Lung-kidney Transplantation Research Articles

Extracorporeal membrane oxygenation as a bridge to thoracic multiorgan transplantation

BackgroundExtracorporeal membrane oxygenation (ECMO) has emerged as a crucial tool in the care of patients with multiorgan failure, and is increasingly utilized as a bridge to transplantation. While data on ECMO as a bridge to isolated heart and lung transplantation have been described, our emerging experience with ECMO as a bridge to thoracic multiorgan transplantation is not yet well understood. This study aims to investigate temporal trends, utilization, and outcomes in ECMO as a bridge to thoracic multiorgan transplantation. MethodsThe United Network for Organ Sharing database was used to identify adult patients undergoing thoracic multiorgan transplantation between 1987 and 2022. Exclusion criteria were recipient age <18 and bridging with other mechanical circulatory support including ventricular assist device (VAD) and intra-aortic balloon pump (IABP). Survival analysis was performed to compare outcomes between patients bridged to transplantation with ECMO and those who were not bridged. ResultsOf 3,927 patients undergoing thoracic multiorgan transplantation, a total of 203 (5.2%) patients received ECMO as a bridge to transplantation. Among ECMO recipients, patients were most commonly bridged to heart-lung (45.8%), followed by heart-kidney (34.5%), and lung-kidney transplantation (11.8%). At a median follow-up of 35.5 months, unadjusted survival among patients bridged with ECMO was decreased versus multiorgan transplant recipients who were not bridged (p<0.001). With adjusted multivariable Cox regression, ECMO was independently associated with an elevated risk of mortality following multiorgan transplantation (HR 1.56 [1.21-2.02], p<0.01). Among patients surviving past 30 days following transplantation, conditional long-term survival was similar between those bridged with ECMO and those not bridged (p = 0.82). ConclusionECMO is increasingly utilized as a bridge to thoracic multiorgan transplantation, and is associated with increased 30 day mortality and decreased long-term survival. In select patients surviving to 30 days following transplantation, similar long-term survival is seen between patients bridged with ECMO and those not bridged.

Simultaneous Lung-Kidney Transplantation in the United States

BackgroundSimultaneous lung-kidney transplantation is rarely performed. Contemporary national practice trends and outcomes are unclear. MethodsFrom the United Network for Organ Sharing database, we identified 108 lung-kidney transplant recipients (2005-2022). They were compared with isolated lung recipients with pretransplantation dialysis or estimated glomerular filtration rate (eGFR) ≤30 mL/min per 1.73 m2 (n = 372) and isolated non–dialysis-dependent lung recipients with 30 < eGFR < 50 mL/min per 1.73 m2 (n = 1416), respectively. Lung-kidney recipients were also compared with recipients of the contralateral kidney from the same donors (n = 90). ResultsLung-kidney transplantation was performed by 36 centers, with increasing annual volume (1 in 2005, 16 in 2022; P < .01). Forty percent (44/108) of lung-kidney recipients received pretransplantation dialysis, and of those without pretransplantation dialysis, median eGFR was 30.7 mL/min per 1.73 m2. Lung-kidney recipients had improved survival compared with isolated lung recipients with eGFR ≤30 mL/min per 1.73 m2 or pretransplantation dialysis (adjusted hazard ratio, 0.59; 95% CI, 0.38-0.92). However, no survival benefit was observed when lung-kidney recipients were compared with isolated lung recipients with 30 < eGFR < 50 mL/min per 1.73 m2 and no pretransplantation dialysis (adjusted hazard ratio, 0.88; 95% CI, 0.55-1.41). Compared with isolated kidney recipients using the contralateral kidney from the same donors, lung-kidney recipients had a higher risk of kidney allograft loss (adjusted hazard ratio, 3.27; 95% CI, 1.22-8.78), a difference largely accounted for by patient death with a functioning kidney allograft. ConclusionsRecipients of lung-kidney transplants had improved survival compared with isolated lung recipients with eGFR ≤30 mL/min per 1.73 m2 or pretransplantation dialysis. However, lung-kidney recipients had a higher rate of kidney allograft loss than recipients of the contralateral kidney allograft from the same donors.

