Potential Role of Computed Tomography Volumetry in Size Matching in Lung Transplantation

BackgroundAccumulated knowledge on the outcomes related to size mismatch in lung transplantation derives from predicted total lung capacity equations rather than individualized measurements of donors and recipients. The increasing availability of computed tomography (CT) makes it possible to measure the lung volumes of donors and recipients before transplantation. We hypothesize that CT-derived lung volumes predict a need for surgical graft reduction and primary graft dysfunction.MethodsDonors from the local organ procurement organization and recipients from our hospital from 2012 to 2018 were included if their CT exams were available. The CT lung volumes and plethysmography total lung capacity were measured and compared with predicted total lung capacity using Bland Altman methods. We used logistic regression to predict the need for surgical graft reduction and ordinal logistic regression to stratify the risk for primary graft dysfunction.ResultsA total of 315 transplant candidates with 575 CT scans and 379 donors with 379 CT scans were included. The CT lung volumes closely approximated plethysmography lung volumes and differed from the predicted total lung capacity in transplant candidates. In donors, CT lung volumes systematically underestimated predicted total lung capacity. Ninety-four donors and recipients were matched and transplanted locally. Larger donor and smaller recipient lung volumes estimated by CT predicted a need for surgical graft reduction and were associated with higher primary graft dysfunction grade.ConclusionThe CT lung volumes predicted the need for surgical graft reduction and primary graft dysfunction grade. Adding CT-derived lung volumes to the donor-recipient matching process may improve recipients’ outcomes.     

Adaptation Over a Wide Range of Donor Graft Lung Size Discrepancies in Living‐Donor Lobar Lung Transplantation

Living‐donor lobar lung transplantation (LDLLT), unlike deceased donor lung transplantation, often involves a wide range of size discrepancies between donors and recipients. The aim of this study was to evaluate the function of donor lung grafts in the recipient thorax in 14 cases of bilateral LDLLT involving 28 successfully transplanted lower‐lobe grafts. Pulmonary function tests and three‐dimensional computed tomography (3D‐CT) volumetry were performed perioperatively. According to 3D‐CT size matching, donor graft volumes ranged from 40% to 161% of the hemilateral thoracic volumes of the recipients. Graft forced vital capacity (FVC) values increased over time, reaching 102 ± 39% of preoperatively estimated values at 12 months postoperatively. Graft volumes also increased over time, reaching 120 ± 38% of the original values at 12 months postoperatively. Undersized donor grafts expanded more after LDLLT than oversized donor grafts, producing greater FVC values than those estimated preoperatively, whereas oversized donor grafts became inflated to their original size and maintained FVC values that approached the preoperative estimates. Thus, donor grafts were found to overinflate or underinflate to the extent that they could preserve their native function in the new recipient's environment.     

Comparison of Lung Volume Measurements In Individuals With Spinal Cord Injury By Two Different Methods

Abstract

Background/Objective: Few detailed studies have been performed among subjects with spinal cord injury (SCI) using whole body plethysmography for measurement of static lung volumes. Because abdominal gas volumes and respiratory patterns among subjects with varying Ieveis of SCI may differ significantly from able-bodied individuals, methodological concerns related to this technique could conceivably Iead to inaccuracies in lung volume measurements. The purpose of this study was to compare lung volume parameters obtained by whole body plethysmography with those determined by the commonly used nitrogen washaut technique among individuals with SCI.

Participants: Twenty-nine clinically stable men, 14 with chronic tetraplegia (injury C4-C7) and 15 with paraplegia (injury below T5) participated in the study.

Methods: Lung volumes were obtained using whole body plethysmography and the open-circuit nitrogen washout technique. Within both study groups, data were evaluated by the paired Student’st test and by determination of correlation coefficients.

Results: No statistically significant differences for any lung volume parameter were found within either group. ln subjects with tetraplegia on paraplegia, respectively, strong correlation coefficients were found for measurements of totallung capacity (.8 6 and .97), functional residual capacity (.87 and .96), and residual volume (.77 and .85).

Conclusion: These findings indicate that body plethysmography is a valid technique for determining lung volumes among subjects with SCI. Because airway resistance measurements can also be obtained du ring same study sessions for assessment of airway caliber and bronchial responsiveness, body plethysmography is a useful tool for examining multiple aspects of pulmonary physiology in this population.     

