ABSTRACT
We present management strategies utilised for the first case of an urgent live-donor ABO incompatible B blood group renal transplant, in a patient with a prior A blood group lung transplant for cystic fibrosis. Three years on, renal function is excellent and stable, whilst lung function has improved.
Subject(s)
ABO Blood-Group System/immunology , Cystic Fibrosis/therapy , Graft Rejection/immunology , Isoantigens/immunology , Kidney Failure, Chronic/therapy , Kidney Transplantation , Lung Transplantation , Sepsis/therapy , Acute Disease , Adult , Disease-Free Survival , Female , Graft Rejection/drug therapy , HLA Antigens/immunology , Humans , Living Donors , Middle Aged , Mothers , Mycophenolic Acid/therapeutic use , Plasmapheresis , Prednisolone/therapeutic use , Tacrolimus/therapeutic use , Withholding TreatmentABSTRACT
Lung transplantation (LTx) is a therapeutic option for severe pulmonary arterial hypertension (PAH) patients failing optimal medical therapy. The use of donation after circulatory determination of death (DCDD) donor lungs for PAH LTx has rarely been reported, primarily reflecting concerns that DCDD lungs represent extended criteria donors, at risk of morbidity and mortality. A retrospective study of all Alfred Hospital DCDD and DNDD (donation after neurologic determination of death) PAH LTx was undertaken. Protocolized fluid/inotrope/ventilator and extracorporeal membrane oxygenation (ECMO) strategies were utilized. Since our first DCDD LTx in 2006, 512 LTx have been performed. Of 31 PAH recipients, 11 received DCDD lungs (11% of DCDD LTx) and 20 received DNDD lungs (5% of DNDD LTx) (p = 0.04). Only one PAH patient died on the LTx waiting list. Peri-LTx ECMO was utilized in 3/11 (27%) DCDD and 6/20 (30%) DNDD PAH LTx (p = 0.68). Primary graft dysfunction, intensive care, and overall stay were the same in both groups. Survival at 1 and 8 years was 100% and 80% for DCDD versus 100% and 70% for DNDD LTx (p = 0.88), respectively. In conclusion, excellent results can be achieved for PAH LTx. DCDD donor lungs are not extended lungs per se having passed the toughest test.
Subject(s)
Blood Circulation , Brain Death , Graft Rejection/epidemiology , Hypertension, Pulmonary/surgery , Lung Transplantation , Pulmonary Artery/surgery , Tissue Donors , Adolescent , Adult , Australia/epidemiology , Female , Follow-Up Studies , Graft Survival , Humans , Male , Middle Aged , Postoperative Complications , Primary Graft Dysfunction , Prognosis , Retrospective Studies , Risk Factors , Tissue and Organ Procurement , Young AdultABSTRACT
UNLABELLED: Bronchoalveolar lavage (BAL) neutrophilia has been repeatedly observed in lung transplant recipients with established bronchiolitis obliterans syndrome (BOS). Little is known of the fluctuations in BAL and airway neutrophilic inflammation post-transplant. This prospective longitudinal study aimed to evaluate the dynamic changes of lung allograft neutrophils with time, immunosuppression, infection and BOS. A total of 28, initially healthy, BOS 0, lung transplant recipients underwent 134 bronchoscopic assessments, including BAL and endobronchial biopsies (EBB) (with immunohistochemistry) over 3-year follow up. Subsequently, 21 developed BOS 0p and 16 ultimately BOS. Compared to controls, there was early and persistent BAL neutrophilia (p < 0.05), contrasting with an initially normal EBB that shows a progressive increased airway wall neutrophil infiltrate. BAL neutrophilia (but not airway wall neutrophilia) was most striking when there was concomitant bronchopulmonary infection, particularly in the patients with BOS. Univariate and multivariate analyses suggested that BAL neutrophilia was linked to markers of infection while EBB neutrophilia was linked with coexistent inflammation with macrophages and lymphocytes. IN CONCLUSION: (i) BAL neutrophilia is predominantly associated with infection; (ii) Airway wall neutrophilia (as monitored by EBB) increases with time post-transplant and is not associated with infection; (iii) By itself, BOS is not the major contributor to BAL and EBB neutrophilia.
Subject(s)
Lung Transplantation/pathology , Lung/pathology , Neutrophils/pathology , Adult , Biopsy , Bronchoalveolar Lavage Fluid/cytology , Bronchoscopy , Female , Follow-Up Studies , Humans , Lung Transplantation/adverse effects , Male , Middle Aged , Postoperative Complications , Prognosis , Prospective StudiesABSTRACT
OBJECTIVE: To investigate the use and effects of birth plans and how women perceive them. DESIGN: Retrospective questionnaire survey. SETTING: A teaching hospital with approximately 3000 deliveries per annum in Dundee, Scotland. PARTICIPANTS: 143 primigravidae, six to 13 weeks following delivery. FINDINGS: The study achieved a 71% response rate. Ninety per cent of women had completed a birth plan. Most women thought the process of completion of the plan had been useful by allowing discussion of available options beforehand. Half said the birth plan did not make any difference to the amount of control they felt during labour, although many thought that not enough attention had been paid to what they had written. Most women said they would make another birth plan in a future pregnancy. CONCLUSIONS: The majority of women found completion of a birth plan was beneficial. IMPLICATIONS FOR PRACTICE: More attention should be paid to the birth plan by carers during labour.
