Lung cancer (LC) is uncommon among lung transplant recipients, being most often described in the native lung of single-lung transplant recipients. Its appearance in the transplanted lung is a very uncommon phenomenon, in which donor and recipient factors appear to be involved. We present a case of 2 distinct metachronous lung neoplasms diagnosed in the transplanted lung of a non-smoker patient with progressive massive silicosis (PMS), who underwent left unipulmonary transplantation at 39 years. The donor was a smoker and thoracic computed tomography (CT) performed before the organ collection showed no abnormalities. Thirty months after transplantation, a new node with significant avidity in positron emission tomography (PET)-CT was diagnosed in the upper left lobe (ULL). The Thoracic Surgery team chose to proceed directly to surgery with atypical resection of the nodule. Anatomopathologic study revealed an epidermoid carcinoma (pT1aNx). Multidisciplinary group decided clinical surveillance; however, 2 years later, the appearance of 2 new nodules in the ULL (PET-CT positive) was observed. It was again decided to proceed to the surgery with a second atypical resection. The anatomopathologic study of one nodule revealed pulmonary adenocarcinoma (pT1aNx), and the other was compatible with epidermoid carcinoma (pT1aNx). One month later, the patient was hospitalized with a pulmonary abscess and posteriorly developed a probable acute allograft rejection, eventually dying at the age of 44, 51 months after transplantation. This case raises relevant questions regarding the donor selection criteria and the approach to LC diagnosed in the post-transplantation period.

BACKGROUND:The optimal length of cytomegalovirus (CMV) prophylaxis in lung transplantation according to CMV serostatus is not well established.METHODS:We have performed a prospective, observational, multicenter study to determine the incidence of CMV infection and disease in 92 CMV-seropositive lung transplant recipients (LTR), their related outcomes and risk factors, and the impact of prophylaxis length.RESULTS:At 18 months post transplantation, 37 patients (40%) developed CMV infection (23 [25%]) or disease (14 [15.2%]). Overall mortality was higher in patients with CMV disease (64.3% vs 10.2%; P<.001), but only one patient died from CMV disease. In the multivariate analysis, CMV disease was an independent death risk factor (odds ratio [OR] 18.214, 95% confidence interval [CI] 4.120-80.527; P<.001). CMV disease incidence was higher in patients with 90-day prophylaxis than in those with 180-day prophylaxis (31.3% vs 11.8%; P=.049). Prophylaxis length was an independent risk factor for CMV disease (OR 4.974, 95% CI 1.231-20.094; P=.024). Sixteen patients withdrew from prophylaxis because of adverse events.CONCLUSION:CMV infection and disease in CMV-seropositive LTR remain frequent despite current prophylaxis. CMV disease increases mortality, whereas 180-day prophylaxis reduces the incidence of CMV disease.

Introduction: Video-assisted thoracoscopic surgery has become the technique of choice in the early stages of lung cancer in many centers although there is no evidence that all of the surgical approaches achieve the same long-term survival.Method: We carried out a retrospective review of 276 VATS lobectomies performed in our department, analyzing age, sex, comorbidities, current smoker, FEV1 and FCV, surgical approach, TNM and pathological stage, histologic type, neoadjuvant or coadjuvant chemotherapy, relapse and metastasis time, with the main aim of evaluating the survival rate and disease-free time, especially with regard to the two/three versus single port approach.Result: The one/four year global survival rate was 88.1 and 67.6% respectively. Bivariate analysis found that the variables associated with survival are comorbidity, histological type, stage, surgical approach and need for chemotherapy. When we independently analyzed the surgical approach, we found a lower survival rate in the single-port group vs. the two/three-port group (VATS). Stratifying by tumoral stage (stage I) and by tumor size (T2) survival was significantly lower for patients with single-port group in comparison to VATS approach. In the multivariate analysis, single-port group is associated with a higher risk of death (HR= 1.78). In analyzing disease-free survival, differences were found in both cases in favor of two/three port VATS: P =.093 for local relapses and p =.091 for the development of metastasis.Conclusions: These results challenge the use of the single port technique in malignant lung pathologies,suggesting the need for clinical trials in order to identify the role this technique may have in lung cancer surgery. (C) 2016 SEPAR. Published by Elsevier Espa (n) over tildea, S.L.U. All rights reserved.

AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema（2000-2012）. The outcomes of patients undergoing single-lung transplantation（SL）（n = 40） or double-lung transplant（DL）（n = 33） were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization（ONT）. RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL（P = 0.032）. Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL（P = 0.96）. Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterialrespiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival（P = 0.48）. To support our results, national data on all patients with emphysema in waiting list were obtained（n = 1001）. Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted（P = 0.875）.CONCLUSION: Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.

Background. Chronic renal dysfunction (CRD) after lung transplantation (LT) is a common and noteworthy complication associated with increased morbidity and mortality rates. The study objectives were to determine the prevalence of CRD according to different diagnostic criteria and describe its therapeutic management.Methods. This observational, multicenter, retrospective study included LT patients with >= 2 years of evolution. CRD was defined according to 2 different methods: (1) by the physician's subjective clinical criteria and (2) by analytical criteria (estimated glomerular filtration rate [eGFR] by Modification of Diet in Renal Disease of <= 59 mL/min).Results. We included 113 patients; 65.5% were men and the mean age at transplant was 49.1 (12.6) years. At 6 months after transplant, approximately half of patients had CRD according to analytical criteria, and, at 2 years after transplantation, the prevalence rose to 80%. Although clinical prevalence and analytical prevalence were similar (68.8% and 78.6%), a weak concordance was observed (Kappa index: 0.6). Among patients who were not classified as having CRD according to clinical criteria, 40.0% (14/35) were diagnosed with CRD according to analytical criteria. None of the patients underwent renal biopsy, and 5.1% of patients required dialysis. In 77.0% of patients with clinical CRD diagnosis, the immunosuppressive regimen was modified: reduction of isolated calcineurin inhibitors (CNIs) (35.0%), CNIs decreased with mycophenolic acid change (23.3%), and CNIs lowering with mammalian target of rapamycin introduction (6.7%). In a multivariate logistic regression model, the independent factors associated with CRD were an older recipient age, low body mass index (BMI) at transplant, treatment with cyclosporine/azathioprine, and low eGFR at the first month after transplant.Conclusions. We found a high incidence of CRD at the first year after transplantation, which increased subsequently. Moreover, CRD was considerably underestimated by physicians' subjective clinical criteria. End points related to CRD development were older age, low BMI, azathioprine use, and low eGFR during the first month after transplant. The latter finding provides an opportunity to implement prevention strategies.

C l i n M e d International Library Citation: Borro JM, Delgado M, Rey T, Rama P (2015) Impact of Donor Cytomegalovirus Serology and duration of Prophylaxis on Follow-Up Strategy in Lung Transplant Recipients. Int J Transplant Res Med 1:007 Received: May 25, 2015: Accepted: July 02, 2015: Published: July 04, 2015 Copyright: © 2015 Borro JM. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Borro et al. Int J Transplant Res Med 2015, 1:2

This is a review article on the main postoperative complications after lung transplantation: airways complications, vascular complications, pleural complications, surgical wound complications, and abdominal complications. Incidence data, severity, and major management regimens are reported. Postoperative complications after lung transplantation result in a significantly increased morbidity and mortality, with early diagnosis and therapy being extremely important.

This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.09.006. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.09.007. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Advanced kidney disease is usually considered an absolute contraindication for lung transplantation due to the difficult management of these patients in the post-operative period. Combined lung-kidney transplantation, however, could offer an opportunity for selected patients with renal and pulmonary dysfunction. This study summarizes the long-term success of a double transplantation in a 38-year-old male patient with cystic fibrosis who presented respiratory and kidney failure. After a complicated postoperative period, the patient currently lives completely independently 46 months after the operation and he enjoys excellent pulmonary and renal function. (C) 2012 SEPAR. Published by Elsevier Espana, S.L. All rights reserved.

Immunosuppression in transplantation has experienced changes in recent years as a result of the introduction of new drugs that act upon the different pathways of the host immune response with the purpose of securing more individualized immune suppression, with fewer side effects.Although following in the steps of other solid organ transplant modalities, lung transplantation, because of its special characteristics, has not yielded similar middle- and long-term results.Improved understanding of the underlying rejection mechanisms, the pharmacodynamic control of drugs, new administration routes designed to reduce the side effects, and new drug substances or immune modulating processes will all contribute to improve the expectations associated to lung transplantation in the near future. (C) 2012 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.

