Cynthia S. Herrington

Ninety-day mortality and major complications are not affected by use of lung allocation score.

BACKGROUND In May 2005 the Organ Procurement Transplant Network (OPTN) and United Network for Organ Sharing (UNOS) implemented the donor lung allocation score (LAS) system to prioritize organ allocation among prospective transplant recipients. The purpose of our study was to determine the impact of LAS implementation on 90-day survival, early complications and incidence of severe primary graft dysfunction (PGD) after the transplant procedure. METHODS Early outcomes among 78 patients receiving transplants after the initiation of the scoring system were compared with those of the 78 previous patients. Survival rates at 90 days and 1 year were the primary end-points of the study. Arterial blood-gas measurements were collected for all patients at the time of ICU arrival and at 12, 24 and 48 hours after surgery to determine the distribution of International Society of Heart and Lung Transplant (ISHLT) PGD grade. Major complications within 30 days post-transplant were recorded. RESULTS We found a small but significant 1-year survival advantage among post-LAS implementation patients, which was largely due to decreased early mortality in comparison to the control cohort. The incidence of ISHLT Grade 3 PGD measured within the first 24 hours after transplant did not differ between groups, nor was there an increase in the rate of major post-operative complications. CONCLUSIONS Implementation of the LAS system has not been associated with an increase in early mortality, immediate PGD or major complications.

Outcomes after lung transplantation and practices of lung transplant programs in the United States regarding hepatitis C seropositive recipients.

Background. The estimated prevalence of hepatitis C virus (HCV) infection among lung transplant (LT) recipients is 1.9%. Many thoracic transplant programs are reluctant to transplant HCV-seropositive patients due to concerns of hepatic dysfunction caused by immunosuppression. The aims of this study are to survey current practices of US LT programs regarding HCV-seropositive patients and using the Organ Procurement and Transplantation Network/United Network for Organ Sharing database and to assess the clinical outcomes of HCV-positive compared with HCV-negative LT recipients. Methods. A survey of US transplant centers that have performed more than 100 LTs was conducted. In addition, 170 HCV-seropositive and 9259 HCV-seronegative recipients who received HCV-seronegative donor organs between January 1, 2000, to December 31, 2007, were identified from the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. Outcome variables including patient survival were compared between the two groups. Results. A total of 64.4% centers responded to the survey. Ten of 29 (34.5%) programs would not consider HCV-seropositive patients for LT. Among the 19 programs that will consider HCV-seropositive patients, only five centers would transplant actively viremic patients. Overall patient survival rates of HCV-seropositive patients were similar to HCV-seronegative patients (84.7% at 1 year, 63.9% at 3 years, 49.4% at 5 years for HCV-seropositive group vs. 82.0% at 1 year, 65.0% at 3 years, 51.4% at 5 years for HCV-seronegative group, P=0.712). Relative risk of recipients for death remained statistically insignificant after adjusting for recipient age, donor age, obesity, sensitization, serum creatinine, and medical condition at time of transplant (relative risk [RR]=1.07 [0.84–1.38], P=0.581). Conclusions. Since 2000, patient survival rates of HCV-positive patients are identical to those who are HCV-negative. However, most of these HCV-seropositive patients were probably nonviremic.

Timing of transesophageal echocardiography in diagnosing patent foramen ovale in patients supported with left ventricular assist device

Left ventricular assist devices unload the left ventricle and decrease left atrial pressure. This hemodynamic change may cause a right to left atrial shunt and hypoxemia in patients with patent foramen ovale. We prospectively studied the best time for performing diagnostic transesophageal echocardiography in left ventricular assist device patients. Intraoperative transesophageal echocardiography was performed in 14 patients before cardiopulmonary bypass was initiated and after left ventricular assist device was implanted. No patent foramen ovale was detected when transesophageal echocardiography was done before bypass, but a patent foramen ovale was found in 3 patients when transesophageal echocardiography was performed after left ventricular assist device was activated. Patent foramen ovale was confirmed by inspection in all three patients and surgically closed during the same procedure. There were no patent foramen ovale closure-related complications.

