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. · Nov 2001
Sputum levels of metalloproteinase-9 and tissue inhibitor of metalloproteinase-1, and their ratio correlate with airway obstruction in lung transplant recipients: relation to tumor necrosis factor-alpha and interleukin-10.
Chronic transplant rejection is characterized by progressive narrowing of small airways caused by matrix remodeling and fibrosis. Matrix-metalloproteinases (MMPs) and their inhibitors, the tissue inhibitors of metalloproteinases (TIMPs), are involved in the turnover of extracellular matrix. ⋯ These data underline the possible contribution of proteases such as MMP-9 to chronic transplant rejection, and suggest that an imbalance of MMP-9 and TIMP-1 may be involved in the pathogenesis of airway obstruction after LTx. We found that MMP-mediated inflammation seems to be controlled by TNF-alpha whereas IL-10 might elicit anti-inflammatory effects through different pathways.
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J. Heart Lung Transplant. · Nov 2001
Comparative StudyExercise-related ventilatory abnormalities are more specific for functional impairment in chronic heart failure than reduction in peak exercise oxygen consumption.
Impaired functional capacity during exercise is used to assess need for transplantation in congestive heart failure patients, although impaired capacity is present in several chronic illnesses. The purpose of this study was to test the hypothesis that ventilatory abnormalities during exercise, rather than functional capacity, are specific to congestive heart failure patients. ⋯ Although functional impairment characterizes both congestive heart failure and chronic liver disease, only congestive heart failure patients exhibit exercise-related ventilatory abnormalities. Exercise-related ventilatory abnormalities may be more specific to the underlying pathophysiology of chronic heart failure and should be considered when evaluating patients for heart transplantation.
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J. Heart Lung Transplant. · Oct 2001
Recipient treatment with trimetazidine improves graft function and protects energy status after lung transplantation.
Ischemia-reperfusion injury remains an important obstacle to successful lung transplantation. Trimetazidine is an anti-ischemic drug that restores the ability of ischemic cells to produce energy and reduces the generation of oxygen-derived free radicals. The aim of this study was to assess the protective effect of trimetazidine after prolonged ischemia in lung transplantation. ⋯ Recipient treatment with TMZ provided significant protection of energy status, better oxygenation and reduced lipid peroxidation. Our data suggest that TMZ may be an important adjunct in the prevention of post-transplant lung ischemia-reperfusion injury.
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J. Heart Lung Transplant. · Sep 2001
Comparative StudySingle vs bilateral, sequential lung transplantation for end-stage emphysema: influence of recipient age on survival and secondary end-points.
The appropriate age to perform bilateral, sequential lung transplants (BSLT) in patients with chronic obstructive pulmonary disease (COPD) remains controversial. Although single lung transplant (SLT) offers an advantage in terms of organ availability, the long-term survival may not warrant this strategy in all age groups. ⋯ Single lung transplant may offer acceptable early survival for patients with end-stage respiratory failure. However, long-term survival data favors BSLT in recipients until approximately age 60 years. These data suggest that a BSLT approach offers a significant survival advantage to recipients younger than 60 years of age.
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J. Heart Lung Transplant. · Aug 2001
Comparative StudyPreliminary result of an algorithm to select proper ventricular assist devices for high-risk patients with extracorporeal membrane oxygenation support.
Extracorporeal membrane oxygenation (ECMO) is not suitable for long-term support because of its high incidence of complications. Conversion from ECMO to ventricular assist device (VAD) is reasonable, and we have developed a simple algorithm for selecting proper VADs for these ECMO-supported patients. ⋯ Using a conversion protocol provides a good guideline for making decisions. According to the protocol, right heart and pulmonary function can be clearly assured before shifting to LVAD in these critical ECMO-supported patients.