Long-Term Outcomes of Adult Lung Transplantation Recipients: A Single-Center Experience in South Korea

( Kyung-wook Jo ),( Sang-bum Hong ),( Dong Kwan Kim ),( Sung Ho Jung ),( Hyeong Ryul Kim ),( Se Hoon Choi ),( Geun Dong Lee ),( Sang-oh Lee ),( Kyung-hyun Do ),( Eun Jin Chae ),( In-cheol Choi ),( Dae 대한결핵 및 호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.4

Background: Recently, the number of lung transplants in South Korea has increased. However, the long-term outcome data is limited. In this study, we aimed to investigate the long-term outcomes of adult lung transplantation recipients. Methods: Among the patients that underwent lung transplantation at a tertiary referral center in South Korea between 2008 and 2017, adults patient who underwent deceased-donor lung transplantation with available follow-up data were enrolled. Their medical records were retrospectively reviewed. Results: Through eligibility screening, we identified 60 adult patients that underwent lung (n=51) or heart-lung transplantation (n=9) during the observation period. Idiopathic pulmonary fibrosis (46.7%, 28/60) was the most frequent cause of lung transplantation. For all the 60 patients, the median follow-up duration for post-transplantation was 2.6 years (range, 0.01-7.6). During the post-transplantation follow-up period, 19 patients (31.7%) died at a median duration of 194 days. The survival rates were 75.5%, 67.6%, and 61.8% at 1 year, 3 years, and 5 years, respectively. Out of the 60 patients, 8 (13.3%) were diagnosed with chronic lung allograft dysfunction (CLAD), after a mean duration of 3.3±2.8 years post-transplantation. The CLAD development rate was 0%, 17.7%, and 25.8% at 1 year, 3 years, and 5 years, respectively. The most common newly developed post-transplantation comorbidity was the chronic kidney disease (CKD; 54.0%), followed by diabetes mellitus (25.9%). Conclusion: Among the adult lung transplantation recipients at a South Korea tertiary referral center, the long-term survival rates were favorable. The proportion of patients who developed CLAD was not substantial. CKD was the most common post-transplantation comorbidity.

A Successful Lobar Lung Transplantation from a Marginal Deceased Donor with Bronchiectasis and Fibrosis at the Left Upper Lobe and a History of Treated Pulmonary Tuberculosis: A Case Report

( Jisu Yu ),( Ho Cheol Kim ),( Sang-bum Hong ),( Sehoon Choi ),( Geun Dong Lee ),( Dong Kwan Kim ),( Sang-oh Lee ),( Jong-min Song ),( Dong Kyu Oh ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Background The shortage of available donor lungs is a continuing clinical problem. Lobar lung transplantation and the extension of donor lung criteria may expand the pool of donor lungs. Methods Medical records of an index patient were retrospectively reviewed with related literatures. Results A 48-year-old female diagnosed with idiopathic pulmonary arterial hypertension was listed for lung transplantation, but no donor lungs were available for 2 years and her condition rapidly deteriorated. Donor lungs finally became available but were too large for her and had a marginal status for transplantation purposes. Moreover, the donor had a history of treated pulmonary tuberculosis, causing bronchiectasis and fibrosis in the left upper lobe. We decided to perform a lobar lung transplantation in this case, which removes the affected left upper lobe and transplants the right whole lung and the left lower lobe. We also commenced chemoprophylaxis for latent tuberculosis infection with isoniazid immediately after surgery. There was no primary graft dysfunction within the first 72 hours. The patient was extubated on postoperative day 6 and transferred to the general ward on day 26. At 3 months post-transplantation, this patient is alive without infection. Conclusions Our experience suggests that a lobar lung transplantation can be considered not only in cases of size mismatches but also for use of locally damaged lungs. Lungs from a donor who received treatment for pulmonary tuberculosis may be feasible for transplantation with chemoprophylaxis for latent tuberculosis infection. Our current case indicates one possible option for overcoming the persistent shortage of available donor lungs.

