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Current Status and Future Trends in Lung Transplantation
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Current Status and Future Trends in Lung Transplantation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: closed (25 September 2023) | Viewed by 9524

Special Issue Editors

Prof. Dr. Matthias Loebe

E-Mail Website
Guest Editor
Department of Surgery, Division of Thoracic Transplant and Mechanical Support, University of Miami, Coral Gables, FL, USA
Interests: lung transplantation; cardiothoracic surgery; extracorporeal oxygenation; respiratory failure; adult respiratory distress syndrome; primary graft dysfunction
Dr. Scott Scheinin

E-Mail Website
Guest Editor
Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY, USA
Interests: lung transplantation; heart-lung transplant; lung cancer; mediastinal abnormalities; mediastinal tumors; thymectomy; tracheal stenosis

Special Issue Information

Dear Colleagues,

Lung transplantation has evolved rapidly in recent years. While the COVID-19 pandemic produced a completely new set of candidates for lung support and replacement, new techniques in organ preservation have expanded the pool of available donor organs. Extracorporeal perfusion and preservation of donor organs provide the possibility to measure organ function and improve organ quality. As ECMO has generally evolved as a much safer technology to support patients in advanced lung failure, pre- and post-transplant mechanical support is taking on a bigger role in lung transplantation. Improvements in intensive care and pre- and post-transplant rehabilitation have had a significant impact on early and long-term success.

These topics will be addressed in this Special Issue. The papers will be designed to give the internal medicine practitioner a solid understanding of where lung transplantation stands today and what benefits can be expected for patients suffering from end-stage lung disease.

Prof. Dr. Matthias Loebe
Dr. Scott Scheinin
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lung transplantation
  • cardiothoracic surgery
  • extracorporeal oxygenation
  • respiratory failure
  • adult respiratory distress syndrome
  • primary graft dysfunction

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Published Papers (4 papers)

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Review

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9 pages, 231 KiB  
Review
Prevention and Management of Infections in Lung Transplant Recipients
by Anum Fayyaz, Mohammed Raja and Yoichiro Natori
J. Clin. Med. 2024, 13(1), 11; https://doi.org/10.3390/jcm13010011 - 19 Dec 2023
Cited by 1 | Viewed by 1873
Abstract
Anti-rejection medications are essential in preventing organ rejection amongst solid organ transplant recipients; however, these agents also cause profound immunosuppression, predisposing lung transplant recipients (LTRs) to infectious complications. The timely management including prevention, diagnosis, and treatment of such infectious complications is vital to [...] Read more.
Anti-rejection medications are essential in preventing organ rejection amongst solid organ transplant recipients; however, these agents also cause profound immunosuppression, predisposing lung transplant recipients (LTRs) to infectious complications. The timely management including prevention, diagnosis, and treatment of such infectious complications is vital to prevent significant morbidity and mortality in solid organ transplant recipients and allograft dysfunction. LTRs are inundated with microbes that may be recognized as commensals in hosts with intact immune systems. Bacterial infections are the most common ones, followed by viral pathogens. Indications of a brewing infectious process may be subtle. Hence, the importance of adapting vigilance around isolated hints through symptomatology and signs is pivotal. Signals to suggest an infectious process, such as fever and leukocytosis, may be dampened by immunosuppressive agents. One must also be vigilant about drug interactions of antibiotics and immunosuppressive agents. Treatment of infections can become challenging, as antimicrobials can interact with immunosuppressive agents, and antimicrobial resistance can surge under antimicrobial pressure. Transplant infectious disease physicians work in concert with transplant teams to obtain specimens for diagnostic testing and follow through with source control when possible. This heavily impacts medical decisions and fosters a multidisciplinary approach in management. Furthermore, the reduction of immunosuppression, although it augments the risk of allograft rejection, is as crucial as the initiation of appropriate antimicrobials when it comes to the management of infections. Full article
(This article belongs to the Special Issue Current Status and Future Trends in Lung Transplantation)
9 pages, 280 KiB  
Review
Treatment of Hyperammonemia Syndrome in Lung Transplant Recipients
by Sarah Yun, Ciana Scalia and Sara Farghaly
J. Clin. Med. 2023, 12(22), 6975; https://doi.org/10.3390/jcm12226975 - 8 Nov 2023
Cited by 2 | Viewed by 2714
Abstract
Hyperammonemia syndrome is a complication that has been reported to occur in 1–4% of lung transplant patients with mortality rates as high as 60–80%, making detection and management crucial components of post-transplant care. Patients are treated with a multimodal strategy that may include [...] Read more.
Hyperammonemia syndrome is a complication that has been reported to occur in 1–4% of lung transplant patients with mortality rates as high as 60–80%, making detection and management crucial components of post-transplant care. Patients are treated with a multimodal strategy that may include renal replacement therapy, bowel decontamination, supplementation of urea cycle intermediates, nitrogen scavengers, antibiotics against Mollicutes, protein restriction, and restriction of parenteral nutrition. In this review we provide a framework of pharmacologic mechanisms, medication doses, adverse effects, and available evidence for commonly used treatments to consider when initiating therapy. In the absence of evidence for individual strategies and conclusive knowledge of the causes of hyperammonemia syndrome, clinicians should continue to design multimodal regimens based on suspected etiologies, institutional drug availability, patient ability to tolerate enteral medications and nutrition, and availability of intravenous access. Full article
(This article belongs to the Special Issue Current Status and Future Trends in Lung Transplantation)
11 pages, 273 KiB  
Review
Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient
by Brian Housman, Daniel Laskey, Gbalekan Dawodu and Scott Scheinin
J. Clin. Med. 2023, 12(21), 6789; https://doi.org/10.3390/jcm12216789 - 27 Oct 2023
Viewed by 1469
Abstract
Introduction: The optimal treatment for Secondary Pulmonary Hypertension from End-Stage Lung Disease remains controversial. Double Lung Transplantation is widely regarded as the treatment of choice as it eliminates all diseased parenchyma and introduces a large volume of physiologically normal allograft. By comparison, [...] Read more.
Introduction: The optimal treatment for Secondary Pulmonary Hypertension from End-Stage Lung Disease remains controversial. Double Lung Transplantation is widely regarded as the treatment of choice as it eliminates all diseased parenchyma and introduces a large volume of physiologically normal allograft. By comparison, the role of single lung transplantation for pulmonary hypertension (PAH) is less clear. The remaining diseased lung will limit clinical improvements and permit downstream sequelae; including residual cough, recurrent infection, and continued pulmonary hypertension. But not every patient can undergo DLT. Advanced age, frailty, co-morbid conditions, and limited availability of organs will all affect surgical candidacy and can offset the benefits of double lung procedures. Studies that compare SLT and DLT do not commonly explore the utility of single lung procedures even though multiple theoretical advantages exist; including reduced waiting times, less waitlist mortality, fewer surgical complications, and lower operative mortality. Worse, multiple forms of publication and selection bias may favor DLT in registry-based studies. In this review, we present the prevailing literature on single and double lung transplants in patients with secondary pulmonary hypertension and clarify the potential utility of these procedures. Materials and Methods: A PubMed search for English-language articles exploring single and double lung transplants in the setting of secondary pulmonary hypertension was conducted from 1990 to 2023. Key words included “single lung transplant”, “double lung transplant”, “pulmonary hypertension”, “rejection”, “complications”, “extracorporeal membranous oxygenation”, “death”, and all appropriate Boolean operators. We prioritized research from retrospective studies that evaluated clinical outcomes from single centers. Conclusions: The question is not whether DLT is better at resolving lung disease; instead, we must ask if SLT is an acceptable form of therapy in a select group of high-risk patients. Further research should focus on how best to identify recipients that may benefit from each type of procedure, and the clinical utility of perioperative VA ECMO. Full article
(This article belongs to the Special Issue Current Status and Future Trends in Lung Transplantation)

