Outcomes after lung transplantation in patients with chronic hepatitis C virus infection.

BACKGROUND: Hepatitis C virus (HCV) infects 4 million people in the USA, with a prevalence of 1.4%. The seropositivity rate among potential lung transplant candidates is 1.9%, yet little information is available regarding outcomes of lung transplantation in HCV-positive lung transplant recipients. Our study reports outcomes of lung transplantation in HCV-positive recipients and compares them to HCV-negative controls. METHODS: A retrospective analysis of the Cleveland Clinic Foundation's lung transplant database (465 patients) identified six HCV-positive patients. Demographic data, etiology of HCV infection, HCV viral load pre- and post-transplant, pre-transplant hepatic pathology, serial transaminases, incidence of acute hepatitis, graft function data and patient survival data were obtained by chart extraction. RESULTS: Five HCV-positive recipients had a pre-transplant liver biopsy, none of whom had evidence of cirrhosis pre-transplant. Although HCV RNA levels markedly increased post-transplant, no concomitant increase in transaminases was noted. There was no significant difference in the incidence of acute rejection at 1 year in our HCV-positive cohort compared with the HCV-negative lung transplant recipients from our institution. One patient developed bronchiolitis obliterans syndrome (BOS) during the follow-up period. Two patient deaths occurred, one at 8 months and the other at 2 years post-transplant. No evidence of hepatic dysfunction was noted in either deceased patient. The four surviving patients are alive at a median 3.2 years (range 1 to 6 years). CONCLUSIONS: No significant difference in patient or graft survival was noted between the HCV-positive lung transplant recipients and the HCV-negative recipients.

Restless legs syndrome in lung transplant recipients.

BACKGROUND: Given the increased incidence of steroid-induced diabetes and drug-induced anemia, renal dysfunction and neuropathy, we believed that lung transplant recipients would be at an increased risk of developing restless legs syndrome (RLS). We performed a cross-sectional, observational study to determine the prevalence and characteristics of RLS in this population. METHODS: Patients filled out two questionnaires during a routine visit: (1) a diagnostic tool for RLS, based on the core clinical features; and (2) a 10-question rating scale used to assess severity. Data were obtained by medical record review with regard to demographics, lung transplant characteristics and known risk factors for RLS. RESULTS: Forty-two lung transplant recipients (age 46.6 +/- 15.4 years [mean +/- SD]; 24 women, 18 men) without a family history of RLS were recruited. RLS was found in 47.6% (20 of 42) of the patients and 80% had moderate or severe RLS. Seventy-five percent of those with RLS were women (p = 0.03). RLS patients had a serum calcium level that was higher than those without RLS (p = 0.05) and were more likely to be recipient (p = 0.02) or donor positive (p = 0.07) for cytomegalovirus (CMV). All 4 hypothyroid patients on replacement therapy were in the RLS group. The prevalence of diabetes mellitus and chronic renal failure were not significantly different between the RLS and non-RLS groups. CONCLUSIONS: There was a very high prevalence of RLS in our lung transplant population and most patients had moderate or severe symptoms. RLS patients were more likely to be women, donor or recipient positive for CMV, hypothyroid, and to have an elevated serum calcium level.

Acanthosis nigricans following single lung transplantation: a case report.

Acanthosis nigricans was observed 3 months after single lung transplantation in a 51-year-old African American woman with idiopathic pulmonary fibrosis. The patient had no endocrinological abnormalities and was not taking any medications known to cause acanthosis nigricans; extensive investigation did not reveal an underlying malignant process. Because acanthosis nigricans may occur as a paraneoplastic phenomenon, it is important to rule out an underlying malignancy. This is especially important in solid-organ transplant recipients receiving chronic immunosuppressive therapy.

Discordant utility of ideal body weight and body mass index as predictors of mortality in lung transplant recipients.

BACKGROUND: An upper limit of 130% predicted ideal body weight (PIBW) has been promulgated for assessing lung transplant (LTx) candidacy, but no data in the lung transplant population support this value. A prior study used body mass index (BMI) to suggest greater mortality risk in obese allograft recipients, but the number of studied patients was small. METHODS: Pre-operative PIBW percentage and BMI were obtained for all first-time, adult LTx recipients at our institution (n = 283). We compared survival data at 90 days and as of July 31, 2002, using multivariable regression and Cox modeling. RESULTS: There were 46 obese (BMI > or = 30) patients and 72 patients >130% PIBW, including 43 patients previously thought to fall within a normal PIBW range who were reclassified as overweight for this analysis. Cox modeling revealed no significant impact of PIBW (>130% or continuous) or BMI (>30 kg/m(2) or continuous) on overall survival. Predicted ideal body weight also had no influence on 90-day mortality. When we tested PIBW in the group previously deemed of acceptable weight, we likewise found no association with mortality at 90 days or overall. For BMI only, 90-day odds ratios for death were significantly greater for obese (BMI > or = 30; odds ratio, 3.16; 95% confidence interval, 1.05-9.48) patients than for normal-weight patients. CONCLUSION: Indices of pre-operative obesity did not predict long-term outcome in this large cohort of LTx recipients. The data suggest that BMI stratification may identify a group of patients at risk for increased short-term mortality, whereas PIBW is not a significant outcome predictor.