말기 폐기종 환자에서 기능적 기준에 의한 일측 폐이식술

조현민,백효채,김도형,강두영,이두연 대한흉부외과학회 2003 Journal of Chest Surgery (J Chest Surg) Vol.36 No.2

The Single Lung Transplantation for End-Stage Emphysema by Functional Criteria 말기 폐기종 환자에 대한 치료로 폐이식이 가장 효과적인 방법으로 받아들여지고 있으나 장기 공여자를 구하기가 쉽지 않고 다른 장기에 비해 비교적 건강한 폐를 얻기가 매우 어려운데다가 키와 몸무게, 흉곽크기 등을 고려한 장기 크기의 적합성을 맞추기는 더욱 힘들다. 공여자의 폐가 절대적으로 부족한 상황에서 일측 폐이식술이 양측 폐이식술에 비해 많이 시행되고 있는 추세이며 수술 결과에 따른 장기 생존율에 있어서도 큰 차이가 없는 것으로 보고되고 있다. 최근에는 폐이식 수술 시 흉곽크기 등을 고려한 장기 크기 측정보다는 기능적 기준으로서 나이, 성별, 키를 변수로 한 예측 총폐활량이 보다 적절한 평가방법으로 받아들여지고 있다.1.Hosenpud JD, Bennett LE, Keck BM, Fiol B, Boucek MM, Novick RJ. The Registry of the International Society for Heart and Lung Transplantation: sixteenth report-1999. J Heart Lung Transplant 1999;18:611-26.2.Weill D, Kshavjee S. Lung Transplantation for Emphysema: Two Lungs or One. J Heart Lung Transplant 2001;20:739-42.3.Gammie JS, Keenan RJ, Pham SM, et al. Single versus double lung transplantation for pulmonary hypertension. J Thorac Cardiovasc Surg 1998;115:397-403.4.신화균, 김해균, 이두연 등. 폐기종 환자에서의 우측 폐이식술. 대흉외지 2000;33:585-9.5.류송현, 김해균, 이두연 등. 이형 혈액형에서 시행한 폐이식술. 대흉외지 2001;34:94-6.6.Meyer DM, Bennet LE, Novick RJ, Hosenpud JD. Single vs Bilateral, Sequential Lung Transplantation for End- Stage Emphysema: Influence of Recipient Age on Survival and Secondary End-points. J Heart Lung Transplant 2001; 20:935-941. 7. Miyoshi S, Demertzis S, Eckstein F, Hohlfeld J, Schaefers HJ. Chest size matching in single and double lung transplantation. Jpn J Thorac Cardiovasc Surg 1999;47(4): 163-70.8.Hayden AM, Scarlett MV, Fox K. Relationship between donor/recipient lung size mismatch and functional outcome in single lung transplantation for COPD. J Transpl Coord 1996;6(3):155-8.

Performance Changes Following the Revision of Organ Allocation System of Lung Transplant: Analysis of Korean Network for Organ Sharing Data

여혜주,김도형,김윤성,전두수,조우현 대한의학회 2021 Journal of Korean medical science Vol.36 No.12

Background: There is currently a lack of data on the impact of the recent revision of the domestic lung allocation system on transplant performance. Methods: We conducted a retrospective analysis of transplant candidates and transplant patients registered in Korean Network for Organ Sharing between July 2015 and July 2019. Study periods were classified according to the introduction of the revised lung allocation system as follows: period 1 from July 2015 to June 2017 and period 2 from August 2017 to July 2019. Results: During the study period, a total of 627 patients were on the waiting list, of which 398 lung transplantations were performed. Total waiting list size increased by 98.6%, from 210 in period 1 to 417 in period 2. The number of transplant patients also increased by 32.7%, from 171 in period 1 to 227 in period 2. The number of donors decreased from 1,042 to 878, whereas the usage rate, i.e., the number of lung donors used for transplantation among the total number of reported lung donors, increased from 16.4% to 25.9%. The proportion of patients with high urgent status at transplantation increased from 45% to 60.4%, whereas those with urgent status decreased from 46.8% to 35.7% (P = 0.006). The use of marginal donor lungs increased from 29.8% to 53.7% (P < 0.001). To adjust urgency status and marginal donor usage between two groups, we conducted a propensity score matching analysis. No significant differences were detected in 1-year survival rates between the two periods after propensity score matching. As well, no significant difference was observed in mortality on the waiting list between the two periods. Conclusion: The recent revision of the lung allocation system in Korea did not change the performance of lung transplant in terms of waiting list mortality and 1-year survival. The rapid increase in the volume of waiting list between the two periods increased the waiting time, transplantation of high-urgency patients, and use of marginal lung donors.