(1209) A Case of Dual Organ Lung-Kidney Transplant in a Highly Sensitized Patient

(1209) A Case of Dual Organ Lung-Kidney Transplant in a Highly Sensitized Patient

(925) Combined Lung-Kidney Transplantation Yields Better Survival Than Isolated Lung Transplantation in Recipients with Underlying Renal Failure

(925) Combined Lung-Kidney Transplantation Yields Better Survival Than Isolated Lung Transplantation in Recipients with Underlying Renal Failure

Short Term Outcomes of Patients Who Underwent Lung Transplant for COVID-19 ARDS

PurposeLung transplantation is a life saving treatment option for patients with COVID-19 ARDS. We aim to assess the short-term outcomes of patients who underwent lung transplantation for COVID ARDS.MethodsThis is a single-center retrospective cohort study of patients who underwent lung transplantation for COVID 19 ARDS between 7/1/2020 and 06/30/2021. Study was IRB-approved. Baseline demographic data, pre transplant variables, peri operative data and post transplant variables were extracted. Post-transplant graft function variables were followed until 09/30/2021.ResultsTwenty patients underwent lung transplantation alone, and one patient underwent lung kidney transplantation. Nineteen patients (90%) were ECMO bridge to transplant and twenty patients (95%) were on mechanical ventilator until the transplant. These patients were followed for a median of 234 days [IQR (188-339)]. Three patients (14%) completed a one-year follow-up. Eighteen patients (86%) completed six months follow-up. None of the patients required dialysis. At the end of the follow up period, all patients have good graft function and none of the patients are on supplemental oxygen.ConclusionWith careful selection, lung transplants can be performed with reasonable post-transplant outcomes in COVID 19 ARDS patients. However, these patients tend to have a prolonged post transplant hospital stay, a median of 48 days with IQR (28.5 - 73.5). 50% of patients had at least one return to operating room post transplant for hemothorax.

Factors Related to Survival in Low–Glomerular Filtration Rate Cohorts Undergoing Lung Transplant

BackgroundHistorically, a glomerular filtration rate (GFR) of less than 50 mL/min per 1.73 m2 has been considered a contraindication to lung transplantation. Combined or sequential lung–kidney transplantation is an option for those with a GFR less than 30 mL/min per 1.73 m2. Patients with a GFR of 30 to 50 mL/min per 1.73 m2 are provided with no options for transplantation. This study explores factors associated with improved survival in patients who undergo isolated lung transplantation with a GFR of 30 to 50 mL/min per 1.73 m2. MethodsThe United Network for Organ Sharing database was queried for adult patients undergoing primary isolated lung transplantation between January 2007 and March 2018. Regression models were used to identify factors associated with improved survival in lung recipients with a preoperative GFR of 30 to 50 mL/min per 1.73 m2. The propensity score method was used to match highly performing patients (outpatient recipients aged less than 60 years) with a GFR of 30 to 50 mL/min per 1.73 m2 with patients who had a GFR greater than 50 mL/min per 1.73 m2. Kaplan-Meier, Cox, and logistic regression analyses compared outcomes in matched populations. ResultsA total of 21,282 lung transplantations were performed during the study period. Compared with patients with a GFR greater than 50 mL/min per 1.73 m2, survival was significantly worse for patients with a GFR of 30 to 50 mL/min per 1.73 m2. Multivariate analysis of patients with a GFR of 30 to 50 mL/min per 1.73 m2 demonstrated outpatient status and age less than 60 years to be predictive of superior survival. After propensity matching, survival of this highly performing subset with a GFR of 30 to 50 mL/min per 1.73 m2 was no different from that of patients with a normal GFR. ConclusionsOutpatient recipients aged less than 60 years represent an optimal subset of patients with a GFR of 30 to 50 mL/min per 1.73 m2. Lung transplant listing should not be declined based only on a GFR less than 50 mL/min per 1.73 m2.

