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. · Apr 1996
Yield of surveillance transbronchial biopsies performed beyond two years after lung transplantation.
Acute lung rejection after transplantation may lead to significant graft dysfunction. Hence surveillance protocols which include transbronchial biopsies have been established to monitor for early findings suggestive of acute rejection. However, the frequency of acute rejection diminishes as time from the transplant procedure increases. We therefore sought to examine the incidence of acute rejection seen on surveillance transbronchial biopsy performed at least 2 years after transplantation. ⋯ We conclude that transbronchial biopsy-proven acute rejection may occur in patients with asymptomatic, stable conditions who have survived at least 2 years, but the yield of transbronchial biopsy performed beyond 4 years is exceedingly low.
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J. Heart Lung Transplant. · Apr 1996
Comparative StudyThromboxane receptor blockade does not attenuate pulmonary pressor response in porcine single lung transplantation.
The ischemia-reperfusion lung injury is characterized by increased pulmonary vascular resistance, edema, and subsequent deterioration of oxygenation. Other models of acute lung injury suggest that thromboxane A2 may contribute to the pulmonary hypertension after transplantation. ⋯ Thromboxane does not seem to be among the principal mediators in the pulmonary hypertension after transplantation.
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J. Heart Lung Transplant. · Mar 1996
Comparative StudyControlled pressure reperfusion of rat pulmonary grafts yields improved function after twenty-four-hours' cold storage in University of Wisconsin solution.
Pulmonary graft recipients commonly have a degree of pulmonary hypertension. Immediate reperfusion of stored pulmonary grafts at supraphysiologic or even physiologic pressures may be detrimental to subsequent function. We wished to test the hypothesis that initial reperfusion of pulmonary grafts at low pressures may be beneficial. ⋯ The pressure at which pulmonary grafts are initially reperfused appears to be critical to their subsequent integrity. A protocol of controlled reperfusion may reduce reperfusion injury and improve graft function in clinical practice.
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J. Heart Lung Transplant. · Feb 1996
Comparative StudyDiagnostic yield and therapeutic impact of flexible bronchoscopy in lung transplant recipients.
Bronchoalveolar lavage and transbronchial biopsy are often used for definitive diagnosis of lung rejection and infection in lung transplant recipients. Although protected specimen brushing is of value in nosocomial bacterial pneumonia, its role in lung transplant recipients had not been widely reported. The aim of the study is to review the diagnostic yield and therapeutic impact of flexible bronchoscopy with the use of a combination of bronchoalveolar lavage, protected specimen brushing, and transbronchial biopsy in lung transplant recipients. ⋯ We conclude that bronchoscopy, with the use of a combination of bronchoalveolar lavage, protected specimen brushing, and transbronchial biopsy, is safe with a high diagnostic yield and therapeutic impact for treating lung transplant recipients.
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J. Heart Lung Transplant. · Feb 1996
Lung retransplantation: institutional report on a series of twenty patients.
Between 1986 and 1995, 124 isolated lung and 29 combined heart-lung transplantations were performed at our institution. Twenty of these procedures were retransplantations. Four different types of reoperations were performed: ipsilateral single lung retransplantation (n = 3), single lung retransplantation after bilateral or heart-lung transplantation (n = 7), bilateral retransplantation after bilateral lung transplantation (n = 5), and bilateral retransplantation after single lung transplantation (n = 5). Nine patients underwent retransplantation while still in the intensive care unit after the primary transplantation. Indications for retransplantation in these patients were primary graft failure in seven and bronchial complications in two patients. In 11 patients a late retransplantation (3 to 30 months after the first transplantation) was performed. The indication was obliterative bronchiolitis in nine and late bronchial complications in two patients. Overall, 13 patients were ventilator-dependent before retransplantations. ⋯ We conclude that late and elective lung retransplantation achieves acceptable results when offered to patients with chronic pulmonary dysfunction but with otherwise stable conditions. In view of the poor results, early acute retransplantation should be performed much more restrictively.