연속 양측 폐이식 실험견에서 LPDG용액을 이용한 폐보존 효과연구

김정식,권건영,유영선,전석길,박창권 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.1

Background: As lung transplantation has recently become successful, the shortage of suitable donor organs has become urgent problems. The current tolerable ischemic time has been accepted until 10 hours. Improvements in lung preservation would increase the number of suitable donor lungs by permitting lung harvest from longer distances, and by promoting the sharing of the two donor lungs between different centers. We prepared LPDG(low potassium dextran glucose)solution for lung preservation study. In this study we examined the efficacy of LPDG solution in 24-hour lung preservation by using of a sequential bilateral canine lung allotransplant model. Method: Seven bilateral lung transplant procedures were performed using weight-matched pairs(23 to 26 kg) of adult mongrel dogs. The donor lungs were flushed with LPDG solution and maintained hyperinflated with 100% oxygen at 10℃ for a planned ischemic time of 24 hours for the lung implanted first. After sequential bilateral lung transplantation, dogs were maintained on a ventilator for 3 hours: arterial oxygen tension, pulmonary arterial pressure, and pulmonary vascular resistance were determined in the recipients hourly after bilateral reperfusion and compared with pretransplant-recipient values, which used as controls. After 2 hours of reperfusion, the chest X-ray, computed tomogram and lung perfusion scan were performed for assessment of early graft lung function. And pathological examinations for ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery were performed. Results: Five dogs of seven experiments had successfully finished the whole assessments after bilateral reperfusion for three hours. Arterial oxygen tension in the recipients was markedly decreased in immediate reperfusion period hut gradually recovered after reperfusion for three hours. The pulmonary arterial pressureand pulmonary vascular resistance showed singificant elevation (p<0.05 versus control values) but also recovered after reperfusion for three hours (p<0.05 versus immediate period value). The ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery showed reversible mild injury in 24 hours of lung preservation and reperfusion. Conclusions: The present study suggests that LPDG solution provide excellent preservation and transplanted lung function after 24 hours of preservation in a canine model in which the dog is completely dependent on the fuction of transplanted lung.

이식을 위한 가토 적출 폐의 실험적 보존 방법

김수현,김송명 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.9

An experimental comparative study was done to determine the protective effects of three preservation solutions on isolated rabbit heart-lung bloc during acute ischemia and reperfusion of the lung during lung transplantation. Thirty Isolated rabbit heart-lung blocs were divided into 3 groups , group I(n:9) was preserved with Hartmann's solution, group II(n: 10) with modified University of Wisconsin solution, and group III(n: 1 1) with Kosin solution. The isolated heart-lung blocs were washed with Hartmann's so ution. Aftar infusion of each preservation solution into pulmonary artery, the heart-lung bloc was stored at 4'c cold preservation solution for each group for 4 hours and .then the heart-lung blocs were reventilated and reperfused. The changes of weight of heart-lung blocs, airway pressure, percent change of PCO2, level of lactate and adenosine deaminase(ADA) and microscopic structure of the lung parenchyme were evaluated. Results were as follows 1. A change of weight of the heart lung bloc after reperfusion was lowest in group 111(p< .05) 2. The airway pressure increased after reperfusion in group I but decreased in group II, and II. Especially in group II, post-reperfusion airway pressure returned to level lower than that of en-bloc resection. 3. Pulmonary artery pressure during reperfusion after 4 hour preservation was lowest in group III, and pulmonary artery pressure in group II was higher than in group I(P> 0.1). 4. The level of lactate and ADA in the lung tissue were higher in group III than in group I and II(P< .05) 5. The percent change of PCO2 in perfusate was slightly higher in group III than group I and II. 6. Microscopic changes in lung tissue after reperfusion were diffuse pulmonary edema, expansion of inter- stitial tissue, focal aggregation of erythrocytes, and basement membrane abnormalities, but no differences were found among the three groups. In conclusion, the protective effects of modified University of Wisconsin solution and Kosin solution were slightly superior to Hartmann's solution. 폐이식의 임상적용에 있어 공여폐의 기능보존 여부가 술후 경과에 결정적인 영향을 미치므로, 이식폐의 채취에서부터 이식까지의 기간동안의 적절한 보존 방법의 개발이 선행되어야되므로, 폐기능 보존에 적절한 용액의 조성을 알아보기위하여 이 실험을 시행하였다. 실험은 세포외액 조성인 Hartmann's solution에 보존한 군을 대조군(1군)으로 하고, 세포내액 조성 인 modified University of Wisconsin solution에 보존한 군(2군), 세포내액과 세포외액 중간형에 여러가지 substrates가 함유된 Kosin solution에 보존한 군(3군)으로 나누어 가토의 적출폐를 대상으로 시행하였다. 폐기능 보존효과를 비교하기 위하여 heart-lung blocs의 중량의 변화, 기도내압, 관류액내의 이산화탄소 분압의 변화를, 폐조직내의 lactate 및 adenosine deaminase의 수치를 측정하였고, 폐조직의 미세구조 변화를 관찰하여 다음과 같은 결과를 얻었다. 1. 재관류후 heart-lung bloc의 중량변화는 3군에서 가장 낮았다(P< .05). 2. 기도내압은 1군에서는 재관류후 증가되 었으나, 2, 3군에서는 감소되 었고, 특히 2군에서는 보존전의 기 도내압보다 더 낮았다. 3.재관류동안의 \ulcorner동맥압은 3군에서 가장 낮았고, 2군은 1군보다 더 높았다(P>0.1). 4. 폐조직내에서의 lactate와 ADA치는 3군이 1,2군보다 높았다(P< .05). 5. 관류액내의 이산화탄소 분압의 변화률은 3군이 1,2군보다 약간 높았다. 6.폐조직 미세구조의 변화는전반적얀 폐부종, 간질조직의 확장, 출혈 및 기저막의 이상소견을 보였으나 각 군간의 저명한 차이는 없었다. 결론적으로 modified University of Wisconsin solution과 Kosin solution의 폐기능 보존 효과는 Hartmann's solution 에 비하여 다소 우수한 것으로 생각된다.

