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Common Variable Immunodeficiency and Other Immunodeficiency Syndromes in Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 525-536 DOI: 10.1055/s-0041-1730893Immunodeficiency represents a vast number of diseases and syndromes. Both primary and secondary forms of immunodeficiency are important contributors to the development of bronchiectasis. Primary immune deficiencies, in particular, are increasingly identified and defined as contributors. Specific immune deficiencies that are closely associated with bronchiectasis and as discussed in this article are common variable immunodeficiency, specific antibody deficiency, immunodeficiencies involving immunoglobulin E, DOCK8 immunodeficiency, phosphoglucomutase 3 ...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: McShane, Pamela J. Tags: Review Article Source Type: research

Diagnosis and Initial Investigation of Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 513-524 DOI: 10.1055/s-0041-1730892Bronchiectasis refers to both the name of a disease and a single radiological appearance that may, or may not, be associated with disease. As chronic respiratory disease, bronchiectasis is characterized by a variable range of signs and symptoms that may overlap with other chronic respiratory conditions. The proper identification of bronchiectasis as a disease in both primary and secondary care is of paramount importance. However, a standardized definition of radiologically and clinically significant bronchiectasis is still missing. Disease heterogeneit...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Amati, Francesco Simonetta, Edoardo Pilocane, Tommaso Gramegna, Andrea Goeminne, Pieter Oriano, Martina Pascual-Guardia, Sergi Mantero, Marco Voza, Antonio Santambrogio, Martina Blasi, Francesco Aliberti, Stefano Tags: Review Article Source Type: research

Pathophysiology of Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 499-512 DOI: 10.1055/s-0041-1730891Bronchiectasis is a complex, heterogeneous disorder defined by both a radiological abnormality of permanent bronchial dilatation and a clinical syndrome. There are multiple underlying causes including severe infections, mycobacterial disease, autoimmune conditions, hypersensitivity disorders, and genetic conditions. The pathophysiology of disease is understood in terms of interdependent concepts of chronic infection, inflammation, impaired mucociliary clearance, and structural lung damage. Neutrophilic inflammation is characteristic of the disease, wit...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Keir, Holly R. Chalmers, James D. Tags: Review Article Source Type: research

Bronchiectasis: Advances in Diagnosis and Treatment
Semin Respir Crit Care Med 2021; 42: 497-498 DOI: 10.1055/s-0041-1730903 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Chalmers, James D. Tags: Preface Source Type: research

Skin Cancers and Lung Transplant
This article will provide an overview of the risk factors for the development of cutaneous malignancies in organ transplant recipients as well as a detailed discussion of various immunosuppressant and prophylactic medications used in this patient population that contribute to the risk of developing cutaneous malignancies, with an emphasis on NMSC (cSCC and BCC) in lung transplant recipients. Finally, this article includes a discussion on the clinical and dermatologic management of this high-risk immunosuppressed population including a review of topical and systemic agents for field therapy of actinic damage and chemopreven...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Wilken, Reason Carucci, John Stevenson, Mary L. Tags: Review Article Source Type: research

Fungal Infection in Lung Transplantation
Semin Respir Crit Care Med 2021; 42: 471-482 DOI: 10.1055/s-0041-1729173Invasive fungal infections threaten lung transplant outcomes with high associated morbidity and mortality. Pharmacologic prophylaxis may be key to prevent posttransplant invasive fungal infections, but cost, adverse effects, and absorption issues are barriers to effective prophylaxis. Trends in fungal infection diagnostic strategies utilize molecular diagnostic methodologies to complement traditional histopathology and culture techniques. While lung transplant recipients are susceptible to a variety of fungal pathogens, Candida spp. and Aspergillus spp...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Kennedy, Cassie C. Pennington, Kelly M. Beam, Elena Razonable, Raymund R. Tags: Review Article Source Type: research

Mycobacteria: Selection of Transplant Candidates and Post –lung Transplant Outcomes
Semin Respir Crit Care Med 2021; 42: 460-470 DOI: 10.1055/s-0041-1727250 Mycobacterium is a large, clinically relevant bacterial genus made up of the agents of tuberculosis and leprosy and hundreds of species of saprophytic nontuberculous mycobacteria (NTM). Pathogenicity, clinical presentation, epidemiology, and antimicrobial susceptibilities are exceptionally diverse between species. Patients with end-stage lung disease and recipients of lung transplants are at a higher risk of developing NTM colonization and disease and of severe manifestations and outcomes of tuberculosis. Data from the past three decades have inc...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Friedman, Daniel Z.P. Doucette, Karen Tags: Review Article Source Type: research

Community-Acquired Respiratory Viruses Post –Lung Transplant
Semin Respir Crit Care Med 2021; 42: 449-459 DOI: 10.1055/s-0041-1729172Survival in lung transplant recipients (LTRs) lags behind heart, liver, and kidney transplant, in part due to the direct and indirect effects of infection. LTRs have increased susceptibility to infection due to the combination of a graft continually exposed to the outside world, multiple mechanisms for impaired mucus clearance, and immunosuppression. Community-acquired respiratory viral infections (CARVs) are common in LTRs. Picornaviruses have roughly 40% cumulative incidence followed by respiratory syncytial virus and coronaviruses. Although single-c...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Sweet, Stuart C. Tags: Review Article Source Type: research

