Pulmonary circulatory parameters as indices for the early detection of acute rejection after single lung transplantation

P < 0.001). This was not accompanied by any abnormalities on chest roentgenography. The histology was consistent, with marked perivascular lymphocytic infiltration with little alveolar or interstitial changes. During rejection, the increased pulmonary vascular resistance in the graft was probably the result of perivascular inflammatory cell infiltration, which was seen prior to changes on chest roentgenography. Changes in the left pulmonary artery flow and histology thus appear to be closely correlated in the early stages of acute rejection. (Received for publication on Mar. 10, 1997; accepted on Nov. 6, 1997)     

Horner's syndrome following single lung transplantation

Lung transplantation have significantly improved quality of life in patients with end stage respiratory failure, however use of lifelong immunosuppressive therapy and development of bronchiolitis obliterans reflects in a 5-year survival is less the 60%. Ophthalmic complications following lung transplantation are uncommon. Some cases of infectious and malignant ophthalmic complications have been described previously. Here we describe a case of Horner's syndrome following single lung transplantation.     

The effects of single lung transplantation in rats with monocrotaline-induced pulmonary hypertension

Abstract Acute haemodynamic change after single lung transplantation for primary pulmonary hypertension was evaluated using a rat transplantation model. Inbred Fisher 344 rats were administered with 40 mg/kg monocrotaline in order to induce pulmonary hypertension. The rats whose mean pulmonary arterial pressure (PAP) was over 30.0 mmHg received a left lung isograft from a normal donor after right heart catheterization. In the control group, PAP increased after single lung transplantation. On the other hand, in the pulmonary hypertensive group, PAP was significantly decreased 60 min after the transplantation, but 3 and 6 h after the transplantation, the PAP significantly increased again. On the day after the operation, it again decreased significantly. Left-to-right lung blood flow ratio was significantly increased in rats with pulmonary hypertension compared to rats with normal pulmonary pressure on both the 1st and 3rd postoperative days. The oedema of the grafted lung was more severe in the pulmonary hypertensive group than in the control group in the acute phase. In conclusion, single lung transplantation for pulmonary hypertension shifted pulmonary blood perfusion to the grafted lung and this shift made pulmonary oedema of the grafts more severe in the acute phase. These oedematous changes, which were more pronounced in the grafts in the pulmonary hypertensive rats, might have contributed to the transient rise in PAP in those rats after single lung transplanation.     

Graft damage after a single lung transplantation for pulmonary hypertension in a rat model

The hemodynamic effect and degree of damage in grafts of single lung transplants for pulmonary hypertension were studied in rats with monocrotaline-induced pulmonary hypertension. Inbred male Lewis rats (weight 200–230 g) were divided into two groups. Group 1 (control group,n = 16) underwent isogenic left lung transplantation, while group 2 (n = 15) received an intravenous administration of monocrotaline (80 mg/kg i.v.) and underwent isogenic left single lung transplantation 3 weeks later. Hemodynamic evaluations were performed prior to transplantation, at 1h postoperatively, and on days 3 and 7 after transplantation. Mean pulmonary arterial pressure (mPAP) rapidly declined after transplantation in group 2, from 39.3 ± 8.7 mmHg to 18.5 ±3.0 mmHg 1h after transplantation, and remained stable on day 7 after tranaplantation. No significant difference in the mPAP between the two groups was observed after tranaplantation. The extravascular lung water volume (ELWV: dry/wet ratio) in the right lung of group 2 significantly increased on day 3 (0.86 ± 0.02) (P < 0.01), and subsequently decreased to control levels on day 7 (0.83 ± 0.02). There was no significant difference in the ELWV in the grafted lungs between the two groups (0.84 ± 0.03 vs 0.86 ± 0.04), but there was tendency toward an increase in ELWV in group 2 on days 3 and 7. These data thus demonstrated that a hemodynamic improvement was obtained by single lung transplantation; however the degree of graft damage was remarkable in the pulmonary hypertension group.     

Potential functional and survival benefit of double over single lung transplantation for selected patients with idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a frequent indication for lung transplantation (LTX) with pulmonary hypertension (PH) negatively affecting outcome. The optimal procedure type remains a debated topic. The aim of this study was to evaluate the impact of pretransplant PH in IPF patients. Single LTX (SLTX, n = 46) was the standard procedure type. Double LTX (DLTX, n = 30) was only performed in cases of relevant PH or additional suppurative lung disease. There was no significant difference for pretransplant clinical parameters. Preoperative mean pulmonary arterial pressure was significantly higher in DLTX recipients (22.7 ± 0.8 mmHg vs. 35.9 ± 1.8 mmHg, P < 0.001). After transplantation, 6‐min‐walk distance and BEST‐FEV₁ were significantly higher for DLTX patients (6‐MWD: 410 ± 25 m vs. 498 ± 23 m, P = 0.02; BEST‐FEV₁: 71.2 ± 3.0 (% pred) vs. 86.2 ± 4.2 (% pred), P = 0.004). Double LTX recipients demonstrated a significantly better 1‐year‐, overall‐ and Bronchiolitis obliterans Syndrome (BOS)‐free survival (P < 0.05). Cox regression analysis confirmed SLTX to be a significant predictor for death and BOS. Single LTX offers acceptable survival rates for IPF patients. Double LTX provides a significant benefit in selected recipients. Our data warrant further trials of SLTX versus DLTX stratifying for potential confounders including PH.     