Long-Term Persisting Donor-Derived Human Leukocyte Antigen Antibody as a Possible Passenger Lymphocyte Syndrome Following Lung Transplantation: A Case Report

Herein, we reported the transfer of donor-derived antihuman leukocyte antigen (HLA) antibodies in 2 recipients after lung transplantation. Case 1: A 39‐year‐old woman with pleuroparenchymal fibroelastosis underwent a single brain-dead donor lung transplantation. Antibody screening 36 days after transplantation demonstrated high levels of de novo nondonor HLA class I-specific antibodies. The antibody screening in the donor serum revealed that the donor demonstrated a largely overlapping antibody profile. Importantly, the donor serum also included high-level HLA-specific antibodies against the recipient HLA-specific antigens, which were not detected in the recipient sera after transplantation. Donor-derived anti-HLA antibodies were still detected in the recipient 39 months after transplantation, without causing any complications such as graft-vs-host disease. Case 2: A 47‐year‐old woman underwent living-donor lobar lung transplantation for pulmonary complications after bone marrow transplantation with a right lower lobe from her husband and the left lower lobe from her sister. On postoperative day 39, the recipient's anti-HLA-class I antibody profile was found to be similar to that of the highly sensitized left lung donor. These donor-derived anti-HLA antibodies remained to be produced in the recipient 66 months after transplantation, without the development of complications.     

The effect of recipient lung size on lung physiology after heart-lung transplantation

We studied the postoperative course of lung volumes in 32 heart-lung transplant recipients relative to the predicted total lung capacity of the individual donors, to assess the degree of inaccuracy likely to result from the radiological method of matching of donor and recipient lung sizes. There was a tendency for recipients with large preoperative lung volumes--from, for example, emphysema--to receive smaller lungs, while those with smaller volumes from pulmonary vascular disease received bigger donor lungs, but no immediate problems were incurred. After an initial fall in total lung capacity, the postoperative value of the total lung capacity approached the recipients' pretransplant value about one year after the operation irrespective of the size of the donor lungs. This suggests that chest wall compliance is the major determinant of postoperative lung volume and not the donor lung size or compliance. Exact matching of donors' and recipients' lung sizes may not be necessary, and if required can be simply achieved by comparing the measured total lung capacity in the recipient with the predicted value of the donor based on sex, age, and height.     

Measuring the impact of surgical intervention on pediatric pectus excavatum using white light scanning

BackgroundObjective preoperative assessment of pectus excavatum (PE) deformity in patients is limited to preoperative measurement of severity using computed tomography (CT) or magnetic resonance imaging (MRI). Postoperative assessment is currently subjective as postoperative CT scans are not recommended in light of radiation exposure and high cost to families. White Light Scanning (WLS) is a novel 3D imaging modality that offers an alternative that is a quick, nonionizing, inexpensive, and safe strategy for measurement both pre- and postsurgery. Our prior investigation demonstrated the feasibility of using WLS to measure PE deformity and showed very strong correlation of a new WLS-derived PE severity index, the Hebal–Malas Index (HMI), with CT-derived HI. The purpose of this study was to demonstrate use of WLS to assess extent of correction of PE deformities after the Nuss procedure.MethodsWLS scan data were gathered prospectively in pediatric patients with PE from 2015 to 2018. HMI was obtained from the preoperative and postoperative WLS scans. Analysis assessed the differences of preoperative and postoperative HMI. Preoperative CT-derived HI was collected from the medical record and estimated postoperative Haller Index was calculated from HMI and correlation of HMI and HI using historical data.ResultsA total of 71 patients received a preoperative CT scan and underwent surgery for PE. Of those, 63 (89%) received WLS preoperatively and 51 (72%) had complete preoperative and postoperative WLS data. The average postoperative decrease in the WLS-derived HMI was 0.35 (SD: 0.15) and 1.73 (SD: 1.03) in WLS-estimated HI.ConclusionsWLS is highly effective in objectively quantifying the extent of surgical correction in PE patients.Level of evidenceIVType of studyDiagnostic Study     

Relation Between Atherosclerotic Calcifications Detected in Chest Computed Tomography and Lung Function