The antiproliferative effect of everolimus provides a therapeutic option in the immunosuppression therapy of lung transplantation, by reducing both the risk of acute rejection and the process of progressive fibrosis that determines chronic graft rejection. However, few data on the use of everolimus in lung transplantation have been published to date, and the specific indications of the drug, along with the most adequate time for its introduction or dosing, have not been defined yet. The aim of this article is to propose recommendations for the use of everolimus in lung transplant recipients, including indications, dosing schedules and the use of concomitant immunosuppression. This consensus document has been developed by experts of all the Spanish lung transplant groups from the review of the existing literature and the clinical experience.

The Spanish Lung Transplant Registry (SLTR) began its activities in 2006 with the participation of all the lung transplantation (LT) groups with active programs in Spain. This report presents for the first time an overall description and results of the patients who received lung transplants in Spain from 2006 to 2010. LT activity has grown progressively, and in this time period 951 adults and 31 children underwent lung transplantation. The mean age of the recipients was 48.2, while the mean age among the lung donors was 41.7. In adult LT, the most frequent cause for lung transplantation was emphysema/COPD, followed by idiopathic pulmonary fibrosis, both representing more than 60% the total number of indications. The probability for survival after adult LT to one and three years was 72% and 60%, respectively, although in patients who survived until the third month post-transplantation, these survival rates reached 89.7% and 75.2%. The factors that most clearly influenced patient survival were the age of the recipient and the diagnosis that indicated the transplantation. Among the pediatric transplantations, cystic fibrosis was the main cause for transplantation (68%), with a one-year survival of 80% and a three-year survival of 70%. In adult as well as pediatric transplantations, the most frequent cause of death was infection. These data confirm the consolidated situation of LT in Spain as a therapeutic option for advanced chronic respiratory disease, both in children as well as in adults.

Immunosuppression in transplantation has experienced changes in recent years as a result of the introduction of new drugs that act upon the different pathways of the host immune response with the purpose of securing more individualized immune suppression, with fewer side effects. Although following in the steps of other solid organ transplant modalities, lung transplanta-tion, because of its special characteristics, has not yielded similar middle-and long-term results. Improved understanding of the underlying rejection mechanisms, the pharmacodynamic control of drugs, new administration routes designed to reduce the side effects, and new drug substances or immune modulating processes will all contribute to improve the expectations associated to lung transplantation in the near future. nuevos fármacos o procesos inmunomoduladores contribuyen a mejorar las expectativas de este trasplante en un próximo futuro.

BACKGROUND The aim of this study was to analyze patient satisfaction and adherence in a sample of renal transplant patients living with a working allograft. METHODS An epidemiological cross-sectional multicenter study was carried out with renal recipients who had received a transplant 6-24 months before and were undergoing immunosuppressant therapy (IT). Sociodemographic and clinical variables registered were dosage, allograft functioning, number of medications, health-related quality of life (HRQoL by SF-6D), patients' satisfaction (SAT-Q) and adherence to medication (abnormal levels of immunosuppressant in blood tests [ALIBT] and clinical impression). Relationships between those parameters were contrasted (chi-square test, Spearman correlation coefficient and Mann-Whitney U-test). Multivariate regression models (linear and logistic) were computed to analyze the factors related to patients' satisfaction and adherence to medication, respectively. RESULTS Data from 206 patients were collected (61.2% males with a mean age of 53.35 years). Nonadherence rates (29.1% and 31.1%) were found according to clinical impression and ALIBT, respectively (chi-square = 31.810, p<0.001). Overall, global patients' satisfaction (74.000 ± 1.251) and HRQoL (0.765 ± 0.011) levels were high. Low-moderate significant associations between satisfaction and adherence to IT and HRQoL were found (p<0.01). Finally, age, vitality, allograft functioning and dosage were correlated with patient satisfaction (R2=0.174; F(1,185)=4.134; p<0.043). Number of medications (odds ratio [OR] = 0.890; 95% confidence interval [95% CI], 0.812-0.975; p=0.012), convenience domain (OR=1.037; 95% CI, 1.005-1.070; p=0.021) and clinical criteria (OR=6.135; 95% CI, 2.945-12.782; p<0.001) were associated with adherence. CONCLUSIONS In renal transplant patients, satisfaction with IT is related to the levels of HRQoL and compliance.

