Lung Transplant Population Research Articles

"For your eyes only": ophthalmic complications following lung transplantation.

Ophthalmic complications in the lung transplant population are a little-known entity. It includes a spectrum of diseases ranging from infections such as cytomegalovirus (CMV) retinitis, herpetic keratitis, Pseudallescheria boydii to non-infectious complications such as posterior subcapsular cataracts (PSCs), cyclosporine retinopathy, and post-transplant lymphoproliferative disorder (PTLD). These diseases can be attributed to high levels of immunosuppression, advanced age, and drug-specific side effects. Underlying comorbidities such as diabetes mellitus may also play a role in the pathogenesis. Patients can present with varied symptoms such as blurry vision, floaters or eye pain. Prompt diagnosis often requires a high index of suspicion. With increasing numbers of transplants being performed worldwide, it is imperative for the pulmonologist and transplant physician to recognize these often subtle symptoms. Any visual symptom should trigger an ophthalmological evaluation in order to manage these complications; some of which pose the risk of systemic dissemination and significant morbidity. The following article provides an in-depth review of the common presenting symptoms, treatments and recent advances related to common ophthalmic complications following lung transplantation. While this article focuses on the lung transplant sub-population, the authors would like to point out that some of these complications are shared by other solid-organ transplants as well, by virtue of their shared immunosuppressive therapies.

Epidemiology of Clostridium difficile Infection in the Lung Transplant Population at a High Volume Transplant Center

Introduction:Clostridium difficile infection (CDI) is a leading cause of health care-associated infections in the United States. Significant risk factors for CDI include antibiotic and hospital exposure. Immunosuppression increases susceptibility to CDI. In the lung transplant (LTx) population, incidence of CDI ranges from 6-22.5%. We aim to provide an update on epidemiology of post-operative CDI in the LTx population in a high-volume lung transplant center. Methods: Adult patients who received a LTx at our institution from January 2014-January 2018 were identified and charts were reviewed for a positive PCR assay for CDI (CDI+) after LTx. We also collected relevant demographic and treatment data to make comparisons between the CDI+ and non-CDI (CDI-) populations. Statistics, including t-tests, chi-square and logistic regression were performed with SPSS v25.0. Results: A total of 376 patients underwent LTx during the study period. The overall incidence of CDI post-LTx was 6.4% (24/376 patients). Post-LTx CDI- and CDI+ patients were similar in terms of gender (67% vs 54% male, p=0.20), mean age at time of transplant (64 vs 61 years, p=0.18), race (76% vs 79% Caucasian, p=0.40) and mean Lung Allocation Score (LAS) (50 vs 52, p=0.77). Indication for transplant was significantly different between groups (p=<0.001), namely because there were no CDI+ patients with primary pulmonary hypertension. Of the 24 CDI+ patients, 11 had incident CDI on the same admission as LTx (average time post-LTx: 31 days) and 13 had infection at a subsequent admission (average time post-LTx: 303 days). Seventeen patients had 1 episode of CDI, four patients had 1 recurrence, and 3 patients had multiple recurrences. Most patients (96%) received peri-operative antibiotics for longer than 3 days after transplant. In terms of disease severity, 71% had mild-moderate CDI, 16.5% had severe CDI, and 12.5% had severe/complicated CDI. There were no deaths from CDI. In a logistic regression model, no available risk factor predicted the development of CDI. Conclusion: In our large LTx cohort, the incidence of CDI post-LTx was low compared to other studies. There were no obvious predictors for development of CDI in this population. Interestingly, age at time of LTx and LAS were similar in both groups. Further studies are warranted to further examine the effect of CDI on the morbidity and mortality of LTx patients.

Acute hypocalcaemia following denosumab in heart and lung transplant patients with osteoporosis.