Background and objectivesA few recent epidemiological findings indicate a link between atherosclerosis and some lung functions. We studied further the relation between calcified chest atherosclerosis as seen in computed tomography (CT) and several lung functional parameters.Patients and methodsMale construction workers originally screened for occupational lung cancer with CT had their chest atherosclerosis (aorta, the origins of its cervical branches, the coronary arteries and heart valves) visually classified. The relation between the atherosclerotic calcification scores and lung function (total lung capacity [TLC], forced expiratory volume in one second [FEV₁%], forced vital capacity [FVC%], maximal expiratory flow when 50% of FVC remains to be exhaled, total and specific diffusing capacities; all above expressed as percent of predicted value, and the FEV₁/FVC% ratio) were studied with the general linear model adjusted for smoking, exposure years for asbestos, and body mass index (n = 432).ResultsAll lung functions except TLC showed significant negative associations with calcifications in aorta and in its branches. TLC showed such association only with atherosclerosis in the ascending aorta.ConclusionsAortic atherosclerosis seems to be related with poor lung function. This may be due to deteriorated bronchial circulation, but other mechanisms can also be involved. Lung function poorer than would be expected due to pulmonary reasons may indicate aortic atherosclerosis.     

Critical evaluation of computerised x ray planimetry for the measurement of lung volumes.

BACKGROUND--Computerised x-ray planimetry has been advocated as an alternative to body plethysmography and helium dilution for measuring static lung volumes. The accuracy and reproducibility of this method has been assessed in comparison with these standard methods. METHODS--Plethysmographic and planimetric measurements of total lung capacity (TLC) and functional residual capacity (FRC) were made in 10 normal subjects and in 12 patients with chronic obstructive pulmonary disease (COPD), with additional helium dilution measurements in the latter 12 patients. RESULTS--Mean lung volumes (TLC and FRC) for groups of subjects measured by planimetry and by plethysmography were similar in both groups and larger than the helium dilution measurement in patients with COPD. Intraindividual agreement between planimetry and plethysmography was poor, however, with a wide confidence interval (-2.2 to +2.31). The planimeter did not measure reliably changes in volume from TLC to FRC in individuals. CONCLUSIONS--Mean lung volumes measured by planimetry in a group of patients probably reflect a regression to the mean of the computer algorithm rather than accurate TLC estimation. The technique is not yet robust enough to replace the established techniques of helium dilution or plethysmography.     

Phenotyping Chronic Lung Allograft Dysfunction Using Body Plethysmography and Computed Tomography

Restrictive subtype of chronic lung allograft dysfunction (CLAD) was recently described after lung transplantation. This study compares different definitions of a restrictive phenotype in CLAD patients and impact on survival. Eighty‐nine CLAD patients out of 1191 screened patients (September 1987 to July 2012) were included as complete longitudinal lung volume measurements and chest computed tomography (CT) after CLAD onset was available. CT findings and lung volumes were quantified and survival was calculated for distinctive groups and predictive factors for worse survival were investigated. Graft survival in patients with total lung capacity (TLC) between 90% and 81% of baseline (BL) (n = 13, 15%) in CLAD course was similar to those with TLC >90% BL (n = 64, 56%; log‐rank test p = 0.9). Twelve patients (13%) developed a TLC ≤80% BL and 10 (11%) had significant parenchymal changes on CT, of whom 6 (46%) also had TLC ≤80% BL. CT changes correlated with TLC ≤80% BL (Φ‐coefficient = 0.48, p = 0.001). Patients with either TLC ≤80% or significant CT changes (n = 16, 18%) had a significantly reduced survival (log‐rank p < 0.001). Forced vital capacity loss at CLAD onset was associated with poorer survival but did not correlate with the TLC or CT changes. A restrictive subtype of CLAD may be defined by either TLC ≤80% BL or severe parenchymal changes on chest CT.     

