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Inverted Lung Transplantation: Interposition of Pericardial Conduit for Pulmonary Venous Anastomosis
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The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
baseline of 8.9 g/dL to 6.9 g/dL. He underwent push enteroscopy during this hospital stay which demonstrated bleeding jejunal angioplastic lesions. The PAP readings during the episodes of GI bleeding were reviewed. There was a significant reduction in PAP at the date of symptom onset from one day prior; from 57/26 mmHg (mPAP 38 mmHg) on 6/3 to 48/24 mmHg (mPAP 34 mmHg) on 6/4 corresponding with 2 g/dL drop in Hb level (See figure). This phenomenon was seen in a prior episode of GI bleeding 2 months prior. The PAP numbers dropped considerably to 39/18 mmHg (mPAP 27 mmHg) at the onset of symptoms compared with 49/22 mmHg (mPAP 33 mmHg) 1 day prior associated with 2.9 g/dL decline in Hb level. During the time PAP changes were observed, diuretic therapy was not modified. Summary: In patients implanted with CardioMEMS device, a sudden drop in PAP can herald a GI bleeding episode. Monitoring PAP trends can be helpful in LVAD patients who are at higher risk for GI bleeding.
69 Successful Bacteriophage Therapy for Treatment of MultidrugResistant Pseudomonas aeruginosa Infection in a Cystic Fibrosis Patient N. Law,1 C. Logan,1 C. Furr,2 S. Lehman,2 S. Morales,2 F. Rosas,2 A. Gaidamaka,2 I. Bilinsky,2 P. Grint,2 R. Schooley,1 and S. Aslam.1 1University of California, San Diego, San Diego, CA; and the 2 AmpliPhi Biosciences Inc, San Diego, CA.
68 Inverted Lung Transplantation: Interposition of Pericardial Conduit for Pulmonary Venous Anastomosis H. Yamamoto,1 K. Miyoshi,2 T. Kurosaki,1 S. Otani,1 M. Okazaki,1 S. Sugimoto,1 M. Yamane,1 S. Toyooka,1 and T. Oto.1 1General Thoracic Surgery, Organ Transplant Center, Okayama University Hospital, Okayama, Japan; and the 2General Thoracic Surgery, Okayama Medical Center, Okayama, Japan. Introduction: Lung transplantation (LTx) is still limited by a shortage of suitable donor lungs. Evolving flexible surgical procedures help increase the chances of LTx by unfolding recipient-to-donor matching options based on the pre-existing organ allocation concept. In particular, right single LTx using an inverted left donor lung may be considered under the following conditions: 1) Despite a right-side-predominant lung dysfunction in a recipient candidate, the option is limited to the use of a left single donor lung due to evidence of lung injury in the right donor lung or necessity to share the organ with another candidate prioritized on the waitlist; 2) Left side LTx in the recipient is impossible due to a past history in the recipient of thoracic surgery. One of the key challenges in performing inverted LTx is to adjust the positional relationship between the recipient’s and graft’s hilar structures. Herein, we report a case of successful left-to-right inverted LTx using interposition of a pericardial conduit for pulmonary venous anastomosis. Case Report: A left lung graft was offered to a 59-year-old male who had predominant damage of the right lung by idiopathic pulmonary fibrosis (Fig.1A). We decided to transplant the left donor lung into the right thorax of the recipient, considering his serious disease condition. Due to the anterior-posterior position gap, adjustment of the cuff length of the pulmonary artery and vein was required. Pulmonary artery anastomosis could be performed by leaving both the donor and recipient cuff long, but an extension of the pulmonary vein by interposition of a pericardial conduit was required for anastomosis (Fig.1B). The patient developed no anastomotic complications after the LTx. Summary: left-to-right inverted LTx is technically feasible by using an autologous pericardial conduit in selected cases. The technique has the potential benefit of encouraging exploration and expansion of unprecedented donor-recipient matching patterns in LTx.
Introduction: Bacteriophages are host-specific lytic viruses that are of increasing interest as adjunctive therapy for treatment of multi-drug resistant (MDR) pathogens. Case Report: We describe the use of bacteriophage therapy (BT) in a 26year-old cystic fibrosis (CF) patient awaiting lung transplantation who was admitted for respiratory failure requiring mechanical ventilation for 12 days. The hospital course was complicated by MDR Pseudomonas aeruginosa (PA) pneumonia, persistent respiratory failure, and colistin-induced renal failure (listed for concomitant kidney transplant). Due to worsening clinical status, BT was explored as an adjunct to antibiotics. The patient was approved under emergency IND#17710 by the FDA to receive AB-PA01 (combination of 4 lytic phages) active against the clinical PA isolates. This was given every 6 hours intravenously (IV) for 8 weeks. As noted in Figure 1, the patient was bed-bound due to severe dyspnea and required 30 L/min O2 via high flow nasal cannula (NC) at BT initiation. MDR PA pneumonia resolved by Day 7. Her respiratory status continued to improve and by end of therapy (EOT) she was on 4 L/min O2 via NC and was able to work with physical therapy. No adverse events related to BT occurred. There was no recurrent pneumonia or CF exacerbation within 90-days following the end of treatment. Renal failure resolved once off colistin and the patient was removed from the kidney transplant waitlist. Summary: We describe the successful use of BT in a CF patient awaiting lung transplant. Given the concern for MDR PA in CF patients, BT may offer a viable anti-infective adjunct to traditional antibiotic therapy.
70 Tocilizumab for Antibody-Mediated Rejection in the Setting of Cardiac Allograft Vasculopathy S. January,1 A. Pottebaum,1 D. Raymer,1 and K. Lavine.2 1Barnes-Jewish Hospital, St Louis, MO; and the 2Washington University School of Medicine, St Louis, MO.
