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Lung TransplantationRecipient selection, donor management, outcomes Hertz MI, Boucek NM, Deng MC, et al. Scientific Registry of the International Society for Heart and Lung Transplantation: introduction to the 2005 annual reports. J Heart Lung Transplant 2005;24:939-44. Provides links to an extensive summary of indications, survival, immunosuppression, morbidity, and mortality for lung transplantation over the past 20 years. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16102426 Angel LF, Levine DJ, Restrepo MI, et al. Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes. Am J Respir Crit Care Med 2006;174:710-6. An educational intervention for the organ procurement organization combined with alveolar recruitment maneuvers, pulmonary toilet, and diuresis increased the lung procurement rate from 11.5% during the 4-year pre-intervention period to 25.5% in the 4 years after protocol implementation. Donors initially considered poor candidates but subsequently used for transplant had 30-day and 1-year survival comparable to organs initially classified as suitable. http://www.ncbi.nlm.nih.gov/pubmed/16799075?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Rejection 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). http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16612275&query_hl=27&itool=pubmed_docsum 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. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12672648 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. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12615629 Medical complications of lung transplantation | |||||||||
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