objetivos: Estudiar la incidencia y los factores de riesgo de infección nosocomial en pacientes sometidos a una cirugía toracoscópica videoasistida. Métodos: Estudio de cohortes prospectivo de todos los pacientes a los que se practicó una toracoscopia videoasistida durante 20 meses consecutivos. Los pacientes se visitaron diariamente hasta ser dados de alta hospitalaria. Resultados: Durante el periodo de estudio se le practicó una toracoscopia videoasistida a 217 pacientes (70,1% hombres; edad media: 50,9 años, rango, 15-85 años). Se diagnosticaron 14 (6%) infecciones en 13 pacientes: 9 desarrollaron una infección de vías respiratorias bajas, 2 neumonía, 2 infección del sitio quirúrgico y 1 infección urinaria. En el análisis de regresión logística el tener una inmusupresión previa, (odds ratio [OR] ajustada: 2,70; intervalo de confianza [IC] 95%, 1,52- 4,84), infección previa (OR: 14,9; IC 95% 1,91-116,5), estancia preoperatoria > 2 días (OR: 3,37; IC 95% 1,00-11,40), neoplasia (OR: 3,69; IC 95%, 1,94-7,06), duración de la cirugía > 45 minutes (OR: 5,91; IC 95%, 1,00-36,40) y la presencia de catéter venoso central (OR: 16,40; IC 95%, 2,29-117,20), se comportaron como factores independientes de riesgo de infección nosocomial. Conclusiones: La tasa de infección nosocomial después de una cirugía toracoscópica videoasistida es baja. Las infecciones respiratorias fueron las más frecuentes. Los factores de riesgo independientes fueron los relacionados con la inmunidad previa del paciente, la estancia prequirúrgica y el momento perioperatorio(AU)

Objectives: To assess the incidence and risk factors for nosocomial infection after video-assisted thoracic surgery (VATS). Methods: Prospective cohort study of all consecutive patients who underwent VATS surgery during 20 months. Patients were visited on a daily basis and followed up until they were discharged from the hospital Results: During the study period 217 patients (70.1% men; mean age, 50.9 years, range 15-85 years) underwent VATS. Fourteen (6%) episodes of postoperative infection were diagnosed in 13 patients, including pneumonia (n = 2), lower respiratory tract infection (n = 9), surgical site infection (n = 2), and urinary tract infection (n = 1). Prior inmunosupresion (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52-4.84), prior infections (OR, 14.9; 95% CI 1.91-116.5), preoperative stay > 2 days (OR, 3.37; 95% CI 1.00-11.40), neoplasia (OR, 3.69; 95% CI, 1.94-7.06) duration of surgery > 45 minutes (OR, 5.91; 95% CI, 1.00-36.40) and presence of central venous catheter (OR, 16.40; 95% CI, 2.29-117.20), were independent risk factors for nosocomial infection. Conclusions: Nosocomial infection rate after VATS was low. Respiratory infection was the most common infection. Factors which affect patient immunity, preoperative stay and perioperative-related variables were independently associated with infection(AU)

Normativa para la selección de pacientes candidatos a trasplante pulmonar / Guidelines for the Selection of Lung Transplantation Candidates

La presente normativa ha sido elaborada con el consenso de, al menos, un representante de cada uno delos hospitales con programa de trasplante pulmonar en España. Además, previamente a su publicación,ha sido revisada por un grupo de revisores destacados por su reconocida trayectoria en el campo del trasplantepulmonar. En las siguientes páginas, el lector encontrará los criterios de selección de pacientescandidatos a trasplante pulmonar, cuándo y cómo remitir un paciente a un centro trasplantador y, finalmente,cuándo incluir al paciente en lista de espera. Se ha atribuido un nivel de evidencia a las cuestionesmás relevantes. Este documento pretende ser una guía práctica para los neumólogos que no participandirectamente en el trasplante pulmonar pero que deben considerar este tratamiento para sus pacientes.Finalmente, se ha propuesto de una forma consensuada un documento que recoge de forma estructuradalos datos del paciente potencial candidato a trasplante pulmonar que son relevantes para poder tomar lamejor decisión(AU)

The present guidelines have been prepared with the consensus of at least one representative of eachof the hospitals with lung transplantation programs in Spain. In addition, prior to their publication,these guidelines have been reviewed by a group of prominent reviewers who are recognized for theirprofessional experience in the field of lung transplantation. Within the following pages, the reader willfind the selection criteria for lung transplantation candidates, when and how to remit a patient to atransplantation center and, lastly, when to add the patient to the waiting list. A level of evidence hasbeen identified for the most relevant questions. Our intention is for this document to be a practical guide for pulmonologists who do not directly participate in lung transplantations but who should consider thistreatment for their patients. Finally, these guidelines also propose an information form in order to compilein an organized manner the patient data of the potential candidate for lung transplantation, which arerelevant in order to be able to make the best decisions possible(AU)

Guidelines for the selection of lung transplantation candidates.

The present guidelines have been prepared with the consensus of at least one representative of each of the hospitals with lung transplantation programs in Spain. In addition, prior to their publication, these guidelines have been reviewed by a group of prominent reviewers who are recognized for their professional experience in the field of lung transplantation. Within the following pages, the reader will find the selection criteria for lung transplantation candidates, when and how to remit a patient to a transplantation center and, lastly, when to add the patient to the waiting list. A level of evidence has been identified for the most relevant questions. Our intention is for this document to be a practical guide for pulmonologists who do not directly participate in lung transplantations but who should consider this treatment for their patients. Finally, these guidelines also propose an information form in order to compile in an organized manner the patient data of the potential candidate for lung transplantation, which are relevant in order to be able to make the best decisions possible.

Nosocomial infection after lung surgery: incidence and risk factors.

STUDY OBJECTIVES: To assess the incidence and risk factors for nosocomial infection after lung surgery. DESIGN: Prospective cohort study. SETTING: Service of thoracic surgery of an acute-care teaching hospital in Santander, Spain. PATIENTS: Between June 1, 1999, and January 31, 2001, all consecutive patients undergoing lung surgery were prospectively followed up for 1 month after discharge from the hospital to assess the development of nosocomial infection, the primary outcome of the study. INTERVENTIONS: During the hospitalization period, patients were visited on a daily basis. Postdischarge surveillance was based on visits to the surgeon. MEASUREMENTS AND RESULTS: We studied 295 patients (84% men; mean age, 60.9 years), 89% of whom underwent resection operations. Ninety episodes of nosocomial infection were diagnosed in 76 patients, including pneumonia (n = 10), lower respiratory tract infection (n = 47), wound infection (n = 16; one third were detected after hospital discharge), urinary tract infection (n = 9), and bacteremia (n = 8; three fourths were catheter-related bacteremia). Twenty patients had severe infections (pneumonia or empyema), with a mortality rate of 60%. COPD (adjusted odds ratio [OR], 2.70; 95% confidence interval [CI], 1.52 to 4.84), duration of surgery with an increased risk for each additional minute (Mantel-Haenzel chi(2) test for trend, p = 0.037), and ICU admission (OR, 3.69; 95% CI, 1.94 to 7.06) were independent risk factors for nosocomial infection. The use of an epidural catheter was a protective factor (OR, 0.45; 95% CI, 0.22 to 0.95). There were no differences according to the use of amoxicillin/clavulanate or cefotaxime for surgical prophylaxis. CONCLUSIONS: Nosocomial infections are common after lung surgery. One third of wound infections were detected after hospital discharge. The profile of a high-risk patient includes COPD as underlying disease, prolonged operative time, and postoperative ICU admission.