The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
-
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.
-
J. Heart Lung Transplant. · Sep 2010
The impact of recipient body mass index on survival after lung transplantation.
Lung transplant (LTx) candidates are frequently over or underweight. Few studies have examined recipient weight and outcomes after LTx. The United Network for Organ Sharing (UNOS) database provides an opportunity to examine outcomes related to body mass index (BMI) in a large cohort of LTx patients. ⋯ Mortality is higher in underweight, overweight, and obese LTx patients than in normal-weight controls. However, this effect appears to be governed by survival in the first year after LTx.
-
J. Heart Lung Transplant. · Sep 2010
Cytomegalovirus disease among donor-positive/recipient-negative lung transplant recipients in the era of valganciclovir prophylaxis.
Valganciclovir prophylaxis is advocated for lung transplant recipients, but its efficacy is unknown. ⋯ Valganciclovir prophylaxis among donor-positive/recipient-negative lung transplant recipients delayed but did not eliminate CMV disease or CMV-related deaths and was limited by toxicity and ganciclovir-resistance. Our experience suggests that valganciclovir at reduced-doses or for less than 6 months is sub-optimal in preventing CMV disease.
-
J. Heart Lung Transplant. · Sep 2010
Is stress cardiomyopathy the underlying cause of ventricular dysfunction associated with brain death?
Most deaths in the first 30 days after cardiac transplantation are due to failure of the donor heart, often with the clinical picture of right ventricular failure. Indeed, there is a significant reduction in contractility of the human donor heart and loss of contractile reserve before and soon after transplantation. This myocardial insult appears in association with brain death in the donor and follows a "catecholamine storm" associated with a rapidly rising intracranial pressure. ⋯ There are 3 common features between stress cardiomyopathy and the heart of a brain-dead donor: exposure of the heart to unusually high catecholamine levels, ventricular dysfunction, and prompt recovery. Stress cardiomyopathy is a temporary myocardial dysfunction that has been described after sub-arachnoid hemorrhage, traumatic head injury, pheochromocytoma, acute emotional distress, exogenous administration of catecholamines, and non-related surgery. Given the common features of this catecholamine-mediated myocardial insult, we ask if brain-dead donor heart dysfunction is an extreme variant of stress cardiomyopathy? And, if so is it, like stress cardiomyopathy, reversible? Can we therefore expect recovery of the dysfunctional donor heart over time, thereby permitting increased use of hearts offered for transplantation?