Long-term Prognosis After Lung Transplantation: A Monocentric Study in 510 Patients.

INTRODUCTION: Lung transplantation is the final treatment option in patients with respiratory failure. Morbidity and mortality rates associated with the management of complications is high despite advances. Postoperative complications include acute transplant rejection, bronchiolitis obliterans, and infections. Because of that, the success of this treatment option depends on the correct choice of donor and candidates to receive a transplant. OBJECTIVE: This study aims to perform a survival analysis of transplanted patients in our center and determine predictive variables of mortality. PATIENTS AND METHODS: This study is a retrospective assessment of data collected from 510 patients at the Hospital University Reina Sofía from October 1993 to December 31, 2016. Patients who were retransplanted were excluded. We collected data regarding basal characteristics of the donors and candidates to receive a transplant. We analyzed the impact in terms of future survival of basal variables from donor and donor recipients. RESULTS: Five hundred ten patients were included (average age 44 ± 17 years, 69% male), with a maximum follow-up period of 21.6 years (average follow-up 4.52 years, interquartile ratio: 0.13 to 6.97 years). Two hundred twenty-seven patients died (54.3% of the total amount). The influence of donor's basal characteristics on mortality was analyzed; moreover, the relationship between basal variables and survival were analyzed using univariate analysis. Available variables were analyzed through multivariate analysis. CONCLUSION: Lung transplantation is a treatment option with an acceptable risk of morbidity and mortality. Increased awareness of features of evolution could help to reduce postoperative complications.

Indicadores de calidad en los informes de alta por neumonía adquirida en la comunidad / Quality indicators in medical history by Community-Adquired Pneumonia

INTRODUCCIÓN: Como fase inicial de un proyecto para elaborar una guía clínica sobre neumonía adquirida en la comunidad, se plantea conocer la situación de partida en nuestro centro. OBJETIVO: Evaluar el abordaje diagnóstico y terapéutico en pacientes hospitalizados por neumonía, analizando en los informes clínicos de alta parámetros de calidad previamente publicados. PACIENTES Y MÉTODOS: Estudio observacional, retrospectivo de pacientes ingresados por neumonía en el Hospital Universitario Reina Sofía, de Córdoba, en los últimos 5 años (2010 - 2014). La fuente de información han sido los informes de alta hospitalaria y su correspondiente episodio de urgencias. Se estudiaron variables generales, clínicas e indicadores de calidad, medidos mediante proporciones. RESULTADOS: El total de pacientes ingresados por neumonía fue de 884, seleccionándose aleatoriamente 196 de ellos, 131 hombres (66,8 %) y 65 mujeres (33,2 %), con una edad media de 58 años y una estancia media de 11,56 días. Cumplimiento de los indicadores de calidad: Cualquier tipo de cultivo 70,4%; hemocultivos antes del tratamiento antibiótico 32,7%; determinación antígeno de Legionella y S. Pneumoniae 60,2%; cultivo de esputo 40,8%; broncoaspirado 8,7%; realización de radiografía de tórax al 99%; realización de gasometría arterial 82,1%; tratamiento empírico de acuerdo a las guías 94,9%; pruebas complementarias (hemograma y bioquímica) 99,5%; índices de gravedad PSI/CURB65 0%. CONCLUSIONES: Se reflejan de manera adecuada en un alto porcentaje de pacientes los criterios de calidad indicados en las guías, aunque un claro punto a mejorar es hacer referencia a los índices de gravedad (PSI y CURB65) como criterios de hospitalización

