Journal of Heart and Lung Transplantation最新文献

Background: In pediatric living-donor lobar lung transplantation, whether transplanting adult lobes could result in satisfactory long-term survival and respiratory functional outcomes during and after the growth period in pediatric patients remains unclear. This study aimed to evaluate the long-term survival and functional prognosis after pediatric living-donor lobar lung transplantation and deceased-donor lung transplantation.

Methods: We retrospectively reviewed clinical data of pediatric patients (age: ≤17 years) who underwent lung transplantation between March 2001 and December 2022 at 3 institutions in Japan.

Results: Seventy and 24 patients who underwent living-donor and deceased-donor transplantation, respectively, were included. The 5-year and 10-year overall survival rates were 84.6% and 75.0% after living-donor transplantation and 85.8% and 85.8% after deceased-donor transplantation (p = 0.75), respectively. With a median follow-up period of 89.2 months, 48 living-donor cases (100%) and 16 deceased-donor cases (84.2%) had performance status 0 to 2 among 48 living-donor cases and 19 deceased-donor cases who were alive without retransplantation. They showed height growth (median +9.7 cm, p < 0.01); however, the height standard deviation score decreased after transplantation (median -0.22, p = 0.03). The difference in height standard deviation score between the last follow-up and pretransplantation was negative (median -0.42) in living-donor cases and significantly smaller than that in deceased-donor cases (median +0.19, p = 0.02).

Conclusions: Pediatric living-donor lobar lung transplantation provided satisfactory long-term survival and functional prognosis that were comparable to those of deceased-donor lung transplantation. The limited post-transplant height growth in living-donor cases might be attributed to this favorable functional prognosis.

Bone health after lung transplantation has not been comprehensively reviewed in over 2 decades. This narrative review summarizes the available literature on bone health in the context of lung transplantation, including epidemiology, presentation, and postoperative management. Osteoporosis is reported in approximately 30% to 50% of lung transplant candidates, largely due to disease-related impact on bone and lifestyle, and corticosteroid-related effects during end-stage lung disease (interstitial lung diseases, chronic obstructive pulmonary disease, and historically cystic fibrosis). After lung transplantation, many patients experience steroid-induced bone loss, followed by stabilization or recovery to baseline levels with pharmacologic management. Although evidence on fracture incidence is limited, fracture risk appears to increase in the year following transplantation, with common fracture sites including the vertebrae and the ribs. Vertebral and rib fractures restrict chest expansion and affect lung function, underscoring the importance of fracture prevention in lung transplant recipients. There is limited evidence on the pharmacologic management of osteoporosis after lung transplantation. Existing randomized controlled trials have focused on parenteral bisphosphonates and calcitriol but have been underpowered to evaluate their effect on fracture outcomes. Resistance training, particularly in conjunction with antiresorptive therapy, has also been shown to improve bone health when initiated 2 months after transplantation. No studies to date have documented the effectiveness of denosumab in lung transplant recipients; more studies on pharmacotherapy are warranted to elucidate optimal medical management. Considering the high osteoporosis prevalence and fracture risk in lung transplant populations, the development of formal guidance is warranted to promote improved management after transplantation.

Background: To investigate through a meta-analysis of comparative studies the impact of donor type (brain death DBD vs circulatory death DCD) on the short- and long-term outcomes of lung transplantation(LTx).

Methods: Literature search (terms "lung transplantation" AND "donation after circulatory death") was performed up to July 2022 and studies comparing outcomes of LTx from DCD versus DBD were selected. Primary endpoints were early and long-term mortality. Secondary outcomes included primary graft dysfunction (PGD),acute rejection and postoperative complications. The long-term survival was analyzed by retrieving data from each available Kaplan-Meier and restricted mean survival time difference between DBD and DCD for long-term survival was estimated.

Results: 21 studies were included comprising 60105 patients (DBD=58548 DCD=1557). Recipient and donor baseline characteristics were similar between the two groups. No significant publication bias was observed. The estimated pooled odds ratio of early mortality favored DBD (OR=0.75,CI=0.56-1.00, I²=0%). No statistically significant difference was observed in the risk of acute rejection (OR=1.33, CI=0.82-2.17), and PGD grade 2-3 (OR=0.88, CI=0.69-1.13). One- and 5-year survival were 82.1% and 51.2%, and 86.2% and 62.7% for DBD and DCD groups, respectively (Log-rank,p<0.0001). Unadjusted hazard ratio was 0.693, with DCD as reference. DCD lungs demonstrated improved survival by 4.82% over 5-years when compared to DBD lungs.

Conclusions: This meta-analysis of comparative studies between DCD and DBD demonstrates significant long-term survival advantage of DCD LTx despite an initial small but statistically significant increased mortality risk in the short-term. Data supports the continued implementation of DCD to increase the lung donor pool.

Background: Genetically engineered porcine hearts may have an application for infants in need of a bridge to cardiac allotransplantation. The current animal model that resulted in 2 human applications has been validated in adult non-human primates only. We sought to create an infant animal model of life sustaining cardiac xenotransplantation to understand limitations specific to this age group.

Methods: We performed 11 orthotopic cardiac xenotransplants from genetically modified infantile pigs into size-matched baboons (Papio spp). Porcine grafts were preserved using a modified Del Nido solution. Protocolized post-operative care and outcomes were tracked with invasive monitoring, echocardiogram, and serial chemistries (including a 7-cytokine panel).

Results: Mean ischemic time was 52.1 +/- 13.9 min. All porcine hearts separated from bypass in normal sinus rhythm with normal systolic function documented by echocardiogram at chest closure and again at 24 h. In the first 48 post-operative hours, mean vasoactive inotropic score for the recipients was 9.6 +/- 3.5. Survival >3months was achieved in 6 animals. Five animals succumbed early (<7days) either due to errors in care (n=2) or pulmonary complications (n=3) confirmed on chest radiograph and necropsy. Cytokine levels objectively increased following xenograft implant but were not significantly different between survivors and non-survivors.

Conclusions: In a non-human primate model of infant orthotopic cardiac xenotransplantation, cardiac function does not hinder early peri-operative survival. Instead, pulmonary edema and pleural effusions in the setting of systemic inflammation preclude clinical progression. Targeted therapies are necessary to encourage prolonged survival.