Characteristics and Outcomes of Lung Transplant Candidates With Preexisting Renal Dysfunction

BackgroundThe proportion of lung transplant candidates with comorbid renal dysfunction (RD) may rise as sicker patients are being considered for lung transplant (LT). There is lack of data regarding the characteristics and outcome of patients with RD and the role of simultaneous lung-kidney transplant (SLuKi) among these patients. MethodsThe United Network of Organ Sharing database was queried for adult patients (18 years or older) undergoing LT between 1995 and 2014. Pretransplant RD was defined as estimated glomerular filtration rate (eGFR), using the Chronic Kidney Disease Epidemiology Collaboration equation of <60 mL/min/1.73 m2 at the time of transplant listing. The recipient, donor, and procedure-related variables and survival were compared among patients with RD undergoing LT alone (split on the basis of eGFR impairment: 30-60 mL/min/1.73 m2 and ≤ 30 mL/min/1.73 m2) vs those with SLuKi. ResultsThe frequency of pretransplant RD was 5.42% (n = 1337). Patients with RD have significantly higher 1-year mortality (23.2% vs 15%; P < .001) and 3-year mortality (38.3% vs 28%; P < .001) than patients with eGFR > 60mL/min/1.73 m2. The proportion of patients with RD undergoing SLuKi was 2.84% (38 of 1337). Both the number and proportion of patients undergoing SLuKi progressively increased during the study period, especially in the lung allocation score era (30 of 38 SLuKi patients in the post lung allocation score era (linear R2 = 0.641, P < .001). The patients who underwent SLuKi were significantly younger, had lower body mass index, serum albumin, and listing eGFR (P < .001 for all comparisons). Patients with SLuKi were more likely to have cystic fibrosis or vascular diseases as the underlying diagnosis (29.7% vs 13.8%, P = .004). Despite higher need of early dialysis support after transplant, there was no difference in the 30-day, 1-year, or 3-year survival between the 2 groups. ConclusionsA significant proportion of LT candidates have a pre-existing RD, and this comorbidity is associated with significantly worse 1- and 3-year survival. Despite being the sicker group at baseline, patients with RD who undergo SLuKi have 1-year outcomes similar to patients with LT alone.

The start of the Hungarian lung transplantation program and the first results

The first lung transplantation in Hungary was performed on 12th of December, 2015. It was a joint effort of the National Institute of Oncology and the Semmelweis University. Hereby we summarise the results and experiences from the first three years. Until August, 2018, 55 lung transplantations were performed in Hungary. This was a retrospective analysis. All patients were listed according to the recommendation of the Lung Transplantation Committee. All implanted lungs have been procured from brain dead donors. Postoperative treatment and rehabilitation of the patients were continued at the Semmelweis University. Between 12. 12. 2015 and 31. 07. 2018, our team performed 76 organ retrievals: out of 45 Hungarian offers, 23 came from Eurotransplant countries and 8 outside of the Eurotransplant region. From these donations, 54 double and 1 single side transplantations were successfully performed. The surgical approach was single side thoracotomy (n = 1), bilateral thoracotomy (n = 1) and in the majority of the cases clamshell incision (n = 53). For the intraoperative veno-arterial extracorporeal membrane oxygenation support was used. The extracorporeal membrane oxygenation support had to be prolonged in 3 patients into the early postoperative period, two other recipients were bridged to transplant with extracorporeal membrane oxygenation. In the same time period, one combined lung-kidney transplantation was also performed. The distribution of recipients according to the underlying disease was: chronic obstructive pulmonary disease (n = 28); idiopathic pulmonary fibrosis (n = 8); cystic fibrosis (n = 12); primary pulmonary hypertension (n = 2); hystiocytosis-X (n = 1); bronchiectasis (n = 2); lymphangioleiomyomatosis (n = 1); and re-transplantation following bronchiolitis obliterans syndrome (n = 1), respectively. The mean age of recipients was 47.5 ± 15.18 years. The youngest recipient was 13 years old. We unfortunately lost 12 patients on our waiting list. The mean intensive care unit stay was 24.6 ± 18.18 days. Two patients were lost in the early postoperative phase. Tracheostomy was necessary in 13 cases due to the need of prolonged ventilation. 1-year survival of the recipients was 82.96% (until 31. 07. 2018). When looking at the first three years of the program, the case numbers elevated quickly throughout the years which is rather unique when compared to other centres in their starting period. Perioperative mortality and morbidity is comparable with high-volume lung transplantation centres. In the future we would like to increase the number of patients on the waiting list, thus increasing the total number of transplantations performed, and we are also planning to implement the use of the ex vivo lung perfusion system (EVLP) in our program. Orv Hetil. 2018; 159(46): 1859-1868.