肺移植受者术后肺功能的变化特点

目的 分析肺移植受者术后肺功能的变化特点。 方法 收集81例行双肺移植及心肺联合移植受者的临床资料,分析受者术后一般情况。分析肺移植受者术后1个月、3个月、每3个月（术后3~18个月）以及每6个月（术后18~36个月）肺通气及弥散功能指标。分析受者术后的最佳肺功能特点。 结果 受者术后机械通气时间为4（2,9）d,术后重症监护室入住时间为10（7,20）d。81例受者中,27例术后发生原发性移植物功能障碍（PGD）,发生率为33%。受者术后用力肺活量（FVC）占预计值百分比（FVC%pred）、第1秒用力呼气容积（FEV₁）占预计值百分比（FEV₁%pred）、FEV₁/FVC占预计值百分比（FEV₁/FVC%pred）、校正后肺一氧化碳弥散功能占预计值百分比（D_LCOc%pred）随时间发生变化（均为P<0.001）。FVC%pred、FEV₁%pred在术后9个月内逐渐上升,D_LCOc%pred在术后3个月内逐渐上升（均为P<0.05）。FVC%pred≥80%者36例,FEV₁%pred≥80%者41例,FEV₁/FVC%pred≥92%者76例;FVC%pred≤40%者1例,FEV₁%pred≤40%者1例。D_LCOc%pred≥80%者16例,校正后肺一氧化碳弥散功能/肺泡容量占预计值百分比（D_LCOc/V_A%pred）≥80%者63例;D_LCOc%pred≤40%者4例,D_LCOc/V_A%pred≤40%者1例。原发病为阻塞性肺疾病的受者术后FVC%pred、FEV₁/FVC%pred、D_LCOc%pred均高于原发病为限制性肺疾病的受者（均为P<0.05）。发生PGD的受者术后D_LCOc%pred低于未发生PGD的受者（P<0.05）。 结论 肺移植受者肺通气功能在术后9个月达到最佳状态且达到稳态,肺弥散功能在术后3个月达到稳态,原发病以及是否发生PGD可能对术后肺功能存在影响。     

肺移植闭塞性细支气管炎免疫机制研究进展

闭塞性细支气管炎是影响肺移植患者长期生存的主要因素.适应性免疫一直是肺移植排斥反应的研究重点.但是越来越多的研究表明,体液免疫、自体免疫、固有免疫等亦是闭塞性细支气管炎发生的重要因素.     

体外静脉-静脉转流下原位肝移植术病人体、肺循环的变化

目的观察体外静脉-静脉转流下原位肝移植体肺循环血液动力学的变化。方法20例原位肝移植手术病人,在无肝期采用体外静脉-静脉转流术,采用Swaan-Ganz漂浮导管监测不同时期体、肺循环血液动力学的变化。结果与基础值相比,手术期间MAP基本稳定;中心静脉压(CVP)、心输出量(CO)、心脏指数(CI)、左心功指数(LVSW)和右心功指数(RVSW),在转流期间有降低,在开放后新肝期15分钟有增高(P<0．05);肺动脉压(PAP)和肺毛细血管楔压(PAWP)在新肝期15分钟一定增加(P<0．05);体循环阻力(SVR)在无肝期增高,在新肝期15分钟降低(P<0．05);肺血管阻力(PVR)在新肝期15分钟增高;心率在转流期间加快(P<0．05)。结论原位肝移植手术中,在无肝期采用体外静脉-静脉转流术有助于血压的稳定,但体、肺循环血流动力学在无肝期和新肝早期仍有明显的变化。     

Native lung complications after single lung transplantation for emphysema

We reviewed the impact of the presence of the native diseased contralateral lung on the outcome after single lung transplantation for emphysema. Twenty consecutive recipients of single lung transplants for emphysema were reviewed for complications related to the native lung. Five patients (25 %) suffered major complications arising in the native lung and resulting in serious morbidity and mortality. The timing of onset varied from 1 day to 43 months after transplantation. We conclude that the susceptibility of the native lung to complications such as those described in this report is an additional fact to be considered in choosing the ideal transplant procedure for patients with obstructive lung disease. Received: 2 July 1996 Received after revision: 15 October 1996 Accepted: 28 October 1996     

