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ABSTRACT: Lung transplantation cases have immunosuppression maintained using a calcineurin inhibitor, anti-metabolites, and steroid.
We report 2 clinical cases in which anti-metabolites (mycophenolate mofetil) were successfully withdrawn after living donor lobar lung transplantation by monitoring immune function using the ImmuKnow® assay. In the first case, a 43-year-old woman underwent living donor lobar lung transplantation for pulmonary alveolar proteinosis. Two healthy relatives donated a lower lobe each. Immunosuppression was maintained using tacrolimus, mycophenolate mofetil, and steroid. Six months posttransplantation, she developed invasive pulmonary aspergillosis. During anti-fungal treatment, we withdrew mycophenolate mofetil and tacrolimus trough levels were kept around 8 ng/mL. Despite the resulting low-level immunosuppression, the ImmuKnow assay showed immune function to be in the moderate range with tacrolimus and steroid alone, encouraging us to maintain this strategy to avoid recurrence of invasive pulmonary aspergillosis. In the second case, a 24-year-old man underwent living donor lobar lung transplantation for cystic fibrosis. Two healthy relatives donated a lower lobe each. Immunosuppression was maintained using tacrolimus, mycophenolate mofetil, and steroid. Five months posttransplantation, he developed persistent Pseudomonas aeruginosa pneumonia derived from the paranasal sinuses. Under ImmuKnow assay monitoring, mycophenolate mofetil was withdrawn, but immune function was maintained within the moderate range using tacrolimus and steroid alone.
Respiratory function in both cases was maintained; no findings of bronchiolitis obliterans syndrome were noted during this period. To the best of our knowledge, no reports have described successful anti-metabolite withdrawal in lung transplantation with ImmuKnow monitoring. Immune evaluation by ImmuKnow could offer a useful method to monitor and control immune status, particularly among recipients susceptible to infection, revealing that moderate immune function could be maintained using tacrolimus and steroid in living donor lobar lung transplantation.
Transplantation Proceedings 01/2013; 45(1):356-9. · 1.00 Impact Factor
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ABSTRACT: After major noncardiac thoracic operations, various types of arrhythmia would occur. Particularly atrial fibrillation (Af), have remained one of the most frequent complications. In the literatures, risk factors for post operative Af have identified age, male, extent of pulmonary resection and mediastinal lymph node dissection. When we would meet the patients complicated with arrhythmia, the etiology of it must be identified and treated before operations. If accidental arrhythmia occurred during or after operations, the etiology of arrhythmia as hypoxia, hypercapnea, electrolyte disorder, overhydration and cardiac ischemia would be checked and cleared at first. Then appropriate drugs should be considered to use due to the type of arrhythmia. In supraventricular tachyarrhythmia, especially Af, landiolol and verapamil would be effective for the rate control and disopyramide and procaineamide for the defibrillation. Lidocaine and propranolol would be an appropriate choice for ventricular tachyarrhythmia during operations. For ventricular tachyarrhythmia related with acute myocardial infarction, lidocaine and mexiletine would be proper. In bradyarrhythmias a temporary pacing should be the first choice for urgent therapy. A prompt assessment and an adequate therapy must be mandatory for the arrhythmias after major noncardiac thoracic operations.
Kyobu geka. The Japanese journal of thoracic surgery 07/2008; 61(8 Suppl):715-20.
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ABSTRACT: To find out the optimal surgical indication in stage IV lung cancer patients, we evaluated them retrospectively.
From 1975 to 2005, 62 patients without multiple metastases were operated at our hospital. The most common histological type was adenocarcinoma (67.7%). The metastatic lesions were lung (33.9%), brain (24.2%), liver, bone, adrenal gland and so on. The overall survival rate of stage IV lung cancer was 10.4% at 5-year. Five-year survival for patients with lung or brain metastasis who had no lymph node metastasis were significantly more superior than those with lymph node metastasis (p=0.0389, 0.0021). Four of 62 patients had 5-year survival. Two were lung and the others were brain and adrenal gland metastasis without lymph node metastasis.
Stage IV lung cancer with lung or brain or adrenal gland metastasis without lymph node metastasis should be resected.
Kyobu geka. The Japanese journal of thoracic surgery 01/2006; 59(1):36-40.
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ABSTRACT: We investigated the effect of gamma-hydroxybutyrate (GHB) when added to the low-potassium University of Wisconsin (LPUW) solution used for the preservation of canine lung for 24 hr. We also examined the effect of pretreatment of donor and recipient dogs with GHB on lung function after transplantation.
Two groups were investigated. In the LPUW group, donor lungs were flushed with LPUW solution without GHB. In the GHB group, donor and recipient dogs were pretreated with GHB, and donor lungs were flushed with LPUW containing GHB.
Posttransplant graft function was best in the GHB group. At 1 hr after reperfusion, PaO2 in the GHB group (475.7+/-96.2 mmHg) was significantly higher than in the LPUW group (188.3+/-102.7 mmHg, P<0.05). Furthermore, the use of GHB resulted in a significant increase in lung compliance (28.3+/-6.5 ml/cm H2O) compared with LPUW group (21.5+/-2.8 ml/cm H2O).
Our results suggest that GHB is potentially useful for functional improvement of hypothermically preserved canine lung allografts after reperfusion.
Transplantation 02/1999; 67(4):529-33. · 4.00 Impact Factor
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S Yamamoto,
K Kawahara,
T Takahashi,
S Akamine,
T Tagawa,
A Nakamura,
M Muraoka,
S Ide,
N Sasaki,
H Shingu,
T Nagayasu, N Yamasaki,
M Tomita
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ABSTRACT: 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 week later. Hemodynamic evaluations were performed prior to transplantation, at 1 h 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 1 h after transplantation, and remained stable on day 7 after transplantation. No significant difference in the mPAP between the two groups was observed after transplantation. 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.
Surgery Today 01/1997; 27(1):51-6. · 1.22 Impact Factor
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Transplantation Proceedings 07/1996; 28(3):1400-1. · 1.00 Impact Factor
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Transplantation Proceedings 07/1996; 28(3):1418-9. · 1.00 Impact Factor
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Transplantation Proceedings 07/1996; 28(3):1893-4. · 1.00 Impact Factor
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ABSTRACT: The efficacy of 15-deoxyspergualin (DSG), cyclosporin A (CyA), and splenectomy--alone or in combination--in prolonging the survival of concordant lung xenotransplants was studied in the hamster-to-rat model. In the untreated group, rejection occurred within 3 days, with an elevation of lymphocytotoxic antibody titers. The rejected lung revealed that ED1 + cells were more prevalent than MRC OX8 + cells in the perivascular infiltrates. In the DSG group, the antibody response was suppressed and median survival increased to 7.5 days. The rejected lungs demonstrated a highly significant depression in ED1 + cellular infiltration and a moderate MRC OX8 + cellular infiltration. When maintenance CyA was combined with a short course of DSG, survival dramatically increased to beyond 100 days. There were no deposits of IgM, IgG, or C3 or of any cell infiltrate in the grafts of two animals sacrificed 107 and 119 days post-transplantation. We conclude that initial treatment with DSG combined with continuous CyA can suppress acute rejection in the hamster-to-rat lung xenograft model, resulting in long-term graft survival.
Transplant International 02/1996; 9(3):184-93. · 2.92 Impact Factor