Osteoporosis is highly prevalent in the heart and lung transplant population. Given high rates of concurrent renal impairment, there is increasing use of denosumab in this population. However, denosumab may be associated with hypocalcaemia, particularly in patients with chronic kidney disease (CKD). To explore the risk of hypocalcaemia in a heart and lung transplant cohort prescribed denosumab for osteoporosis. We performed a retrospective database review of all surviving heart and lung transplant patients who had received denosumab for osteoporosis between January 2012 and November 2015. We assessed the rates of hypocalcaemia in this cohort and collected baseline clinical data to determine associated factors. Ten patients received denosumab and had laboratory results available within 3 months of the dose. Of these, three patients developed severe (grade 4) hypocalcaemia, while two patients developed mild (grade 1) hypocalcaemia. In comparison to the five patients who remained normocalcaemic, patients with hypocalcaemia had significantly lower baseline mean estimated glomerular filtration rate but similar baseline mean corrected serum calcium. Unexpectedly, patients developing hypocalcaemia had non-significantly higher levels of 25-hydroxyvitamin D and lower baseline doses of prednisone. In heart and lung transplant patients, denosumab should be used judiciously in patients with advanced renal disease due to the risk of hypocalcaemia.

Infections after lung transplantation.

The good clinical result of lung transplantation is constantly undermined by the high incidence of infection, which negatively impacts on function and survival. Moreover, infections may also have immunological interactions that play a role in the acute rejection and in the development of chronic lung allograft dysfunction. There is a temporal sequence in the types of infection that affects lung allograft: in the first postoperative month bacteria are the most frequent cause of infection; following this phase, cytomegalovirus and Pneumocystis carinii are common. Fungal infections are particularly feared due to their association with bronchial complication and high mortality. Scrupulous postoperative surveillance is mandatory for the successful management of lung transplantation patients with respect to early detection and treatment of infections. This paper is aimed to address clinicians in the management of the major infectious complications that affect the lung transplant population.

Cryotherapy of Airway Stenosis after Lung Transplant

Bronchial stenosis remains the most common complication after lung transplantation and a therapeutic challenge. Cryotherapy and cryodebridement are newer treatment modalities for airway obstructions and stenoses, but are not well characterized in the lung transplant population. We describe the procedure and analyze the safety profile of cryotherapy in lung transplant recipients.

Posttransplant Lymphoproliferative Disorders in Epstein-Barr Virus Donor Positive/Recipient Negative Lung Transplant Recipients

Epstein-Barr virus (EBV) donor positive/recipient negative (D+/R-) status is a significant risk factor for posttransplant lymphoproliferative disorder (PTLD) in lung transplant. There are, however, no studies that identify the risk factors for PTLD in the EBV D+/R- lung transplant population to guide the decision to proceed with an EBV-positive donor. This was a retrospective cohort study of adults listed in the Scientific Registry of Transplant Recipients between May 5, 2005, and August 31, 2016. Cox proportional hazards models were used to assess the impact of EBV D+/R- status on the development of PTLD, the impact of PTLD on survival, and survival differences between EBV D+/R- and EBV D-/R- recipients. The incidence of PTLD was 6.2% (79 of 1,281) versus 1.4% (145 of 10,352) in EBV D+/R- versus allother recipients (adjusted odds ratio 4.0; 95% confidence interval: 2.8 to 5.9, p < 0.001). Among EBV D+/R- recipients, age less than 40 years and white race were associated with PTLD. The EBV D+/R- patients who had PTLD had increased adjusted risk of death (hazard ratio 1.91; 95% confidence interval: 1.35 to 2.71; p< 0.001). Compared with EBV D+/R- recipients, EBV D-/R- recipients did not have improved adjusted survival (hazard ratio 0.82; 95% confidence interval: 0.57 to 1.18; p= 0.30). Despite increased rates of PTLD and associated mortality in the EBV D+/R- population, EBV seronegative patients did not have worse mortality when transplanted with lungs from EBV seropositive donors compared with lungs from EBV seronegative donors. Consideration should be given for close monitoring for PTLD among EBV D+/R- recipients, particularly those who are white and less than 40 years of age.

