The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
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J. Heart Lung Transplant. · Aug 2008
Pre-arrest administration of the cell-permeable free radical scavenger tempol reduces warm ischemic damage of lung function in non-heart-beating donors.
Lungs retrieved from non-heart-beating donors (NHBDs) may alleviate the shortage of suitable organs for transplantation. The critical point is the preservation of lungs during warm ischemia, when severe damage is caused by free radicals. We investigated the effect of ventilation, pre-arrest administration of heparin, and the cell-permeable free radical scavenger, tempol, on the function of NHBD grafts. ⋯ The free radical scavenger tempol, which has a very good ability to permeate biologic membranes, contributes to better preservation of lungs retrieved from NHBDs.
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J. Heart Lung Transplant. · Aug 2008
Comparative StudyLong-term health-related quality of life and walking capacity of lung recipients with and without bronchiolitis obliterans syndrome.
Outcome after lung transplantation (LTx) is affected by the onset of bronchiolitis obliterans syndrome (BOS) and lung function decline. Reduced health-related quality of life (HRQL) and physical mobility have been shown in patients developing BOS, but the impact on the capacity to walk is unknown. We aimed to compare the long-term HRQL and 6-minute walk test (6MWT) between lung recipients affected or not by BOS Grade > or =2. ⋯ Despite significantly less time lived without clinical complications and progressive decline of self-reported health status, the capacity to walk of patients affected by BOS remained relatively stable over time. These findings may indicate that the development of moderate to severe BOS does not prevent lung recipients from walking independently and pursuing an autonomous life.
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J. Heart Lung Transplant. · Aug 2008
Airway colonization and gastric aspiration after lung transplantation: do birds of a feather flock together?
Both gastroesophageal reflux and airway colonization with Pseudomonas aeruginosa (P aeruginosa) are common in lung transplantation (LTx) recipients. There is mounting evidence that, due to their interaction with the epithelium, both may be involved in chronic allograft dysfunction/bronchiolitis obliterans syndrome (BOS) after LTx. We investigated whether gastric aspiration and airway colonization with P aeruginosa after LTx are associated. ⋯ Bile acid aspiration and airway colonization by P aeruginosa after LTx seem to be associated. This relationship between reflux and airway colonization and their role in the development of chronic allograft dysfunction/BOS after LTx should be further elucidated; nevertheless, induction of IL-8-mediated neutrophilic airway inflammation may be a putative mechanism.
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J. Heart Lung Transplant. · Aug 2008
Case ReportsSuccessful treatment of rotary pump thrombus with the glycoprotein IIb/IIIa inhibitor tirofiban.
Despite advances in blood pump technology, thrombus formation within left ventricular assist devices (LVADs) is a life-threatening complication with few therapeutic options. A 38-year-old woman who underwent rotary LVAD implantation as a bridge to cardiac transplant developed labile flows (4 to >10 liters), associated with power spikes (4 to 12 watts) and an increase in plasma free hemoglobin (0.86 g/liter), consistent with pump thrombus at Day 140 post-LVAD implantation, despite thromboprophylaxis with aspirin and warfarin. Within 12 hours of commencing an intravenous infusion of tirofiban at a rate of 0.1 mug/kg/min, there were signs of improvement of pump dysfunction, and complete resolution was evident at Day 4 with, stable flows, power consumption and normalization of plasma free hemoglobin. Tirofiban may be considered as an alternative thrombolytic treatment strategy in rotary pump thrombus to avoid the need for LVAD replacement.