Imaging indications and findings in evaluation of lung transplant graft dysfunction and rejection
AbstractLung transplantation is a treatment option in end-stage lung disease. Complications can develop along a continuum in the immediate or longer post-transplant period, including surgical and technical complications, primary graft dysfunction, rejection, infections, post-transplant lymphoproliferative disorder, and recurrence of the primary disease. These complications have overlapping clinical and imaging features and often co-exist. Time of onset after transplant is helpful in narrowing the differential diagnosis. In the early post transplantation period, imaging findings are non-specific and need to be interpreted in the context of the clinical picture and other investigations. In contrast, imaging plays a key role in diagnosing and monitoring patients with chronic lung allograft dysfunction. The goal of this article is to review primary graft dysfunction, acute rejection, and chronic rejection with emphasis on the role of imaging, pathology findings, and differential diagnosis.
Alemtuzumab, a monoclonal antibody targeting CD52 that causes lymphocyte apoptosis, is a form of advanced immunosuppression that is currently used as a therapy for refractory acute cellular rejection and chronic lung allograft dysfunction in lung transplant recipients (1–3). Side effects of alemtuzumab include bone marrow suppression, infection, and malignancy. Whether alemtuzumab can be safely used in allograft recipients that have an increased propensity for bone marrow suppression due to telomeropathies is unknown. In a retrospective case series, we report outcomes associated with alemtuzumab in three lung allogra...
Of the four major solid organ transplants, median survival following lung transplantation (LTx) remains the shortest (5.7-5.8 years) with negligible improvements reported over the last decade due to high rates of chronic lung allograft dysfunction (CLAD), a progressive and ultimately fatal complication limiting long-term survival in transplantees.1 Bronchiolitis obliterans syndrome (BOS), often dubbed the “Achilles Heel” of lung transplantation, is the most common manifestation of CLAD and is resistant to most current treatment modalities, leaving repeat lung transplantation (re-LTx) the only treatment option.
Conclusions. Airway instillation of LPS in allografts under immunosuppression resulted in BOS-like airway-centered inflammation and fibrosis distinct from RAS-like diffuse fibrosis, which was induced by a shortened course of immunosuppression. We propose novel animal models for BOS and RAS after lung transplantation.
Conclusions. Chronic airway injury and dysregulated repair programs are evident in airway epithelium obtained from patients with BOS, particularly with SAEC. We also show that azithromycin partially mitigates this pathology.
Conclusions. Blocking Nlrp3 inflammasome activation with MCC950 ameliorates OB lesions. The mechanistic analysis showed that MCC950 regulated the balance of Th1/Th17 and Treg cells and that this process is partially mediated by inhibition of IL-1β and IL-18. Therefore, targeting the Nlrp3 inflammasome is a promising strategy for controlling OB after lung transplantation.
Gastroesophageal reflux disease (GERD) is a risk factor for chronic lung allograft dysfunction (CLAD). The presence of bile acids —putative markers of gastric microaspiration—and inflammatory proteins in the bronchoalveolar lavage (BAL) has been associated with CLAD, but their relationship with GERD remains unclear. While GERD is thought to drive chronic microaspiration, selection of patients for anti-reflux surgery lacks precision. This multicenter study aimed to test the association of BAL bile acids with GERD, lung inflammation, allograft function, and anti-reflux surgery.
CONCLUSIONS: This novel drug might be a useful method to allow doctors to guarantee a better chance for long-term survival in recurrent, metastatic HCC patients with previous LT. However, it should be used with caution in allograft recipients due to the risk of acute graft rejection, further larger, prospective studies are needed to determine optimal immunomodulatory therapy to achieve optimal anti-tumor efficacy with transplant liver preservation. PMID: 32433005 [PubMed - as supplied by publisher]
Central Message: Utilization of donation after circulatory death lungs can be improved with appropriate interventions. International guidelines should be developed to facilitate improved organ recovery. (185/200 characters)Perspective Statement: Waitlist mortality is currently at an all-time high in lung transplantation in the United States. Donation after circulatory death lungs have shown promise in expanding the donor pool, yet the US lags behind several other countries in utilizing these organs.
Purpose of review In this article, an overview of the survival after lung transplantation will be given, with a focus on factors affecting outcome and differences in survival determined by underlying disease. Recent findings Lung transplantation is an established treatment modality for patients with various end-stage lung diseases. The most recent International Society for Heart and Lung Transplantation Registry reports a 1 and 5-year survival of 85 and 59%, respectively, for adult lung transplant recipients transplanted since 2010. Over the past decades, significant improvements in patient outcomes have been achieved...
Purpose of review Lung transplantation (LTx) is a worthwhile treatment for children with end-stage lung diseases who have no practicable medical or surgical solutions. But the long-term survival remains the lowest in all solid-organ transplant, with a median survival of 5.7 years, limited by the onset of chronic lung allograft dysfunction (CLAD). This reviews a recent publication in pediatric patients that focuses on translational regulation by microRNA. Recent findings The mechanisms that cause transplanted lung allografts have been difficult to identify. This review discusses pertinent findings in the first and larg...