Increased risk of PTLD in lung transplant recipients with cystic fibrosis

BackgroundPost-transplant lymphoproliferative disease (PTLD) is an important cause of morbidity and mortality following lung transplantation. Recipients with cystic fibrosis (CF) may have an increased risk of PTLD although the literature is limited to single center cohorts. Our primary aim is to examine PTLD in an adult lung transplant population by utilizing the International Society for Heart and Lung Transplantation Registry. MethodsWe studied 30,598 adult recipients of lung transplants performed between 1999 and 2011. The primary outcome was development of and time to PTLD. In addition to indication for transplant, other predictors examined included Epstein–Barr virus (EBV) and cytomegalovirus (CMV) serostatus, gender, and age. Outcomes were assessed with univariable and multivariable Cox proportional hazard models to obtain hazard ratios (HR). Results17% of the cohort had a diagnosis of CF. PTLD developed in 2% of CF recipients compared to 1% for non-CF recipients (p<0.001). Compared to non-CF recipients, CF recipients had higher prevalence of EBV and CMV seronegativity and higher prevalences of high risk EBV and CMV mismatch (D+/R−). There is a significant association between CF and the development of PTLD [HR 1.66 (95% CI 1.30–2.12)]. Stratified multivariable analysis controlling for age revealed EBV negative non-CF recipients have an almost 2 fold increased risk of developing PTLD, whereas EBV negative CF recipients had an almost 6.5 fold increased risk. ConclusionsCF recipients have a higher risk for PTLD compared to non-CF recipients. Further studies are needed to account for additional risk factors and management in this population post-transplant.

(983) - Impact of Prolonging CMV Prophylaxis in High Risk (CMV D+/R-) Lung Transplant Recipients

Purpose Cytomegalovirus (CMV) seronegative recipients receiving a seropositive allograft (D+/R-) are at a high risk of developing CMV disease. Our program increased the duration of CMV prophylaxis from 6 to 9 months in May 2013. Here, we present the impact on the incidence of CMV infection, disease, side effects and other factors. Methods Retrospective cohort of 241 CMV (D+/R-) transplanted from January 1, 2008 to December 31, 2017. Blood CMV testing was done according to protocol. All patients received ganciclovir/valganciclovir as prophylaxis. We recorded the incidence and timing of CMV infection and disease up to 6 months after cessation of prophylaxis. CMV infection was defined as detectable CMV-viremia in the absence of symptoms. CMV disease was defined as CMV syndrome or tissue-invasive disease. Side effects of prophylaxis were recorded. Results 9-month prophylaxis both delayed and decreased the rate of CMV disease (Figure 1) with no difference in the rate of CMV infection (Figure 1). The rate of biopsy-proven acute cellular rejection was lower in the extended 9 month prophylaxis group, although not statistically significant (Table 1). There was no difference in the rate of adverse effects or development of CMV resistance between the two groups. Conclusion Extending duration of CMV-prophylaxis from 6 to 9 months resulted in a delayed and decreased incidence of CMV disease in our lung transplant population. The incidence of CMV infection, and ganciclovir resistance and side effects were similar between the two groups. Our results suggest that extending CMV prophylaxis in the highest risk CMV D+/R- group is effective in reducing CMV-disease.

What makes a good pediatric transplant lung: Insights from in vivo lung morphometry with hyperpolarized 3 He magnetic resonance imaging.

Obtaining information on transplanted lung microstructure is an important part of the current care for monitoring transplant recipients. However, until now this information was only available from invasive lung biopsy. The objective of this study was to evaluate the use of an innovative non-invasive technique, in vivo lung morphometry with hyperpolarized ³He MRI-to characterize lung microstructure in the pediatric lung transplant population. This technique yields quantitative measurements of acinar airways' (alveolar ducts and sacs) parameters, such as acinar airway radii and alveolar depth. Six pediatric lung transplant recipients with cystic fibrosis underwent in vivo lung morphometry MRI, pulmonary function testing, and quantitative CT. We found a strong correlation between lung lifespan and alveolar depth-patients with more shallow alveoli were likely to have a negative outcome sooner than those with larger alveolar depth. Combining morphometric results with CT, we also determined mean alveolar wall thickness and found substantial increases in this parameter in some patients that negatively correlated with DLCO. In vivo lung morphometry uniquely provides previously unavailable information on lung microstructure that may be predictive of a negative outcome and has a potential to aid in lung selection for transplantation.

