Lung transplant recipients have complex drug regimens. Study objectives were to assess drug therapy problems (DTPs), pharmacist recommendations, and patient satisfaction with pharmacist services.

Many lung transplant programs are challenged with the lifelong follow-up of recipients who reside at a distance from the transplant center. The Ontario Lung Transplant Telehealth Program aims to deliver post-transplant follow-up care to such patients through secure remote videoconferencing. Our objectives were to evaluate the feasibility and effectiveness of this service.

Late-onset cytomegalovirus (CMV) disease commonly occurs after discontinuation of antiviral prophylaxis. We determined the utility of testing CD8+ T-cell response against CMV as a predictor of late-onset CMV disease after a standard course of antiviral prophylaxis. Transplant patients at high-risk for CMV disease were enrolled. CD8+ T-cell-mediated immunity (CMI) was tested using the QuantiFERON-CMV assay at baseline, 1, 2 and 3 months posttransplant by measurement of interferon-gamma response to whole blood stimulation with a 21-peptide pool. The primary outcome was the ability of CMI testing to predict CMV disease in the first 6 months posttransplant. There were 108 evaluable patients (D+/R+ n = 39; D-/R+ n = 34; D+/R- n = 35) of whom 18 (16.7%) developed symptomatic CMV disease. At the end of prophylaxis, CMI was detectable in 38/108 (35.2%) patients (cutoff 0.1 IU/mL interferon-gamma). CMV disease occurred in 2/38 (5.3%) patients with a detectable interferon-gamma response versus 16/70 (22.9%) patients with a negative response; p = 0.038. In the subgroup of D+/R- patients, CMV disease occurred in 1/10 (10.0%) patients with a detectable interferon-gamma response (cutoff 0.1 IU/mL) versus 10/25 (40.0%) patients with a negative CMI, p = 0.12. Monitoring of CMI may be useful for predicting late-onset CMV disease.

The immunogenicity of influenza vaccine is suboptimal in lung transplant recipients. Use of a booster dose and vaccine delivery by the intradermal rather than intramuscular route may improve response. We prospectively evaluated the immunogenicity and safety of a 2-dose boosting strategy of influenza vaccine. Sixty lung transplant recipients received a standard intramuscular injection of the 2006-2007 inactivated influenza vaccine, followed 4 weeks later by an intradermal booster of the same vaccine. Immunogenicity was assessed by measurement of geometric mean titer of antibodies after both the intramuscular injection and the intradermal booster. Vaccine response was defined as 4-fold or higher increase of antibody titers to at least one vaccine antigen. Thirty-eight out of 60 patients (63%) had a response after intramuscular vaccination. Geometric mean titers increased for all three vaccine antigens following the first dose (p < 0.001). However, no significant increases in titer were observed after the booster dose for all three antigens. Among nonresponders, 3/22 (13.6%) additional patients responded after the intradermal booster (p = 0.14). The use of basiliximab was associated with a positive response (p = 0.024). After a single standard dose of influenza vaccine, a booster dose given by intradermal injection did not significantly improve vaccine immunogenicity in lung transplant recipients.

Background: The clinical significance of Mycobacterium abscessus infection in the lung transplant population is not well understood.Methods: An international survey was performed to determine the incidence and clinical outcomes of M abscessus infections before and after lung transplantation.Results: Thirty-one (50%) of the 62 transplant centers affiliated with the International Society of Heart and Lung Transplantation responded to the survey. Of 5,200 transplants performed, 17 patients (0-33%) (M/F, 12:5) were identified with M abscessus after transplantation. Two patients had respiratory colonization before lung transplantation. Post-transplantation M abscessus infections occurred in the pulmonary allograft in 12, in skin/soft tissue in 3, or both in 2. Median time to diagnosis after transplantation was 18.5 months (range, 1-111 months). Therapies included multiple antibiotics in 16, surgical debridement in 2, interferon-gamma in 1, or no therapy owing to presumed colonization in 1. Eleven (73%) of 16 treated patients had a radiologic or microbiologic response to treatment. Concurrent infections were common, with Aspergillus (n = 8) and Pseudomonas aeruginosa (n 5) most frequently seen. Death in 2 patients was attributed to M abscessus. Ten of 17 patients are alive and considered cured.Conclusions: M abscessus infection in the lung transplant recipient is uncommon and challenging; however, successful treatment can occur. Prolonged combination anti-microbial therapy is required for pulmonary involvement, and surgical debridement is recommended for cutaneous lesions. Concurrent, infections are common and may contribute to mortality in this immunosuppressed population.

PURPOSE:To determine the role of lung transplantation in the treatment of patients presenting with bronchogenic carcinoma and end-stage lung disease.METHODS:An international survey was conducted to determine the outcome of patients with bronchogenic carcinoma in the explanted lung at the time of transplantation. A group of 69 patients was collected from 33 centers.RESULTS:Twenty-six patients underwent 29 lung transplantations for advanced multifocal bronchioloalveolar carcinoma (BAC) as the primary indication for transplantation, and 13 developed a recurrence, with an overall 5-year actuarial survival of 39%. Incidental bronchogenic carcinomas classified as stage I (n = 22), II (n = 12), and III (n = 2), or as incidental multifocal BAC (n = 7), were found in the explanted lung of the remaining 43 patients. The 5-year actuarial survival was 51% in patients with stage I carcinomas, and was significantly better than for patients with stage II and III carcinomas (survival of 14%) or with incidental multifocal BAC (survival of 23%). Time from transplantation to recurrence and from recurrence to death was significantly longer in patients with multifocal BAC than in patients with other types of bronchogenic carcinoma. In addition, the site of recurrence was limited to the transplanted lung in 88% of the patients with multifocal BAC, whereas it was always widespread in patients with other types of bronchogenic carcinoma.CONCLUSION:This study demonstrates that long-term survival can be achieved after lung transplantation in patients with stage I bronchogenic carcinoma or with advanced multifocal BAC.

Introduction: The long-term outcome of heart and lung function after isolated lung transplantation for end-stage pulmonary hypertension has rarely been reported.

Background: Calcineurin inhibitors (CI) are associated with significant side effects. Sirolimus (SRL) is a new immunosuppressant with novel mechanisms of action, usually used in combination with lower doses of CI, thus providing a renal sparing effect. We report our experience with SRL-based, CI-free, immunosuppression for patients undergoing lung transplantation.

Introduction: Bronchogenic carcinoma (BC) may occasionally be diagnosed in the explanted lung prior to or at the time of lung transplantation (LTx). However, the risk of recurrence is not well known because of the limited number of cases in each center.