To the Editor:The lung is the most frequent site of extrahepatic hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT).Pulmonary metastasis from hepatocellular carcinoma(PM-HCC)carries a poor prognos...To the Editor:The lung is the most frequent site of extrahepatic hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT).Pulmonary metastasis from hepatocellular carcinoma(PM-HCC)carries a poor prognosis as the patient could finally die of pulmonary failure secondary to the tumor despite maintaining ideal liver function.展开更多
Introduction Organ transplantation increases survival and improves qual-ity of life to many patients with end-stage organ failure.Or-gan shortage is a worldwide problem that restricts organ trans-plantation[1].Organ p...Introduction Organ transplantation increases survival and improves qual-ity of life to many patients with end-stage organ failure.Or-gan shortage is a worldwide problem that restricts organ trans-plantation[1].Organ procurement and preservation as well as ischemia-reperfusion injury(IRI)after transplantation are the im-portant factors affecting prognosis of recipients.Since the de-velopment of organ transplantation technology in the 20th cen-tury,organ protection technology has been a most promising con-cept in this field.Organ preservation solutions such as the Collins solution,University of Wisconsin(UW)solution,and histidine-tryptophan-ketoglutarate(HTK)solution were developed sequen-tially[2],which developed rapidly in static cold storage(SCS)tech-niques.SCS remains the standard preservation technique for organ transplantation[2].展开更多
The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation(LT)waiting list.A steady increase in the threshold at which age is taken into consideration for LT has been observe...The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation(LT)waiting list.A steady increase in the threshold at which age is taken into consideration for LT has been observed.This retrospective cohort study recruited 166 lung transplant recipients aged≥65 years between January 2016 and October 2020 in the largest LT center in China.In the cohort,subgroups of patients aged 65–70 years(111 recipients,group 65–70)and≥70 years(55 recipients,group≥70)were included.Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years.A significantly higher percentage of coronary artery stenosis was observed in the group≥70(30.9%vs.14.4%in group 65–70,P=0.014).ECMO bridging to LT was performed in 5.4%(group 65–70)and 7.3%(group≥70)of patients.Kaplan–Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality.After adjusting for potential confounders,cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality(HR 6.37,P=0.0060).Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.展开更多
Background:Lung transplantation(LT)has been demonstrated as the only effective therapy for patients with end-stage lung diseases.Increasing listed lung transplant candidates and expanding volumes of lung transplant ce...Background:Lung transplantation(LT)has been demonstrated as the only effective therapy for patients with end-stage lung diseases.Increasing listed lung transplant candidates and expanding volumes of lung transplant centers across China require wellorganized programs and registry data collection based on the large population.This study aimed to summarize and analyze the data of LT development in China.Methods:We retrospectively collected and analyzed data from the China Lung Transplantation Registry(CLuTR).Key data were reported from the registry with transplant types,indications,donor and recipient characteristics,outcomes and survival.The survival<30 days,1-year and 3-year survival rates were estimated with risk factors identified.Results:CLuTR contained data from 1053 lung transplants performed through January 1st,2015 to December 31st,2018 reported by 18 registered transplant centers.The largest category of diagnosis before transplantation was idiopathic interstitial pneumonitis.The total<30 days,1-year and 3-year survival rates in CLuTR were 81.45%,70.11%,and 61.16%with discrepancy by indications.Large proportion of recipients who were more than 60 years old required higher standard of care.Infection-related complications resulted in more death events in the early post-surgery periods.New York Heart Association grading at listing,extra-corporeal membrane oxygenation usage peri-transplantation,allograft dysfunction(primary graft dysfunction>Grade 0),renal insufficiency(estimated glomerular filtration rate<60 mL min_11.73 m^2),were independently associated with a higher risk for 3-year mortality in the entire cohort.Conclusions:Facing more end-stage of lung diseases and comorbidities,this study analyzed the outcomes and survival of LT recipients in China.Further prospectively stratified analyses with longer follow-up will be needed.展开更多
Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreve...Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreversible fatal respiratory failure.Lung transplantation(LT)as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.Methods:From February 10 to March 10,2020,three male patients were urgently assessed and listed for transplantation.After conducting a full ethical review and after obtaining assent from the family of the patients,we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.Results:Two of the three recipients survived post-LT and started participating in a rehabilitation program.Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved.The pathological results of the explanted lungs were concordant with the critical clinical manifestation,and provided insight towards better understanding of the disease.Government health affair systems,virology detection tools,and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.Conclusions:LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis.If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT,LT provided the final option for these patients to avoid certain death,with proper protection of transplant surgeons and medical staffs.By ensuring instant seamless care for both patients and medical teams,the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.展开更多
To the Editor:During the coronavirus disease 2019(COVID-19)pandemic in China,cadaveric organ donation became drastically reduced,which exacerbated the waitlist morbidity and mortality of lung transplant(LTx)patients.W...To the Editor:During the coronavirus disease 2019(COVID-19)pandemic in China,cadaveric organ donation became drastically reduced,which exacerbated the waitlist morbidity and mortality of lung transplant(LTx)patients.We report a case where we were able to maximize the utilization of the lungs from a single cadaveric donor by performing a single left LTx for one recipient using the donor’s left lung,and by bipartitioning the donor’s right lung,we were able to perform bilateral lobar transplantation for another recipient.展开更多
Background:Acute kidney injury(AKI)is a common and serious complication following lung transplantation(LTx),and it is associated with high mortality and morbidity.This study assessed the incidence of AKI after LTx and...Background:Acute kidney injury(AKI)is a common and serious complication following lung transplantation(LTx),and it is associated with high mortality and morbidity.This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.Methods:This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019.The outcomes were AKI incidence,risk factors,mortality,and kidney recovery.Multivariate analysis was performed to identify independent risk factors.Survival analysis was presented using the Kaplan-Meier curves.Results:AKI occurred in 137 of the 191 patients(71.7%),with transient AKI in 43(22.5%)and persistent AKI in 94(49.2%).AKI stage 1 occurred in 27/191(14.1%),stage 2 in 46/191(24.1%),and stage 3 in 64/191(33.5%)of the AKI patients.Renal replacement therapy(RRT)was administered to 35/191(18.3%)of the patients.Male sex,older age,mechanical ventilation(MV),severe hypotension,septic shock,multiple organ dysfunction(MODS),prolonged extracorporeal membrane oxygenation(ECMO),reintubation,and nephrotoxic agents were associated with AKI(P<0.050).Persistent AKI was independently associated with pre-operative pulmonary hypertension,severe hypotension,post-operative MODS,and nephrotoxic agents.Severe hypotension,septic shock,MODS,reintubation,prolonged MV,and ECMO during or after LTx were related to severe AKI(stage 3)(P<0.050).Patients with persistent and severe AKI had a significantly longer duration of MV,longer duration in the intensive care unit(ICU),worse downstream kidney function,and reduced survival(P<0.050).Conclusions:AKI is common after LTx,but the pathogenic mechanism of AKI is complicated,and prerenal causes are important.Persistent and severe AKI were associated with poor short-and long-term kidney function and reduced survival in LTx patients.展开更多
Although the pathological findings of coronavirus disease 2019(COVID-19)associated with acute respiratory distress syndrome(ARDS)have been reported in previous studies,the data of histopatho-logical features of end-st...Although the pathological findings of coronavirus disease 2019(COVID-19)associated with acute respiratory distress syndrome(ARDS)have been reported in previous studies,the data of histopatho-logical features of end-stage COVID-19 lungs are still lacking.We have previously reported the clini-cal features and managements of three COVID-19 patients with irreversible deterioration of pulmonary function who received lung transplantation(LT)after being supported by extracorporeal membrane oxygenation(ECMO)[1].展开更多
文摘To the Editor:The lung is the most frequent site of extrahepatic hepatocellular carcinoma(HCC)recurrence after liver transplantation(LT).Pulmonary metastasis from hepatocellular carcinoma(PM-HCC)carries a poor prognosis as the patient could finally die of pulmonary failure secondary to the tumor despite maintaining ideal liver function.