Antipseudomonal Drug Exposure Associated with MDR Organisms in the Liver and Lung Transplant Population

BackgroundMulti-drug resistant (MDR) Gram-negative bacteria (GNB) are an emerging complication in transplant recipients. This study describes the prevalence of and risk factors for MDR-GNB infection/colonization in the liver and lung transplant population.MethodsCross-sectional study with nested case-case–control included adult liver or lung transplant candidates/recipients from 1/10-7/16. Patients with a positive GNB culture were classified as MDR- or Susceptible (S)-cases; MDR was defined as in vitro resistance to ≥ 3 antibiotic classes. Patients without a positive GNB culture were controls. Primary variable of interest: antibiotic days of therapy (DOT) during time at risk. Patient and isolate characteristics were collected and compared.ResultsWe included 150 patients: 110 (73%) liver, 40 (27%) lung. Median (IQR) patient age and Charlson comorbidity index were 59 years (52–63) and 5 points (3–6). Isolated organisms: 31 (34%) E. coli, 28 (31%) K. pneumoniae, 33 (36%) others. Resistance to cefepime, piperacillin/tazobactam, and ertapenem: 38%, 27%, and 14%. 61 (41%) MDR-GNB, 21 (14%) S-GNB, 68 (45%) controls. Median (IQR) cumulative antibiotic DOT was: MDR-case – 24.5 days (6–46.5), S-case – 5 days (2–24, P = 0.017 vs. MDR), controls – 0 days (0–10, P < 0.001 vs. MDR). Median (IQR) antipseudomonal (AP) DOT was: MDR-case – 7 days (1–16), S-case – 1 day (0–8, P = 0.055 vs. MDR), controls – 0 days (0–1, P < 0.001 vs. MDR); AP exposure was independently associated with MDR-GNB infection/colonization after correcting for severity of disease pre-transplant (adjOR: 2.9, 95% CI: 1.6–5.3) (Table 1).ConclusionMDR-GNB represent a significant burden to the liver and lung transplant population. A detailed antibiotic history, including AP DOT, may help with risk assessment to guide empiric therapy selection.Table 1.Variables associated with MDR-GNB infection/colonization during time at risk (AdjOR, 95% CI)MDR-cases vs. S-cases, (n = 82)MDR-cases vs. controls, (n = 129)MDR-cases vs. combined comparator, (n = 150)High MELD (> 30) or LAS (>50)1.1 (0.6–1.9)1.3 (0.7–2.3)1.5 (0.8–2.6)AP drug exposure1.1 (0.6–2.0)3.5 (1.9–6.3)2.9 (1.6–5.3)Prior hospitalization–0.9 (0.7–1.0)–Disclosures S. L. Davis, Allergan: Grant Investigator and Scientific Advisor, Consulting fee and Research grant; Merck: Grant Investigator and Scientific Advisor, Consulting fee and Research grant