성견의 연속 양측 폐이식을 이용한 폐보존 평가 연구

박창권,김재범,유영선,권건영,전석길,김정식 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.5

Background: Numerous studies of safe, long term preservation for lung transplantation have been performed using ex vivo models or in vivo single lung transplantation models. However, a safe preservation time which is applicable for clinical use is difficult to determine. We prepared LPDG solution for lung preservation study. In this study we examined the efficacy of LPDG(low potassium dextran glucose) solution in 24-hour lung preservation by using a sequential bilateral canine lung allotransplant model. Material and Method: Seven bilateral lung transplant procedures were performed using weight-matched pairs(24 to 25kg) of adult mongrel dogs. The donor lungs were flushed with LPDG solution and maintained hyperinflated with 100% oxygen at 1$0^{\circ}C$ for a planned ischemic time of 24 hours for the lung implanted first. After sequential bilateral lung transplantation, dogs were maintained on ventilators for 3 hours: arterial resistance were determined if the recipients hourly after bilateral reperfusion and compared with pretransplant-recipient values, which were used as controls. After 2hours of reperfusion, the chest X-ray, computed tomogram and lung perfusion scan were performed for assessmint of early graft lung function. Pathological examinations for ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery were performed. Result: Five of seven experiments successfully finished the whole assessments after bilateral reperfusion for three hours. Arterial oxygen tension in the recipients was markedly decrased in immediate reperfusion period but gradually recovered after reperfusion for three hours. The pulmonary artery and pulmonary vascular resistance showed singificant elevation(p<0.05 versus control values) but also recovered after reperfusion for three hours(p<0.05 versus immediate period value). The ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery showed reversible mild injury in 24 hours of lung perservation and reperfusion. Conclusion : This study suggests that LPDG solution provides excellent preservation in a canine model in which the dog is completely dependent on the function of the transplanted lung.