青少年特发性脊柱侧凸患者术前肺功能与肺容积相关性研究：利用CT三维重建肺容积

目的 搜集三维CT重建下青少年特发性脊柱侧凸患者术前总肺容积（total lung volume,Vt）、右肺容积（volume of right lung,Vr ）、左肺容积（volume of left lung,Vl ）和左侧肺容积/右侧肺容积比值（Vl/Vr）与年龄相关对照值比较是否存在差异,并且回顾性研究术前肺容积和肺功能参数相关性.方法 共24例患者,平均Cobb角52°.所有患者术前行肺功能检查（通气和弥散）,胸部CT扫描,并进行肺实质三维重建.Vt、Vr、Vl、Vl/Vr和右侧与左侧肺容积差值绝对值（︱Vr-Vl︱）分别与肺功能测量结果进行相关性分析.以肺活量（vital capacity,VC）、用力肺活量（forced vital capacity,FVC）和肺总量（total lung capacity,TLC）为因变量,与肺容积数据建立多元线性回归分析模型,获得回归方程.结果 Vt与VC、FVC呈正相关（P＜0.05）,Vt与TLC近似正相关（P=0.055）,与50%肺活量时最大呼气流量（forced expiratory flow of 50% forced vital capacity,FEF50%）、FEF75%呈负相关,与其他参数均无相关性（P＞0.05）.︱Vr-Vl︱与最大通气量占预计值百分比（percentages of maximal ventilatory volume to predicted values,MVV%）呈负相关,与弥散参数无相关性（P＞0.05）;男性和女性患者Vt与Vr较对照值均减小,女性患者Vl/Vr和对照值差异有统计学意义.结论 青少年特发脊柱侧凸术前Vt与VC、FVC、TLC呈明显正相关;侧凸患者Vt、Vr较正常对照值减小.从单纯的保存肺功能角度,建议后路手术尽量减少两侧肺容积不对称性,可以阻止MVV%继续下降.     

The Improvement of Patient's Quality of Life After Kidney Transplantation in Cipto Mangunkusumo Hospital,Indonesia

ObjectivesKidney transplantation has become the chosen kidney replacement therapy for end stage chronic kidney disease. In Indonesia, no study about quality of life (QoL) in kidney transplantation recipient after surgery has been done. This study aims to determine whether there is a significant difference in the recipient's QoL before and after kidney transplantation surgery.Methods and MaterialsThis was a prospective study using Kidney Disease QoL-Short Form (KDQoL-SF) questionnaire before and after surgery (first, third, and sixth month). Samples were consecutively taken from January 2016 until May 2016 and followed up to December 2016. KDQoL-SF has been validated in Indonesian language to assess recipient's QoL (Cronbach alfa >0,6). The data were analyzed using SPSS statistical software 21.0 version and repeated analysis of variance with posthoc comparison Bonferroni was used.ResultsThere were 33 patients included in this study from January through December 2016. The average age was 44.6 ± 12.88 years old, and average body mass index was 23.8 ± 3.74 kg/m². The most frequent comorbidity was hypertension (32, 97%). Compared to baseline, the QoL in recipients increased at the first, third, and sixth month after their operation. Major changes in the perceived QoL were noted only between the preoperative stage (median, 50%; interquartile range, [IQR]) ±20) and 1 month after operation (median, 90%; IQR, 0).ConclusionsThis study showed that there were significant improvements in almost all aspect in recipient's QoL after kidney transplantation.     

Lung volumes in normal Cantonese subjects: preliminary studies.

Measurements of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, functional residual capacity (FRC), total lung capacity (TLC), residual volume (RV), and RV/TLC ratio have been made in 331 normal Cantonese subjects (134 male and 197 female). The results have been expressed in multiple regression equations relating the volumes to age, height, and weight and have been compared with those of other workers. Lung volumes obtained in this study are in general lower for Chinese subjects than those reported for Caucasians. Similar findings for FVC were reported by Chuan and Chia (1969) in Singapore and by Wu and Yang (1962) in Taiwan. Significant differences, however, are noted for FRC, TLC, RV, and RV/TLC between our findings and those of Chuan and Chia. Our series is unbalanced because of an uneven distribution of age groups. In fact in none of the reported studies on Chinese subjects, including that of da Costa (1971), is the series large or balanced. Clearly, further research is required in this ethnic group to get more reliable predictive formulae for lung volumes.     