Restless Legs Syndrome Following Lung Transplantation

Complications following lung transplantation are common and significantly reduce quality of life, and increase morbidity and mortality. Increasing evidence suggests sleep disorders are prevalent following lung transplantation, but factors associated with their development are not known. We sought to evaluate the prevalence of restless legs syndrome (RLS) in a lung transplant population and determine if a relationship exists between RLS and exposure to immunosuppressant medications. Subjects were recruited through the University of Wisconsin Hospital and Clinics Lung Transplant Clinic (N = 125). Participants (N = 81) completed sleep questionnaires, including the four RLS diagnostic criteria, insomnia severity index, and Sheehan disability scale. Cumulative tacrolimus exposure was determined in 62 subjects by calculating an area under the curve (AUC) to assess for a relationship with restless legs syndrome. Prevalence of RLS was 35 percent. Cumulative mean ± SEM tacrolimus exposure was similar in patients with RLS versus those without RLS (17446 ± 1855 ng days/mL vs. 15303 ± 1643 ng days/mL, respectively; p = 0.42). Insomnia severity index scores (12.5 ± 1.0 vs 6.8 ± 0.7, p < 0.0001) and Sheehan disability scores (7.8 ± 1.3 vs 3.6 ± 0.6, p = 0.003) were significantly higher in those with vs those without RLS symptoms, respectively. Our data confirms increased prevalence of RLS following lung transplantation reported by previous studies. RLS symptoms were not related to estimated tacrolimus exposure. Predictors of RLS following lung transplantation need to be further investigated to better identify and control RLS symptoms and reduce associated insomnia and disability.

(114) - Incidence of Vocal Cord Palsy and Aspiration Status in the Lung Transplant Population

(r= 0.531, p= 0.008) but not FEV1% (r= -0.163, p= 0.446), age (r= -0.310, p= 0.150), or pre-LTx PAL (r= 0.258, p= 0.235). However, ∆PAL was not correlated to age (r= 0.168, p= 0.443), ∆FEV1% (r= -0.036, p= 0.872), ∆6MWD (r= 0.340, p= 0.112) or ∆QS% (r= 0.228, p= 0.296). Conclusion: Despite substantial improvements in respiratory function and exercise capacity post lung transplantation, recipients’ physical activity does not change significantly from pre-transplant levels. Exercise capacity and quadriceps strength appear important determinants of post-transplant PAL. However, the factors influencing change in PAL from pre to post-transplant have not been identified.

Energy Requirements of a Pediatric Lung Transplant Population

Background: Comparison of estimated energy requirements using predictive equations (PBMR) to measured resting energy requirements (MREE) using indirect calorimetry is not widely investigated in the pediatric lung transplant (LTx) population. In this population, optimal nutrition delivery may promote appropriate weight gain post-transplantation. The purpose of this case series was to evaluate the difference between predicted and measured energy requirements pre- and post- transplant by comparing PBMR calculated by the World Health Organization (WHO) equation and MREE by indirect calorimetry. The secondary aim was to determine if the diagnosis of Cystic Fibrosis (CF) influenced energy expenditure. It was predicted that the majority of LTx children would have higher MREE than PBMR (denoted as % PBMR). The % PBMR value is relative to MREE. Methods and findings: After exclusion, there were 7 LTx patients (n=5 male, n=4 CF, median age 11.55, age range: 4-16 y) and 14 measurements (7 repeated measures). Measurements were conducted pre- or post- transplant. Pre-LTx patients (n=4 patients, n=2 CF) exhibited a median 106% PBMR (interquartile range: 24%). Post-LTx patients (n=3 patients, n=2 CF) exhibited a median 105% PBMR (24%). The median % PBMR did not differ significantly between CF and non-CF LTx children irrespective of transplant status (113% (22%), 103% (19%), respectively, P=0.12). Conclusion: These results suggest that MREE was higher than PBMR; the WHO equation may underestimate energy requirements for pre- and post-LTx children. There was a trend towards decreasing energy requirements post-LTx. In children post-LTx, the diagnosis of CF may not affect energy requirements.

Sleep Disordered Breathing in the Lung Transplant Population, a Case Report and Literature Review

Background: Patients waiting for and having received lung transplantation commonly demonstrate known risk factors for sleep disordered breathing (SDB) including central sleep apnea (CSA). However, little is known is about the prevalence or clinical implications of SDB in this patient population. Methods: We report a 61 year old man who underwent uncomplicated bilateral lung transplantation. Approximately 5 weeks post-transplant, the patient developed fatigue, somnolence, and mild intermittent confusion. Extensive cardiologic and neurologic evaluations were unrevealing regarding cause of symptoms. Diagnostic polysomnogram revealed severe central sleep apnea with a periodic respiratory pattern. Results: The patient was initiated on positive airway pressure therapy during sleep with an adaptive servoventilation device which successfully treated central sleep apnea and improved daytime symptoms. A repeat diagnostic polysomnogram performed 8 months post-transplant showed resolution of central sleep apnea. Conclusion: SDB including CSA is a poorly understood occurrence in the lung transplantation patient population that warrants clinical attention and further investigation.