The Impact of Resistant Bacterial Pathogens including Pseudomonas aeruginosa and Burkholderia on Lung Transplant Outcomes
Semin Respir Crit Care Med 2021; 42: 436-448 DOI: 10.1055/s-0041-1728797 Pseudomonas and Burkholderia are gram-negative organisms that achieve colonization within the lungs of patients with cystic fibrosis, and are associated with accelerated pulmonary function decline. Multidrug resistance is a hallmark of these organisms, which makes eradication efforts difficult. Furthermore, the literature has outlined increased morbidity and mortality for lung transplant (LTx) recipients infected with these bacterial genera. Indeed, many treatment centers have considered Burkholderia cepacia infection an absolute contraindication...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Mitchell, Alicia B. Glanville, Allan R. Tags: Review Article Source Type: research

Antibody-Mediated Rejection and Lung Transplantation
Semin Respir Crit Care Med 2021; 42: 428-435 DOI: 10.1055/s-0041-1728796Antibody-mediated rejection (AMR) is now a widely recognized form of lung allograft rejection, with mounting evidence for AMR as an important risk factor for the development of chronic lung allograft dysfunction and markedly decreased long-term survival. Despite the recent development of the consensus diagnostic criteria, it remains a challenging diagnosis of exclusion. Furthermore, even after diagnosis, treatment directed at pulmonary AMR has been nearly exclusively derived from practices with other solid-organ transplants and other areas of medicine,...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Halverson, Laura P. Hachem, Ramsey R. Tags: Review Article Source Type: research

Acute Rejection in the Modern Lung Transplant Era
Semin Respir Crit Care Med 2021; 42: 411-427 DOI: 10.1055/s-0041-1729542Acute cellular rejection (ACR) remains a common complication after lung transplantation. Mortality directly related to ACR is low and most patients respond to first-line immunosuppressive treatment. However, a subset of patients may develop refractory or recurrent ACR leading to an accelerated lung function decline and ultimately chronic lung allograft dysfunction. Infectious complications associated with the intensification of immunosuppression can also negatively impact long-term survival. In this review, we summarize the most recent evidence on the ...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Renaud-Picard, Benjamin Koutsokera, Angela Cabanero, Michael Martinu, Tereza Tags: Review Article Source Type: research

Chronic Lung Allograft Dysfunction: Evolving Concepts and Therapies
Semin Respir Crit Care Med 2021; 42: 392-410 DOI: 10.1055/s-0041-1729175The primary factor that limits long-term survival after lung transplantation is chronic lung allograft dysfunction (CLAD). CLAD also impairs quality of life and increases the costs of medical care. Our understanding of CLAD continues to evolve. Consensus definitions of CLAD and the major CLAD phenotypes were recently updated and clarified, but it remains to be seen whether the current definitions will lead to advances in management or impact care. Understanding the potential differences in pathogenesis for each CLAD phenotype may lead to novel therapeu...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Amubieya, Olawale Ramsey, Allison DerHovanessian, Ariss Fishbein, Gregory A. Lynch, Joseph P. Belperio, John A. Weigt, S. Samuel Tags: Review Article Source Type: research

Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant
Semin Respir Crit Care Med 2021; 42: 380-391 DOI: 10.1055/s-0041-1728795Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary technology capable of supporting cardiac and respiratory function in the presence of end-stage lung disease. Initial experiences using ECMO as a bridge to lung transplant (ECMO-BTLT) were characterized by high rates of ECMO-associated complications and poor posttransplant outcomes. More recently, ECMO-BTLT has garnered success in preserving patients' physiologic condition and candidacy prior to lung transplant due to technological advances and improved management. Despite recent growth, cl...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Stokes, John W. Gannon, Whitney D. Bacchetta, Matthew Tags: Review Article Source Type: research

Primary Graft Dysfunction
Semin Respir Crit Care Med 2021; 42: 368-379 DOI: 10.1055/s-0041-1728794Primary graft dysfunction (PGD) is a form of acute lung injury after transplantation characterized by hypoxemia and the development of alveolar infiltrates on chest radiograph that occurs within 72 hours of reperfusion. PGD is among the most common early complications following lung transplantation and significantly contributes to increased short-term morbidity and mortality. In addition, severe PGD has been associated with higher 90-day and 1-year mortality rates compared with absent or less severe PGD and is a significant risk factor for the subseq...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Natalini, Jake G. Diamond, Joshua M. Tags: Review Article Source Type: research

Pushing the Envelope for Donor Lungs
Semin Respir Crit Care Med 2021; 42: 357-367 DOI: 10.1055/s-0041-1729859The shortage of organ donors remains the major limiting factor in lung transplant, with the number of patients on the waiting list largely exceeding the number of available organ donors. Another issue is the low utilization rate seen in some types of donors. Therefore, novel strategies are continuously being explored to increase the donor pool. Advanced age, smoking history, positive serologies, and size mismatch are common criteria that decrease the rate of use when it comes to organ utilization. Questioning these limitations is one of the purposes of...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Abdelnour-Berchtold, Etienne Ali, Aadil Cypel, Marcelo Keshavjee, Shaf Tags: Review Article Source Type: research