Other

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8 pages, 499 KiB  
Brief Report
High-Flow Tracheal Oxygen for Tracheostomy Tube Removal in Lung Transplant Recipients
by Federico Lionello, Gabriella Guarnieri, Giovanna Arcaro, Leonardo Bertagna De Marchi, Beatrice Molena, Cristina Contessa, Annalisa Boscolo, Federico Rea, Paolo Navalesi and Andrea Vianello
J. Clin. Med. 2023, 12(24), 7566; https://doi.org/10.3390/jcm12247566 - 8 Dec 2023
Cited by 1 | Viewed by 2675
Abstract
(1) Background: Because of a complicated intraoperative course and/or poor recovery of graft function, approximately 15% of lung transplant (LT) recipients require prolonged mechanical ventilation (PMV) and receive a tracheostomy. This prospective study aimed to assess the effect of High-Flow Tracheal Oxygen (HFTO) [...] Read more.
(1) Background: Because of a complicated intraoperative course and/or poor recovery of graft function, approximately 15% of lung transplant (LT) recipients require prolonged mechanical ventilation (PMV) and receive a tracheostomy. This prospective study aimed to assess the effect of High-Flow Tracheal Oxygen (HFTO) on tracheostomy tube removal in LT recipients receiving PMV postoperatively. (2) Methods: The clinical course of 14 LT recipients receiving HFTO was prospectively evaluated and compared to that of 13 comparable controls receiving conventional oxygen therapy (COT) via tracheostomy. The study’s primary endpoint was the number of patients whose tracheostomy tube was removed at discharge from an Intermediate Respiratory Care Unit (IRCU). (3) Results: Setting up HFTO proved easy, and it was well tolerated by all the patients. The number of patients whose tracheostomy tube was removed was significantly higher in the HFOT group compared to the COT group [13/14 vs. 6/13 (p = 0.0128)]. (4) Conclusions: HFTO is an effective, safe therapy that facilitates tracheostomy tube removal in LT recipients after weaning from PMV. Full article
(This article belongs to the Special Issue Current Status and Future Trends in Lung Transplantation)
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