Follow-up care of adults after lung transplantation - an evidence based guideline
The S3 Guideline provides evidence- and consensus-based recommendations for the structured follow-up care of adult patients after lung transplantation. Its goal is to standardize long-term management in order to optimize survival, functional status, and quality of life. The guideline is addressed to professionals in pulmonology, internal medicine, surgery, and general practice, as well as to transplant centers and inpatient institutions in the German-speaking countries of Germany, Austria, and Switzerland. The guideline is led by the Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP).Methodologically, it is based on systematic literature searches and GRADE-based evidence assessment, combined with the development of an interdisciplinary and multiprofessional consensus involving patient representatives.The guideline emphasizes lifelong, individualized follow-up care founded on close cooperation between transplant centers, community physicians, and patients. Core topics include immunosuppression - specifically the selection, combination, and monitoring of calcineurin inhibitors, antimetabolites, and mTOR inhibitors - as well as strategies to minimize adverse effects and nephrotoxicity.Additional key areas are the prevention and management of infections, including the prophylaxis of opportunistic infections (such as CMV, Aspergillus, and Pneumocystis jirovecii), and vaccination strategies. The guideline also provides recommendations for standardized patient monitoring through bronchoscopy, biopsy, and spirometry within structured follow-up intervals and preventive examinations.Further topics include acute cellular rejection, non-adherence, chronic graft dysfunction, and comorbidities such as diabetes, chronic kidney disease, osteoporosis, and tumor prevention.
- Research Article
66
- 10.1016/j.healun.2011.08.011
- Oct 1, 2011
- The Journal of Heart and Lung Transplantation
The Registry of the International Society for Heart and Lung Transplantation: Fourteenth Pediatric Lung and Heart-Lung Transplantation Report—2011
- Front Matter
7
- 10.1016/j.jtcvs.2018.08.010
- Aug 18, 2018
- The Journal of Thoracic and Cardiovascular Surgery
National Heart, Lung, and Blood Institute and American Association for Thoracic Surgery Workshop Report: Identifying collaborative clinical research priorities in lung transplantation
- Research Article
15
- 10.1097/tp.0000000000004336
- Dec 8, 2022
- Transplantation
Chronic kidney disease (CKD) after lung transplantation is common and limits the survival of transplant recipients. The calcineurin inhibitors (CNI), cyclosporine A, and tacrolimus being the cornerstone of immunosuppression are key mediators of nephrotoxicity. The mammalian target of rapamycin (mTOR) inhibitors, sirolimus and everolimus, are increasingly used in combination with reduced CNI dosage after lung transplantation. This systematic review examined the efficacy and safety of mTOR inhibitors after lung transplantation and explored their effect on kidney function. mTOR inhibitors are often introduced to preserve kidney function. Several clinical trials have demonstrated improved kidney function and efficacy of mTOR inhibitors. The potential for kidney function improvement and preservation increases with early initiation of mTOR inhibitors and low target levels for both mTOR inhibitors and CNI. No defined stage of CKD for mTOR inhibitor initiation exists, nor does severe CKD preclude the improvement of kidney function under mTOR inhibitors. Baseline proteinuria may negatively predict the preservation and improvement of kidney function. Discontinuation rates of mTOR inhibitors due to adverse effects increase with higher target levels. More evidence is needed to define the optimal immunosuppressive regimen incorporating mTOR inhibitors after lung transplantation. Not only the indication criteria for the introduction of mTOR inhibitors are needed, but also the best timing, target levels, and possibly discontinuation criteria must be defined more clearly. Current evidence supports the notion of nephroprotective potential under certain conditions.
- Research Article
2
- 10.3238/arztebl.m2024.0232
- Jan 24, 2025
- Deutsches Arzteblatt international
Lung transplantation is the treatment of choice for end-stage nonmalignant lung disease. It has become a routine procedure through advances in donor lung preservation, extracorporeal membrane oxygenation, immunosuppression, intensive care medicine, and follow-up care. This review is based on publications about lung transplantation that were retrieved by a selective literature search, and on the procedures and experience of two large-volume lung transplantation centers. The mean survival time after lung transplantation is six years, which is the shortest after the transplantation of any solid organ. Chronic graft dysfunction is present in 41% of patients at five years and is the main cause of death after lung transplantation, followed by infection and cancer. Despite all the advances in lung transplantation, acute and-above all-chronic graft dysfunction still pose a major challenge for large-volume transplantation centers. Immunosuppression that is individually tailored to prevent both graft rejection and infection is important for these patients' longterm survival. Xenotransplantation and so-called lung bioengineering may become available in the future as alternatives to allotransplantation.
