BACKGROUNDLung transplantation (LT) is a viable option for patients with end-stage lung diseases, but in China, the supply is limited, and the experience with LT is rare too. This study aimed to evaluate the survival and postoperative complications of recipients undergone LT.

METHODSFrom January 2003 to May 2010, all patients who underwent LT were included. The clinical data of recipients were analyzed retrospectively, including demographic characteristics, survival rate, and the occurrences of postoperative complications, acute rejection and bronchiolitis obliterans syndrome.

RESULTSIn total, 37 patients underwent LT. The early mortality (≤ 30 days) was 14% (5/37). Cumulative survival rate was 78%, 70%, 70% and 42% at 1, 3, 5 and 6 years, respectively. In 37 patients, 5 (14%) developed fungal infections, 9 (24%) pulmonary bacterial infections, and 6 (16%) had bronchial anastomosis complications after LT. At three months post-transplantation, a significant improvement was observed in lung function (P < 0.05). Fifteen recipients (41%) developed acute rejection within the first year. Freedom from bronchiolitis obliterans syndrome was 89%, 85% and 80% at 1, 2 and 3 years after transplantation.

CONCLUSIONSDespite the limited number of cases, the survival and occurrences of complications after LT were comparable to the international experience. Single LT may be a reasonable option for some patients with end-stage pulmonary diseases.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Kaplan-Meier Estimate ; Lung Diseases ; mortality ; surgery ; Lung Transplantation ; adverse effects ; mortality ; Male ; Middle Aged ; Postoperative Complications ; mortality ; Survival Rate ; Young Adult

BACKGROUND/AIMS: Infections are major causes of both early and late death after lung transplantation (LT). The development of prophylaxis strategies has altered the epidemiology of post-LT infections; however, recent epidemiological data are limited. We evaluated infections after LT at our institution by time of occurrence, site of infections, and microbiologic etiologies. METHODS: All consecutive patients undergoing lung or heart-lung transplantation between October 2008 and August 2014 at our institution were enrolled. Cases of infections after LT were initially identified from the prospective registry database, which was followed by a detailed review of the patients' medical records. RESULTS: A total of 108 episodes of post-LT infections (56 bacterial, 43 viral, and nine fungal infections) were observed in 34 LT recipients. Within 1 month after LT, the most common bacterial infections were catheter-related bloodstream infections (42%). Pneumonia was the most common site of bacterial infection in the 2- to 6-month period (28%) and after 6 months (47%). Cytomegalovirus was the most common viral infection within 1 month (75%) and in the 2- to 6-month period (80%). Respiratory viruses were the most common viruses after 6 months (48%). Catheter-related candidemia was the most common fungal infection. Invasive pulmonary aspergillosis developed after 6 months. Survival rates at the first and third years were 79% and 73%, respectively. CONCLUSIONS: Although this study was performed in a single center, we provide valuable and recent detailed epidemiology data for post-LT infections. A further multicenter study is required to properly evaluate the epidemiology of post-LT infections in Korea.
Adult ; Bacterial Infections/diagnosis/*microbiology/mortality ; Catheter-Related Infections/microbiology/virology ; Cytomegalovirus Infections/virology ; Female ; Heart-Lung Transplantation/*adverse effects/mortality ; Humans ; Kaplan-Meier Estimate ; Lung Transplantation/*adverse effects/mortality ; Male ; Medical Records ; Middle Aged ; Mycoses/diagnosis/*microbiology/mortality ; Pneumonia, Bacterial/microbiology ; Registries ; Republic of Korea/epidemiology ; Risk Factors ; Time Factors ; Treatment Outcome ; Virus Diseases/diagnosis/mortality/*virology

OBJECTIVETo study the incidence, etiology, outcome, and risk factors of early (is less than or equal to 30 days) pulmonary infection following adult-to-adult living donor liver transplantation (AALDLT).

METHODSMedical records of 108 AALDLT without pre-operative respiratory disease from 2005 to 2008 were retrospective to evaluate the incidence, etiology, outcome, and risk factors of pulmonary infection following AALDLT. Univariate analysis was used to determine relative risk factors leading to postoperative pneumonia, and significant factors (P less than 0.05) were then used for multivariate logistic regression analysis.

