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Aims Heart–lung transplantation (HLTx) remains a life‐saving intervention for patients with end‐stage cardiopulmonary failure. We retrospectively analysed long‐term HLTx outcomes at our centre to assess survival trends and evaluate the impact of evolving immunosuppressive, surgical and perioperative strategies. Methods and results This single‐centre retrospective cohort study included 80 patients who underwent HLTx between 1983–1995 (Era 1) and 1996–2010 (Era 2), with follow‐up through June 2024. All patients had severe cardiorespiratory failure. The primary endpoint was all‐cause mortality. Secondary endpoints included early and late post‐transplant outcomes. Overall survival at 1, 5 and 10 years post‐transplant was 60 ± 6%, 46 ± 6% and 35 ± 6%, respectively. Survival improved significantly between Era 1 (46 ± 10%, 18 ± 9% and 9 ± 6%) and Era 2 (66 ± 7%, 5 ± 7% and 45 ± 7%) (P < 0.001), correlating with advancements in immunosuppression, organ preservation and perioperative care. Univariable risk factors for increased mortality included Euro Collins versus Perfadex lung preservation (P < 0.001), University of Wisconsin (UW2) versus Histidine‐Tryptophan‐Ketoglutarate (HTK) solution cardioplegia (P < 0.001), and Epstein–Barr virus infection (P = 0.036). Heart failure: OR 4.557 (95% CI: 1.057–19.648, P = 0.042) and gastrointestinal bleeding: OR 2.739 (95% CI: 1.310–5.726, P = 0.016) were identified as risks for mortality. These factors remained significant in multivariable analysis. Conclusions HLTx outcomes at our centre are consistent with international benchmarks. Survival has improved in Era 2, likely due to individualised immunosuppressive regimens, novel organ preservation techniques and enhanced surveillance. These results support ongoing optimisation of multidisciplinary care for complex cardiopulmonary failure.

The number of organ donations after brain death has significantly increased since the revised Japanese Organ Transplant Law took effect in July 2010. Sixty-one lung transplantations were conducted throughout Japan in 2013, including 20 living-donor lung transplantations and 41 brain-dead-donor lung transplantations (23 bilateral lungs, 17 single lungs, and 1 heart–lung transplantation). The number of lung transplant candidates newly registered at the Japan Organ Transplantation Network also increased to 126 in 2013, suggesting a severe donor shortage in Japan. More than 60 % of offered brain-dead-donor, lungs were used for transplantation, indicating the effort of Japanese lung transplant centers to overcome the challenge of donor shortage. After lung transplantation, patients generally enjoyed a good quality of life with excellent survival of 86.2 % at 1 year, 79.6 % at 3 years, and 73.7 % at 5 years post-transplantation. There was no significant difference in patient survival between living-donor and brain-dead-donor lung transplantation. Early mortality of lung transplant recipients within 90 days was attributable to graft failure followed by infection, while long-term mortality was mostly explained by chronic lung allograft dysfunction (chronic rejection), infection, and malignancy. Eight lung transplant centers are currently approved to conduct lung transplantation in Japan (Tohoku, Dokkyo, Chiba, Kyoto, Osaka, Okayama, Fukuoka, and Nagasaki Universities). These centers are expected to continue to make a special effort to save critically ill patients waiting for lung transplantation.

We compared posttransplant outcomes following double-lung transplantation (DLTx) and heart–lung transplantation (HLTx), based on a search of PubMed, Cochrane Library, and Embase, from inception to March 8, 2022, for studies that report outcomes of these procedures. We then performed a meta-analysis of baseline characteristics and posttransplant outcomes. Subgroup analyses were implemented according to indication, publication year, and center. This study was registered on PROSPERO (number CRD42020223493). Ten studies were included in this meta-analysis, involving 1230 DLTx patients and 1022 HLTx patients. The DLTx group was characterized by older donors ( P  = 0.04) and a longer allograft ischemia time ( P  < 0.001) than the HLTx group. The two groups had comparable 1-year, 3-year, 5-year, 10-year survival rates (all P  > 0.05), with similar results identified in subgroup analyses. We found no significant differences in 1-year, 5-year, and 10-year chronic lung allograft dysfunction (CLAD)-free survival, length of intensive care unit stay and hospital stay, length of postoperative ventilation, in-hospital mortality, or surgical complications between the groups (all P  > 0.05). Thus, DLTx provides similar posttransplant survival to HLTx for end-stage cardiopulmonary disease. These two procedures have a comparable risk of CLAD and other posttransplant outcomes.

BackgroundThe value of epidural analgesia in pediatric patients having heart and lung transplant surgery is unknown. We aimed to characterize various quality outcomes in patients who did and did not have epidural analgesia.MethodsData were collected retrospectively for 62 patients from 2006 to 2023 at a tertiary care transplant center. Patients were evaluated by epidural status. The primary outcome was a hospital stay in days. Other measures of morbidity and mortality were measured as secondary endpoints.ResultsThe mean age was 12.7 (3) years; 54 (87%) received bilateral lung transplantation, and 8 (13%) received en bloc heart-lung transplantation. 41 (66%) were female. Epidural utilization rate was 74 %, n=45. On univariate analysis, epidural analgesia compared with no epidural was associated with a reduction in the median length of hospital stay from 26.5 to 20 days (p=0.02). After adjustment for age, sex and type of operation, there was no significant difference in LOS. Other findings following univariate analysis included reduced time of postoperative ventilation with a median reduction of 7–2 days (p=0.019), and a reduced 5-day postoperative opioid requirement; median of 2.94–1.21 mg/kg/24 hours (p=0.004) with epidural analgesia. Epidural analgesia was not associated with a change in overall survival (p=0.49).ConclusionDespite a likely improvement in analgesia, we could not demonstrate a definitive impact of epidural analgesia on outcomes in this small cohort of patients. Larger datasets through registries and institutional collaboration will be needed to increase sample size to identify effect sizes and adjust for confounders.