A novel hybrid technique for transcatheter pulmonary valve implantation within a dilated native right ventricular outflow tract.

References 1. Craig JM, Darling RC, Rothney WB. Total pulmonary venous drainage into the right side of the heart; report of 17 autopsied cases not associated with other major cardiovascular anomalies. Lab Invest. 1957;6:44-64. 2. Bharati S, Lev M. Total anomalous pulmonary venous drainage. In: Bharati S, Lev M, eds. The pathology of congenital heart disease: a personal experience with more than 6,300 congenitally malformed hearts. Armonk (NY): Futura Publishing; 1996. 609-26.

A randomized, placebo-controlled trial of aprotinin to reduce primary graft dysfunction following lung transplantation

Herrington CS, Prekker ME, Arrington AK, Susanto D, Baltzell JW, Studenski LL, Radosevich DM, Kelly RF, Shumway SJ, Hertz MI, Bittner HB, Dahlberg PS. A randomized, placebo‐controlled trial of aprotinin to reduce primary graft dysfunction following lung transplantation.
Clin Transplant 2011: 25: 90–96.

Fontan Procedure: old lessons and new frontiers

The Fontan procedure is an operation created for patients with single ventricular physiology. These patients have the potential to survive well into adulthood, however new problems can arise. Various topics, including physiological constraints, patient care, morbidity and clinical outcomes are discussed. The aim of this review is to identify current topics within the care of the Fontan patient population for the physician not comfortable with their unique physiology and complications.

Rapidly fatal disseminated acanthamoebiasis in a single lung transplant recipient

BACKGROUND Lung transplant recipients are at great risk for developing various infectious complications. These infections portend a significant morbidity and mortality throughout their lifetime following transplantation. At times, cutaneous manifestations are the only clues to systemic infection. CASE REPORT A 62 year-old man with a history of idiopathic pulmonary fibrosis presented 6 months after receiving bilateral sequential cadaveric lung transplantation for anorexia, early satiety, weight loss, exertional dsypnea, arthralgia, and depression. On exam, two rapidly growing non-painful 1.5-3 centimeter erythematous nodules with purulent draining on the anterior chest wall were noted. On Hospital Day 7, the patent was found to be un-responsive, hypotensive, and febrile. Brain imaging revealed diffuse thick nodular enhancement of leptomeningeal surface and multiple areas of hypodenisty associated with mass effect in the bilateral vermis and cerebellar hemispheres with effacement of the fourth ventricle. CSF PCR analysis showed Acanthamoeba sp. confirmed by the Center for Disease Control. Despite multi-modal therapy, his clinical course deteriorated and resulted in brain death. CONCLUSION Acanthamoeba infection is extremely rare in thoracic organ recipients. We report the fifth case of progressive disseminated acanthamoebiasis in a lung transplant recipient.

Synchronous HIV/AIDS-related Epstein-Barr Virus-associated smooth muscle tumors in a 20-year-old female.

We present a case of simultaneous endobronchial and adrenal Epstein-Barr Virus-associated smooth muscle tumors in a 20-year-old female with AIDS. Blood Epstein-Barr Virus polymerase chain reaction was negative at the time of diagnosis.

ALTERNATIVES TO HIGH RISK PEDIATRIC HEART TRANSPLANT

Some pediatric patients referred for heart transplant (Htx) evaluation are not suitable candidates for Htx. The outcomes of such patients are presumed to be dismal, but are not well described. Information about the destiny of these children may help with decision-making regarding alternative

Aprotinin Decreases Lung Reperfusion Injury and Dysfunction

Reduced lung perfusion and subsequent pulmonary ischemia can cause increased pulmonary vascular resistance, decreased oxygenation capacity, worsened compliance, and edema formation.