Pediatric lung transplantation: supply and demand.

Pediatric lung transplantation: supply and demand. Curr Opin Organ Transplant. 2019 Jun;24(3):324-328 Authors: Benoit TM, Benden C Abstract PURPOSE OF REVIEW: Lung transplantation has become an accepted therapy in infants, children, and adolescents suffering from end-stage lung diseases, an impaired quality of life and reduced life expectancy. The aim of this review is to highlight specific aspects of pediatric lung transplantation and to give an update on recent findings. RECENT FINDINGS: Currently, over 100 lung transplant procedures are performed in children annually worldwide. Long-term success is limited by availability of donor organs and waitlist mortality pretransplant, and an increased infection risk because of immunosuppression, and most importantly late complications, such as chronic lung allograft dysfunction, medication nonadherence, and transition intricacies. SUMMARY: Specific aspects of pediatric lung transplantation will be reviewed and an update on most recent developments in the management of pediatric lung transplant recipients given. PMID: 31090643 [PubMed - in process]
Source: Current Opinion in Organ Transplantation - Category: Transplant Surgery Authors: Tags: Curr Opin Organ Transplant Source Type: research

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Limited donor lung availability and prolonged wait times remain substantial barriers to lung transplant. According to the Scientific Registry of Transplant Recipients, 11% of patients were removed from the wait-list in 2017 because of death or clinical deterioration and 40% of patients waited longer than 1 year before transplant. Ex vivo lung perfusion (EVLP) provides the opportunity to expand the donor pool, but despite encouraging early posttransplant outcomes, the long-term effect of EVLP remains unclear. In this issue of JAMA Surgery, Divithotawela et al present 10-year outcomes of the Toronto Lung Transplant Group &rs...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research
We aimed to assess the main causes of intensive care unit (ICU) readmissions in lung transplant adults and to identify independent predictors of ICU mortality (primary end-point). This Spanish five-centre prospective cohort study enrolled all lung transplant adults with ICU readmissions after post-transplant ICU discharge between 2012 and 2016. Patients were followed until hospital discharge or death. 153 lung transplant recipients presented 174 ICU readmissions at a median (interquartile range) of 6 (2–25) months post-transplant. Chronic lung allograft dysfunction was reported in 39 (25.5%) recipients, 13 of whom (a...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Interstitial and orphan lung disease, Respiratory infections and tuberculosis Original Articles: Infection and lung transplantation Source Type: research
CONCLUSION: The Korean urgency classification for LTx is determined by using very limited parameters and may not be a true reflection of urgency. Status 0 patients seem to have poor outcomes compared to the other urgency status patients, despite having the highest priority for donor lungs. Further multi-center and nationwide studies are needed to revise the lung allocation system to reflect true urgency and provide the best benefit of lung transplantation. PMID: 31538435 [PubMed - in process]
Source: Yonsei Medical Journal - Category: Universities & Medical Training Authors: Tags: Yonsei Med J Source Type: research
Conclusion: The addition of nitroprusside to the lung transplant perfusate in this clinical trial did not improve survival; however, a large randomized trial would likely reduce confounding ischemia times and increase the power of the study. PMID: 31528134 [PubMed]
Source: Ochsner Journal - Category: General Medicine Tags: Ochsner J Source Type: research
Gastroesophageal reflux (GERD) has been associated with several pulmonary and airway pathologies, including asthma, subglottic stenosis, pulmonary fibrosis, and bronchiolitis obliterans in patients who had a lung transplantation. Surgical treatment of GERD improves survival in patients with pulmonary fibrosis,1 improves lung allograft function,2 and decreases the need for steroids in patients with asthma.3 Idiopathic tracheal stenosis appears to be associated with GERD,4 and the treatment of GERD might improve outcomes.
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Commentary Source Type: research
AbstractCytidine 5' ‐triphosphate synthetase (CTPS) is known to be a central enzyme in thede novo synthesis of CTP. We have recently demonstrated that a deficiency in CTPS1 is associated with an impaired capacity of activated lymphocytes to proliferate leading to a combined immunodeficiency disease. In order to better document its role in immunomodulation, we developed a method for measuring CTPS activity in human lymphocytes. Using liquid chromatography ‐mass spectrometry, we quantified CTPS activity by measuring CTP in cell lysates. A stable isotope analog of CTP served as internal standard. We characterized the kine...
Source: Journal of Mass Spectrometry - Category: Chemistry Authors: Tags: RESEARCH ARTICLE Source Type: research
In this study, we investigated the effect of tacrolimus (FK506) combined with GM6001,a matrix metalloproteinase (MMP) inhibitor, on the formation of OB using a mouse heterotopic tracheal transplantation model. METHODS: Syngeneic tracheal grafts were transplanted heterotopically from BALB/c mice to BALB/c mice. Allografts from C57BL/6 mice were transplanted to BALB/c mice. Isograft group, allograft group, allograft+FK506 group, allograft +GM6001 group and allograft+FK506 + GM6001 group was given respectively intraperitoneal injection of saline, saline, FK506, GM6001 and FK506 + GM6001 once a day. At 28 da...
Source: Transplant Immunology - Category: Transplant Surgery Authors: Tags: Transpl Immunol Source Type: research
ConclusionsHydrogen water suppressed the development of mid-term obliterative airway disease in a mouse tracheal allograft model via anti-oxidant and -inflammatory mechanisms and through the activation of Tregs. Thus, hydrogen water is a potential treatment strategy for BOS that can improve the outcome of lung transplant patients.
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
We describe the case of an urgent lung transplantation in which veno-venous extracorporeal membrane oxygenation was used after open-chest management and volume reduction to allow the lung allograft to accommodate to a smaller chest cavity. The use of venous-venous extracorporeal membrane oxygenation in this case facilitated early chest closure in a patient with graft-cavity disparity while lowering the risk of infection without hemodynamic or respiratory compromise.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
There has been continuous improvement in survival after heart transplantation (HTx) and lung transplantation (LTx), facilitated by developments regarding surgical procedures and postoperative immunosuppressive regimens.1,2 However, primary graft dysfunction remains a significant source of early and late morbidity and mortality among transplant recipients.1-4 Such conditions include bronchiolitis obliterans syndrome (BOS) in LTx recipients and coronary allograft vasculopathy (CAV) in HTx recipients.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
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