Treatment of life-threatening pseudomonas aeruginosa infection by pheresis of inhibitory antibodies

Pseudomonas aeruginosa (P. aeruginosa) is a common pathogen in the setting of lung transplantation.1 Most recipients become chronically colonized with P. aeruginosa. Previously we have demonstrated in a subgroup of patients with non-cystic fibrosis (CF) bronchiectasis who are chronically colonized with P. aeruginosa, the presence of high titres of IgG2 antibodies specific for the O-antigen of lipopolysaccharide (LPS) which impair serum-mediated killing of the cognate strain.2 In contrast to the serum bactericidal effect normally associated with antibody, this ‘inhibitory antibody’ prevented immune killing of the infecting strain.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Case Anecdotes, Comments and Opinions Source Type: research

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Introduction: Identification of risk factors that predict poor survival can aid clinical decision making and allow optimization of any potentially modifiable factors (Stephenson, A.L. et al. J Heart Lung Transplant 2015;34:1139–1145). This may facilitate improved patient selection and ultimately improve overall outcomes.Aims: To describe the Irish experience of co-morbidity post-transplant for cystic fibrosis and to investigate potential non-pulmonary pre-transplant risk factors that could impact on long term survival.Methods: We performed a retrospective review of all 61 patients who received a lung transplant for c...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Transplantation Source Type: research
Cystic fibrosis (CF) is the most common genetically inherited disease in the Caucasian population [1]. Respiratory manifestations of CF include reduction of mucus clearance, chronic pulmonary infections, and bronchiectasis, causing a progressive respiratory failure that is the primary cause of death in CF patients. Advanced CF might be complicated by pulmonary hypertension, right ventricular hypertrophy, and right heart failure [2]. Bilateral lung transplantation (LUTX) is a viable option for CF, providing a significant survival benefit [3].
Source: Journal of Cystic Fibrosis - Category: Respiratory Medicine Authors: Source Type: research
Abstract Sickle cell disease afflicts millions of people worldwide and approximately 100,000 Americans. Complications are myriad and arise as a result of complex pathological pathways 'downstream' to a point mutation in DNA, and include red blood cell membrane damage, inflammation, chronic hemolytic anemia with episodic vaso-occlusion, ischemia and pain, and ultimately risk of cumulative organ damage with reduced patient lifespan. The National Heart, Lung, and Blood Institute's 2014 evidence-based guideline for sickle cell disease -management states additional research is needed before investigational curative the...
Source: Haematologica - Category: Hematology Authors: Tags: Haematologica Source Type: research
A 30-year-old cystic fibrosis (CF) male with recurrent multi-drug resistant Burkholderia multivorans infections developed persistent bacteremia, despite high-dose antibiotics for>10 days, and ventilator as well as venovenous (VV) extracorporeal membrane oxygenation (ECMO) dependence limiting his transplant candidacy.1,2 No non-pulmonary sources of infection were identified; his chest radiograph demonstrated significant pulmonary disease. We performed bilateral pneumonectomies to clear his infection.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Case Anecdotes, Comments and Opinions Source Type: research
A 30-year-old male with cystic fibrosis with recurrent multidrug-resistant Burkholderia multivorans infections developed persistent bacteremia, despite high-dose antibiotics for>10 days and ventilator as well as veno-venous (VV) extracorporeal membrane oxygenation (ECMO) dependence limiting his transplant candidacy.1,2 No non-pulmonary sources of infection were identified; his chest radiograph demonstrated significant pulmonary disease. We performed bilateral pneumonectomies to clear his infection.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: CASE ANECDOTES Source Type: research
Since lung transplantation became a viable option for cystic fibrosis (CF) lung disease, adult transplant recipients with CF have superior survival compared to all the other major diagnostic indications. However, among adults, recipients with CF have a younger age at transplant in comparison to other transplant recipients. Over time, the frequency and proportion of lung transplants for CF has increased for adults in comparison to children. Using a large international transplant registry, we investigated time trends in numbers of transplants, age at transplant, and post-transplant survival and cause of death for recipients with CF.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
Since lung transplantation became a viable option for cystic fibrosis (CF) lung disease, adult transplant recipients with CF have superior survival than all the other major diagnostic indications. However, among adults, recipients with CF have a younger age at transplant than other transplant recipients. Over time, the frequency and proportion of lung transplants for CF has increased for adults compared with children. Using a large international transplant registry, we investigated time trends in numbers of transplants, age at transplant, and post-transplant survival and cause of death for recipients with CF.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: ORIGINAL CLINICAL SCIENCE 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
Cytomegalovirus (CMV) is a betaherpesvirus, the impacts of which are well known to clinicians providing post-transplant cystic fibrosis care. Lung transplant recipients have the highest risk of any solid-organ transplant for CMV reactivation and ganciclovir resistance [1, 2]. Furthermore, CMV reactivation increases the risk of chronic lung allograft dysfunction. However, even in general populations, CMV seropositivity is associated with adverse outcomes including cognitive impairment, frailty, heart disease and all-cause mortality [3–5]. How CMV may contribute to disease is not evident but many streams of evidence su...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: Research letters Source Type: research
CONCLUSION: These new recommendations, close to French practices, help clinicians to find the right time for referral of patients to transplantation centers. This is crucial for the prognosis of lung transplantation. PMID: 31006579 [PubMed - as supplied by publisher]
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research
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