Right and Left Inverted Lobar Lung Transplantation

Adult recipients frequently withdraw from living‐donor lobar lung transplantation because of the small size of donor grafts. The right lower lobe is 120% larger than the left lower lobe. We developed a novel surgical technique in which an inverted right lower lobe graft can be transplanted into the left thorax. The first patient was a 43‐year‐old woman with end‐stage idiopathic interstitial pneumonia. Her husband was the only eligible donor for living‐donor lobar lung transplantation. His right lower lobe was estimated to provide 45% of the recipient's predicted forced vital capacity, which would provide the borderline function required for living‐donor lobar lung transplantation. Since lung perfusion scintigraphy of the recipient showed a right‐to‐left ratio of 64:36, transplanting the right lower lobe graft into the left thorax and sparing the native right lung was considered the only treatment option. We simulated this procedure using three‐dimensional models produced by a three‐dimensional printer. In living‐donor lobar lung transplantation, all anastomoses were performed smoothly as planned preoperatively. Because of the initial success, this procedure was performed successfully in two additional patients. This procedure enables larger grafts to be transplanted, potentially solving critical size matching problems in living‐donor lobar lung transplantation.     

Influence of Fluid Therapy on Kidney Function in the Early Postoperative Period After Lung Transplantation

BackgroundPerioperative fluid therapy among patients undergoing lung transplantation (LT) has a significant clinical importance, including developing of acute kidney injury (AKI). The presence of AKI in the early postoperative period is associated with increased mortality in lung transplant recipients. Analysis includes the relationship between the volume of infused fluids, the balances of crystalloids and colloids during LT procedure and in the first 24 hours and the estimated glomerular filtration rate (eGFR) values in the following days of the postoperative period.MethodsRetrospective study of 73 consecutive patients undergoing LT between 2015 and 2018 in our institution. Deterioration of renal function was defined as the change in eGFR that occurred between baseline eGFR and the first and 7 first postoperative days following transplantation. The Chronic Kidney Disease Epidemiology Collaboration formula was used to calculate the eGFR value.ResultsThe greatest decline of eGFR in the early postoperative period was demonstrated on day 7 (ΔeGFR = 75.76 ± 40.08). Increased negative crystalloid balances during the LT procedure were strongly associated to less decrease in eGFR value on the seventh day post-LT (r = –0.997, P < .05). Increased volumes of transfused colloids during LT were correlated to less decline of eGFR value on day 7 (r = –0.3981, P < .05).ConclusionsNegative crystalloid balance in the early postoperative period post-LT has a potentially protective effect on kidney function, although fluid balances management should be individually considered for potential clinical benefits. The impact of the fluid administration after LT on the occurrence and recovery of AKI among lung transplant recipients requires further investigation.     

Lung function abnormalities in repaired oesophageal atresia and tracheo-oesophageal fistula.

BACKGROUND: Respiratory complications are common after neonatal repair of oesophageal atresia and tracheo-oesophageal fistula. The prevalence of lung function abnormalities and the relation between gastrointestinal complications and lung function has not been studied in a large number of patients. METHODS: Lung volumes and flow-volume loops were measured in 155 patients without spinal curvature aged 6-37 years who had undergone surgery for oesophageal atresia and tracheo-oesophageal fistula. RESULTS: Sixty four of the 155 patients had evidence of mild lower airways disease, with values for FEV1 more than two standardised scores below the predicted value in 39 (25%) and above 2 standardised scores for the residual volume (RV)/total lung capacity (TLC) ratio in 64 (41%). Restrictive lung disease (TLC more than 2 standardised scores below predicted) was present in 28 (18%). Severe lung function abnormalities were present in under 10% of the 155. Half the subjects had some evidence of extra-thoracic tracheal obstruction, with a high ratio of expiratory to inspiratory flow for peak flow in 76 (50%) and at 50% of vital capacity in 59 (38%). Patients with radiological gastro-oesophageal reflux in early childhood had more airways obstruction and smaller lung volumes. Patients with current gastrointestinal symptoms were similar in their lung function to symptom free patients. CONCLUSIONS: Minor lung function abnormalities are common in patients after repair of oesophageal atresia. Early diagnosis and management of gastro-oesophageal reflux may help to minimise these lung function abnormalities.     

