Expanding the Lung Donor Pool
This article focuses on the expansion of donor lungs for transplantation after DCD, the use of EVLP in evaluating extended criteria lungs, and the use of lung grafts from donors with hepatitis C.” (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Sahar A. Saddoughi, Marcelo Cypel Source Type: research
The Highly Sensitized Recipient
Highly sensitized patients, who are often black and Hispanic women, are less likely to be listed for lung transplant and are at higher risk for prolonged waitlist time and waitlist death. In this review, the authors discuss strategies for improving access to transplant in this population, including risk stratification of crossing pretransplant donor-specific antibodies, based on antibody characteristics. The authors also review institutional protocols, such as perioperative desensitization, for tailoring transplant immunosuppression in the highly sensitized population. The authors conclude with suggestions for future resea...
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Andrew Courtwright, Carl Atkinson, Andres Pelaez Source Type: research
Antibody-Mediated Rejection
Antibody-mediated rejection (AMR) is a form of lung allograft rejection that is emerging as an important risk factor for chronic lung allograft dysfunction and decreased long-term survival. In this review, we provide a brief overview of our current understanding of its pathophysiology with an emphasis on donor-specific antibodies before moving on to focus on the current diagnostic criteria and treatment strategies. Our goal is to discuss the limitations of our current knowledge and explore how novel diagnostic and therapeutic options aim to improve outcomes through earlier definitive diagnosis and preemptive targeted treat...
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Laura P. Halverson, Ramsey R. Hachem Source Type: research
Conventional and Novel Approaches to Immunosuppression in Lung Transplantation
Most therapeutic advances in immunosuppression have occurred over the past few decades. Although modern strategies have been effective in reducing acute cellular rejection, excess immunosuppression comes at the price of toxicity, opportunistic infection, and malignancy. As our understanding of the immune system and allograft rejection becomes more nuanced, there is an opportunity to evolve immunosuppression protocols to optimize longer term outcomes while mitigating the deleterious effects of traditional protocols. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Caroline M. Patterson, Elaine C. Jolly, Fay Burrows, Nicola J. Ronan, Haifa Lyster Source Type: research
Critical Care Management of the Lung Transplant Recipient
Lung transplantation is often the only treatment option for patients with severe irreversible lung disease. Improvements in donor and recipient selection, organ allocation, surgical techniques, and immunosuppression have all contributed to better survival outcomes after lung transplantation. Nonetheless, lung transplant recipients still experience frequent complications, often necessitating treatment in an intensive care setting. In addition, the use of extracorporeal life support as a means of bridging critically ill patients to lung transplantation has become more widespread. This review focuses on the critical care aspe...
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Jake G. Natalini, Emily S. Clausen Source Type: research
Acute Rejection and Chronic Lung Allograft Dysfunction
Lung transplantation is an established treatment of well-selected patients with end-stage respiratory diseases. However, lung transplant recipients have the highest rates of acute and chronic rejection among transplanted solid organs. Owing to ongoing alloimmune recognition and associated immune-driven airway/vascular remodeling, precipitated by multifactorial, endogenous or exogenous, post-transplant injuries to the bronchovascular axis of the secondary pulmonary lobule, most lung transplant recipients will suffer from a pathophysiological decline of their allograft, either functionally and/or structurally. This review di...
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Hanne Beeckmans, Saskia Bos, Robin Vos, Allan R. Glanville Source Type: research
Opportunistic Infections Post-Lung Transplantation: Viral, Fungal, and Mycobacterial
Opportunistic infections are a leading cause of lung transplant recipient morbidity and mortality. Risk factors for infection include continuous exposure of the lung allograft to the external environment, high levels of immunosuppression, impaired mucociliary clearance and decreased cough reflex, and impact of the native lung microbiome in single lung transplant recipients. Infection risk is mitigated through careful pretransplant screening of recipients and donors, implementation of antimicrobial prophylaxis strategies, and routine surveillance posttransplant. This review describes common viral, fungal, and mycobacterial ...
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Gabriela Magda Source Type: research
Common Noninfectious Complications Following Lung Transplantation
This article focuses on most common noninfectious complications with significant clinical impact. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Harpreet Singh Grewal, Tany Thaniyavarn, Selim M. Arcasoy, Hilary J. Goldberg Source Type: research
Future of Lung Transplantation
This article discusses the current status of lung xenotransplantation, and challenges related to immunology, physiology, anatomy , and infection. Tissue engineering as a feasible alternative to develop a viable lung replacement solution is discussed. (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Justin C.Y. Chan, Ryan Chaban, Stephanie H. Chang, Luis F. Angel, Robert A. Montgomery, Richard N. Pierson Source Type: research
History of Lung Transplantation
Lung transplantation remains the only available therapy for many patients with end-stage lung disease. The number of lung transplants performed has increased significantly, but development of the field was slow compared with other solid-organ transplants. This delayed growth was secondary to the increased complexity of transplanting lungs; the continuous needs for surgical, anesthetics, and critical care improvements; changes in immunosuppression and infection prophylaxis; and donor management and patient selection. The future of lung transplant remains promising: expansion of donor after cardiac death donors, improved out...
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Stephanie H. Chang, Justin Chan, G. Alexander Patterson Source Type: research
40 Years in the Making: Lung Transplantation Past, Present, and Future
The year 2023 has marked historic milestones in the evolution of lung transplantation. Sixty years ago, on June 11, 1963, Dr James Hardy performed the first human lung transplant at the University of Mississippi. It was not until November 7, 1983 that the current modern era of lung transplantation began after a successful single-lung transplantation performed by Dr Joel D. Cooper at the Toronto Lung Transplant Program. Today, 40 years later and with nearly ninety thousand transplant procedures performed worldwide, we confidently feel that lung transplantation has evolved —becoming an excellent alternative for thousands o...
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Luis F. Angel, Stephanie M. Levine Tags: Preface Source Type: research
Lung Transplantation
CLINICS IN CHEST MEDICINE (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Authors: Luis F. Angel, Stephanie M. Levine Source Type: research
Copyright
ELSEVIER (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Source Type: research
Contributors
LUIS F. ANGEL, MD (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Source Type: research
Contents
Luis F. Angel and Stephanie M. Levine (Source: Clinics in Chest Medicine)
Source: Clinics in Chest Medicine - February 10, 2023 Category: Respiratory Medicine Source Type: research