基金Major Science and Technology Projects of Hainan Province(ZDKJ2019009)Research Project of Ji’nan Microecological Biomedicine Shandong Labora-tory(JNL-2022002A and JNL-2022023C)+3 种基金Public Projects of Zhe-jiang Province(LGF21H030006)Research Unit Project of Chinese Academy of Medical Sciences(2019-I2M-5-030)the National Natu-ral Science Foundation of China(81721091,62073211)the Na-tional S&T Major Project for Infectious Diseases(2017ZX10203205).
文摘Introduction Organ transplantation increases survival and improves qual-ity of life to many patients with end-stage organ failure.Or-gan shortage is a worldwide problem that restricts organ trans-plantation[1].Organ procurement and preservation as well as ischemia-reperfusion injury(IRI)after transplantation are the im-portant factors affecting prognosis of recipients.Since the de-velopment of organ transplantation technology in the 20th cen-tury,organ protection technology has been a most promising con-cept in this field.Organ preservation solutions such as the Collins solution,University of Wisconsin(UW)solution,and histidine-tryptophan-ketoglutarate(HTK)solution were developed sequen-tially[2],which developed rapidly in static cold storage(SCS)tech-niques.SCS remains the standard preservation technique for organ transplantation[2].
文摘The current organ allocation rules prioritize elderly and urgent patients on the lung transplantation(LT)waiting list.A steady increase in the threshold at which age is taken into consideration for LT has been observed.This retrospective cohort study recruited 166 lung transplant recipients aged≥65 years between January 2016 and October 2020 in the largest LT center in China.In the cohort,subgroups of patients aged 65–70 years(111 recipients,group 65–70)and≥70 years(55 recipients,group≥70)were included.Group D restrictive lung disease was the main indication of a lung transplant in recipients over 65 years.A significantly higher percentage of coronary artery stenosis was observed in the group≥70(30.9%vs.14.4%in group 65–70,P=0.014).ECMO bridging to LT was performed in 5.4%(group 65–70)and 7.3%(group≥70)of patients.Kaplan–Meier estimates showed that recipients with cardiac abnormalities had a significantly increased risk of mortality.After adjusting for potential confounders,cardiac abnormality was shown to be independently associated with the increased risk of post-LT mortality(HR 6.37,P=0.0060).Our result showed that LT can be performed in candidates with an advanced age and can provide life-extending benefits.
文摘Background:Lung transplantation(LT)has been demonstrated as the only effective therapy for patients with end-stage lung diseases.Increasing listed lung transplant candidates and expanding volumes of lung transplant centers across China require wellorganized programs and registry data collection based on the large population.This study aimed to summarize and analyze the data of LT development in China.Methods:We retrospectively collected and analyzed data from the China Lung Transplantation Registry(CLuTR).Key data were reported from the registry with transplant types,indications,donor and recipient characteristics,outcomes and survival.The survival<30 days,1-year and 3-year survival rates were estimated with risk factors identified.Results:CLuTR contained data from 1053 lung transplants performed through January 1st,2015 to December 31st,2018 reported by 18 registered transplant centers.The largest category of diagnosis before transplantation was idiopathic interstitial pneumonitis.The total<30 days,1-year and 3-year survival rates in CLuTR were 81.45%,70.11%,and 61.16%with discrepancy by indications.Large proportion of recipients who were more than 60 years old required higher standard of care.Infection-related complications resulted in more death events in the early post-surgery periods.New York Heart Association grading at listing,extra-corporeal membrane oxygenation usage peri-transplantation,allograft dysfunction(primary graft dysfunction>Grade 0),renal insufficiency(estimated glomerular filtration rate<60 mL min_11.73 m^2),were independently associated with a higher risk for 3-year mortality in the entire cohort.Conclusions:Facing more end-stage of lung diseases and comorbidities,this study analyzed the outcomes and survival of LT recipients in China.Further prospectively stratified analyses with longer follow-up will be needed.