Long-Term Outcomes of Cadaveric Lobar Lung Transplantation: An Important Surgical Option

Background: Cadaveric lobar lung transplantation (L-LTx) is developed to overcome donor–recipient size mismatch. Controversial short- and long-term outcomes following L-LTx have been reported compared to full-sized lung transplantation (F-LTx). This study reports long-term outcomes after L-LTx.Methods: We reviewed patients undergoing lung transplantation (LTx) between 2000 and 2016. The decision to perform L-LTx was made based mainly on donor–recipient height discrepancy and visual assessment of donor lungs. Predicted donor–recipient total lung capacity (TLC) ratio was calculated more recently. Primary outcome was overall survival.Results: In all, 370 bilateral LTx were performed during the study period, among those 250 (67%) underwent F-LTx and 120 (32%) underwent L-LTx, respectively. One- and 5-year survival rates were 85% vs. 90% and 53% vs. 63% for L-LTx and F-LTx, respectively (p = 0.16). Chronic lung allograft dysfunction (CLAD)-free survival at 5 years was 48% in L-LTx vs. 51% in F-LTx recipients (p = 0.89), respectively. Age, intraoperative extracorporeal membrane oxygenation (ECMO) use, intensive care unit (ICU) stay, and postoperative renal replacement therapy (RRT) were significant prognostic factors for survival using multivariate analysis.Conclusions: Overall survival and CLAD-free survival following L-LTx were comparable to F-LTx. Given the ongoing donor organ shortage, cadaveric L-LTx remains as an important resource in LTx.     

Evaluation of postoperative change in lung volume in adolescent idiopathic scoliosis: Measured by computed tomography

Background:

Change in total lung volume after surgical correction in adolescent idiopathic scoliosis (AIS), measured by computed tomography (CT), has not been studied previously. The primary objective of this study was to measure the change in lung volume between pre and postoperative AIS using low-dose CT and secondary objective was to investigate its relationship to postoperative pulmonary complications.

Materials and Methods:

55 AIS patients underwent surgery for correction and fusion using a posterior only approach and pedicle screws. Pre and postoperative lung volumes were measured using a 3-dimensional (3D) whole spine CT (low dose protocol: Tube current, 60 mA; tube voltage 120 kV). Postoperative low dose CT was undertaken at 4 weeks after operation to evaluate the acute changes of postoperative lung volumes and pulmonary complications. The software that was used recognizes the “air density shade” of the lung and the volume of every section of the lung. The software then automatically calculates total lung volume by summation of all section volumes. The relationships between postoperative pulmonary complications and changes in lung volume on low dose CT as well as preoperative forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV₁) were calculated using logistic regression analysis.

Results:

There was a decrease of 12% ± 23.2% in total lung volume postoperatively on 3D low dose CT (P < 0.001). Thirteen patients had increased lung volume while 42 had decreased lung volume postoperatively. Pulmonary complications were treated without severe sequale. Lung volume increased by 19.65% ± 19.84% in 13 patients and decreased by 21.85% ± 13.32% in 42 patients (P = 0.647). Lung volume was increased in patients whose preoperative lung volume, FEV₁ and FVC were lower than in patients whose values were higher (r = −0.273, −0.291 and − 0.348; P = 0.044, 0.045 and 0.015, respectively). Postoperative lung volume was also increased when intraoperative fluid administration was larger and operative time was longer (r = 0.354, 0.417 and P = 0.008, 0.002, respectively). There was a statistically significant negative correlation in the change of lung volume in female patients when compared with male patients (r = −0.294, P = 0.03).

Conclusion:

Patients with AIS who have preoperative reduced lung volumes or lung functions can achieve further increased lung volume after surgical correction. Pulmonary complications during perioperative period were mostly treated with proper management without severe sequale. Therefore, although surgery for AIS is considered to be a high risk procedure, we can recommend to correct spine deformity in patients with severe AIS in order to improve lung function and long term prognosis.     

