Krisztina Czebe

Influence of condensing equipment and temperature on exhaled breath condensate pH, total protein and leukotriene concentrations

BACKGROUND Exhaled breath condensate analysis is an attractive but still not fully standardised method for investigating airway pathology. Adherence of biomarkers to various condensing surfaces and changes in condensing temperature has been considered to be responsible for the variability of the results. Our aims were to compare the efficacy of different types of condensers and to test the influence of condensing temperature on condensate composition. METHODS Breath condensates from 12 healthy persons were collected in two settings: (1) by using three condensers of different type (EcoScreen, R-Tube, Anacon) and (2) by using R-Tube condenser either cooled to -20 or -70 degrees C. Condensate pH at standardised CO(2) level was determined; protein content was measured by the Bradford method and leukotrienes by EIA. RESULTS Breath condensates collected using EcoScreen were more alkaline (6.45+/-0.20 vs. 6.19+/-0.23, p<0.05 and 6.10+/-0.26, p<0.001) and contained more protein (3.89+/-2.03 vs. 2.65+/-1.98, n.s. and 1.88+/-1.99 microg/ml, p<0.004) as compared to the other devices. Only parameters obtained with R-Tube and Anacon correlated. Condensing temperature affected condensate pH (5.99+/-0.20 at -20 degrees C and 5.82+/-0.07 at -70 degrees C, p<0.05) but not protein content. Leukotriene B(4) was not found in any sample and cysteinyl-leukotriene was not found in condensates collected with R-Tube or Anacon. CONCLUSION Condenser type influences sample pH, total protein content and cysteinyl-leukotriene concentration. Condensing temperature influences condensate pH but not total protein content. These results suggest that adherence of the biomarkers to condenser surface and condensing temperature may play a role but does not fully explain the variability of EBC biomarker levels.

Variability of exhaled breath condensate pH in lung transplant recipients

Background: Measurement of pH in exhaled breath condensate (EBC) may represent a novel method for investigating airway pathology. Objectives: The aim of this longitudinal study was to assess the variability of EBC pH in stable lung transplant recipients (LTR). Methods: During routine clinical visits 74 EBC pH measurements were performed in 17 LTR. EBC pH was also measured in 19 healthy volunteers on four separate occasions. EBC pH was determined at standard CO2 partial pressure by a blood gas analyzer. Results: Mean EBC pH in clinically stable LTR and in controls was similar (6.38 ± 0.09 vs. 6.44 ± 0.16; p =nonsignificant). Coefficient of variation for pH in LTR and controls was 2.1 and 2.3%, respectively. The limits of agreement for between-visit variability determined by the Bland-Altman test in LTR and healthy volunteers were also comparable (–0.29 and 0.46 vs. –0.53 and 0.44). Conclusions: Our data suggest that the variability of EBC pH in stable LTR is relatively small, and it is similar to that in healthy nontransplant subjects.

Analysis of cytokine pattern in exhaled breath condensate of lung transplant recipients with bronchiolitis obliterans syndrome

IntroductionExhaled breath condensate (EBC) analysis is a promising method for investigating airway pathology. In this pilot study we tested the cytokine pattern of EBC of lung transplant patients with and without clinical evidence of bronchiolitis obliterans syndrome (BOS).Materials and methods Breath condensates collected from eight BOS patients and eight stable BOS-free lung transplant recipients in three consecutive visits were pooled in order to increase protein concentration and were then used for antibody microarray analysis detecting 120 cytokines simultaneously.ResultsNine cytokines exhibited more than twofold increase and four exhibited more than twofold decrease in BOS patients as compared to stable subjects. ConclusionWe conclude that inflammatory cytokines are present in EBC of lung transplant recipients, however the potential benefit of detecting the EBC proteome warrants further studies.

The first 12 years of history of Hungarian lung transplantations

12 years have passed since the first Hungarian patient went through lung transplantation. A small but dedicated group of clinicians work to make lung transplantation an easily accessible, accepted therapy for Hungarian patients. Transplantation is recommended for patients suffering from end stage vascular or parenchymal diseases of the lung after conservative therapies are proven unsuccessful. Lung transplantation as a surgical intervention is currently not available in Hungary. In the past 12 years 64 Hungarian patients were transplanted at the Department of Cardiothoracic Surgery, Medical University of Vienna, in Austria by the Vienna Lung Transplant Group led by Prof. Walter Klepetko. Our patients went through lung transplantation for the following indications: cystic fibrosis (22), idiopathic lung fibrosis (18), primer pulmonary hypertonia (8), lymphangioleimyomatosis (5), emphysema (4) and other (7). The 64 patients altogether went through 68 transplantation procedures. In 4 cases re-transplantation was necessary. The surgery techniques employed were as follows: bilateral lung transplantation (33), bilateral lobar transplantation (18), single lung transplantation (13), heart-lung transplantation (2) and split-lung transplantation (2). Bilateral living-donor lung lobar transplantation was performed in one case. The mean age of patients at the time of surgery was 33.3 years (between age 14 and 58). 48 of the 64 patients are still alive.

