Redha Souilamas

Risk factors for post‐transplant lymphoproliferative disease in patients with cystic fibrosis

Saueressig MG, Boussaud V, Amrein C, Guillemain R, Souilamas J, Souilamas R. Risk factors for post‐transplant lymphoproliferative disease in patients with cystic fibrosis.
Clin Transplant 2011: 25: E430–E436.

Advanced normothermic ex vivo lung maintenance using the mobile Organ Care System

To the Editor: A 39-year-old woman with cerebral hemorrhage was mechanically ventilated for 6 days prior to organ retrieval. No immediate-match local recipient was available but donor lung functional assessment showed a PaO2/FIO2 311 and favorable chest X-ray and bronchoscopy findings. The donor lungs were used experimentally to test for extended perfusion ex vivo, after harvesting with routine Perfadex flush. The main pulmonary artery and the trachea were cannulated, while the left atrial cuff was left to drain freely into the chamber of mobile a Organ Care System (OCS). The perfusate consisted of 1 liter of Steen solution and leukocyte-depleted packed red blood cells (RBCs), with adjustment of hematocrit to a range of 20% to 25% at a temperature of 37°C. Graft function was assessed by two integrated methods in the OCS. The first method involves continuous de-oxygenation of the perfusate through a gas exchanger while ventilating the lungs with room air. Venous and arterial saturations were monitored and blood samples taken for routine blood-gas analysis. The second method involves de-oxygenation of the perfusate followed by a timed reoxygenation with room-air ventilation.

Effects of cyclosporine a in ex vivo reperfused pig lungs.

Several works highlight the role of CsA in the prevention of IRI, but none focus on isolated lungs. Our objective was to evaluate the effects of CsA on IRI on ex vivo reperfused pig lungs.

Urgent lung transplantation in cystic fibrosis patients: experience of a French center

OBJECTIVE We report preliminary results obtained with urgent lung transplantation (ULTx) in cystic fibrosis (CF) patients, based on a French high emergency lung allocation (HELA) system, and the impact of this system on waiting-list death. METHODS The medical records of the first 15 CF patients receiving ULTx between June 2007 and May 2010 at Hôpital Européen Georges Pompidou, France, were retrospectively reviewed. ULTx patients (URG group, n=15) were compared with our entire cohort of CF patients receiving elective lung transplants (LTx) (ELT group, n=118). RESULTS Both groups were similar in terms of use of cardiopulmonary bypass (CPB), length of stay in the intensive care unit (ICU), and intubation > 72 h. Incidence of primary graft dysfunction (PGD) and perioperative mortality was also similar in both groups, but graft ischemic time and severity of PGD were higher in the URG group. One-year and 2.5-year survival rates were, respectively, 73% and 54.5% for the URG group. Death on the waiting list and time to LTx (including all pulmonary diagnoses) decreased by 67% and 64%, respectively. CONCLUSIONS Although still preliminary and with a short follow-up period, our results suggest that the allocation of LTx to CF patients based on the HELA criteria yielded acceptable outcomes and improved waiting-list death rate and time to LTx.

Extra corporal membrane oxygenation in general thoracic surgery: a new single veno-venous cannulation

Extracorporeal membrane oxygenation (ECMO) is used in severe respiratory failure to maintain adequate gas exchange. So far, this technique has not been commonly used in general thoracic surgery. We present a case using ECMO for peri-operative airway management for pulmonary resection, using a novel single-site, internal jugular, veno-venous ECMO cannula.

Pulmonary resection after lung transplantation in cystic fibrosis patients

Pulmonary resection after lung transplantation in end-stage cystic fibrosis presents unique challenges, and scant literature exists to guide physicians. We retrospectively reviewed 78 transplants for cystic fibrosis performed between 2003 and 2008. Fourteen patients underwent posttransplantation pulmonary resection. We analyzed the indications, surgical procedures, outcomes, and survival. Three pneumonectomies, 4 lobectomies, and 11 wedge resections were carried out. We identified 2 groups based on indication: a diagnostic group, and a therapeutic group of patients in whom the indications were septic native lung in 2, allograft infection in 2, lobar torsion in 2, pulmonary infarction in 2, and size mismatch in 4. The mean intensive care unit and hospital stays were 29 and 50 days, respectively. Four (28.57%) patients died during follow-up, including 2 who underwent pneumonectomy; 10 (71.43%) are still alive. Survival was 43.43 ± 8.06 months, and it was not significantly different from that in cystic fibrosis patients who had lung transplantation without pulmonary resection. Pulmonary resection following lung transplantation in cystic fibrosis patients showed acceptable survival and surgical risk, but metachronous pneumonectomy was associated with higher mortality.