Lung Transplant Pathology
Alloimmune reactions are, besides various infections, the major cause for impaired lung allograft function following transplant. Acute cellular rejection is not only a major trigger of acute allograft failure but also contributes to development of chronic lung allograft dysfunction. Analogous to other solid organ transplants, acute antibody-mediated rejection has become a recognized entity in lung transplant pathology. Adequate sensitivity and specificity in the diagnosis of alloimmune reactions in the lung can only be achieved by synoptic analysis of histopathologic, clinical, and radiological findings together with serologic and microbiologic findings.
Over the past four decades, cardiac transplantation has achieved considerable success in patients with end-stage heart disease; however, the incidence of antibody-mediated rejection (AMR) remains high and is considered to be an important cause of life-threatening cardiac allograft dysfunction.1-3
We read with great interest the article by Van Keer et al. assessing the long term outcomes of cardiac allograft vasculopathy (CAV).1 We commend the authors on their large well-characterized dataset over a 25-year period, and for contributing knowledge on an important disease we do not yet fully understand. Importantly, this is one of the largest analysis and external validation of the ISHLT CAV classification system.2 We believe a few points merit further consideration.
Long-term survival following heart transplantation (HTx) is compromised by cardiac allograft vasculopathy (CAV) characterized by coronary macro and microvascular disease. The pathogenesis of CAV is unclear and may involve coronary thrombosis. We investigated whether HTx patients with CAV had higher platelet aggregation and turnover than HTx patients without CAV and healthy controls. Furthermore, we investigated the antiplatelet effect of low-dose aspirin in HTx patients.
Allograft vasculopathy (AV) is the main limiting factor for long-term graft survival. Increased activity of matrix metalloproteinases (MMPs) contributes to neointima formation in AV and represents a potential therapeutic target. Adeno associated viral (AAV) gene therapy comprises a potentially benign vector model for long-term expression of MMP antagonists.
AbstractBackgroundWe previously demonstrated high diagnostic accuracy of Rubidium-82 positron emission tomography (PET) myocardial blood flow (MBF) quantification for CAV. The purpose of this study was to validate multiparametric PET detection of CAV by combined rate-pressure-product-corrected myocardial flow reserve (cMFR), stress MBF, and coronary vascular resistance (CVR) assessment.Methods and ResultsDiagnostic CAV cut-offs of cMFR
AbstractBackgroundA low level of evidence exists regarding the choice of calcineurin inhibitor (CNI) for immunosuppression after lung transplantation (LTx). Therefore, we designed a randomized clinical trial according to good clinical practice rules to compare tacrolimus with cyclosporine after LTx.MethodsThe ScanCLAD study is an investigator-initiated, pragmatic, controlled, randomized, open-label, multicenter study evaluating if an immunosuppressive protocol based on anti-thymocyte globulin (ATG) induction, once-daily tacrolimus dose, mycophenolate mofetil, and corticosteroid reduces the incidence of chronic lung allogra...
In this study, we determined whether symptomatic respiratory viral infections in post-lung transplantation induce circulating exosomes that contain lung-associated self-antigens, and to assess whether these exosomes activate immune responses to self-antigens.
In this study, we determined whether symptomatic respiratory viral infections after lung transplantation induce circulating exosomes that contain lung-associated self-antigens and assessed whether these exosomes activate immune responses to self-antigens.
Authors: Mombelli M, Kampouri E, Manuel O Abstract Introduction: In solid organ transplant (SOT) recipients, influenza is associated with significant morbidity, including high hospital admission and mortality rates. Influenza may also impair allograft outcomes, in particular in lung transplant recipients. Early treatment with antivirals and seasonal vaccination contribute to reduce influenza-associated morbidity in this population.Areas covered: We selected a number of publications by searching into Pubmed to review the epidemiology, clinical presentation, and outcomes of influenza in SOT recipients. We discuss cur...
ConclusionDLT followed by percutaneous ASD closure is an efficient therapeutic approach in patients with end-stage ASD associated PAH that may offer an alternative option to HLT.