The effect of graft ischemic time on early graft function and long-term survival of patients who underwent lung transplantation remains controversial. Consequently, graft ischemic time has not been incorporated in the decision-making process at the time of graft acceptance. To investigate the relationship between graft ischemic time and (1) early graft function and (2) long-term survival after lung transplantation. The data from 752 patients who underwent single lung transplantation (n = 258), bilateral lung transplantation (n = 247), and heart-lung transplantation (n = 247) in seven French transplantation centers during a 12-year period were reviewed. Independent data quality control was done to ensure the quality of the collected variables. Mean graft ischemic time was 245.8 +/- 96.4 minutes (range 50-660). After adjustment on 11 potential confounders, graft ischemic time was associated with the recipient Pa(O2)/FI(O2) ratio recorded within the first 6 hours and with long-term survival in patients undergoing single or double lung transplantation but not in patients undergoing heart-lung transplantation. The relationship between graft ischemic time and survival appears to be of cubic form with a cutoff value of 330 minutes. These results were unaffected by the preservation fluid employed. The results of this large cohort of patients suggest a close relationship between graft ischemic time and both early gas exchange and long-term survival after single and double lung transplantation. Such relationship was not found in patients undergoing heart-lung transplantation. The expected graft ischemic time should be incorporated in the decision-making process at the time of graft acceptance.

Unilateral interruption of pulmonary artery is a rare congenital anomaly which is usually associated with other congenital heart disease. Even more rarely it may occur in isolation. Most of the cases are incidentally detected in adulthood. Some cases develop pulmonary hypertension for yet unknown reasons; such cases usually present in infancy with right heart failure. Surgical correction in such cases is associated with adverse outcomes. Heart lung transplantation should be considered in such patients. We report a 3-year-old boy with interruption of right pulmonary artery with severe pulmonary hypertension and right heart failure who was considered for heart lung transplantation.

Background. With the improvement in survival rates after lung transplantation, concern has arisen about evaluating quality of life (QoL). This multicenter cross-sectiol study aimed at describing QoL and identifying factors associated with it. Methods. We assessed QoL in 129 lung transplant recipients from 5 centres in Italy, during scheduled followup visits, using the SF-36, GHQ and St George's respiratory questionires (SGRQ). Results. The SF-36 elicited impaired QoL in the physical, but not in the mental domains (PCS=44; MCS=53). The GHQ identified 29 patients (23%) with psychological discomfort and the SGRQ scores were significantly better than those of patients with chronic respiratory disease. On multivariate alysis, exertiol dyspnea was an independent predictor of the PCS (adjusted Δ -6.3 (p5. Conclusions. The study identified exertiol dyspnea as the main determint of QoL as measured both by SF36 (PCS) and GHQ. Other objective measures contributed only to the PCS. Thus, the SF-36 (PCS) and GHQ were useful in identifying patients who needed treatment not only for complications but also psychological support and continued physical rehabilitation.

Standards and new developments of thoracic organ transplantation are reviewed with particular focus on current treatment strategies, alternatives to transplantation, and xenotransplantation. The current indications for heart, single and bilateral sequential lung, and heart-lung transplantation as well as the technical aspects of each procedure are presented. Criteria for transplant recipients and absolute and relative contraindications are pointed out. Criteria for donor selection are also reviewed. The results of single, double-sequential, and heart-lung transplantation over the past 10 years as reported by the International Society for Heart and Lung Transplantation Database are stated. In addition, the experience of the lung and heart-lung transplantation program at the Hannover Medical School is reviewed, including the current immunosuppression regimens. This experience includes 1075 heart,heart-lung, and lung transplantations since 1983. The 1- and 5-year actuarial survival rates for heart transplant recipients are 81% and 70%, for heart-lung recipients 76% and 61%, and for single and double lung transplant recipients 77% and 59%, respectively. During the past decade there has been continuous improvement in the results of heart, lung, and heart-lung transplantation. Alternatives to thoracic organ transplantation, living-related lobar transplantation, new antirejection agents, and xenograft transplantation are areas for continuing and future investigation.

Background: Recent reports have shown evidence of host derived parenchymal engraftment in several human allografts including the lung, leading to speculation that stem cell therapy may be useful for lung repair in diseases such as cystic fibrosis (CF). To date, previous studies have looked at single surgical or autopsy specimens and no longitudinal studies have been reported. The aim of this study was to assess whether transbronchial biopsies could be used to study the time course of chimerism following lung transplantation. Methods: Specimens of archived transbronchial lung biopsies from five time points taken for clinical purposes from two boys who had received a sex mismatched heart-lung transplant for end stage CF were examined. Sections were dual stained for cytokeratin (epithelium) and a mixture of leucocyte common antigen and CD68 for inflammatory cells. Co-localisation of cells containing a Y chromosome was confirmed by fluorescent in situ hybridisation. Results: Evidence of chimerism was found in up to 6.6% of epithelial cells in bronchial (median 1.4% (range 0–6.6)) and alveolar (median 3.6% (range 2.3–5.5) tissue without apparent evidence of fusion. This engraftment was seen as early as 3 weeks and remained relatively constant up to 37 months. Conclusions: This study has demonstrated proof of principle for long term chimerism in lung epithelium. Transbronchial biopsies may provide a new method for studying the kinetics of stem cell engraftment in the lung.