Browsing by Subject "Lung Transplantation"
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Item Bone Health Outcomes in Post-Lung Transplant Patients with Cystic Fibrosis(2023-05-01T05:00:00.000Z) Tran, Triet Vincent Minh; Maalouf, Naim M.; Jain, Raksha; Lederer, Eleanor D.BACKGROUND: Osteoporosis is a common comorbidity in patients with cystic fibrosis (CF). Although lung transplantation (LTx) improves quality of life of CF patients, there is little research examining long-term bone health outcomes following LTx in these patients. OBJECTIVE: We sought to compare long-term bone health outcomes in LTx patients with and without CF, as well as determine factors associated with adverse bone health in CF patients. METHODS: Data were collected on 59 patients who underwent LTx between 2006-2019, including 30 with CF and 29 without CF. We compared baseline characteristics, long-term bone mineral density (BMD) trends, and fracture incidence between the two patient populations, and examined factors associated with post-LTx fractures in CF patients. RESULTS: Compared with non-CF patients, patients with CF were younger, had lower body mass index, and lower baseline BMD Z-scores at the lumbar spine, femoral neck, and total hip (all p<0.001). BMD at all sites declined in both groups in the first year post-LTx. In subsequent years, CF patients exhibited better BMD recovery relative to pre-transplantation, but continued to have lower BMD post-LTx. Post-transplant fractures occurred in 30% and 34% of CF and non-CF patients, respectively. CF patients who developed fractures after LTx had significantly lower BMD and lower pre-transplantation percent predicted forced expiratory volume in one second (FEV1%). CONCLUSION: Although CF patients exhibit better BMD recovery following LTx compared to their non-CF counterparts, CF patients start with significantly lower pre-LTx BMD and experience a similarly high rate of post-LTx fractures. These findings highlight the unique contribution of the CF disease process to bone health, as well as a clear need for better prevention and treatment of osteoporosis in CF patients before and after LTx.Item Ex-vivo lung perfusion and the orphan lung program: novel paradigms for augmenting the donor pool(2021-03-12) Banga, AmitItem Immune mechanisms in lung transplatation(2017-04-21) Kaza, VaidehiItem Incidence, Risk Factors, and Outcomes among Patients with Venous Thromboembolic Events in the Early Post-Transplant Period(2018-01-23) Kanade, Rohan; Smith, Lauren; Mahan, Luke; Bollineni, Srinivas; Mullins, Jessica; Kaza, Vaidehi; Mohanka, Manish; Wait, Michael; Torres, Fernando; Banga, AmitINTRODUCTION: With the introduction of lung allocation score (LAS), progressively sicker patients are undergoing lung transplantation (LT) which has the potential to increase the risk of venous thromboembolic (VTE) events during the post-transplant period. This study was conducted to determine the incidence and risk factors for early VTE and its association with 2 year survival. METHODS: All adult patients with single, double or heart LT at the UT Southwestern Medical Center between 2012-14 (n=193) were included in the study. Various demographic, clinical and laboratory variables before and after LT were recorded. Development of any VTE events during the first 30 days after LT was the primary outcome variable. Variables were compared among patients with and without VTE to identify risk factors for VTE. Survival at two years was compared among patients with and without VTE. RESULTS: Overall incidence of VTE during the first 30 days after LT was 28.5% (n=55) among which, majority were upper extremity thrombosis (48/55). Pulmonary embolism was uncommon (n=3). Majority events (78%) were diagnosed with in the first 15 days after LT. Pre-transplant history of hyperlipidemia (adjusted OR, 95%CI: 2.8, 1.1-7.2; p=0.03) and use of anticoagulants (AC) for at least 72 hours (4.1, 1.8-9.5; p=0.001) were independently associated with a reduced risk of VTE. On the other hand, development of primary graft dysfunction at 72 hours (1.6, 1.1-2.4; p=0.009) and use of >3 central catheters during the post-transplant period (25.9, 2-342.1; p=0.013) were independently associated with increased risk of VTE. Development of VTE was associated with increased risk of 2 year mortality (log rank p=0.036, see figure). CONCLUSION: A significant proportion of patients develop VTE early after LT and it is associated with worse survival at 2 yr post-LT. Despite majority being catheter related VTE, the use of AC appears to be protective. Protective effect of hyperlipidemia may be linked to statin use among these patients which needs to be investigated further in future studies.Item Lung Transplant: today(2013-08-09) Torres, FernandoItem Lung transplantation: a viable option for end stage lung disease(2005-09-15) Rosenblatt, RandallItem Lung Volume Predicts Survival and Diaphragm Plications on ILD Patients Undergoing Transplant Using Frustum Model(2017-01-17) Park, So-Youn; Wait, Michael; Pruszynski, Jessica; Ring, StevePURPOSE: To validate the frustum model for lung volumes in patients with interstitial lung disease (ILD) undergoing lung transplantation, and to test whether lung size by frustum model is associated with cumulative survival advantage and