• Journal of Chest Surgery
• /
• 제55권4호
• /
• pp.325-331
• /
• 2022

Postoperative critical care management for lung transplant recipients in the intensive care unit (ICU) has expanded in recent years due to its complexity and impact on clinical outcomes. The practical aspects of post-transplant critical care management, especially regarding ventilation and hemodynamic management during the early postoperative period in the ICU, are discussed in this brief review. Monitoring in the ICU provides information on the patient's clinical status, diagnostic assessment of complications, and future management plans since lung transplantation involves unique pathophysiological conditions and risk factors for complications. After lung transplantation, the grafts should be appropriately ventilated with lung protective strategies to prevent ventilator-induced lung injury, as well as to promote graft function and maintain adequate gas exchange. Hypotension and varying degrees of pulmonary edema are common in the immediate postoperative lung transplantation setting. Ventricular dysfunction in lung transplant recipients should also be considered. Therefore, adequate volume and hemodynamic management with vasoactive agents based on their physiological effects and patient response are critical in the early postoperative lung transplantation period. Integrated management provided by a professional multidisciplinary team is essential for the critical care management of lung transplant recipients in the ICU.

• Journal of Chest Surgery
• /
• 제22권3호
• /
• pp.416-424
• /
• 1989

We have performed eight, single transplantations of right lung in dogs from September, 1988 to March 1989 at the Thoracic & Cardiovascular Surgical department, Yonsei University, College of Medicine, Seoul, Korea. We wrapped bronchial anastomosis site with great omentum and used cyclosporin in preoperative and postoperative periods in seven cases except one. The one without wrapping the bronchial anastomotic site with omentum and using cyclosporin died due to bronchial anastomotic site rupture in postoperative fourth day. If there is no reason to choose one side over the other, we would generally choose to do left-sided transplant as this is technically somewhat easier because of the long length of recipient bronchus and the ease of clamping the left atrium proximal to the pulmonary veins. The right atrium limits the amount of left atrium that can have incorporated into the clamp proximal to the pulmonary veins on the right side. But we had chosen to do right-sided transplant of lung because we must take variable technical experiences on right sided lung transplant in dogs. We have to anastomose one of pulmonary vein and left atrial wall on right-sided transplant easily only with double ligation of one pulmonary vein because right atrium limited the clamp of left atrium proximal to pulmonary veins with decreased venous return and cardiac output in some dogs. All seven dogs with right-sided lung transplant had survived more than one day with good condition except one. The one dog have to be sacrificed to evaluate the difference between the gas analysis in pulmonary venous and arterial blood in post-operative eight hours. We found hemorrhagic pulmonary edematous changes of contralateral left lung in this dog. And also all dogs have to be sacrificed for the evaluation of surgical problems, anytime in post-operative periods without any cardiopulmonary resuscitative efforts when the general condition would be worse progressively. We found no any surgical technical errors in seven dogs except one with thrombi in suture site of left atrium. There were hemorrhagic pulmonary edematous changes of transplanted right lung in one, of contralateral left lung in one, of contralateral left lung with double ligation of its pulmonary artery in one, thrombi around left atrial sutures sites in one, multiple air leakage in one bronchial rupture in one due to rejection or infection. There were accidental extubation and delayed intubation in one and unknown cause of death in one.

• 중환자간호학회지
• /
• 제16권3호
• /
• pp.73-86
• /
• 2023

Purpose : This study aimed to identify the factors affecting the quality of life of lung transplant patients. Method : The participants were patients who received lung transplants at a general hospital in City Y. Data were collected through structured questionnaires from June 2023 to August 2023. General characteristics, lung transplantation-related characteristics, quality of life, functional disability, treatment compliance, social support, anxiety, and depression-were measured. For data analysis, hierarchical multiple regression was performed using SPSS/WIN 29.0. Results : In the final model, quality of life was associated with income, self-help group attendance, functional disability, social support, treatment compliance, and anxiety and depression. Together, they explained 61.2% of the total variance in the results. Conclusion : Our findings suggest that improving lung transplant patients' quality of life requires active intervention in stress management to perform treatment instructions well, a social support system that can help them financially, and encouraging and participating in social activities as patients.

• Tuberculosis and Respiratory Diseases
• /
• 제69권3호
• /
• pp.201-206
• /
• 2010

Nontuberculous mycobacterial (NTM) diseases are increasing worldwide. However NTM lung disease in organ transplant recipients has been rarely reported. Here, we report 2 cases of NTM lung disease in heart transplant recipients. A 37-year-old man, who had undergone a heart transplant one year previous, was admitted to hospital due to a cough. Chest CT scan showed multiple centrilobular nodules in both lower lungs. In his sputum, M. abscessus was repeatedly identified by rpoB gene analysis. The patient improved after treatment with clarithromycin, imipenem, and amikacin. An additional patient, a 53-year-old woman who had undergone a heart transplant 4 years prior and who suffered from bronchiectasis, was admitted because of purulent sputum. The patient's chest CT scan revealed aggravated bronchiectasis; M. intracellulare was isolated repeatedly in her sputum. Treatment was successfully completed with clarithromycin, ethambutol, and ciprofloxacin. NTM lung disease should be considered as a potential opportunistic infection in organ transplant recipients.