Double Valve Replacement: A Heroic and Unique Life-Saving Procedure in a Lung-Kidney Transplant Recipient; a Case Report

Double Valve Replacement: A Heroic and Unique Life-Saving Procedure in a Lung-Kidney Transplant Recipient; a Case Report

Outcomes of simultaneous heart-kidney and lung-kidney transplantations: the Australian and New Zealand experience.

Heart or lung transplantation alone in individuals with significant pre-existing renal impairment results in high mortality and morbidity. Simultaneous heart-kidney (SHK) or simultaneous lung-kidney (SLK) transplantation may be considered in patients with dual organ failure not suitable for single organ transplantation. We aimed to outline the Australian and New Zealand experience of SHK and SLK transplantations, focussing on patient characteristics and survival. We analysed all SHK and SLK transplants performed in four centres across Australia and New Zealand between 1990 and 2014. Over the study period, 35 SHK and 3 SLK transplants were performed across 4 transplant centres. Mean age at transplantation for SHK transplants was 45 years, and for SLK transplant was 27 years. The most common aetiology of renal failure was glomerulonephritis. Most SHK transplant patients (77%) required renal replacement therapy prior to transplantation, with only one of the three patients undergoing SLK transplant, dialysis dependent. One-year survival for the cohort was 79%, which is lower than reported for single organ transplantation. However, 5- and 10-year survivals of 76% and 68%, respectively, were comparable. Isolated renal graft loss was seen in five patients, with only one patient successfully re-transplanted and the rest commencing dialysis. The Australian and New Zealand experience of SHK and SLK includes 38 patients with a high 1-year mortality, but excellent 5- and 10-year survivals. Based on this, it seems reasonable to continue to offer combined organ transplantation to select patients with dual organ failure.

Combined Lung-Kidney Transplantation: An Analysis of the UNOS/OPTN Database

Poor outcomes after thoracic transplantation with concurrent renal dysfunction are well described: without transplantation or with thoracic-only transplantation, patients face unacceptably high mortality. Outcomes after combined lung-kidney transplantation (LKT) remain largely uninvestigated. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database was queried to identify all LKTs, lung transplantations (LTs), and kidney transplantations (KTs) performed in the United States from 1995 to 2013. Survival was calculated using the Kaplan-Meier method and compared using log-rank tests or Cox regression models. Thirty-one LKTs were performed. Mean recipient age was 45.4 ± 13.5 years; 48.3 per cent were male. Retransplantation for graft failure was the leading indication for LT (n = 13) and the most common renal indication was calcineurin inhibitor nephrotoxicity (n = 11). Mean lung allocation score was 46.6 ± 14.4, mean creatinine was 3.7 ± 2.8 g/dL, and glomerular filtration rate was 23.1 (interquartile range 11.9, 38.3) mL/min/1.7 m(2), and 11 (35.5%) were dialysis dependent. Patient survival after LKT was 92.9 per cent, 71.0 per cent, and 71.0 per cent at one month, six months, and one year, with a median survival of 95.2 months. One- and five-year survival after LKT, 71.0 per cent and 59.9 per cent, were similar to LT (n = 23,913), 81.7 per cent and 51.4 per cent (P = 0.061 and 0.55), and inferior to KT (n = 175,269), 94.9 per cent and 82.8 per cent (P < 0.0001), respectively. Patient survival after LKT was similar to isolated LT, and these results suggest that LKT is a feasible therapeutic option for LT candidates with significant renal dysfunction.

