Pulmonary Complications of Lung Transplantation

Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA 22042, USA.
Chest (Impact Factor: 7.48). 02/2011; 139(2):402-11. DOI: 10.1378/chest.10-1048
Source: PubMed


Lung transplantation is an effective treatment option for select patients with a variety of end-stage lung diseases. Although transplant can significantly improve the quality of life and prolong survival, a myriad of pulmonary complications may result in significant morbidity and limit long-term survival. The recognition and early treatment of these complications is important for optimizing outcomes. This article provides an overview and update of the pulmonary complications that may be commonly encountered by pulmonologists caring for these patients.

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    • "In chronic lung disease patients who have severe progressive impairment and a high level of inactivity, lung transplantation is recommended as an essential therapeutic intervention, being an effective treatment option.( 3 ) The most common indications for this intervention are emphysema (in 36%), idiopathic pulmonary fibrosis (in 20%), and cystic fibrosis (in 16%).( 4 ) In transplantation candidates, assessment of their level of physical activity is an important tool for quantifying the impact of the disease on their activities of daily living (ADL).( 5 ) "
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    ABSTRACT: Objective: To evaluate the applicability of the London Chest Activity of Daily Living (LCADL) scale in patients on the waiting list for lung transplantation. Methods: This was a cross-sectional study, conducted between May and September of 2010, involving 26 male and female patients on the waiting list for lung transplantation and treated at the Pulmonary Rehabilitation Program in the Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, located in the city of Porto Alegre, Brazil. We evaluated the patients using the six-minute walk test (6MWT) and pulmonary function tests. We also obtained the LCADL scores, as well as the modified Borg scale scores for sensation of dyspnea and leg fatigue. Cronbach's alpha coefficient was used to determine the internal consistency of the LCADL scale. Linear regression analysis was used in order to identify associations between the total LCADL score (expressed as a percentage) and the variables studied. Results: According to the LCADL scale results, 69% of the patients reported that the performance of their activities of daily living was significantly impaired by their dyspnea. The internal consistency of the LCADL scale was 0.89. After adjusting for age and FEV1, we found that the total LCADL scale score showed statistically significant negative associations with the six-minute walk distance (β = -0.087; p < 0.001) and the six-minute walk work (β = -0.285; p < 0.001). Conclusions: Our findings suggest that the LCADL scale is a useful tool for assessing patients on the waiting list for lung transplantation.
    Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 02/2013; 39(1):92-97. DOI:10.1590/S1806-37132013000100013 · 1.02 Impact Factor
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    ABSTRACT: Die Lungentransplantation (LTx) ist ein Therapieverfahren für Patienten im Endstadium von Lungenerkrankungen. Das Verfahren kann bei sorgfältiger Empfängerauswahl die Prognose und die Lebensqualität des Empfängers verbessern. Im Vergleich zur Transplantation anderer solider Organe hat sich dieses Verfahren erst relativ spät zu einer therapeutischen Alternative bei fortgeschrittenem Organversagen entwickelt. Dies liegt u.a. an den immunogenen Problemen, den hohen technischen/chirurgischen Herausforderungen sowie den deutlich erhöhten Komplikationen nach Transplantation. Zurzeit werden in Deutschland etwa 300Transplantationen pro Jahr durchgeführt. Die häufigsten Indikationen sind das Lungenemphysem, verschiedene Formen der Lungenfibrose und die zystische Fibrose (CF). Im ersten Jahr nach Transplantation herrschen Infektionen und Abstoßung als Komplikationen vor, später bestimmt das Bronchiolitis-obliterans-Syndrom (BOS) als Zeichen der chronischen Allograft-Dysfunktion das weitere Überleben. Für eine Verbesserung des Überlebens sind die rasche Diagnose und Therapie typischer Komplikationen wichtig. Durch die Bronchoskopie kann komplikationsarm Material aus dem Transplantat entnommen und eine direkte Inspektion der zentralen Atemwege und Anastomosenregion durchgeführt werden. Die transbronchiale Biopsie (TBB) und bronchoalveoläre Lavage (BAL) haben mit virologischen und mikrobiologischen Testverfahren besondere Bedeutung für die Abgrenzung der Abstoßung von Infektionen, die Diagnostik invasiver Pilz- und Virusinfektionen sowie die Abklärung unklarer Herdbefunde. Dieser Beitrag stellt die wesentlichen Befunde und Differenzialdiagnosen in der Diagnostik der TBB dar. For terminal lung disease lung transplantation is the only therapeutic option. The 5-year survival only reaches about 50% and is worse than for other solid organ transplants. In the first year post transplantation acute rejection and infections predominate as complications; later survival is dictated by bronchiolitis obliterans syndrome (BOS), e.g. the obliteration of small airways of the lung. To improve survival swift diagnosis and therapy of typical complications are necessary. Transbronchial biopsy (TBX) taken together with the results from viral and microbiological testing is an important tool to differentiate rejection from infection, to diagnose invasive viral and mycotic infections and to evaluate focal lung lesions. This review covers typical findings and their differential diagnosis in the TBX from lung transplants. SchlüsselwörterBiopsie–Lunge–Infektion–Abstoßung–Transplantation KeywordsBiopsy–Infection–Lung–Transplantation–Rejection
    Der Pneumologe 09/2011; 8(5):338-344. DOI:10.1007/s10405-010-0470-6
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    ABSTRACT: Lung transplantation is a well-established treatment option for selected patients with end-stage lung disease, leading to improved survival and improved quality of life. The last 20 years have seen a steady growth in number of lung transplantation procedures performed worldwide. The increase in clinical activity has been associated with tremendous progress in the understanding of cellular and molecular processes that limit both short- and long-term outcomes. This review gives a comprehensive overview of the current status of lung transplantation for the referring physician. It demonstrates that careful selection of potential recipients, optimisation of their condition prior to transplant, use of carefully assessed donor organs, excellent surgery and meticulous long-term follow-up are all essential ingredients in determining a successful outcome.
    Chronic Respiratory Disease 02/2012; 9(2):131-45. DOI:10.1177/1479972311435909 · 2.69 Impact Factor
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