Transplant ID
Review: Lung Transplantation
16 Nov, 2024 | 13:33h | UTCIntroduction: Lung transplantation has progressed from experimental to standard therapy for life-threatening lung diseases, offering improved survival and quality of life. Challenges include primary graft dysfunction, chronic lung allograft dysfunction (CLAD), infections, and long-term immunosuppression effects. This review highlights current practices, developments, and opportunities to enhance this transformative therapy.
Key Recommendations
- Candidate Selection: Selection criteria have shifted from strict contraindications to a holistic approach emphasizing physiologic age, frailty, and recoverability. Early referral and multidisciplinary assessment are recommended to address barriers and optimize outcomes.
- Donor-Lung Utilization: Extended-criteria donors, including older donors and those with smoking histories, are increasingly used. Ex vivo lung perfusion allows detailed lung assessment and reconditioning, while antiviral therapies enable transplantation of lungs from hepatitis C-positive donors.
- Lung Allocation: Urgency-weighted scores prioritize factors like medical urgency and post-transplant survival. Recent updates include biologic disadvantages, patient access, and logistical efficiency to improve fairness and outcomes.
- Surgical Techniques: Bilateral sequential lung transplantation is standard, with ECMO replacing cardiopulmonary bypass in many cases. Surgical approaches are tailored to individual needs, with options like volume reduction or lobectomy for size mismatches.
- Postoperative Management: Primary graft dysfunction affects up to 25% of recipients and is a major early complication. Preventive strategies, ECMO support, and infection management are critical. Attention to airway complications and acute kidney injury further improves recovery.
- Immunosuppression: Maintenance therapy typically includes a calcineurin inhibitor, glucocorticoid, and cell-cycle inhibitor. Induction therapy is individualized. Ongoing studies are exploring adjunct therapies like mTOR inhibitors and inhaled immunosuppressants to prevent CLAD.
- Management of ALAD and CLAD: Early detection and treatment of acute lung allograft dysfunction are essential. CLAD, affecting half of recipients within 5 years, remains a major challenge. Current therapies slow progression, but further research is needed for targeted prevention and treatment.
- Infections: Infections remain a leading cause of morbidity and mortality. Prophylaxis against cytomegalovirus, fungal pathogens, and community-acquired viruses is essential to minimize complications and reduce CLAD risk.
- Cancer Risk: Post-transplant cancer risk is elevated due to immunosuppression. Lung cancer and post-transplant lymphoproliferative disease are the most common malignancies, emphasizing the need for routine surveillance and early intervention.
- Long-Term Outcomes: Median survival remains limited at 6.7 years. Efforts focus on improving long-term outcomes by balancing graft function maintenance with minimizing adverse effects of immunosuppression. Collaborative research aims to refine diagnostics, personalize therapies, and address CLAD mechanisms.
Conclusion: Enhanced donor utilization, tailored candidate selection, refined perioperative care, and robust long-term monitoring are pivotal to advancing lung transplantation. Ongoing research and collaboration are critical to overcoming challenges like CLAD, improving survival, and enhancing patient quality of life.
Consensus Paper | Primary prophylaxis of invasive fungal diseases in patients with hematological malignancies
23 Jun, 2023 | 13:23h | UTC
Review | Antifungal stewardship interventions in patients with hematologic malignancies
16 Jun, 2023 | 13:47h | UTCAntifungal Stewardship Interventions in Patients with Hematologic Malignancies
Review | Challenges and opportunities in antimicrobial stewardship among hematopoietic stem cell transplant and oncology patients
13 Jun, 2023 | 13:55h | UTC
RCT | Letermovir demonstrates noninferiority to valganciclovir for CMV prophylaxis in kidney transplantation
12 Jun, 2023 | 13:38h | UTCLetermovir vs Valganciclovir for Prophylaxis of Cytomegalovirus in High-Risk Kidney Transplant Recipients: A Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: A New Antiviral Option for Cytomegalovirus Prevention After Kidney Transplant – JAMA (free for a limited period)
See also: Visual Abstract
An investigational T-cell therapy shows promise against six viral infections common after stem cell transplants
13 Jan, 2023 | 13:10h | UTC
RCT: Maribavir for refractory Cytomegalovirus infections with or without resistance post-transplant.
7 Dec, 2021 | 08:37h | UTC
Study Commentary: Febrile Neutropenia – Procalcitonin vs. MASCC Score.
8 Jul, 2021 | 08:57h | UTCFebrile Neutropenia – Procalcitonin vs MASCC Score – Journal Feed
Review: Long-Term Infectious Complications of Kidney Transplantation
22 Apr, 2021 | 08:16h | UTC
[Abstract Only] Randomized trial: Antibiotics vs. no therapy in kidney transplant recipients with asymptomatic bacteriuria
11 Sep, 2020 | 01:10h | UTC
Commentary on Twitter
More data ❌ screening/Rxing asymptomatic bacteriuria in kidney transplantation
199 KTx recipients (>2 mo out) randomized to Rx/no Rx for ASB
Rx arm had
?No ⬇️ in symptomatic UTI
?5x more ABx exposure
?subsequent bacteriuria w resistant bacteria #TxIDhttps://t.co/a7aVjIJj0z pic.twitter.com/ngTkJLHCfU— Ilan Schwartz MD PhD (@GermHunterMD) September 10, 2020