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. · Oct 2010
Comparative StudyComparison of bronchiolitis obliterans syndrome to other forms of chronic lung allograft dysfunction after lung transplantation.
The radiographic presence of allograft infiltrates is atypical of bronchiolitis obliterans (BO) and inconsistent with the definition of bronchiolitis obliterans requires that restrictive processes are ruled out. The natural history of these other forms of chronic allograft dysfunction has not been well characterized. We examined the prognostic significance of radiographic and spirometric restrictive processes in comparison to BOS among lung transplant recipients. ⋯ Patients with CLAD and persistent radiographic infiltrates have a similar prognosis to BOS patients but may still represent a clinically distinct phenotype. BOS patients frequently exhibited a restrictive pattern on spirometry, which also did not offer further prognostic information, but could still represent a unique disease phenotype.
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J. Heart Lung Transplant. · Oct 2010
Long-term outcomes in pulmonary arterial hypertension in the first-line epoprostenol or first-line bosentan era.
The aim of this study was to describe the long-term outcomes in idiopathic pulmonary arterial hypertension (IPAH) treated with first-line bosentan or intravenous (IV) epoprostenol, and additional therapy as needed. ⋯ First-line epoprostenol treatment may lead to greater improvement in exercise capacity than first-line bosentan. However, these greater exercise improvements did not translate into longer time to disease progression or survival.
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J. Heart Lung Transplant. · Oct 2010
Comparative StudyComparison of wait times and mortality for idiopathic pulmonary fibrosis patients listed for single or bilateral lung transplantation.
Lung transplantation is the one form of solid-organ transplantation in which there is the option for patients to receive one or two organs. Idiopathic pulmonary fibrosis (IPF) candidates can be accommodated by either procedure but the decision about these two options remains controversial. Therefore, we sought to determine whether IPF patients listed for bilateral lung transplantation only had longer wait times and higher mortality on the waiting list than those listed for single lungs only. Patients with chronic obstructive pulmonary disease (COPD) were also analyzed as a comparison group. ⋯ There has been a significant improvement in wait times and mortality for IPF patients since the inception of the LAS system. Nonetheless, despite the goal of transplant equity, IPF patients listed for bilateral lung transplantation might have a clinically meaningful increased risk of pre-transplant mortality. The choice of procedures therefore needs to be made with careful consideration of patients' survival both pre- and post-transplantation. Evaluation of transplant outcomes should not only be based on post-transplant survival, but should also account for the impact of the choice of procedure.