Lung rejectionEffect of Etiology and Timing of Respiratory Tract Infections on Development of Bronchiolitis Obliterans Syndrome
Section snippets
Transplant Management
Selection of appropriate candidates, identification of suitable donors, utilization of protocols to manage lung recipients, administration of immunosuppressive agents, as well as prophylactic anti-microbial strategies against opportunistic infections have been detailed elsewhere.22, 23 Flexible fiber-optic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBB) was performed only when clinically indicated24 and not used for scheduled surveillance monitoring of the
Results
Between November 1990 and November 2005, 202 consecutive patients underwent 208 lung transplantation procedures. Patients undergoing retransplantation and those not surviving beyond 180 days were excluded from analysis. In a median follow-up period of 4.3 years (range 0.5 to 15.0 years), 90 of 161 lung recipients at risk developed BOS. Cumulative incidence of BOS was 11%, 40%, 58% and 76% at 1, 3, 5 and 10 years after lung transplantation, respectively, as illustrated in Figure 1. Median time
Discussion
Early post-operative survival has improved over the last 30 years, largely from advances in areas of organ preservation, immunosuppression, surgical techniques and anti-microbial prophylaxis.27, 28 Despite these advances, 56% of lung transplant recipients have developed BOS, with a 5-year cumulative incidence of 58% in this study. This parallels the 5-year incidence rates of 45% to 75%, as reported by others from 1996 to 1999.2, 3, 4 Moreover, these rates are similar to those in recent
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Center variability in the prognostic value of a cumulative acute cellular rejection “A-score” for long-term lung transplant outcomes
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Donor derived cell free DNA% is elevated with pathogens that are risk factors for acute and chronic lung allograft injury
2021, Journal of Heart and Lung TransplantationThe lung microbiome in lung transplantation
2021, Journal of Heart and Lung TransplantationCitation Excerpt :Herpesviruses, particularly cytomegalovirus (CMV) and herpes simplex virus (HSV), are important pathogens after lung transplantation, and are targets of prophylactic antiviral regimens.74 Community-acquired respiratory viruses (CARV's), such as influenza, enteroviruses, and rhinoviruses, lead to acute morbidity and increased risk of later CLAD.3,88,89 These viruses are typically identified by targeted PCR methods.
Bacterial products in donor airways prevent the induction of lung transplant tolerance
2021, American Journal of Transplantation