Long-Term Survival After Lung Transplantation in Patients with Silicosis and Other Occupational Lung Disease.

Survival after lung transplantation (LTx) for patients with occupational lung disease (OLD) is not well studied. The United Network for Organ Sharing (UNOS) database was queried from 2005 to 2013 to assess survival after LTx in patients with silicosis and non-silicotic OLD compared to non-OLD patients. Of 7273 adult LTx recipients, 7227 (24 with silicosis and 29 with non-silicotic OLD) were included in our univariate and Kaplan-Meier function analysis and 6370 for multivariate Cox models. Univariate Cox models did not identify survival differences in silicosis (HR 0.717; 95 % CI 0.358-1.435; p = 0.347) and non-silicotic OLDs (HR 0.934; 95 % CI 0.486-1.798; p = 0.839). Kaplan-Meier function analysis did not identify a survival disadvantage for either silicosis or non-silicotic OLD (log-rank test: χ (2) 0.93, p = 0.627). Patients with non-silicotic OLD were at risk for worse survival for the first 2.5 years post-transplant; however, at the conclusion of the study, this group had the highest survival rate. Multivariate Cox models confirmed no increased risk for mortality for silicosis (HR 1.264; 95 % CI 0.631-2.534; p = 0.509) and non-silicotic OLD (HR 1.114; 95 % CI 0.578-2.147; p = 0.747). Long-term survival for adult patients with silicosis and non-silicotic OLD after LTx is not significantly different compared to the general lung transplant population.

Allogeneic blood transfusion in bilateral lung transplantation: impact on early function and mortality.

Blood transfusion is associated with higher morbidity and mortality after general cardiothoracic surgery but its impact within the transplant population is unclear. We investigated the profile of blood product transfusion in the bilateral lung transplant population and its impact on function and mortality. Three hundred and eleven adult patients who underwent bilateral lung transplant between 2003 and 2013 were retrospectively reviewed. Patients were stratified according to pretransplant diagnoses and amount of blood products transfused within 24 h of transplant. All-cause mortality at the 1-year follow-up was analysed using a Cox proportional hazards regression model. One hundred and seventy-four male patients and 137 female patients (mean age = 41.4 ± 14.0 years) underwent bilateral lung transplant using cardiopulmonary bypass for cystic fibrosis (48.9%), fibrotic lung disease (12.2%), emphysema (27.0%), bronchiectasis (5.8%), pulmonary hypertension (1.3%) and others (4.5%). The median number of red blood cells in the first 24 h was 3 (0-40) units, fresh frozen plasma (FFP) = 2 (0-26) units and platelets = 1 (0-7) units. The unadjusted all-cause mortality at the 1-year follow-up did not appear to be different between patient subgroups stratified by the median number of units of red blood cells (P = 0.827) or FFP transfused (P = 0.456). However, 1-year mortality was adversely affected when more than the median number of units of platelets was transfused (P = 0.010). Upon adjustment for confounding variables, 1-year mortality was noted to be greater among patients transfused more than the median unit of platelets (adjusted hazard ratios: 2.3, 95% confidence interval: 1.15-4.61, P = 0.019) and those with longer bypass times (P = 0.046). No significant difference in the number of units transfused was noted when patients were stratified by pretransplant diagnosis. Predicted lung function at 3 and 6 months was not significantly affected by greater blood product use. Unlike general cardiothoracic surgery, blood transfusion had no effect on all-cause mortality, whereas a greater administration of platelets was observed to be associated with higher adjusted 1-year mortality. Transfusion rates were not significantly influenced by pretransplant diagnoses. Interestingly, lung function at 3 and 6 months was similar for patients who received more blood product transfusion.