基金This study was supported by grants from the Chen Jingyu team of“Sanming Project of Medicine”in Shenzhen(No.SZSM201812058)the Foundation for Special Projects of COVID-19 Prevention and Control in Wuxi City.
文摘Background:Critical patients with the coronavirus disease 2019(COVID-19),even those whose nucleic acid test results had turned negative and those receiving maximal medical support,have been noted to progress to irreversible fatal respiratory failure.Lung transplantation(LT)as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.Methods:From February 10 to March 10,2020,three male patients were urgently assessed and listed for transplantation.After conducting a full ethical review and after obtaining assent from the family of the patients,we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.Results:Two of the three recipients survived post-LT and started participating in a rehabilitation program.Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved.The pathological results of the explanted lungs were concordant with the critical clinical manifestation,and provided insight towards better understanding of the disease.Government health affair systems,virology detection tools,and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.Conclusions:LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis.If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT,LT provided the final option for these patients to avoid certain death,with proper protection of transplant surgeons and medical staffs.By ensuring instant seamless care for both patients and medical teams,the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.
文摘To the Editor:During the coronavirus disease 2019(COVID-19)pandemic in China,cadaveric organ donation became drastically reduced,which exacerbated the waitlist morbidity and mortality of lung transplant(LTx)patients.We report a case where we were able to maximize the utilization of the lungs from a single cadaveric donor by performing a single left LTx for one recipient using the donor’s left lung,and by bipartitioning the donor’s right lung,we were able to perform bilateral lobar transplantation for another recipient.
基金This work was supported by the Non-profit Central Research Institute Fund of the Chinese Academy of Medical Sciences(No.2019PT320020).
文摘Background:Acute kidney injury(AKI)is a common and serious complication following lung transplantation(LTx),and it is associated with high mortality and morbidity.This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.Methods:This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019.The outcomes were AKI incidence,risk factors,mortality,and kidney recovery.Multivariate analysis was performed to identify independent risk factors.Survival analysis was presented using the Kaplan-Meier curves.Results:AKI occurred in 137 of the 191 patients(71.7%),with transient AKI in 43(22.5%)and persistent AKI in 94(49.2%).AKI stage 1 occurred in 27/191(14.1%),stage 2 in 46/191(24.1%),and stage 3 in 64/191(33.5%)of the AKI patients.Renal replacement therapy(RRT)was administered to 35/191(18.3%)of the patients.Male sex,older age,mechanical ventilation(MV),severe hypotension,septic shock,multiple organ dysfunction(MODS),prolonged extracorporeal membrane oxygenation(ECMO),reintubation,and nephrotoxic agents were associated with AKI(P<0.050).Persistent AKI was independently associated with pre-operative pulmonary hypertension,severe hypotension,post-operative MODS,and nephrotoxic agents.Severe hypotension,septic shock,MODS,reintubation,prolonged MV,and ECMO during or after LTx were related to severe AKI(stage 3)(P<0.050).Patients with persistent and severe AKI had a significantly longer duration of MV,longer duration in the intensive care unit(ICU),worse downstream kidney function,and reduced survival(P<0.050).Conclusions:AKI is common after LTx,but the pathogenic mechanism of AKI is complicated,and prerenal causes are important.Persistent and severe AKI were associated with poor short-and long-term kidney function and reduced survival in LTx patients.
基金This research was supported by the National Natural Science Foundation of China[grant numbers 81922041 and 81772020]the Science and Technology of Jiangsu Province China[grant number BK20170048]and Natural Science Fund for Colleges and Universities in Jiangsu Province[grant number 19KJB340001].
文摘Although the pathological findings of coronavirus disease 2019(COVID-19)associated with acute respiratory distress syndrome(ARDS)have been reported in previous studies,the data of histopatho-logical features of end-stage COVID-19 lungs are still lacking.We have previously reported the clini-cal features and managements of three COVID-19 patients with irreversible deterioration of pulmonary function who received lung transplantation(LT)after being supported by extracorporeal membrane oxygenation(ECMO)[1].
