Regadenoson to the rescue: on the road towards prevention of primary graft dysfunction after lung transplantation

Primary graft dysfunction (PGD), defined as the presence of lung allograft infiltrates consistent with pulmonary edema and hypoxemia, is a devastating early complication of lung transplantation (1). PGD is a major risk factor for poor outcomes after lung transplant including death and development of chronic lung allograft dysfunction (CLAD) (2-4). Numerous studies have defined clinical risk factors for PGD (4) and there is extensive literature studying mechanisms of ischemia-reperfusion injury in experimental model systems (5).
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Editorial Source Type: research

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CONCLUSION: The future of organ bioengineering relies on furthering understanding of organogenesis, in vivo regeneration, regenerative immunology and long-term monitoring of implanted bioengineered organs. PMID: 32463143 [PubMed - in process]
Source: The British Journal of Surgery - Category: Surgery Authors: Tags: Br J Surg Source Type: research
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.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Research Correspondence Source Type: research
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.
Source: Transplantation - Category: Transplant Surgery Tags: Original Basic Science—General Source Type: research
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.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
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...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: LUNG TRANSPLANTATION: Edited by Jasleen Kukreja Source Type: research
Although lung transplantation outcomes in the short term have improved in the past decade, the median survival has stagnated at 6-7 years.[1] Chronic lung allograft dysfunction, infection, malignancy and other medical complications are the predominant causes of graft failure and death beyond the first few years after lung transplantation.[1, 2] Among medical complications, renal dysfunction is a major factor contributing to both early and late morbidity and mortality.[3] Acute kidney injury (AKI) has been reported in up to two-thirds of patients in the perioperative period with 5-8% requiring dialysis in the first few mont...
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Editorial Source Type: research
Chronic lung allograft dysfunction (CLAD) is a heterogeneous condition. Characterization of CLAD phenotypes is essential to enhance the understanding of pathogenesis and guide new therapies. The study objective was to validate the new ISHLT CLAD classification system and further explore patients who do not fall into the defined CLAD sub-categories.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
Chronic lung allograft dysfunction (CLAD), the primary cause of poor outcome after lung transplantation, arises from fibrotic remodeling of the allograft and presents as diverse clinical phenotypes with variable courses. Here, we investigate if bronchoalveolar lavage (BAL) mesenchymal cell activity at CLAD onset can inform regarding disease phenotype, progression and survival.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
Left ventricular assist device is used to support the failing left ventricle when it is refractory to guideline directed medical therapy. It can be either a bridge to cardiac transplantation or a destination therapy. In general, cardiac transplantation offers better long term surival compared to LVAD according data available from devices except the most recent. As per the The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017 [1], there were 126,753 pediatric and adult heart transplants between 1982 and June 2015. Median survival was 10.7 years i...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery LVAD Source Type: blogs
Background: Following transplant, cancer is a leading cause of morbidity and mortality. Human leukocyte antigen-G (HLA-G) – an immune checkpoint molecule – reduces allograft rejection by dampening host immune responses. Reports suggest malignant cells utilize HLA-G to evade the immune system and promote cancer development. Our objective was to evaluate HLA-G donor-recipient polymorphism matching and development of cancer following heart transplant. Methods: Recipients (n=251) and corresponding donors (n=196) were genotyped retrospectively to identify HLA-G polymorphisms in the 5’regulatory (–725, &n...
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Original Clinical Science Source Type: research
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