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Lung transplantation
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Lung transplantation is an established treatment for patients with end-stage lung disease (1). During the last two decades, considerable advances in organ preservation, surgical techniques, immunosuppression and antibiotic therapy have contributed to improvement in postoperative survival. Adults who underwent primary lung transplantation in the era from January 2009 through June 2016 (n = 28,531) had a median survival of 6.5 years (2). This is in comparison to 6.1 years in the era from 1999 to 2008 and 4.3 years between 1990 and 1998 (Figure 42.1) (2). Centres performing more than 20 surgical procedures annually achieve significantly better outcomes than centres performing fewer transplantations (3). With increasing survival rates after lung transplantation, more attention has been directed towards the importance of improving exercise capacity, independent functioning and quality of life (QOL) in these patients (4–6).
Respiratory Medicine
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Colin Wallis, Helen Spencer, Sam Sonnappa
Complications following lung transplantation are common. A delicate balance is required avoiding under-immunosuppression risking rejection and over-immunosuppression, which may increase the risks of infection, post-transplant lymphoproliferative disease (PTLD) and the various side-effects of drugs that have a narrow therapeutic window. Patients undergo intense surveillance following transplant to monitor allograft function and to check for complications. It can be difficult to distinguish between infection and rejection both clinically and radiologically, and so patients are sent home with a hand held spirometer and asked to measure their lung function on a daily basis, reporting back to the transplant centre if there is a 10% drop in their baseline spirometry. Flexible bronchoscopy and transbronchial biopsy and lavage are required to rule out acute cellular rejection and infection (see Figs 4.43, 4.44). Commonly encountered complications following transplant are shown in Table 4.11.
Life Care Planning for Organ Transplantation
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
Two to three days of mechanical ventilation can be expected following lung transplantation. When sufficient tidal volume is reached along with an adequate spontaneous ventilatory rate and an alert mental status, the lung transplant recipient can be extubated. Chest tubes placed during surgery are generally removed post-operatively between days six and eight. Complications following lung transplantation include the reimplantation response; a combination of ischemia, reperfusion, and injury; and lymphatic discontinuity that may contribute to pulmonary edema (Ginns et al., 1999). Ventilatory management is much the same as usual post-operative management, except for those who are transplanted for chronic obstructive pulmonary disease (COPD). These patients, who will continue with one hyperinflated lung in their chest, may be positioned with their native lung down to decrease mechanical pressure from the hyperinflated lung. Minimizing fluid intake is critical for these individuals, so as to reduce risk of pulmonary edema while maintaining hemodynamic stability.
The healthcare resource utilization and costs of chronic lung allograft dysfunction following lung transplantation in patients with commercial insurance in the United States
Published in Journal of Medical Economics, 2022
Ajay Sheshadri, Naomi C. Sacks, Bridget Healey, Phil Cyr, Gerhard Boerner, Howard J. Huang
Lung transplantation is the standard of care for patients with irreversible end-stage lung disease1. According to the Organ Procurement and Transplantation database, for over 30 years, nearly half (49.2%) of lung transplant recipients used commercial insurance as the source of payment for their procedure, and a majority (75.2%) were between 18 and 64 years old2,3. The long-term success of lung transplantation depends on selective donor-recipient pairing, effective surgery and post-surgical management, comprehensive screening for acute or chronic rejection, appropriate initiation and maintenance of immunosuppression, and mitigating the impact of infections4. Over time, outcomes among lung transplant recipients have improved, but median survival after lung transplantation remains only about six years, particularly low when compared with other organ transplantation procedures5,6.
Current status of fertility and family formation in men with cystic fibrosis
Published in Human Fertility, 2021
Stephen J. Bourke, Alan Anderson, Jonathan Briggs, Simon Doe, Carlos Echevarria, Meenakshi Choudhary, Kevin McEleny, Jane Stewart
Approximately, 50% of men in our cohort were single, and being in a relationship is a key factor in deciding whether to seek assisted reproduction. Men with CF may have difficulties in developing and sustaining relationships because of their disease and its associated problems of illness, complex treatments and infertility. Early information and counselling about reproductive options are important for all men with CF so that they can make informed decisions about their life choices, relationships and family formation. The decision to pursue assisted reproduction poses challenges for both partners. The man must undergo assessment and sperm retrieval, and has to confront issues about his prognosis and his capacity to undertake the duties of fatherhood whilst managing his condition. The woman has to undergo invasive procedures including stimulation of ovulation, harvesting of ova, implantation of the embryo and pregnancy. She also has to consider the longevity of her partner and the risk that he might die when the child is still young. In our study, a small number of men died leaving behind young children. Lung transplantation is an additional option which can improve the course of the disease.
Dysphagia and medicine regimes in patients following lung transplant surgery: A retrospective review
Published in International Journal of Speech-Language Pathology, 2021
Anna Miles, Sujay Barua, Naomi McLellan, Lejla Brkic
Lung transplantation is an advanced, end stage procedure for patients with pulmonary diseases (Patti et al., 2016). Since first performed in 1963, the following decades have seen advancements in surgical techniques, immunosuppression and medical therapies (Grover et al., 1997). This has led to increases in quality of life and survival rates (Hatt, Kinback, Shah, Cruz, & Altschuler, 2017). Yet, when compared to other forms of organ transplantation, lung transplant continues to present with higher one-year mortality (Patti et al., 2016). Common causes of poor health outcomes and mortality include infectious complications, rejection/dysfunction of the allograft, as well as Bronchiolitis Obliterans Syndrome (BOS) (Atkins et al., 2010; Kotloff & Thabut, 2011; Robertson et al., 2009; Todd & Palmer, 2011). While infectious complications can occur in the form of bacterial pneumonia, aspiration can also adversely impact the allograft lung (Patti et al., 2016). This may be due to antegrade movement of oral pathogens from oropharyngeal dysphagia and/or retrograde movement of stomach contents from oesophageal dysphagia and gastroesophageal reflux disease (GORD).