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 2007
Case ReportsResolution of severe ischemia-reperfusion injury post-lung transplantation after administration of endobronchial surfactant.
Ischemia-reperfusion injury (IRI) is a prominent cause of primary graft failure after lung transplantation and is associated with an altered surfactant profile. Experimental animal studies have found that replacement with exogenous surfactant administered via fiber-optic bronchoscopy (FOB) enhanced recovery from IRI with improved pulmonary compliance and gas exchange after lung transplantation. We report our clinical experience with FOB instillation of surfactant in severe IRI after human lung transplantation. ⋯ Bronchoscopic instillation of surfactant improves oxygenation and prognosis after severe IRI in lung transplant recipients. It represents a cost-effective, relatively non-invasive therapeutic alternative to extracorporeal membrane oxygenation.
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J. Heart Lung Transplant. · Aug 2007
Randomized Controlled Trial Multicenter StudyMolecular testing for long-term rejection surveillance in heart transplant recipients: design of the Invasive Monitoring Attenuation Through Gene Expression (IMAGE) trial.
Acute rejection continues to occur beyond the first year after cardiac transplantation, but the optimal strategy for detecting rejection during this late period is still controversial. Gene expression profiling (GEP), with its high negative predictive value for acute cellular rejection (ACR), appears to be well suited to identify low-risk patients who can be safely managed without routine invasive endomyocardial biopsy (EMB). ⋯ The IMAGE study is the first randomized, controlled comparison of two rejection surveillance strategies measuring outcomes in heart transplant recipients who are beyond their first year post-transplant. The move away from routine histologic evaluation for allograft rejection represents an important paradigm shift in cardiac transplantation, and the results of this study have important implications for the future management of heart transplant patients.
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Myxomas are the most common primary cardiac tumors but their presence in the transplanted heart is extremely rare. We report a case of left atrial myxoma in a patient after heart transplantation. DNA analysis confirmed a donor origin. To our knowledge, this is the first report of myxoma of donor origin in a transplanted heart.
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J. Heart Lung Transplant. · Jul 2007
Multicenter Study Comparative Study Clinical TrialCreation of a model comparing 6-minute walk test to metabolic equivalent in evaluating treatment effects in pulmonary arterial hypertension.
The 6-minute walk test (6MWT) is the current standard to assess exercise capacity in pulmonary arterial hypertension (PAH). We compared the Naughton-Balke treadmill test reported in exercise metabolic equivalents (METs) with the 6MWT to evaluate whether MET could be a useful tool to assess exercise capacity. ⋯ MET appears to be a reliable measure of exercise capacity in PAH, and correlates with 6MWT. MET can be used in clinical assessment and is helpful in demonstrating improvements in exercise capacity in less sick patients.
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J. Heart Lung Transplant. · Jul 2007
Plasma receptor for advanced glycation end-products predicts duration of ICU stay and mechanical ventilation in patients after lung transplantation.
Primary graft dysfunction, formerly termed reperfusion pulmonary edema, is the leading cause of short-term complications after lung transplantation. New evidence shows that alveolar type I epithelial cells play an active role in alveolar fluid transport and are therefore presumed to be critical in the absorption of pulmonary edema. We tested the potential relevance of a novel marker of alveolar type I cell injury, the receptor for advanced glycation end-products (RAGE), to short-term outcomes of lung transplantation. ⋯ Higher levels of plasma RAGE measured shortly after reperfusion predicted poor short-term outcomes from lung transplantation. Elevated plasma RAGE levels may have both pathogenetic and prognostic value in patients after lung transplantation.