Lung Transplantation
Recipient selection, donor management, and outcomes
Orens JB, Estenne M, Arcasoy S, et al. International guidelines for the selection of lung transplant candidates: 2006 update--a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006;25:745-55. Provides disease-specific summaries of indications and contraindications for transplantation, as well as recommendations for timing of referral.
PMID: 16818116
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Van Raemdonck D, Neyrinck A, Verleden GM et al. Lung donor selection and management. Proc Am Thorac Soc 2009; 6:28-38. Discusses standard and extended donor criteria and summarizes the limited literature on optimal donor management.
PMID: 19131528
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Mascia L, Pasero D, Slutsky AS, et al. Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation: a randomized controlled trial. JAMA 2010;304:2620-7. This multicenter RCT found that a lung protective strategy entailing lower tidal volumes (6 – 8 ml/kg./IBW), higher PEEP (8 – 10 cm H2O), apnea tests performed on CPAP, and suctioning through a closed circuit resulted in lungs being harvested from 54% of potential donor compared to 27% among the conventional group. Of note, the study was stopped prematurely after enrolling 118 patients due to lack of funding.
PMID: 21156950
Christie JD, Edwards LB, Kucheryavaya MS, et al. The Registry of the International Society for Heart and Lung Transplantation: Twenty-seventh official adult lung and heart-lung transplant report—2010. J Heart Lung Transplant 2010;29:1104-18. This portion of the 27th annual ISHLT report presents updated and accrued data from 3,546 heart-lung and 32,652 lung transplants over the last 25+ years.
PMID: 20870165
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More detailed slides can be found at:
http://www.ishlt.org/registries
Rejection
Whelan TPM, Hertz MI. Allograft rejection after lung transplantation. Clin Chest Med 2005;26:599-612. This review nicely summarizes the pathogenesis, presentation, and management of hyperacute rejection, acute rejection, and bronchiolitis obliterans syndrome. PMID: 16263399
McNeil K, Glanville AR, Wahlers T, et al. Comparison of mycophenolate mofetil and azathioprine for prevention of bronchiolitis obliterans syndrome in de novo lung transplant recipients. Transplantation 2006; 81:998-1003. There is controversy over whether MMF provides superior protection against rejection compared to azathioprine. This open label multicenter RCT of 315 newly transplanted patients found no differences in the incidence of acute rejection, severity of BOS, time to acquisition of BOS, or survival after 3 years of follow-up. All patients also received cyclosporine and corticosteroids. These results may have been affected by the higher proportion of patients withdrawing from azathioprine therapy (59.6% vs. 46.5% in MMF group, p = .02).
PMID: 16612275
Gerhardt SG, McDyer JF, Girgis RE, et al. Maintenance azithromycin therapy for bronchiolitis obliterans syndrome: results of a pilot study. Am J Respir Crit Care Med 2003; 168:121-5. Interesting pilot found chronic macrolide therapy improved the FEV1 in 5 of 6 patients with bronchiolitis obliterans syndrome. Subsequently published case series of up to 20 patients also found benefit, but a more definitive study has yet to be published.
PMID: 12672648
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Johnson BA, Iacono AT, Zeevi A, et al. Statin use is associated with improved function and survival of lung allografts. Am J Respir Crit Care Med 2003; 167:1271-8. Although this is a non-randomized, retrospective study, the rigorous analysis, improved outcomes, and the postulated mechanism of benefit for this drug class make the findings provocative.
PMID: 12615629
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Medical complications of lung transplantation
Kotloff RM, Ahya VN. Medical complications of lung transplantation. Eur Respir J 2004;23:334-42. Nicely summarizes common chronic medical challenges in the lung transplant recipient including infection, malignancy, and renal insufficiency.
PMID: 14979513
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**See also Arcasoy et al under Pulmonary Hypertension
