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.

Technique Resource for Difficult Auricular Anastomosis in Lung Transplantation.

OBJECTIVES: Atrial anastomosis in lung transplantation (LT) can present significant technical difficulties, especially when there is a very posterior left inferior pulmonary vein, in donor-recipient disproportion or excessive separation of the receptor's pulmonary veins owing to atrial dilatation; hence, its implementation requires excessive heart handling and longer ischemia time, which result in increased perioperative complications. This technique, which uses the recipient's superior pulmonary vein, avoids these problems, although it is not applicable in all cases because no pressure gradient at the suture level is required. Therefore, the suture diameter must be equal or greater than the sum of both graft pulmonary veins diameters. METHODS: This retrospective study recorded the age/gender (donor and recipient), preoperative morbidity, type of surgery, perioperative, vascular complications, mortality, and postoperative stay. Descriptive and inferential statistical study was made by SPSS. RESULTS: We performed 82 LTs between January 2009 and June 2012, 18 with the new technique (14 men/4 women; 52 ± 15 years). There were 14 single lung and 4 double lung transplants. The new technique does not increase the ischemic times when compared with the classic technique. No vascular dehiscence, fistulas, or thrombosis were found. There were observed fewer vascular complications (P = .042). Early mortality was presented in 4 cases (22.2%). CONCLUSIONS: This new technique achieves the objectives described (no increases in ischemic time, fewer vascular complications). However, an absolute confirmation requires a study comparing similar technical LT given that the new resource was only used in highly complex procedures.

Silicosis en los trabajadores del cuarzo: ¿elevado riesgo para un trasplante pulmonar? / Silicosis in quartz workers: at high risk of becoming lung transplants?

Se ha descrito en la literatura la relación entre la exposición laboral al cuarzo y el desarrollo de silicosis en determinados grupos de pacientes jóvenes, en el contexto de la manipulación de conglomerados de cuarzo artificial. Presentamos el caso de un paciente joven, marmolista, con diagnóstico de silicosis a los 28 años e historia de exposición laboral a cuarzo sin protección respiratoria adecuada. Dada la mala evolución del paciente, debido al desarrollo de una fibrosis pulmonar masiva progresiva, fue sometido a trasplante pulmonar unilateral de forma electiva, con una evolución posterior satisfactoria

The literature has described the relationship between exposition to quartz at work and developing silicosis in certain young patients, within the context of manipulating artificial quartz aggregates. We present the case of a young patient, a stonemason who was diagnosed with silicosis at the age of 28. He had a history of being exposed to quartz on the job, without any adequate respiratory protection. Given the poor evolution of the patient, and due to his developing, progressive and massive pulmonary fibrosis, he underwent an elective, unilateral lung transplant, with satisfactory evolution

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.