Chronic lung allograft dysfunction: light at the end of the tunnel?

Chronic lung allograft dysfunction: light at the end of the tunnel? Curr Opin Organ Transplant. 2019 Jun;24(3):318-323 Authors: Verleden SE, Vos R, Verleden GM Abstract PURPOSE OF REVIEW: Chronic lung allograft dysfunction (CLAD) has been recently introduced as an umbrella-term encompassing all forms of chronic pulmonary function decline posttransplant with bronchiolitis obliterans syndrome and restrictive allograft syndrome as the most important subtypes. Differential diagnosis and management, however, remains complicated. RECENT FINDINGS: Herein, we provide an overview of the different diagnostic criteria (pulmonary function, body plethysmography and radiology) used to differentiate bronchiolitis obliterans syndrome and restrictive allograft syndrome, their advantages and disadvantages as well as potential problems in making an accurate differential diagnosis. Furthermore, we discuss recent insights in CLAD management and treatment and advances in the search for accurate biomarkers of CLAD. SUMMARY: Careful dissection of CLAD phenotypes is of utmost importance to assess patient prognosis, but uniform diagnostic criteria are desperately needed. There is a long way ahead, but the first steps towards this goal are now taken; tailored individualized therapy will be the golden standard to treat CLAD in the future, but randomized placebo-controlled and multicentre trials are needed to identify new and powerful therapeutic agents. PMID: 3109064...
Source: Current Opinion in Organ Transplantation - Category: Transplant Surgery Authors: Tags: Curr Opin Organ Transplant Source Type: research

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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 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
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
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
arte A, Vaquero J Abstract INTRODUCTION: Bronchiolitis obliterans (BO) is the most common expression of chronic allograft dysfunction in lung transplantation. Moreover, BO represents the major cause of death in the long-term after this procedure. On the other hand, mesenchymal stem cells have been tested in animal models of BO aiming to interfere in its development. The aim of this experimental study is to explore the role of bone-marrow derived stem cells (BMSCs) as a preventive intervention of BO occurrence. MATERIALS AND METHODS: This an experimental randomized study. A bronchiolitis obliterans animal mode...
Source: Archivos de Bronconeumologia - Category: Respiratory Medicine Authors: Tags: Arch Bronconeumol Source Type: research
ConclusionsDonor BDD is not associated with post-transplant survival or PGD. Long donor BDD, however, is associated with a decreased risk for acute rejection and improved BOS-free survival. Therefore, lung allografts from donors with a prolonged length of time from brain death until explant should not be viewed less favorably by donor selection centers.Graphical abstract
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
CONCLUSIONS: Donor BDD is not associated with post-transplant survival or PGD. Long donor BDD, however, is associated with a decreased risk for acute rejection and improved BOS-free survival. Therefore, lung allografts from donors with a prolonged length of time from brain death until explant should not be viewed less favorably by donor selection centers. PMID: 31271742 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
This study was designed to identify factors associated with clinical response to extracorporeal photopheresis (ECP) and mortality after ECP in lung allograft recipients with bronchiolitis obliterans. Methods. Forced expiratory volume in 1 second (FEV1) values obtained 6 months before (baseline) and 6 months after initiation of ECP were used to plot the linear relationship between FEV1 versus time before and after ECP. Response to ECP was assigned when a positive integer was derived after subtracting the baseline rate of decline from the rate of decline 6 months after ECP. Univariate and multivariate logistic regression ...
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research
In conclusion, circulating MDSCs are measurable, functional and have a G-MDSC phenotype in lung transplant patients. Their frequency is increased in stable patients, decreased during post-transplant complications, and related to level of immunosuppression. This study may pave the way for further investigations of MDSC in the context of lung transplantation. Introduction From a transplant immunological point of view, graft acceptance is the fundamental element in allograft survival. Graft acceptance is realized by blocking the immune system with immunosuppression preventing host immune cells to recognized and attack...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
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