The Journal of Heart and Lung Transplantation, Vol 38, No 4S, April 2019
baseline of 8.9 g/dL to 6.9 g/dL. He underwent push enteroscopy during this hospital stay which demonstrated bleeding jejunal angioplastic lesions. The PAP readings during the episodes of GI bleeding were reviewed. There was a significant reduction in PAP at the date of symptom onset from one day prior; from 57/26 mmHg (mPAP 38 mmHg) on 6/3 to 48/24 mmHg (mPAP 34 mmHg) on 6/4 corresponding with 2 g/dL drop in Hb level (See figure). This phenomenon was seen in a prior episode of GI bleeding 2 months prior. The PAP numbers dropped considerably to 39/18 mmHg (mPAP 27 mmHg) at the onset of symptoms compared with 49/22 mmHg (mPAP 33 mmHg) 1 day prior associated with 2.9 g/dL decline in Hb level. During the time PAP changes were observed, diuretic therapy was not modified. Summary: In patients implanted with CardioMEMS device, a sudden drop in PAP can herald a GI bleeding episode. Monitoring PAP trends can be helpful in LVAD patients who are at higher risk for GI bleeding.
69 Successful Bacteriophage Therapy for Treatment of MultidrugResistant Pseudomonas aeruginosa Infection in a Cystic Fibrosis Patient N. Law,1 C. Logan,1 C. Furr,2 S. Lehman,2 S. Morales,2 F. Rosas,2 A. Gaidamaka,2 I. Bilinsky,2 P. Grint,2 R. Schooley,1 and S. Aslam.1 1University of California, San Diego, San Diego, CA; and the 2 AmpliPhi Biosciences Inc, San Diego, CA.
68 Inverted Lung Transplantation: Interposition of Pericardial Conduit for Pulmonary Venous Anastomosis H. Yamamoto,1 K. Miyoshi,2 T. Kurosaki,1 S. Otani,1 M. Okazaki,1 S. Sugimoto,1 M. Yamane,1 S. Toyooka,1 and T. Oto.1 1General Thoracic Surgery, Organ Transplant Center, Okayama University Hospital, Okayama, Japan; and the 2General Thoracic Surgery, Okayama Medical Center, Okayama, Japan. Introduction: Lung transplantation (LTx) is still limited by a shortage of suitable donor lungs. Evolving flexible surgical procedures help increase the chances of LTx by unfolding recipient-to-donor matching options based on the pre-existing organ allocation concept. In particular, right single LTx using an inverted left donor lung may be considered under the following conditions: 1) Despite a right-side-predominant lung dysfunction in a recipient candidate, the option is limited to the use of a left single donor lung due to evidence of lung injury in the right donor lung or necessity to share the organ with another candidate prioritized on the waitlist; 2) Left side LTx in the recipient is impossible due to a past history in the recipient of thoracic surgery. One of the key challenges in performing inverted LTx is to adjust the positional relationship between the recipient’s and graft’s hilar structures. Herein, we report a case of successful left-to-right inverted LTx using interposition of a pericardial conduit for pulmonary venous anastomosis. Case Report: A left lung graft was offered to a 59-year-old male who had predominant damage of the right lung by idiopathic pulmonary fibrosis (Fig.1A). We decided to transplant the left donor lung into the right thorax of the recipient, considering his serious disease condition. Due to the anterior-posterior position gap, adjustment of the cuff length of the pulmonary artery and vein was required. Pulmonary artery anastomosis could be performed by leaving both the donor and recipient cuff long, but an extension of the pulmonary vein by interposition of a pericardial conduit was required for anastomosis (Fig.1B). The patient developed no anastomotic complications after the LTx. Summary: left-to-right inverted LTx is technically feasible by using an autologous pericardial conduit in selected cases. The technique has the potential benefit of encouraging exploration and expansion of unprecedented donor-recipient matching patterns in LTx.
Introduction: Bacteriophages are host-specific lytic viruses that are of increasing interest as adjunctive therapy for treatment of multi-drug resistant (MDR) pathogens. Case Report: We describe the use of bacteriophage therapy (BT) in a 26year-old cystic fibrosis (CF) patient awaiting lung transplantation who was admitted for respiratory failure requiring mechanical ventilation for 12 days. The hospital course was complicated by MDR Pseudomonas aeruginosa (PA) pneumonia, persistent respiratory failure, and colistin-induced renal failure (listed for concomitant kidney transplant). Due to worsening clinical status, BT was explored as an adjunct to antibiotics. The patient was approved under emergency IND#17710 by the FDA to receive AB-PA01 (combination of 4 lytic phages) active against the clinical PA isolates. This was given every 6 hours intravenously (IV) for 8 weeks. As noted in Figure 1, the patient was bed-bound due to severe dyspnea and required 30 L/min O2 via high flow nasal cannula (NC) at BT initiation. MDR PA pneumonia resolved by Day 7. Her respiratory status continued to improve and by end of therapy (EOT) she was on 4 L/min O2 via NC and was able to work with physical therapy. No adverse events related to BT occurred. There was no recurrent pneumonia or CF exacerbation within 90-days following the end of treatment. Renal failure resolved once off colistin and the patient was removed from the kidney transplant waitlist. Summary: We describe the successful use of BT in a CF patient awaiting lung transplant. Given the concern for MDR PA in CF patients, BT may offer a viable anti-infective adjunct to traditional antibiotic therapy.
70 Tocilizumab for Antibody-Mediated Rejection in the Setting of Cardiac Allograft Vasculopathy S. January,1 A. Pottebaum,1 D. Raymer,1 and K. Lavine.2 1Barnes-Jewish Hospital, St Louis, MO; and the 2Washington University School of Medicine, St Louis, MO.