原位肝移植术后早期细菌、真菌感染的临床研究

目的:探讨原位肝移植术后病人细菌、真菌感染的临床特点,常见病原菌及其耐药性,总结防治经验。方法:就74例原位肝移植病人术后,针对感染进行各个系统的定期检测,观察感染发生时间、部位、病原谱及药物敏感性等指标。结果:74例肝移植病人中,术后并发感染者48例,感染率为64.9%;包括单纯细菌感染24例(32.4%),单纯真菌感染6例(8.1%),混合感染(细菌合并真菌)18例(24.3%)。其中革兰阴性杆菌共占34.6%,革兰阳性球菌占34.1%。真菌占31.3%。感染大部分发生在术后1个月以内。最常见的感染部位是呼吸道,其次为尿道和胆道。感染的病原菌依次为金黄色葡萄球菌、铜绿假单胞菌和肺炎克雷伯菌。病原菌中革兰阴性杆菌对头孢吡肟和美罗培南敏感性较高,革兰阳性球菌对万古霉素和替考拉宁敏感性较高。结论:肝移植病人术后感染是影响存活的重要因素,应重视移植术前后对病人的监测和预防性抗生素应用等措施。在处理感染病情时,应综合考虑病原菌谱、药敏结果、多部位复合感染及混合感染等因素。     

Perfusatory Recovery of the Grafted Lung During Convalescence from Acute Rejection

(Received for publication on Nov. 2, 1998; accepted on July 13, 1999)     

Bronchiolitis obliterans following lung transplantation: early detection using computed tomographic scanning

BACKGROUND: Computed tomographic (CT) scanning may enable earlier diagnosis of chronic lung allograft dysfunction than forced expiratory volume in 1 second (FEV1). A study was undertaken to determine intra-observer and inter-observer agreement of composite and air trapping CT scores, to examine the association of FEV1 with the composite and air trapping CT score, and to relate the baseline composite CT score to changes in FEV1 and changes in the composite CT score over 1 year. METHODS: Lung function and baseline CT scans following transplantation and at subsequent annual follow ups were analysed in 38 lung transplant recipients. Scans were randomly scored by two observers for bronchiectasis, mucus plugging, airway wall thickening, consolidation, mosaic pattern, and air trapping, and re-scored after 1 month. CT scores were expressed on a scale of 0-100 and correlated with FEV1 as a percentage of the post-transplant baseline value. RESULTS: The mean (SD) interval between baseline and follow up CT scans was 11.2 (4.7) months. Inter-observer and intra-observer agreement was good for both the composite and air trapping CT scores. There was a significant association between FEV1 and the composite CT score, with each unit of worsening in the baseline composite CT score predicting a 1.55% and 1.37% worsening in FEV1 over the following year (p<0.0001) and a 1.25 and 1.12 unit worsening in the composite CT score (p<0.0001) for observers 1 and 2, respectively. CONCLUSION: These findings indicate a potential role for a composite CT scoring system in the early detection of bronchiolitis obliterans.     

单肺移植治疗终末期慢性阻塞性肺疾病患者单中心经验

目的探讨单肺移植治疗终末期慢性阻塞性肺疾病（COPD）患者的疗效、预后相关因素及术后并发症防治。方法回顾性分析同济大学附属上海市肺科医院2003年1月至2011年2月施行的23例终末期COPD患者单肺移植的临床资料,分析术后临床疗效、预后和并发症发生情况,并探讨性别、年龄、原发病等因素对受者预后的影响。结果 COPD患者术后肺通气功能和动脉血气分析结果均明显改善。气管吻合口并发症发生率为13.0%;围手术期病死率为4.3%。术后肺部真菌感染发生率为39.1%,伊曲康唑或卡泊芬净＋两性霉素B预防性抗真菌治疗的受者术后真菌感染的发生率明显降低（P=0.035）。急性排斥反应发生率为34.8%,闭塞性细支气管炎发生率为26.1%。受者术后1、3和5年存活率分别为83%、66%和45%。单肺再次移植2例。结论单肺移植治疗终末期COPD是安全、有效的方法,受者选择和术后并发症的防治对受者长期生存有重要意义。     

Comparing outcomes in patients with end-stage chronic obstructive pulmonary disease: single versus bilateral lung transplants

 Open in a separate windowOBJECTIVESDebate continues on whether a bilateral (BLT) or a single lung transplantation (SLT) is preferred for patients with end-stage chronic obstructive pulmonary disease (COPD). The purpose of this study is to examine the interplay between patient age and transplant type on survival outcomes. METHODSWe performed a retrospective study of lung transplants for COPD at our centre from February 2012 to March 2020 (n = 186). Demographics and clinical parameters were compared between patients based on their age (≤65 vs >65 years old) and type of transplant (single vs bilateral). Cox proportional hazards regression was also performed. P-values <0.05 were considered significant.RESULTSOf the 186 patients with COPD who received lung transplants, 71 (38.2%) received BLTs and 115 (61.8%) received SLTs. There was no significant difference in survival outcomes when looking at patients with single versus BLTs (P = 0.870). There was also no difference in survival between the 2 age groups ≤65 versus > 65 years (P = 0.723). The Cox model itself also did not show a statistically significant improvement in survival outcomes (P = 0.126).CONCLUSIONSLung transplant outcomes in patients with end-stage COPD demonstrated non-inferior results in patients with an SLT compared to patients with a BLT. When we compared the age groups, neither transplant type showed superior survival benefits, suggesting there may be some utility in an SLT in younger recipients.