Factors affecting complications development and mortality after single lung transplant.

Lung transplantation (LT) is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease. Furthermore, as a therapeutic option for high-risk candidates, single LT (SLT) can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single (double) LT (SSLTx). Still, the long-term overall survival is, in general, better for SSLTx. Despite the great success over the years, the early post-SLT period remains a perilous time for these patients. Patients who undergo SLT are predisposed to evolving early or late postoperative complications. This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction, native lung complications, anastomosis complications, infections, cardiovascular, gastrointestinal, renal, and metabolite complications, and their association with morbidity and mortality in these patients. Furthermore, we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.

The Dynamic Changes in Soluble CD30 and Regulatory T Cells Before and After Solid Organ Transplantations: A Pilot Study.

Among multiple parameters, applied in the immunologic monitoring of transplantation, the levels of serum soluble CD30 (sCD30) and peripheral regulatory T cells (Tregs) are very promising. These are relatively new biomarkers, considered to reflect immune activation and tolerance in solid organ transplantation. Results are shown here from a preliminary study on the relevance of sCD30 and Tregs in the monitoring of the early post-transplantation period. Sixteen patients with chronic liver or kidney disease were examined. Nine of them were further selected for transplantation. Follow-up of sCD30 and Tregs was carried out during the first month after transplantation. Until day 30 (D30) after transplantation, a progressive decrease in sCD30 levels was observed in all patients. Conversely, the dynamic of Tregs was dependent on the transplanted organ: in liver recipients, an increase of Tregs was detected at day 7 (D7) followed by a gradual decrease until D30, whereas in kidney recipients, a sustained downward trend starting on D7 was observed. In liver recipients, the increase in Tregs preceded albumin normalization, whereas in kidney recipients, sCD30 was found to have predictive significance for the creatinine levels. Our results demonstrated that peripheral blood sCD30 and Tregs are valuable parameters in the immunologic monitoring of transplanted patients.

Comparison of three estimators for determining cyclosporine dosing in infants after liver transplantation
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OBJECTIVE: To compare and analyze how allometrically- and linearly-scaled daily doses of cyclosporine could affect the therapeutic drug monitoring concentrations when applied to 8 infants with liver transplants. MATERIALS AND METHODS: Eight infants who underwent liver transplantations were put on twice-daily oral cyclosporine immunosuppressive regimens. After starting therapy, the adjustments of individual daily doses were determined by using therapeutic monitoring of plasma cyclosporine levels by measuring trough concentrations (C0) and concentrations at 2 hours after drug administration (C2). These doses were analyzed and compared with the hypothetical doses estimated by allometric and linear scaling in order to compare which of the two methods would yield closer estimates to the actual doses applied. RESULTS: The median therapeutic drug monitoring (TDM)-based dose (n = 53) was 70.00 mg (10.9 mg/kg/day) (5.00 - 190.00 mg), whereas the median allometric (n = 53) and linear (n = 53) doses were 65.21 mg (10.11 mg/kg/day) (57.17 - 79.25 mg) and 35.63 mg (5.52 mg/kg/day) (29.89 - 46.20 mg), respectively. The median allometric dose was significantly different than the median linear dose (p < 0.0001), whereas there was no statistical difference between the median TDM-based dose and median allometric dose (p = 0.72). CONCLUSIONS: The allometric approach, when used to estimate cyclosporine doses in this cohort of liver transplant infants, yielded closer estimates to actually applied daily doses in comparison to linear scaling. Allometric scaling could be employed in calculating starting doses for drugs that lack specific dosing recommendations for infants, in order to achieve therapeutic levels faster, lowering the need for constant monitoring and dose adjustment.
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Correlation between rotation thrombelastometry ROTEM analysis and standard haemostatic parameters during liver transplantation.

BACKGROUND: The determination of the correlations between simultaneously performed rotation thrombelastometry ROTEM analysis and standard haemostatic analysis during liver transplantations is indispensable for performing an adequate perioperative haemostatic monitoring. METHODS: Perioperative haemostatic monitoring was performed to 30 patients undergoing orthotopic liver transplantation (13 male (42%) and 17 female (58%), age: (mean +/- SD; 21 +/- 17 years). Standard coagulation parameters (PT, APTT, FIB) were assessed chronometrically on STA-Compact Analyzer (Diagnostica Stago - La Roche), rotation thrombelastometry analyses - on ROTEM analyzer (Petapharm GmbH) and platelets (PLT) - on Cell Dyn 3700 (Abbott Diagnostica), MAPSS technology. RESULTS: A protocol was successfully developed for the implementation of perioperative haemostatic control during orthotopic liver transplantations, performing parallel thrombelastometric and standard haemostatic analyses. Significant correlation was established between PT(INR) and EXTEM_CFT ( r = 0.834; p < 0.001) and between APTT and INTEM_CFT (r = 0.707; p < 0.001) in the preoperative period (R1). The correlation was reduced to insignificant during the intraoperative periods (R2-R5) and two hours postoperatively (R6). Significant correlation was determined between PLT/INTEM and between FIB/MCF_FIBTEM during all perioperative periods (R1 -R6). CONCLUSIONS: The correlations found in the present study suggest to perform the haemoststic liver transplantation monitoring through a parallel systematic analysis of both standard and rotation thrombelastometry parameters and confirm the ROTEM method as preferable and highly informative.