Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment ...Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment of treatment.The consensus statement from the International Society for Heart and Lung Transplantation on CLAD in 2019 classified CLAD into two main phenotypes:Bronchiolitis obliterans syndrome and restrictive allograft syndrome.Along with this clear classification,further exploration of the mechanisms and the development of appropriate prevention and treatment strategies for each phenotype are desired.In this review,we summarize the new definition of CLAD and update and summarize the existing knowledge on the underlying mechanisms of bronchiolitis obliterans syndrome and restrictive allograft syndrome,which have been elucidated from clinicopathological observations and animal experiments worldwide.展开更多
AIM:To evaluate pre-lung transplant acid reflux on p H-testing vs corresponding bolus reflux on multichannel intraluminal impedance(MII) to predict early allograft injury.METHODS:This was a retrospective cohort study ...AIM:To evaluate pre-lung transplant acid reflux on p H-testing vs corresponding bolus reflux on multichannel intraluminal impedance(MII) to predict early allograft injury.METHODS:This was a retrospective cohort study of lung transplant recipients who underwent pretransplant combined MII-p H-testing at a tertiary care center from January 2007 to November 2012. Patients with pre-transplant fundoplication were excluded. Time-to-event analysis was performed using a Cox proportional hazards model to assess associations between measures of reflux on MII-p H testing and early allograft injury. Area under the receiver operating characteristic(ROC) curve(c-statistic) of the Cox model was calculated to assess the predictive value of each reflux parameter for early allograft injury. Six p H-testing parameters and their corresponding MIImeasures were specified a priori. The p H parameters were upright,recumbent,and overall acid reflux exposure; elevated acid reflux exposure; total acid reflux episodes; and acid clearance time. The corresponding MII measures were upright,recumbent,and overall bolus reflux exposure; elevated bolus reflux exposure; total bolus reflux episodes; and bolus clearance time.RESULTS:Thirty-two subjects(47% men,mean age:55 years old) met the inclusion criteria of the study. Idiopathic pulmonary fibrosis(46.9%) repres e n t e d t h e m o s t c o m m o n p u l m o n a r y d i a g n o s i s leading to transplantation. Baseline demographics,pre-transplant cardiopulmonary function,number of lungs transplanted(unilateral vs bilateral),and posttransplant proton pump inhibitor use were similar between reflux severity groups. The area under the ROC curve,or c-statistic,of each acid reflux parameter on pre-transplant p H-testing was lower than its bolus reflux counterpart on MII in the prediction of early allograft injury. In addition,the development of early allograft injury was significantly associated with three pre-transplant MII measures of bolus reflux:overall reflux exposure(HR = 1.18,95%CI:1.01-1.36,P = 0.03),recumbent reflux exposure(HR = 1.25,95%CI:1.04-1.50,P = 0.01) and bolus clearance(HR = 1.09,95%CI:1.01-1.17,P = 0.02),but not with any p Htesting parameter measuring acid reflux alone.CONCLUSION:Pre-transplant MII measures of bolus reflux perform better than their p H-testing counterparts in predicting early allograft injury post-lung transplantation.展开更多
文摘Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment of treatment.The consensus statement from the International Society for Heart and Lung Transplantation on CLAD in 2019 classified CLAD into two main phenotypes:Bronchiolitis obliterans syndrome and restrictive allograft syndrome.Along with this clear classification,further exploration of the mechanisms and the development of appropriate prevention and treatment strategies for each phenotype are desired.In this review,we summarize the new definition of CLAD and update and summarize the existing knowledge on the underlying mechanisms of bronchiolitis obliterans syndrome and restrictive allograft syndrome,which have been elucidated from clinicopathological observations and animal experiments worldwide.
文摘AIM:To evaluate pre-lung transplant acid reflux on p H-testing vs corresponding bolus reflux on multichannel intraluminal impedance(MII) to predict early allograft injury.METHODS:This was a retrospective cohort study of lung transplant recipients who underwent pretransplant combined MII-p H-testing at a tertiary care center from January 2007 to November 2012. Patients with pre-transplant fundoplication were excluded. Time-to-event analysis was performed using a Cox proportional hazards model to assess associations between measures of reflux on MII-p H testing and early allograft injury. Area under the receiver operating characteristic(ROC) curve(c-statistic) of the Cox model was calculated to assess the predictive value of each reflux parameter for early allograft injury. Six p H-testing parameters and their corresponding MIImeasures were specified a priori. The p H parameters were upright,recumbent,and overall acid reflux exposure; elevated acid reflux exposure; total acid reflux episodes; and acid clearance time. The corresponding MII measures were upright,recumbent,and overall bolus reflux exposure; elevated bolus reflux exposure; total bolus reflux episodes; and bolus clearance time.RESULTS:Thirty-two subjects(47% men,mean age:55 years old) met the inclusion criteria of the study. Idiopathic pulmonary fibrosis(46.9%) repres e n t e d t h e m o s t c o m m o n p u l m o n a r y d i a g n o s i s leading to transplantation. Baseline demographics,pre-transplant cardiopulmonary function,number of lungs transplanted(unilateral vs bilateral),and posttransplant proton pump inhibitor use were similar between reflux severity groups. The area under the ROC curve,or c-statistic,of each acid reflux parameter on pre-transplant p H-testing was lower than its bolus reflux counterpart on MII in the prediction of early allograft injury. In addition,the development of early allograft injury was significantly associated with three pre-transplant MII measures of bolus reflux:overall reflux exposure(HR = 1.18,95%CI:1.01-1.36,P = 0.03),recumbent reflux exposure(HR = 1.25,95%CI:1.04-1.50,P = 0.01) and bolus clearance(HR = 1.09,95%CI:1.01-1.17,P = 0.02),but not with any p Htesting parameter measuring acid reflux alone.CONCLUSION:Pre-transplant MII measures of bolus reflux perform better than their p H-testing counterparts in predicting early allograft injury post-lung transplantation.