- Research Article
1307
- 10.1016/s1053-2498(02)00398-4
- Mar 1, 2002
- The Journal of Heart and Lung Transplantation
Bronchiolitis obliterans syndrome 2001: an update of the diagnostic criteria
- Research Article
11
- 10.1038/s41598-022-09354-y
- Apr 5, 2022
- Scientific Reports
Purpose We aimed to determine predictors of chronic kidney disease (CKD) prevention among patients with diabetes. Method A cross-sectional study was conducted on 1000 selected respondents based on socio-demographic, socio-economic, general CKD perception knowledge, self-monitoring advocacy, preventive behavior, treatment compliance, and psychosocial factors. Using multiple logistic regression, variables and their association with impaired perception of CKD prevention were analyzed. Results Overall, 74% had poor perception regarding CKD prevention (68.7% of men and 31.3% of women). In multivariable analysis, those with weak illness identity fear were two times more likely to have poor perceptions (95% CI 1.563–3.196, p < 0.001). Respondents with weak medical practice (AOR = 2.33, 95% CI 1.609–2.381, p < 0.001) and weak cooperation (AOR = 1.563; 95% CI 1.099–2.224, p < 0.001) were more likely to have poor perceptions on CKD prevention. Concerning poor perception, significant predictors were self-employment, housewives, working in private jobs, weak knowledge on clear glycosuria, sleep problems, print media, digital media, illness identity fear, weak medical practice, and weak co-operation factors. Conclusion Media support is crucial for supporting and improving positive views regarding CKD knowledge. Interventions to reach people with limited awareness on CKD prevention, lower socioeconomic status, and poor social support may improve identification of patients with early-stage CKD. Particular care should be taken to recognize and provide necessary services regarding the early detection of CKD.
- Research Article
351
- 10.1016/j.healun.2009.08.004
- Sep 24, 2009
- The Journal of Heart and Lung Transplantation
The Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Lung and Heart-Lung Transplantation Report—2009
- Research Article
6
- 10.1111/ajt.14260
- Mar 30, 2017
- American Journal of Transplantation
Outcomes of Pediatric Kidney Transplantation in Recipients of a Previous Non-Renal Solid Organ Transplant.
- Research Article
140
- 10.1016/j.healun.2015.08.002
- Aug 28, 2015
- The Journal of Heart and Lung Transplantation
The Registry of the International Society for Heart and Lung Transplantation: Eighteenth Official Pediatric Heart Transplantation Report—2015; Focus Theme: Early Graft Failure
- Research Article
10
- 10.1111/ajt.16321
- Oct 17, 2020
- American Journal of Transplantation
A multicenter case series documenting Medicare Part D plan denials of immunosuppressant drug coverage for organ transplant recipients.
- Research Article
18
- 10.1111/ajt.16368
- Nov 5, 2020
- American Journal of Transplantation
Management of lung transplantation in the COVID-19 era-An international survey.
- Front Matter
2
- 10.1053/j.jvca.2022.04.034
- Apr 29, 2022
- Journal of Cardiothoracic and Vascular Anesthesia
International Consensus Recommendations for Lung Transplantation Anesthetic Management: A New Perioperative Paradigm
- Front Matter
1
- 10.1016/j.jtcvs.2022.01.048
- Mar 1, 2022
- The Journal of Thoracic and Cardiovascular Surgery
The 49th parallel: Does geographic position affect longevity of patients with cystic fibrosis?
- Research Article
591
- 10.1016/j.healun.2016.09.001
- Sep 9, 2016
- The Journal of Heart and Lung Transplantation
The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Lung and Heart–Lung Transplant Report—2016; Focus Theme: Primary Diagnostic Indications for Transplant
- Discussion
73
- 10.1016/s2213-2600(21)00184-3
- May 5, 2021
- The Lancet. Respiratory Medicine
Early humoral response among lung transplant recipients vaccinated with BNT162b2 vaccine