(670) - Assessment of Human Lungs Recovered From Uncontrolled Donation After Circulatory Determination of Death (uDCDD) Donors By Ex-Vivo Lung Perfusion (EVLP) and CT Scan

s S247 Methods: The UNOS/OPTN database was queried to identify all LKT, LT, and KT performed in the U.S. from 1995-2013. Survival was calculated using the Kaplan-Meier method & compared using log-rank tests or Cox regression models. Results: Thirty-one LKT, including 3 heart-lung-kidney transplants, were performed. Median follow-up was 14.46 months (19 days 8.51 years). The mean age of LKT recipients was 44.8 ± 13.1 years & 48% were male. Redo lung transplant for graft failure was the leading indication for LT (n= 13), followed by cystic fibrosis (n= 4). The most common renal indication was calcineurin inhibitor nephrotoxicity (n= 11). Mean lung allocation score (LAS) was 46.6 ± 14.4. No patient required extracorporeal membrane oxygenation. Mean creatinine was 3.7 ± 2.8 mg/dL, MDRD estimated GFR was 26.1 ± 17.6 mL/min/1.73m2, & 11 patients were dialysis-dependent. Ischemic time for lung & kidney grafts was 4.6 ± 1.7 & 12.6 ± 8.1 hours. Patient survival after LKT was 93%, 71%, & 71% at 1 month, 6 months, & 1 year with median survival 95.2 months. Relative to single-organ transplant, 1 & 5 year survival after LKT, 71% & 60%, were similar to LT (n= 23,913), 82% & 51% (p = 0.061 & 0.55), & inferior to KT (n= 175,269), 95% & 83% (p < 0.0001). Outcomes improved in the LAS era: 1 & 5 year survival for LKT (n= 23) were 78% & 72% & remained similar to LT (n= 12,755), 84% & 53% (p = 0.30 & 0.88). Redo status did not increase mortality after LKT at 1 (HR 1.05, 95% CI [0.28, 3.93] & 4 years (HR 1.18 [0.36, 3.88]), in contrast to significantly increased mortality after LT: HR 1.89 [1.68, 2.14] & HR 1.75 [1.60,1.92]. Conclusion: This is the first study to describe outcomes after lung-kidney transplantation. Patient survival following lung-kidney transplant is similar to lung-only transplant & is an acceptable option for lung-transplant candidates with significant renal dysfunction.

(667) - Frailty Is Associated With Increased Mortality and Hospitalization in COPD

s S247 Methods: The UNOS/OPTN database was queried to identify all LKT, LT, and KT performed in the U.S. from 1995-2013. Survival was calculated using the Kaplan-Meier method & compared using log-rank tests or Cox regression models. Results: Thirty-one LKT, including 3 heart-lung-kidney transplants, were performed. Median follow-up was 14.46 months (19 days 8.51 years). The mean age of LKT recipients was 44.8 ± 13.1 years & 48% were male. Redo lung transplant for graft failure was the leading indication for LT (n= 13), followed by cystic fibrosis (n= 4). The most common renal indication was calcineurin inhibitor nephrotoxicity (n= 11). Mean lung allocation score (LAS) was 46.6 ± 14.4. No patient required extracorporeal membrane oxygenation. Mean creatinine was 3.7 ± 2.8 mg/dL, MDRD estimated GFR was 26.1 ± 17.6 mL/min/1.73m2, & 11 patients were dialysis-dependent. Ischemic time for lung & kidney grafts was 4.6 ± 1.7 & 12.6 ± 8.1 hours. Patient survival after LKT was 93%, 71%, & 71% at 1 month, 6 months, & 1 year with median survival 95.2 months. Relative to single-organ transplant, 1 & 5 year survival after LKT, 71% & 60%, were similar to LT (n= 23,913), 82% & 51% (p = 0.061 & 0.55), & inferior to KT (n= 175,269), 95% & 83% (p < 0.0001). Outcomes improved in the LAS era: 1 & 5 year survival for LKT (n= 23) were 78% & 72% & remained similar to LT (n= 12,755), 84% & 53% (p = 0.30 & 0.88). Redo status did not increase mortality after LKT at 1 (HR 1.05, 95% CI [0.28, 3.93] & 4 years (HR 1.18 [0.36, 3.88]), in contrast to significantly increased mortality after LT: HR 1.89 [1.68, 2.14] & HR 1.75 [1.60,1.92]. Conclusion: This is the first study to describe outcomes after lung-kidney transplantation. Patient survival following lung-kidney transplant is similar to lung-only transplant & is an acceptable option for lung-transplant candidates with significant renal dysfunction.