RESULTSThe incidence of pneumonia was 22.2 % (n = 24 ); etiology including bacteria (n = 23, 21.3%), gram negative bacteria account for 78.3%, fungi (n = 4, 3.7%) and virus (n = 1, 0.9%), 4 patients were coinfection by bacteria and fungi; 6 among 24 patients (25%) and 4 out of the other 84 patients (4.76%) died early following the AALDLT, respectively (x2 = 6.850, P = 0.009). In univariate analysis, intraoperative volume of whole blood/packed red blood cells transfusion (P less than 0.01), intraoperative volume of fresh frozen plasma transfusion (P = 0.001), total volume of intraoperative transfusion (P = 0.015), mechanical ventilation (P less than 0.01), intensive unit care (ICU) stay (P = 0.012) and acute rejection (P = 0.001) are of statistical significance. Multivariate logistic regression showed only mechanical ventilation (P = 0.023) and acute rejection (P = 0.026) are independent factors predicting pneumonia.

CONCLUSIONGram negative bacteria is the main etiology for pneumonia following AALDLT which has high morbidity and mortality; mechanical ventilation and acute rejection are independent risk factors.

Adult ; Female ; Graft Rejection ; epidemiology ; Gram-Negative Bacterial Infections ; epidemiology ; mortality ; Humans ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Incidence ; Liver Transplantation ; adverse effects ; methods ; mortality ; Living Donors ; Lung Diseases ; epidemiology ; microbiology ; mortality ; Male ; Middle Aged ; Pleural Effusion ; epidemiology ; Pneumonia ; epidemiology ; microbiology ; mortality ; Postoperative Complications ; epidemiology ; Regression Analysis ; Retrospective Studies ; Risk Factors ; Transfusion Reaction ; Young Adult

BACKGROUND: High-dose chemotherapy is increasingly employed in many refractory malignant diseases. This therapy has been reported to increase response rate and survival benefits but it is also associated with higher treatment-related morbidity and mortality. We evaluated clinical characteristics and course of the pulmonary toxicity following high-dose chemotherapy with peripheral blood stem cell transplantation. METHODS: Ninety-seven patients who had received high-dose chemotherapy with peripheral blood stem cell transplantation were evaluated. Five patients who developed lung lesions which were not related to infection nor primary malignant disease underwent transbronchial lung biopsy. The patients' clinical characteristics, treatments, and prognosis were reviewed retrospectively. RESULTS: Five patients(5.1%) developed idiopathic pneumonia syndrome. The high dose chemotherapy regimens employed were cyclophosphamide, BCNU, and cisplatin in 3 cases, one case of BCNU, etoposide, Ara-C, cyclophosphamide combination, and a regimen consisting of BCNU, etoposide, Ara-C, and melphalan. The total dose of BCNU used was 300-400 mg/m2 and that of cyclophosphsmide was 6,000 mg/m2. All of 5 patients received radiation therapy before this treatment. After an average duration of 14 weeks (4-26 weeks) of high-dose chemotherapy, patients developed cough, dyspnea and fever. The chest X-rays showed bilateral diffuse infiltration in 3 cases and the focal infiltration in the other 2 cases. All the patients received corticosteroid therapy as a treatment for the lung lesions. Two of them progressed to acute respiratory distress syndrome and died. Three patients recovered without residual lung lesion but one of them died of dilated cardiomyopathy. CONCLUSION: High-dose chemotherapy with peripheral blood stem cell transplantation especially which containing BCNU regimen may develop idiopathic pneumonia syndrome related to pulmonary toxicity and corticosteroid therapy may be beneficial in some cases.
Biopsy ; Cardiomyopathy, Dilated ; Carmustine ; Cisplatin ; Cough ; Cyclophosphamide ; Cytarabine ; Drug Therapy* ; Drug-Related Side Effects and Adverse Reactions ; Dyspnea ; Etoposide ; Fever ; Humans ; Lung ; Melphalan ; Mortality ; Peripheral Blood Stem Cell Transplantation* ; Pneumonia ; Prognosis ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Thorax