Pulmonary infections after lung transplantation

Lung transplantation has become an accepted therapeutic modality for end-stage diseases of the lungs and the pulmonary circulation. In the past two decades more than 20,000 lung transplantations were performed all over the world. Due to improvements in immunosuppressive regimens the mortality rate of severe acute rejections has decreased up to 2% in the first post-transplant year. By contrast, infections became the most common cause of morbidity and mortality after lung transplantation. It was reported that 21.2 and 40% of annual deaths are due to infections in the first 30 days and one year, respectively. In the first month 35-70% of transplant recipients develop bacterial pneumonia caused often by Gram-negative organisms especially by Pseudomonas species. All patients should receive prophylactic antibiotics after the operation, which are to be modified according to the resistance patterns of pathogens isolated from the donor lungs. In the early post-operative period, the frequency of invasive fungal (Aspergillus and Candida) and cytomegalovirus (CMV) infections appears to be less then 10% due to prophylactic amphotericin inhalation and systemic valganciclovir administration for 100 days. After withdrawing these drugs, these infections became more common. In the late post-transplant period, the development of bronchiolitis obliterans syndrome (BOS) may predispose to infections. BOS may be manifested in approximately 50% of patients 5 years post-transplant. Routinely or urgently performed screening tests (laboratory and radiological investigations, lung function tests, sputum culture, bronchoscopy) and specific treatments are of central importance in the management of infections. In this review we discuss the clinical manifestation, the diagnosis and the treatment possibilities of the most common pulmonary infections in lung transplant recipients.

The first 12 years of Hungarian lung transplantation

12 years have passed since the first Hungarian patient went through lung transplantation. A small but dedicated group of clinicians work to make lung transplantation an easily accessible, accepted therapy for Hungarian patients. Transplantation is recommended for patients suffering from end stage vascular or parenchymal diseases of the lung after conservative therapies are proven unsuccessful. Lung transplantation as a surgical intervention is currently not available in Hungary. In the past 12 years 64 Hungarian patients were transplanted at the Department of Cardiothoracic Surgery, Medical University of Vienna, in Austria by the Vienna Lung Transplant Group led by Prof. Walter Klepetko. Our patients went through lung transplantation for the following indications: cystic fibrosis (22), idiopathic lung fibrosis (18), primer pulmonary hypertonia (8), lymphangioleimyomatosis (5), emphysema (4) and other (7). The 64 patients altogether went through 68 transplantation procedures. In 4 cases re-transplantation was necessary. The surgery techniques employed were as follows: bilateral lung transplantation (33), bilateral lobar transplantation (18), single lung transplantation (13), heart-lung transplantation (2) and split-lung transplantation (2). Bilateral living-donor lung lobar transplantation was performed in one case. The mean age of patients at the time of surgery was 33.3 years (between age 14 and 58). 48 of the 64 patients are still alive.

Lung transplantation program for Hungarian patients

When conservative treatment fails, lung transplantation often remains the only therapeutic option for patients with end stage parenchymal or vascular lung diseases. According to the statistics of the International Society for Heart and Lung Transplantation, in 2010 more than 3500 lung transplantations have been performed worldwide. The Department of Thoracic Surgery at the University of Vienna is considered to be one of the worlds leading lung transplantation centres; in the last year 115, since 1989 more than 1500 lung transplantation procedures under the supervision of Prof. Dr. Walter Klepetko. Similar to other Central-European countries, lung transplantation procedures of Hungarian patients have also been performed in Vienna whithin the framework of a twinning aggreement. However, many crucial tasks in the process, such indication and patient selection preoperative rehabilitation organ procurement and long term follow-up care have been stepwise taken over by the Hungarian team. Although the surgery itself is still preformed in Vienna, professional experience is already available in Hungary, since the majority of Hungarian recipients have been transplanted by hungarian surgeons who are authors of this article the professional and personal requirements of performing lung transplantations are already available in Hungary. The demand of performing lung transplantation in Hungary has been raising since 1999 and it soon reaches the extent which justifies launching of an individual national program. Providing the technical requirements is a financial an organisational issue. In order to proceed, a health policy decision has to be made.

Special considerations in generic substitution of immunosuppressive drugs in transplantation

Long-term success in solid organ transplantation strongly depends on the optimal use of maintenance immunosuppressive treatment. Cyclosporin and tacrolimus are the most frequently administered immunosuppressants and they are designed to narrow therapeutic index drugs. The substitution of the branded formulation by their generic counterparts may lead to economic benefit only if equivalent clinical outcomes can be achieved. There is no published evidence to date on the guarantee of their long-term therapeutic equivalence and cases of therapeutic failures have been reported due to inadvertent drug conversion. The disadvantageous clinical consequences of a non medical, mechanistic forced switch from the original to generic formulation of tacrolimus and the estimated loss of the payers presumed savings are presented in a kidney transplant recipient population. Special problems related to pediatric patients, drug interactions with concurrent medications and the burden of additional therapeutic drug monitoring and follow up visits are also discussed. The authors are convinced that the implementation of the European Society of Organ Transplantation guidelines on generic substitution may provide a safe way for patients and healthcare payers.

A tüdotranszplantáció magyar történetének elso 12 éve

12 years have passed since the first Hungarian patient went through lung transplantation. A small but dedicated group of clinicians work to make lung transplantation an easily accessible, accepted therapy for Hungarian patients. Transplantation is recommended for patients suffering from end stage vascular or parenchymal diseases of the lung after conservative therapies are proven unsuccessful. Lung transplantation as a surgical intervention is currently not available in Hungary. In the past 12 years 64 Hungarian patients were transplanted at the Department of Cardiothoracic Surgery, Medical University of Vienna, in Austria by the Vienna Lung Transplant Group led by Prof. Walter Klepetko. Our patients went through lung transplantation for the following indications: cystic fibrosis (22), idiopathic lung fibrosis (18), primer pulmonary hypertonia (8), lymphangioleimyomatosis (5), emphysema (4) and other (7). The 64 patients altogether went through 68 transplantation procedures. In 4 cases re-transplantation was necessary. The surgery techniques employed were as follows: bilateral lung transplantation (33), bilateral lobar transplantation (18), single lung transplantation (13), heart-lung transplantation (2) and split-lung transplantation (2). Bilateral living-donor lung lobar transplantation was performed in one case. The mean age of patients at the time of surgery was 33.3 years (between age 14 and 58). 48 of the 64 patients are still alive.