Studies suggest a higher prevalence of pulmonary hypertension (PH) in sickle cell disease (SCD), however, these relied mainly on transthoracic echocardiography (TTE) to establish a diagnosis. PH prevalence confirmed by right heart catheterization (RHC) is not well reported. Tricuspid regurgitant velocity (TRV) as an estimate of right sided pressures in this population is not validated and subject to poor correlation with RHC. We hypothesize that a model incorporating hemoglobin (Hb) concentration and TRV will increase accuracy of PH diagnosis by TTE.

Induction therapy with alemtuzumab (Campath-1H) has been associated with reduced morbidity and mortality at 6 months after lung transplantation (LT). Whether these benefits are maintained in the long term is unknown. We compared 4-year outcomes in lung recipients receiving alemtuzumab to those receiving other induction agents or no induction.

Respiratory infections with Staphylococcus aureus, especially methicillin-resistant strains (MRSA) are common following lung transplantation. Vancomycin is commonly employed to treat these infections, but has several drawbacks including need for intravenous (IV) administration for systemic infection and the promotion of vancomycin-resistant enterococci. We reviewed our experience with linezolid for MRSA and the relative efficacy with vancomycin.

Mycophenolic acid is an effective transplant immunosuppressive medication but gastrointestinal side effects may limit maximal dose and reduce quality of life for lung transplant recipients (LTR). Enteric encapsulation has been an effective strategy to reduce these complications in other organ recipients, but it has not been reported in LTR. We are therefore conducting a randomized, open label, single center, study to compare gastrointestinal symptoms in LTR receiving either mycophenolate mofetil (MMF) or enteric coated mycophenolate sodium (EC-MPS) in combination with tacrolimus and prednisone.

Purpose: BOS is the leading cause of late death following lung transplantation. Early noninvasive detection of BOS is desirable as it would allow earlier therapeutic intervention. We hypothesized that the changes in gene expression in peripheral blood mononuclear cells (PBMCs) would distinguish between chronic rejection (OB) and no evidence of rejection (NER) following lung transplantation. Of particular interest was expression of C-C and C-X-C motif chemokine receptors since CCR5 expression was significantly up-regulated and CXCR4 was significantly down-regulated in PBMCs from subjects with acute graft rejection in our previous cross-sectional study.

Purpose: Currently, no patient report outcome measure: 1) assesses the range of physical and psychological symptoms that lung recipients experience, 2) detects subtle changes in symptoms, or 3) supports real-time entry, retrieval and analysis of symptoms overtime. The reliability, validity, recipient satisfaction, and feasibility of administering the recently modified Questionnaire for Lung Transplant Patients (QLTP), were assessed. Modifications included changing item responses from dichotomous to Likert-scaling, adding psychological symptoms, and converting to an electronic format (e-QLTP).

ABSTRACT Voriconazole penetrated well into the pulmonary epithelial lining fluid (ELF) in lung transplant patients receiving oral prophylaxis. The ELF concentrations exceeded those of the plasma, with an average ELF-to-plasma ratio of 11 (±8). A strong association between plasma and ELF concentrations ( r 2 = 0.95) was noted.

Rationale: Bronchial stenosis after lung transplantation results in obstructive airways disease and increased risk of pulmonary infection. Stenting of bronchial stenosis results in improved airway patency and a reduced infection rate in the year following stent placement. Recurrence of bronchial stenosis after stent placement that fails attempts at debridement and dilatation is a particularly challenging complication. We report our experience with brachytherapy for treatment of 5 cases of recurrent bronchial stenosis after stent placement in lung transplant recipients (LTRs).

The success of lung transplantation has improved over time as evidenced by better long-term survival and functional outcomes. Despite the success of this procedure, there are numerous problems and complications that may develop over the life of a lung transplant recipient. With proper monitoring and treatment, the frequency and severity of these problems can be decreased. However, significant improvement for the overall outcomes of lung transplantation will only occur when better methods exist to prevent or effectively treat chronic rejection.