need for diaphragm plication following lung transplant. METHOD: This retrospective observational study consisted of 180 patients seen in the University of Texas Southwestern-affiliated hospitals during the period from May 2010 to May 2016. Patients receiving bilateral or single lung transplant for ILD with available pre and post-operative CT scans were included. Bilateral lung transplants were performed through thoracosternotomy and single lung transplants through a unilateral thoracotomy. Cardiopulmonary bypass was used in 48% of patients. The frustum equation for a truncated cone was used to calculate total lung volume with pre and post-operative CT and XR chest PA closest to surgery time. Lung height was defined as the distance from the first rib to the diaphragm on XR chest. Radius 1 and 2 were obtained with same landmarks on CT scan. Patients were stratified by post/pre transplant lung volume ratio >1 or ratio ≤ 1. Multivariate logistic regression analysis and Cox proportional hazards regression models were used for statistical analysis of diaphragm plication and overall survival. RESULTS: Of the total 180 patients included, 39 (22%) had lung volume ratio ≤1 and 141 (78%) had ratio > 1. To validate the frustum model, a Pearson Correlation Coefficient was used to assess correlation between plethysmography TLC and frustum volume (n =251, r=.85, p <.01). Multivariate analysis for diaphragm plication included lung ratio, BMI, and smoking status. Lung volume ratio was a significant predictor of diaphragm plication (ratio >1 OR 7.19, p <.05). Multivariable Cox regression model for survival included lung ratio, diabetes, dyslipidemia, reintubation, and post-operative pneumonia. The only significant predictors were lung ratio (ratio ≤1HR 1.79, p <.05) and reintubation (HR 3.43, p<.01). CONCLUSION: The frustum model is a valid method for evaluating lung volumes in transplantation. The study suggests that lung volume confirms previous observations of a survival advantage to larger donor size in ILD. However, larger lung size may require diaphragm plication.Item [Southwestern News](1994-12-20) Abila, ReyesItem Status of lung transplantation, 1990(1990-08-16) Robertson, K. JoyItem Transitions of care in cystic fibrosis(2021-06-11) Cohen, LeahItem [UT Southwestern Medical Center News](2012-04-24) Warshaw, LisaItem Weight Change in Underweight or Obese Patients Awaiting Lung Transplantation Does Not Impact Post-Trasplant Survival(2017-01-17) Li, Kevin; Huffman, Lynn; Pruszynski, Jessica E.; Wait, Michael; Bajona, PietroBACKGROUND: Lung transplantation remains the definitive treatment for end-stage COPD, respiratory complications of cystic fibrosis, and interstitial lung diseases. However, long-term survival after lung transplantation remains poor, with an overall 5-year survival rate of 54%. Initial selection of lung transplant candidates includes evaluation of body mass index (BMI), since obesity is a relative contraindication to lung transplantation. However, BMI changes occurring while waiting for transplantation may not reflect initial listing BMI and may be associated with poorer long-term survival. OBJECTIVE: To determine the effects of pre-transplant BMI change on long-term survival following lung transplantation. METHODS: A retrospective chart review of adult lung transplantations performed between January 2004 and May 2016 was conducted. Patient demographics, survival status, and date of death, hours on the mechanical ventilator (MV hours), and ICU length of stay (ICU LOS) were collected. Cases were categorized as underweight (BMI < 20 kg/m2) or obese (BMI > 30 kg/m2), with change in BMI from time of listing to time of transplantation as subsets. Kaplan-Meier plots were constructed to summarize differences in overall survival between BMI groups. The log rank test was used to assess differences between survival curves. A Z-test using Greenwood's formula was performed to compare post-transplant survival rates at 1, 3, and 5 years. P-values were adjusted using the false discovery rate (FDR). RESULTS: There were 460 cases included in this study. The group sizes were as follows: underweight and lost weight (BMI < 20 kg/m2 -), 35; underweight and gained weight (BMI < 20 kg/m2 +), 47; obese and lost weight (BMI > 30 kg/m2 -), 61; obese and gained weight (BMI > 30 kg/m2 +), 25. Patients with initial BMI between 20.1 kg/m2 - 29.9 kg/m2 were assigned to the control group (n = 292). There were no differences in 1-year, 3-year, or 5-year survival rates (1-year: control 87.6%; BMI < 20 kg/m2 -, 91.3%; BMI < 20 kg/m2 + 86.4%; BMI > 30 kg/m2 - 93.%; BMI > 30 kg/m2 + 71.2%; all comparisons non-significant [NS]) (3-year: 71.1%; 49.2%; 54.1%; 69.8%; 56.6%, NS) (5-year: 61.1%; 35.1%; 45.9%; 49.1%; 50.9%, NS). Kaplan-Meier plots similarly showed no differences in overall survival (p = 0.203). There were no significant differences among the groups in ICU LOS or MV hours. CONCLUSION: Weight change in obese or underweight patients prior to lung transplantation does not affect overall survival. Therefore, BMI > 30 kg/m2 at the time of listing may not be a relative contraindication to lung transplantation.Item What does the kidney have to do with it?: renal perspectives on non-renal solid organ transplantation(2018-08-10) Ghanta, Mythili