(668) - 100 Lung Transplants Delivered in Ireland

s S247 Methods: The UNOS/OPTN database was queried to identify all LKT, LT, and KT performed in the U.S. from 1995-2013. Survival was calculated using the Kaplan-Meier method & compared using log-rank tests or Cox regression models. Results: Thirty-one LKT, including 3 heart-lung-kidney transplants, were performed. Median follow-up was 14.46 months (19 days 8.51 years). The mean age of LKT recipients was 44.8 ± 13.1 years & 48% were male. Redo lung transplant for graft failure was the leading indication for LT (n= 13), followed by cystic fibrosis (n= 4). The most common renal indication was calcineurin inhibitor nephrotoxicity (n= 11). Mean lung allocation score (LAS) was 46.6 ± 14.4. No patient required extracorporeal membrane oxygenation. Mean creatinine was 3.7 ± 2.8 mg/dL, MDRD estimated GFR was 26.1 ± 17.6 mL/min/1.73m2, & 11 patients were dialysis-dependent. Ischemic time for lung & kidney grafts was 4.6 ± 1.7 & 12.6 ± 8.1 hours. Patient survival after LKT was 93%, 71%, & 71% at 1 month, 6 months, & 1 year with median survival 95.2 months. Relative to single-organ transplant, 1 & 5 year survival after LKT, 71% & 60%, were similar to LT (n= 23,913), 82% & 51% (p = 0.061 & 0.55), & inferior to KT (n= 175,269), 95% & 83% (p < 0.0001). Outcomes improved in the LAS era: 1 & 5 year survival for LKT (n= 23) were 78% & 72% & remained similar to LT (n= 12,755), 84% & 53% (p = 0.30 & 0.88). Redo status did not increase mortality after LKT at 1 (HR 1.05, 95% CI [0.28, 3.93] & 4 years (HR 1.18 [0.36, 3.88]), in contrast to significantly increased mortality after LT: HR 1.89 [1.68, 2.14] & HR 1.75 [1.60,1.92]. Conclusion: This is the first study to describe outcomes after lung-kidney transplantation. Patient survival following lung-kidney transplant is similar to lung-only transplant & is an acceptable option for lung-transplant candidates with significant renal dysfunction.

(669) - Combined Lung-Kidney Transplantation: An Analysis of the UNOS/OPTN Database

Poor outcomes after thoracic transplant with concurrent renal dysfunction are well-described: without transplant or with thoracic-only transplant, such patients face unacceptably high mortality. Although combined lung-kidney transplantation (LKT) remains a rare operation, it is performed with increasing frequency. Patient outcomes following LKT remain uninvestigated. We hypothesize that patient survival after LKT is similar to survival after LT & inferior to survival after kidney-only transplantation (KT).

Long-term Success of Combined Kidney–Lung Transplantation in a Patient With Cystic Fibrosis

Advanced kidney disease is usually considered an absolute contraindication for lung transplantation due to the difficult management of these patients in the post-operative period. Combined lung–kidney transplantation, however, could offer an opportunity for selected patients with renal and pulmonary dysfunction. This study summarizes the long-term success of a double transplantation in a 38-year-old male patient with cystic fibrosis who presented respiratory and kidney failure. After a complicated post-operative period, the patient currently lives completely independently 46months after the operation and he enjoys excellent pulmonary and renal function.