Purpose: Chronic obstructive pulmonary disease (COPD) is the most common indication for lung transplantation (LTx) in the United States. There is no consensus about whether single (SLT) or double LTx (DLT) should be performed for patients with COPD. Although ISHLT and United Network for Organ Sharing registry data demonstrates a survival advantage for DLT versus SLT in patients with COPD, this data has not been corrected for age. Transplanting two lungs into one individual may deprive another of a single lung transplant. This contributes to the scarcity of suitable organs, which continues to be one of the major factors limiting widespread use of lung transplantation. We hypothesized that DLT does not confer a survival advantage compared to SLT in patients with COPD when corrected for age. Procedure: UNOS information regarding all COPD patients in the US who received a lung transplant from 1990 - 2000 was reviewed. LTx recipient characteristics were defined. Kaplan-Meier survival curves were generated for DLT vs. SLT before and after adjustment for patients age. The Cox Proportional Hazards Model was used to calculate age adjusted relative risk of mortality.

(A consensus report from The Pulmonary Council of the International Society for Heart and Lung Transplantation)

We report a case of a 32-year-old woman who, after passage of broncholiths, developed a mediastinal abscess that required surgical drainage for treatment. Previously reported infectious complications resulting from broncholiths include obstructive pneumonitis and recurrent aspiration pneumonitis secondary to bronchoesophageal fistulas. Because radiographic evidence of abnormal calcification in the chest is common, but rarely is associated,with broncholithiasis, the patient's history of lithoptysis was crucial to determining the underlying etiology of her abscess.

Given the urgent problem of organ availability in thoracic transplantation, and the associated increasing risk of mortality for patients currently on the waiting list, 1 Arcasoy S.M. Kotloff R.M. Medical progress lung transplantation. N Engl J Med. 1999; 340: 1081-1091 Crossref PubMed Scopus (450) Google Scholar we read with interest the report by Bhorade et al concerning the use of “marginal or extended donors” in lung transplantation. 2 Bhorade S.M. Vigneswaran W. McCabe M.A. Garrity E.R. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transplant. 2000; 19: 1200-1204 Abstract Full Text Full Text PDF Scopus (175) Google Scholar This study strengthened the argument that liberalization of donor criteria may expand the number of thoracic organs available without compromising outcomes by reporting similar pulmonary function and survival at 1 year for recipients of “marginal” or “ideal” donor lung allografts. Although Bhorade et al and the report by the Xenotransplantation Advisory Committee (published in the same issue) 2 Bhorade S.M. Vigneswaran W. McCabe M.A. Garrity E.R. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transplant. 2000; 19: 1200-1204 Abstract Full Text Full Text PDF Scopus (175) Google Scholar acknowledged the importance of active donor management as part of the organ procurement process, we believe that the potential contribution of donor management in improving the donor pool is under-appreciated and warrants greater emphasis.

Case history A 48-yr-old white female was referred for an abnormality on her plain chest radiograph in the setting of progressive exertional dyspnoea. She had initially sought a medical evaluation 2 months previously for worsening headaches and a magnetic resonance imaging (MRI) scan of her brain was ordered. This MRI revealed an old infarct in her right posterior-inferior cerebellar hemisphere. She underwent a transoesophageal echocardiogram that showed a structurally normal heart but a positive bubble contrast study suggesting a right to left shunt. The cardiologist interpreting the study noted that there was no evidence of intracardiac shunt, but the delay after venous injection of the contrast bubbles until their appearance in the left heart suggested an anomalous, perhaps congenital, systemic venous connection to the left atrium. Two days after the echocardiogram was completed, the patient presented to a local emergency department complaining of chest discomfort. She denied any cough, fevers, night sweats, or weight loss. Past history was significant for y20 pack-yrs of cigarette smoking, though she quit 15 yrs ago, and had 1-2 episodes of bronchitis per year. The patient9s physical examination showed: tem- perature 37.8uC; pulse 72 beats?min-1; respirations 14 breaths?min-1; and blood pressure (P) 135/75 mmHg. She was mildly obese and in no distress. Examination of skin, nose and mouth revealed no abnormalities. Examination of the neck revealed no elevation in jugular venous pressure. Chest examination revealed symmetric breath sounds with no crackles, wheezing or rhonchi and resonance to percussion bilaterally. Cardiac examination revealed a regular rhythm with normal first and second heart sounds and no murmurs or pericardial friction rub. The abdomen was soft, nontender and without hepatosplenomegaly. There