(96) - The Location of Intractable Ventricular Arrhythmias Following Left Ventricular Assist Device Implantation

s S45 unilaterally. In the three patients with bilateral involvement, the progression of dysfunction in each lobe was metachronous. The 19 CLADs consist of 11 cases of pure bronchiolitis obliterans Syndrome (BOS) pattern, four restrictive pattern, and four mixed (BOS+Restrictive) pattern. Primary disease, gender and blood relationship to donors are irrelevant to the onset of CLAD. Conclusion: The lower incidence of CLAD with better survival was found in bilateral LDLLT recipients compared to reported common diseased lung transplant population. This favorable outcome can relate to the lower incidence of innate immune-related complication including primary graft dysfunction in the acute stage. Meanwhile the clear laterality for development of CLAD in LDLLT strongly suggests that this pathology purely results from alloimmune-dependent factor and innate immunity can be only a trigger.

IS UNIVERSAL ANTIFUNGAL PROPHYLAXIS MANDATORY IN ADULTS AFTER LUNG TRANSPLANTATION? A METAANALYSIS OF OBSERVATIONAL STUDIES

Lung transplant recipients are at high risk of invasive fungal disease (IFD), particularly invasive aspergillosis and candidiasis. In contrast to liver transplant patients, no randomized controlled trials or international guidelines on antifungal prophylaxis in the lung transplant population exist.

248 * BLOOD TRANSFUSION AFTER LUNG TRANSPLANTATION: IMPACT ON EARLY FUNCTION AND SURVIVAL

Objectives: Blood transfusion is associated with higher morbidity and mortality after general cardiothoracic surgery but little is known of the impact on the transplant population. We investigated the profile of blood product transfusion in the bilateral lung transplant (BLT) population and the impact on function and survival outcomes. Methods: A total of 311 adult patients who underwent BLT between 2003 and 2013 were retrospectively reviewed. Patients were stratified according to pretransplant diagnosis and amount of blood products transfused within 24 h of surgery. Results: Patients, 174 male, 137 female (mean age 41.4 ± 14.0 years) underwent BLT, using cardiopulmonary bypass for cystic fibrosis (48.87%), fibrotic lung disease (12.21%), emphysema (27.01%), bronchiectasis (5.79%), pulmonary hypertension (1.29%) and others (4.50%). Median number of red blood cells (RBC) in the first 24 h was 3 (0–40) units, fresh frozen plasma (FFP) was 2 (0–26) units, platelets = 1 (0–7) units. There were no differences in transfusion rates according to pretransplant diagnosis. Patients were divided according to the number of units transfused in the first 24 h. Survival was not influenced by whether patients were transfused with more or less than the median number of units of RBC (P = 0.162) or FFP (P = 0.298) (Fig. 1). However, survival was adversely affected by platelet transfusion (P = 0.032). Mean FEV1 at 6 months was significantly better for patients transfused with more than the median number of units of RBC (2.66 vs 2.83, P < 0.0001), FFP (2.61 vs 2.89, P < 0.0001) and platelets (2.73 vs 2.82, P < 0.0001). Conclusion: Unlike general cardiothoracic surgery, blood transfusion has no effect on survival, but administration of platelets has an adverse effect. Blood product administration does not differ significantly with pretransplant diagnosis. Interestingly, lung function at 6 months is significantly better for patients with transfusion with more blood products.

Update on Nontuberculous Mycobacterial Infections in Solid Organ and Hematopoietic Stem Cell Transplant Recipients

Nontuberculous mycobacteria (NTM) are recognized as emerging pathogens. NTM disease in transplant recipients remains a diagnostic and therapeutic challenge. Herein, a review of the most recent literature will provide an update in regard to the epidemiology, clinical presentation, diagnosis, treatment, and prevention of NTM disease in solid organ and hematopoietic stem cell transplant recipients. Special consideration will be given to the lung transplant population.