Biomarkers of biological aging in recipients of solid organ transplantation and clinical outcomes: A scoping review

IntroductionBiological aging is the accumulation of cellular and molecular damage within an individual over time. The biological age of a donor organ is known to influence clinical outcomes of solid organ transplantation, including delayed graft function and frequency of rejection episodes. While much research has focused on the biological age of donor organs, the recipient's biological age may also influence transplantation outcomes. The aim of this scoping review was to identify and provide an overview of the existing evidence regarding biological aging in solid organ transplant recipients and the impact on patient outcomes post-transplant.MethodsLiterature searches were carried out on PubMed, Web of Science, Google Scholar, Embase and TRIP using the phrases ‘solid organ transplant’, ‘cell senescence’, ‘cell aging’ and ‘outcomes’, using boolean ‘and/or’ phrases and MeSH terms. Duplicates were removed and abstracts were reviewed by two independent reviewers. Full papers were then screened for inclusion by two reviewers. Data extraction was carried out using a standardised proforma agreed on prior to starting.Results32 studies, including data on a total of 7760 patients, were identified for inclusion in this review; 23 relating to kidney transplant recipients, three to liver transplant, five to lung transplant and one to heart transplantation. A wide range of biomarkers of biological aging have been assessed in kidney transplant recipients, whereas studies of liver, lung and heart transplant have predominantly assessed recipient telomere length. The most robust associations with clinical outcomes are observed in kidney transplant recipients, possibly influenced by the larger number of studies and the use of a wider range of biomarkers of biological aging. In kidney transplant recipients reduced thymic function and accumulation of terminally differentiated T cell populations was associated with reduced risk of acute rejection but increased risk of infection and mortality.ConclusionStudies to date on biological aging in transplant recipients have been heavily biased to kidney transplant recipients. The results from these studies suggest recipient biological age can influence clinical outcomes and future research is needed to prioritise robust biomarkers of biological aging in transplant recipients.     

Long-Term Feasibility of Rescue Reconstruction for Isolated Bile Ducts With Using Cystic Duct in Living Donor Liver Transplantation

BackgroundThe isolated bile duct is sometimes observed in the right liver graft of living donor liver transplantation (LDLT). Even though, as a rescue option, it is known to use the recipient's cystic duct (CyD) for duct-to-duct anastomosis, the long-term feasibility of rescue duct-to-CyD (D-CyD) anastomosis remains unclear.MethodsWe prospectively collected data in the right liver-LDLT cohort and compared rescue D-CyD anastomosis (n = 4) with standard duct-to-hepatic duct (D-HD, n = 45) anastomosis (D-CyD group, n = 4).ResultsThe observation period was over 5 years (range, 68-171 mo) after LDLT.The D-CyD group included the following anastomosis procedures: anastomosis between the intrahepatic bile duct of the graft and the CyD of the recipient and anastomosis between the posterior HD and the CyD. Surgical outcomes between the 2 groups are similar, excluding the time for the biliary reconstruction (D-CyD, 116 ± 13 min vs D-HD, 57 ± 3 min). During the period, one recipient in the D-CyD group exhibited postoperative biliary stricture and biliary stone, and 6 recipients underwent those complications in the D-HD group (D-CyD, 25.0% vs D-HD, 13.3%) All recipients in the D-CyD group are presently alive and have not experienced liver dysfunction.ConclusionsOur findings suggest that rescue D-CyD anastomosis for an isolated bile duct in a right liver LDLT is acceptable as a life-saving option in terms of long-term feasibility.     

Effects of pneumothorax or pleural effusion on pulmonary function.

The effects of pneumothorax or pleural effusion on respiratory function as measured by the commonly applied tests were investigated by studying 13 patients (six with pneumothorax, seven with effusion) with and, as far as possible, without air or fluid in the pleural cavity. Measurements included spirometric volumes, carbon monoxide transfer factor (TLCO), and KCO by the single breath method, maximum expiratory flow-volume curves, and subdivisions of lung volume estimated by both inert gas dilution and body plethysmography. In patients with pneumothorax "pleural volume" was estimated as the difference between lung volumes measured by dilution and thoracic gas volume measured by plethysmography. In patients with effusion the change in "pleural volume" was equated with the volume of fluid subsequently aspirated. "Total thoracic capacity" (TTC) was estimated by adding total lung capacity (TLC) measured by dilution and "pleural volume." Both effusion and pneumothorax produced a restrictive ventilatory defect with reductions of vital capacity, functional residual capacity, and TLC. In the patients with effusion TTC fell after aspiration, suggesting that the pleural fluid produced relative expansion of the chest wall as well as compression of the lung. In patients with pneumothorax, however, there was no difference in TTC with and without air in the pleural space. In the presence of pleural air or fluid there was a slight decrease in TLCO and increase in KCO, with a small but significant increase in the rate of lung emptying during forced expiration.