Lung transplantation is a clinical reality for a select group of patients with advanced-stage lung disease. Organ shortage is one of the main issues restricting development of this treatment. Despite an increase in donation rates—Spain, a leading country, has 35 donors per million population 1 Matesanz R Domíngez-Gil B Coll E de la Rosa G Marazuela R Spanish experience as a leading country: what kind of measures were taken?. Transpl Int. 2011; 24: 333-343 Crossref PubMed Scopus (156) Google Scholar —and protocols to improve donor care, the proportion of viable lungs remains very low. Issues that prevent use of lungs include environmental damage, neurogenic oedema produced by brain death, and pulmonary complications, which are common in intensive-care units. As a result, only about 20% of lungs from multiorgan donors are useful in most developed countries. 2 Coll E Santos F Ussetti P et al. The Spanish Lung Transplant Registry: first report of results (2006–2010). Arch Bronconeumol. 2012; (published online Aug 28.)http://dx.doi.org/10.1016/j.arbres.2012.06.001 PubMed Google Scholar The easiest method to increase the number of patients receiving transplants is to do single-lung transplantations—a practice supported by several studies, 3 Delgado M Borro JM De La Torre MM et al. Lung transplantation as the first choice in emphysema. Transplant Proc. 2009; 41: 2207-2209 Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar , 4 Munson JC Christie JD Halpern SD The societal impact of single versus bilateral lung transplantation for chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2011; 184: 1282-1288 Crossref PubMed Scopus (33) Google Scholar particularly in patients with chronic obstructive pulmonary disease. However, the International Society for Heart & Lung Transplantation's results show that many groups still prefer double-lung transplantation (which has slightly higher survival rates) to shortening of the waiting list. 5 Thabut G Christie JD Ravaud P et al. Survival after bilateral versus single lung transplantation for patients with chronic obstructive pulmonary disease: a retrospective analysis of registry data. Lancet. 2008; 371: 744-751 Summary Full Text Full Text PDF PubMed Scopus (144) Google Scholar Normothermic perfusion of donor lungs for preservation and assessment with the Organ Care System Lung before bilateral transplantation: a pilot study of 12 patientsLungs can be safely preserved with the OCS Lung, resulting in complete organ use and successful transplantation in our series of high-risk recipients. In November, 2011, we began recruitment for a prospective, randomised, multicentre trial (INSPIRE) to compare preservation with OCS Lung with standard cold storage. Full-Text PDF

Background: After lung transplantation (LT), chronic renal dysfunction (CRD) is a common and noteworthy complication, associated with increased morbi-mortality. Nevertheless, prevalence of CRD after LT in Spain is still unknown. Assessing its occurrence and severity will facilitate earlier diagnosis and improvement in management. Objectives of the study were to determine the prevalence of CRD according to different diagnostic criteria and describe their therapeutic management. Methods: Observational, multicenter, national, longitudinal study.113 consecutive LT patients with at least 2 years of evolution were analyzed. CRD was defined according to physicians subjective clinical criteria and by objective laboratory criteria (MDRD£ 59ml/min). Results: 65.5% of patients were men, mean age (SD) 54.2 (12.5) years. The main indications for LT were idiopathic emphysema (27.4%), idiopathic pulmonary fibrosis (23.0%) and cystic fibrosis (17.7%). The median time (range) since transplantation was 5.1(1.8-13.1) years. Only 2 patients had pre-transplant proteinuria values. Although prevalences according to clinical and objective criteria were similar (69.0% and 58.4%), a weak concordance between clinical and objective CRD diagnosis is observed (Kappa index: 0.3). In 11.5% of patients with clinical CRD diagnosis, nephroprotector treatment was introduced at CRD detection. Mean (SD) creatinine value at CRD diagnosis was 1.8 (0.5) mg/dl. None of the patients underwent renal biopsy and 5.3% of patients required dialysis. In 77.9% of patients with clinical CRD diagnosis the immunosuppressive regimen was modified: reduction of isolated calcineurin inhibitors (CNIs)(35.0%), CNIs decrement with micophenolic acid change (23.3%) and CNIs lowering with mammalian target of rapamycin (mTOR) introduction (6,7%). Conclusions: Objective CRD prevalence was 58.4%. According to objective criteria, CRD was underestimated in 21.2% of cases. A weak concordance between investigators and objective CRD diagnosis is observed. Renal biopsy and proteinuria determination was not found to be part of current clinical practice. In 4 of 5 patients with clinical diagnosis of CRD, immunosuppressive treatment was changed, in an attempt to control it.