Long-Term Outcomes of Adult Lung Transplantation Recipients: A Single-Center Experience in South Korea

Jo, Kyung-Wook,Hong, Sang-Bum,Kim, Dong Kwan,Jung, Sung Ho,Kim, Hyeong Ryul,Choi, Se Hoon,Lee, Geun Dong,Lee, Sang-Oh,Do, Kyung-Hyun,Chae, Eun Jin,Choi, In-Cheol,Choi, Dae-Kee,Kim, In Ok,Park, Seung-I The Korean Academy of Tuberculosis and Respiratory 2019 Tuberculosis and Respiratory Diseases Vol.82 No.4

Background: Recently, the number of lung transplants in South Korea has increased. However, the long-term outcome data is limited. In this study, we aimed to investigate the long-term outcomes of adult lung transplantation recipients. Methods: Among the patients that underwent lung transplantation at a tertiary referral center in South Korea between 2008 and 2017, adults patient who underwent deceased-donor lung transplantation with available follow-up data were enrolled. Their medical records were retrospectively reviewed. Results: Through eligibility screening, we identified 60 adult patients that underwent lung (n=51) or heart-lung transplantation (n=9) during the observation period. Idiopathic pulmonary fibrosis (46.7%, 28/60) was the most frequent cause of lung transplantation. For all the 60 patients, the median follow-up duration for post-transplantation was 2.6 years (range, 0.01-7.6). During the post-transplantation follow-up period, 19 patients (31.7%) died at a median duration of 194 days. The survival rates were 75.5%, 67.6%, and 61.8% at 1 year, 3 years, and 5 years, respectively. Out of the 60 patients, 8 (13.3%) were diagnosed with chronic lung allograft dysfunction (CLAD), after a mean duration of $3.3{\pm}2.8years$ post-transplantation. The CLAD development rate was 0%, 17.7%, and 25.8% at 1 year, 3 years, and 5 years, respectively. The most common newly developed post-transplantation comorbidity was the chronic kidney disease (CKD; 54.0%), followed by diabetes mellitus (25.9%). Conclusion: Among the adult lung transplantation recipients at a South Korea tertiary referral center, the long-term survival rates were favorable. The proportion of patients who developed CLAD was not substantial. CKD was the most common post-transplantation comorbidity.

A Review of Anesthesia for Lung Transplantation

김혜진,신상욱,박세연,김희영 대한심장혈관흉부외과학회 2022 Journal of Chest Surgery (J Chest Surg) Vol.55 No.4

Lung transplantation is the only treatment option for patients with end-stage lung disease. Although more than 4,000 lung transplants are performed every year worldwide, the standardized protocols contain no guidelines for monitoring during lung transplantation. Specific anesthetic concerns are associated with lung transplantation, especially during critical periods, including anesthesia induction, the initiation of positive pressure ventilation, the establishment and maintenance of one-lung ventilation, pulmonary artery clamping, pulmonary artery unclamping, and reperfusion of the transplanted lung. Anesthetic management according to the special risks associated with a patient’s existing lung disease and surgical stage is the most important factor. Successful anesthesia in lung transplantation can improve hemodynamic stability, oxygenation, ventilation, and outcomes. Therefore, anesthesiologists must have expertise in transesophageal echocardiography, extracorporeal life support, and cardiopulmonary anesthesia and understand the pathophysiology of end-stage lung disease and the drugs administered. In addition, communication among anesthesiologists, surgeons, and perfusionists during surgery is important to achieve optimal patient results.

Periostin is a Novel Biomarker for Chronic Lung Allograft Dysfunction after Lung Transplant

( Hye Ju Yeo ),( Woo Hyun Cho ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background chronic lung allograft dysfunction (CLAD) is the main cause of poor long-term outcomes after lung transplantation. Until now, no specific biomarker exists. Methods We analyzed differentially expressed genes (DEGs) of 4 paired human lung tissue samples at the different time points of donor and CLAD state. Frozen fresh lung tissue and serum from Pusan National University Yangsan Hospital biobank were used for validation of identified potential biomarkers. Results We identified 20 hub-genes among DEGs (POSTN, COL1A, COL1A2, CXCL10, COL5A2, BGN, CCL5, STAT1, CXCL9, CXCR3, COL6A3, COL5A1, MX1, IDO1, PRF1, SPP1, CCL8, COL14A1, THY1, ACAN). Among them, POSTN was a significantly important gene. In immunohistochemistry and immunofluorescence, higher POSTN expression was found in areas that co-localize with bronchial epithelial cells of the obliterative bronchiole. In addition, upregulation of POSTN was confirmed in a western blot of another sample dataset of human lung tissue through comparison of donor lung and CLAD lung tissue Conclusion Upregulation of POSTN is a feature of CLAD in lung transplant, mostly located in bronchial epithelial cells of the obliterative bronchiole. POSTN could be a potential target for the pathogenic mechanism of CLAD.