Age policy changed for lung transplants
A year ago, Sarah Murnaghan, an 11-year-old Pennsylvania girl, was fighting for her life while her family waged a campaign to change a national policy on lung transplants for child recipients. Their battle has now led to permanent policy change.
Authors: Bondeelle L, Bergeron A Abstract INTRODUCTION: Progress in allogeneic hematopoietic stem cell transplantation (HSCT) procedures have been associated with improved survival in HSCT recipients. However, they have also brought to light organ-specific complications, especially pulmonary complications. In this setting, pulmonary complications are consistently associated with poor outcomes, and improved management of these complications is required. Areas covered: We review the multiple infectious and noninfectious lung complications that occur both early and late after allogeneic HSCT. This includes the descrip...
Publication date: January 2019Source: The Annals of Thoracic Surgery, Volume 107, Issue 1Author(s): Sarah Cullivan, Karen Redmond, Carole Ridge, Oisin J. O’ConnellA 21-year-old patient presented with a short history of fatigue and dyspnea on a background of double-lung transplantation for cystic fibrosis and preexisting chronic superior vena cava obstruction. Computed tomography of the chest demonstrated a 3-cm mass occluding the right pulmonary veins, with associated right upper and lower lobe pulmonary parenchymal infiltrates. Two invasive procedures were performed, with similar complications in both procedures.
Trial and registry data have reported mortality rates and causes of death in patients with left ventricular assist devices (LVADs); however, a more granular description is needed of end of life including location of death and quality of life (QOL) to better guide expectations and care.
Chronic lung allograft dysfunction (CLAD) is the single most important factor limiting long-term survival after lung transplantation (LTx). Azithromycin has been shown to improve CLAD-free and long-term survival, yet the possible impact on early lung allograft function is unclear.
While survival after pediatric heart transplantation (pHT) has improved in the past few decades and mechanical circulatory support is increasingly used to bridge children to transplantation, waiting list deaths remain a stark reality. To increase the donor pool, strategies such as ABO-incompatible transplantation or donation after cardiac death (DCD) have been attempted.1,2 The real question we have to ask is whether the current donor pool offers are appropriately being used. The article by Davies and colleagues in this issue of the journal looked at the rate of declines in donor offers for pediatric recipients and their consequences.
It's not the size of a man, but the size of his heart that matters.Evander Holyfield, American professional boxer (1962-)
Iatrogenic lymphoproliferative disorders have been described in patients receiving immunosuppressive/immunomodulatory agents outside the transplantation setting. Novel biological agents such as TNF-α blockers and JAK-inhibitors have also proven to be effective in many disorders including rheumatoid arthritis, inflammatory bowel disease (ulcerative colitis and Crohn disease), psoriasis, and others. A significant dilemma exists in those lymphoproliferative disorders associated with immunosuppressants and rheumatologic conditions, that relies on whether the association of the process is with the medication or the underl...