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Investigations and diagnosis
Published in Aparna Palit, Arun C. Inamadar, Systemic Sclerosis, 2019
Arun C. Inamadar, Ajit B. Janagond
Patients with SSc require repeated pulmonary screening for interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). Parenchymal and vascular involvement, either alone or in combination, contributes to significant disease morbidity.2–4,8 End-stage pulmonary disease contributes to death in approximately 60% patients with SSc and has been considered as the major cause of mortality.4,8
Chronic lung allograft dysfunction other than bronchiolitis obliterans syndrome
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
Stijn E. Verleden, Robin Vos, Bart M. Vanaudenaerde, Geert M. Verleden
One must be aware that each lung transplantation patient has an individual posttransplant trajectory and not all patients may fit perfectly within a phenotype. For example, some patients with neutrophilia do not respond to azithromycin therapy, whereas other patients without neutrophilia do respond to it. Moreover, many possible confounding factors exist, thus making it difficult to phenotype each patient. Retrospective assessment is extremely difficult because an individual clinic may not yet be using azithromycin or routinely performing full pulmonary function testing (including measurement of TLC) and CT. Patients who received only a single-lung transplant are very difficult to assess because their native lung can have a big influence on the transplanted lung (for example, hyperinflation or further deterioration of the native lung). Moreover, patients with end-stage pulmonary disease are often colonized by bacteria or fungi, which can also lead to an elevated level of airway neutrophilia, thereby making them difficult to classify within a certain phenotype. Some patients can also evolve from one phenotype to another with no clear cause or explanation; hence, care should always be taken when classifying patients at a given moment, and the evolution of their disease should be taken into account.
Complications of Cardiac and Lung Transplantation
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Jay D. Pal, Daniel T. DeArmond, Hao Pan, Scott B. Johnson
Lung transplantation is performed in selected patients with end-stage pulmonary disease with the goal of extending life expectancy and improving dyspnea. The technical aspects of lung transplant have been well established over the last few decades. Continuing limitations to lung transplant include the small donor pool and the long-term complication of chronic rejection leading to graft failure.
Bioengineering lungs — current status and future prospects
Published in Expert Opinion on Biological Therapy, 2021
Vishal Swaminathan, Barry R. Bryant, Vakhtang Tchantchaleishvili, Taufiek Konrad Rajab
Over 11 million American patients suffer from chronic pulmonary disease [1]. Once pulmonary disease progresses to end-stage pulmonary disease, treatment options are very limited. Mechanical ventilation leaves patients at risk of ventilator-associated infections, barotrauma and atrophy of respiratory muscles. Extracorporeal membrane oxygenation (ECMO) is highly invasive and only temporary [2]. In contrast to these treatment options, lung transplantation offers a cure for most patients with end-stage pulmonary disease [3]. However, demand for viable lungs far outpaces the supply [4]. Moreover, lung transplants are plagued by the need for immunosuppression, chronic rejection, and the eventual development of bronchiolitis obliterans syndrome [5].
Lung management protocols increase the incidence of lung procurement and organ transplantation: A meta-analysis
Published in Physiotherapy Theory and Practice, 2020
Cassandra Raios, Elizabeth H Skinner, Jennifer L Keating
Lung transplantation is a key treatment option for people with end-stage pulmonary disease, such as cystic fibrosis, bronchiectasis, idiopathic pulmonary fibrosis, and idiopathic pulmonary hypertension (Gabbay et al., 1999; Kirschbaum and Hudson, 2010; Lau, Patterson, and Palmer, 2004; Sundaresan et al., 1995). The shortage of viable donor lungs is a critical constraint on transplantation availability. In 2011, only 306 of a possible 586 consented donor lungs were considered suitable for transplantation in Australia (Australia and New Zealand Organ Donation Registry, 2012). Though criteria governing the suitability of lungs for donation vary between institutions, they are frequently strict (Filosso et al., 2006; Sundaresan et al., 1995).
Devices for donor lung preservation
Published in Expert Review of Medical Devices, 2022
Cora R Bisbee, Curry Sherard, Jennie H. Kwon, Zubair A. Hashmi, Barry C. Gibney, Taufiek Konrad Rajab
Organ transplantation remains the only effective therapy in end-stage pulmonary disease to extend quality of life and survival. Over four decades, survival after lung transplant has improved, a feat attributed to advances in surgical technique, immunosuppressive therapies, organ preservation, and post-operative care. Transplant volume, however, is restricted by the availability of high-quality donor lungs. The ideal lung donor is described as an individual between 20 and 45 years old, with an arterial partial pressure of oxygen to inspired fraction of oxygen (PaO2/FiO2) ratio greater than 350, no smoking history, a clear chest X-ray, a clean bronchoscopy, and minimal cold ischemic time before transplantation (<6 hours) [1,2]. Unfortunately, these guidelines have resulted in less than 30% utilization of available donor lungs, leaving over two-thousand adult patients in North America listed for lung transplant that either die or are removed from the waitlist after becoming too sick for transplantation [3]. To increase the supply of donor lungs, there are several ongoing efforts to extend criteria for lung donors and optimize preservation of donor lungs. Extended criteria donors (ECD) are defined by 2 or more variances from standard criteria, including age ≥ 55 years, arterial PaO2/FiO2 ≤ 300 mmHg, smoking history ≥ 20 pack years, diabetes, purulent bronchoscopy, blood infection, or abnormal chest radiographs [2]. These variants in ECD may require more extensive physical examination, radiographic imaging, pressure measurements, bronchoscopy, and monitoring. As a result, more time is needed to prepare the recipient for surgery, organize necessary personnel, and perform laboratory testing. Various strategies have been implemented in transplant centers in recent years to accommodate this necessary prolongation in preservation time.