INTRODUCTION: As a project initial stage to draw up a practical guide about Community-Adquired Pneumonia, to know the initial situation in our centre it is approached. OBJECTIVE: To evaluate the diagnostic and therapeutic approach between hospital patients due to pneumonia by analysing quality indicators previously published. METHODS AND MATERIALS: Retrospective observational study of hospitalized patients with pneumonia in University Hospital Reina Sofía, located in Córdoba in the last 5 years (2010- 2014). The source of information was the medical history. General and clinical variable were studied just like quality parameters both measures in proportion. RESULTS: The total amount of hospitalized patients due to pneumonia was 884, chosen at random 196, 131 men (66,8%) and 65 women (33,2%) an average age of 58 and an hospitalized period of 11,56 days. Fulfilment of the quality parameters: any kind of culture 70,4%; blood culture before antibiotic treatment 32,7%; determining Legionella antigen and S. Pneumoniae antigem 60,2%; sputum culture 40,8%; bronchial suction 8,7%; chest X-Ray 99%; arterial blood gas analysis 82,1%; empirical treatment according to regulations 94,9%; additional evidences (blood count and biochemistry) 99,5%; severity rates PSI/CURB65 0%. CONCLUSIONS: It is showed a high rate of patient's percentage quality parameters reordered in regulations, however it is necessary to improve severity rates (PSI and CURB65) such as medical criteria for hospitalization

Analysis of the Incidence of Noncutaneous Neoplasia After Lung Transplantation and Its Impact on Prognosis.

INTRODUCTION: Increased survival in lung transplant recipients, the need for immunosuppressive therapy, and many risk factors before and after transplantation enhance the development of malignancies. This study sought to analyze the incidence of noncutaneous tumors after lung transplantation in our hospital, the risk factors for malignancy, and its impact on prognosis. PATIENTS AND METHODS: A retrospective analysis of clinical records of patients after lung transplantation in our hospital from October 1993 to December 2014. RESULTS: The study population included 443 patients. In total, 35 neoplasia developed in 33 patients (9.6%). Twelve cases were posttransplant lymphoproliferative disorders (PTLDs), 7 localized in the native lung, 7 gynecologic neoplasia (2 in the breast, 4 in the vulva, and 1 in the cervix), 3 in the colon, 2 in the nervous system (one was an astrocytoma), 2 in the prostate, 1 in the kidney, and 1 in the esophagus. The average time between transplantation and malignancy detection was 52.7 ± 45.4 months, being earlier in patients with PTLDs than in non-PTLD. Eleven patients who developed malignancy (all patients with neoplasia in native lung and in cervix, 1 in the colon, 1 PTLD, and 1 in the nervous system) died as a result of it. The only factor associated with an increased risk of malignancy in our population was smoking history. CONCLUSIONS: Almost 10% of lung transplant recipients developed some type of noncutaneous neoplasia and the most frequently diagnosed were PTLDs. Lung neoplasia compromised most survival in these patients.

Mujer de 58 años con dolor centrotorácico y alteración en la radiografía de tórax / 58 year old woman with central-thoracic pain and alterations in the thorax X-Ray

La microlitiasis alveolar es una enfermedad pulmonar difusa infrecuente que se caracteriza por el depósito intraalveolar de formaciones esféricas de fosfato cálcico (microlitos). Se puede presentar a cualquier edad diagnosticándose, en gran parte de los casos, de forma incidental. Aunque la etiología no está del todo aclarada, un 30 - 50% de los pacientes presentan un componente familiar, heredándose de forma autosómica recesiva. Se conoce que dichas alteraciones se relacionan con un gen transportador del fosfato sódico en las células alveolares (SLC34A2), localizado en el cromosoma 4. Esta enfermedad suele ser asintomática hasta estadios finales, existiendo una clara disociación clínico-radiológica. No existe ningún tratamiento específico, siendo el trasplante pulmonar una alternativa posible en estados avanzados. Se presenta el caso de una paciente de 58 años, diagnosticada de forma incidental de microlitiasis alveolar y su evaluación como potencial candidata a trasplante pulmonar

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown cause, characterized by intra-alveolar spherical deposits of calcium phosphate (microlites). These may appear at any age, and for the most part, are diagnosed incidentally. Although the etiology is not fully understood, between 30 - 50% of the patients seem to have a genetic component, inheriting it in an autosomal recessive pattern. It is known that said alteration is linked to a gene transporting sodium phosphate in the alveolar cells (SLC34A2), located in chromosome 4. This disorder is usually asymptomatic until the final stages, with a clear clinicalradiological dissociation. There is no specific treatment, with lung transplant being the only possible alternative in advanced stages. The case of a 58 year old patient is presented. She was diagnosed with alveolar microlithiasis by chance and assessed as a potential candidate for lung transplant