• Journal of Chest Surgery
• /
• 제55권4호
• /
• pp.265-273
• /
• 2022

Lung transplantation is considered a viable treatment option for patients with end-stage lung disease. Recent decades have seen a gradual increase in the number of lung transplantation patients worldwide, and in South Korea, the case number has increased at least 3-fold during the last decade. Furthermore, the waiting list time is becoming longer, and more elderly patients (>65 years) are undergoing lung transplantation; that is, the patients placed on the waiting list are older and sicker than in the past. Hence, proper management during the pre-transplantation period, as well as careful selection of candidates, is a key factor for transplant success and patient survival. Although referring and transplant centers should address many issues, the main areas of focus should be the timing of referral, nutrition, pulmonary rehabilitation, critical care (including mechanical ventilation and extracorporeal membrane oxygenation), psychological support, and the management of preexisting comorbid conditions (coronary artery disease, diabetes mellitus, gastroesophageal reflux disease, osteoporosis, malignancy, viral infections, and chronic infections). In this context, the present article reviews and summarizes the pre-transplantation management strategies for adult patients listed for lung transplantation.

• Journal of Chest Surgery
• /
• 제33권4호
• /
• pp.338-341
• /
• 2000

Renal transplant recipients who received immunosuporessive agent are in high risk of development Kaposi's sarcoma. In Korea a few report of Kaposi's sarcoma has been pubilshed but any report of intrathoracic Kaposi's sarcoma provedn by open lung biopsy has not been pulbilshed until now. We report a case of intrathoracic Kaposi's sarcoma developed in a 25 year old Korean man, who had been operated renal transplantation due to end stage renal disease and received cyclosporine and prednisolone as immunosuppessive agent, without any other organ involvment and was proven by open lung biopsy. Although discontinuation of immunosuppressive agent, temporary symptomatic and radilolgic improvement were observed, he died 11 days later after open lung biopsy because of intractable resiratory failure.

• 한국임상약학회지
• /
• 제29권2호
• /
• pp.89-100
• /
• 2019

Background: Invasive aspergillosis (IA) is associated with high morbidity and mortality, particularly among immunocompromised patients, such as lung transplant recipients. Voriconazole, the first-line therapy for IA, shows a non-linear pharmacokinetic profile and has a narrow therapeutic range. Careful and appropriate administration is necessary, primarily because it is used for critically ill patients; however, the clinical usefulness of therapeutic drug monitoring (TDM) has not been sufficiently verified. Therefore, in this study, we validated the safety and efficacy of voriconazole TDM in lung transplant recipients receiving only voriconazole for IA treatment. Methods: The electronic medical records of lung transplant recipients (${\geq}19$ years of age) administered only voriconazole for > 7 days for treatment of IA from June 1, 2013 to May 31, 2018 were analyzed retrospectively. Results: Among the 54 patients, 27 each were allocated to TDM and non-TDM groups, respectively. There were no significant differences in patient characteristics between the two groups except for ICU-hospitalization status. Of the TDM group patients, 81.5% needed adjustment of voriconazole dosage because the levels were out of target range. Comparison of two groups showed that treatment response was higher throughout treatment and switching rates of second-line agents were significantly lower in the TDM group, but it was insufficient to confirm safety improvements through voriconazole TDM. Conclusions: Considering that the treatment response tended to be higher and the rates of switching to second-line antifungal agents were lower in the TDM group, voriconazole TDM may increase the therapeutic effect on IA in lung transplant patients.

• Journal of Chest Surgery
• /
• 제55권4호
• /
• pp.357-360
• /
• 2022

Patients with severe coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) may exhibit pulmonary fibrosis after the viral illness resolves. Some of these patients may experience severe functional lung impairment, and thus require transplants to prevent death or maintain a tolerable quality of life. Considering the reversibility of COVID-19 ARDS, lung transplant candidates are observed for 1-2 months and must be selected very carefully before transplantation. As the short-term outcomes of such patients are comparable to those of patients with other indications for transplantation, lung transplantation should be actively considered.

• Journal of Chest Surgery
• /
• 제51권1호
• /
• pp.22-28
• /
• 2018

Background: Lung transplantation is a life-saving procedure in patients with end-stage lung disease, and is increasingly performed in Korea. Methods: We retrospectively evaluated the outcomes of patients who received a lung transplant at Asan Medical Center between January 2008 and December 2016. Thirteen of 54 patients experienced multiorgan transplantation; the remaining 41 who received only lung grafts were included. Results: The mean age of the lung transplant recipients was 44.6 years; 27 were men and 14 were women. The most frequent reasons were idiopathic interstitial pneumonia (21 of 41 patients, 51.2%), interstitial lung disease (9 of 41, 22.0%), and bronchiolitis obliterans after bone marrow transplantation (7 of 41, 17.1%). The median waiting time was 47 days, and many patients received preoperative intensive care (27 of 41, 65.9%), ventilator support (26 of 41, 63.4%), or extracorporeal life support (19 of 41, 46.3%). All 41 patients received bilateral lung grafts. Ten deaths occurred (24.3%), including 5 cases of early mortality (12.2%) and 5 cases of late mortality (12.2%). The 1-, 3-, and 5-year survival rates were 78.9%, 74.2%, and 69.3%, respectively. Conclusion: Despite a high percentage of patients who required preoperative intensive care, the transplantation outcomes were acceptable.

• Journal of Chest Surgery
• /
• 제55권4호
• /
• pp.274-276
• /
• 2022

The expansion of indications for lung transplantation, the growth of the waiting list, and donor shortages are increasing the waiting list mortality rate in Korea. The current lung allocation system in Korea is based mainly on urgency, but outcomes should also be considered to avoid futile transplantation. This review describes the current status of, and issues with, the lung allocation system in Korea including donors, the waiting list, and transplant outcomes in the context of an aging society, in which the frequency of end-stage pulmonary disease is increasing.