Éxito a largo plazo de un trasplante combinado de pulmón-riñón en un paciente con fibrosis quística

Advanced kidney disease is usually considered an absolute contraindication for lung transplantation due to the difficult management of these patients in the post-operative period. Combined lung-kidney transplantation, however, could offer an opportunity for selected patients with renal and pulmonary dysfunction. This study summarizes the long-term success of a double transplantation in a 38-year-old male patient with cystic fibrosis who presented respiratory and kidney failure. After a complicated post-operative period, the patient currently lives completely independently 46months after the operation and he enjoys excellent pulmonary and renal function.

Successful Combined Heart-Bilateral Lung-Kidney Transplantation From a Same Donor to Treat Severe Hypertrophic Cardiomyopathy With Secondary Pulmonary Hypertension and Renal Failure: Case Report and Review of the Literature

This study describes the first reported case of a combined heart-lung-kidney transplantation. Our patient suffered from hypertrophic cardiomyopathy due to long-standing hypertension with Dana Point Classification Group 2 pulmonary hypertension from the underlying cardiac disease, along with renal failure necessitating renal replacement therapy. Twenty months after the transplant procedure, she has stable pulmonary and renal function, plus has resumed a normal daily life with improving exercise tolerance. We propose that a combined heart-lung-kidney transplantation may be an acceptable therapeutic option for carefully selected patients with advanced, concomitant cardiac, pulmonary, and kidney disease.

Importance of Suspicion for the Identification ofMycoplasmain Wound Culture: A Case Report

Genital mycoplasmas are rare in extraintestinal specimens, but can cause disseminated infections in immunocompromised patients and wound infections after surgery or injury. We report two cases of Myoplasma hominis wound infections after lung lobectomy and kidney transplantation, and a case of M. salivarium wound infection after aortic graft replacement. Mycoplasmas grew in aerobic and anaerobic cultures as tiny colonies but were not observed by gram- or acid fast stain and were confirmed by MYCOFAST EvolutioN 2 kit or 16S rRNA sequencing. These cases indicated that mycoplasmas were probably underestimated in wound infections because they were not in suspicion. We suggest that Mycoplasma should be suspected when microorganisms are not readily observable in Gram stains but can be cultured. (Korean J Clin Microbiol 2010;13: 121-124)

The Evolution of Kidney Function After Lung Transplantation: A Retrospective Cohort Study

Background Little information exists regarding the rate of kidney functional loss after lung transplantation. The aim of this study was to assess the evolution of kidney function after lung transplantation, seeking to identify a pretransplant glomerular filtration rate (GFR) threshold under which dual lung-kidney transplantation should be considered. Patients and methods We performed a single-center, retrospective cohort study among patients who received a first lung transplant. GFR was measured with the MDRD7 equation immediately before and up to 10 years after transplantation. A hierarchical model of linear regression was used to determine the evolution of GFR over time. Results We studied 241 subjects whose mean GFR was 92 ± 33 mL/min/1.73 m 2 immediately before transplantation. The GFR declined quickly during the first posttransplant month (−24 mL/min/1.73 m 2 vs baseline; 95% confidence interval [CI]: −27, −21 mL/min/1.73 m 2). It decreased slightly between 1 and 12 months (−34 mL/min/1.73 m 2 at 12 months vs baseline; 95% CI: −37, −31 mL/min/1.73 m 2) and then stabilized up to 10 years after transplantation. GFR loss varied according to the baseline GFR. In patients with baseline GFR ≤ 60 mL/min/1.73 m 2, the GFR declined by 9 mL/min/1.73 m 2 (95% CI = 6–15) at 1 year and was stable there after. Conclusion GFR declines rapidly in the first month and at 1 year after lung transplantation, stabilizing thereafter. Because they are likely to develop eligibility for kidney transplantation in the 1 to 2 years following lung transplantation, we believe that dual lung-kidney transplantation should definitely be considered for subjects with a baseline GFR ≤ 35 mL/min/1.73 m 2.