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Idiopathic pulmonary fibrosis (IPF) has poor prognosis. Anti-fibrotic treatment has been shown to slow disease progression. Lung transplantation (LTx) offers a survival benefit. The 5-year survival after LTx in IPF is between 40 and 50.To evaluate which IPF patients have better prognosis following LTx.A retrospective study was conducted with all IPF patients who had undergone LTx in the Rabin Medical Center between 2010 and 2018. We collected data on pre-evaluation of pulmonary function tests, echocardiographic and right heart catherization, and anti-fibrotic treatments. The Kaplan-Meier method was used for survival analysis.Among148 patients who underwent LTx, 58 were double LTx (DLT) and 90 single LTx (SLT). Mean age was 58.07 ± 9.78 years; 104 males and 44 females. DLT patients had significantly lower survival rates than SLT in the short and medium term after LTx. Patients with saturation above 80% after the 6-minute walk test (6MWT) had higher survival rates. Patients over 65 years of age had a lower survival rates. Those with pulmonary hypertension (PHT) above 30 mmHg had a poorer prognosis with lower survival rates.IPF patients with higher mean PHT, older age (65 years), and desaturation following 6MWT had lower survival rates following LTx. DLT may decrease survival rate compared to SLT just for the short and medium period of time after LTx. These results may lead to better selection of IPF patient candidates for LTx. Additional studies are warranted for choosing which patients will have better prognosis after LTx.

Background: Malignancy after lung transplantation is an important cause of morbidity and mortality and is associated with the intensity and cumulative dose of immunosuppressive drugs. There is some evidence that the use of mammalian target of rapamycin (mTOR) inhibitors may reduce the risk of malignancy in kidney transplant recipients. Aims: To compare the effect of everolimus on the incidence of new malignancies, as well as the rate of acute rejection, CMV infection and overall survival between lung transplant recipients who were treated with an everolimus/calcineurin inhibitors (CNI)-based regimen versus CNI-based regimen. Methods: A single center retrospective cohort study including all transplanted patients treated with everolimus for >7 months from 1998-2019. Propensity score matching was used to select a similar control group. Results: 142 lung transplant recipients and matched controls were included. The incidence of malignancies was not significantly different between groups (RR 0.75, CI 0.34-1.67, P=0.48). However, a survival benefit was demonstrated in the everolimus group compared to the control group. In addition, the rate of acute rejection events was lower in the everolimus group (RR 0.31, CI 0.15-0.63, P=0.001). There were also less CMV infection episodes in the everolimus group (8.4%) compared to the control group (16.9%) (P=0.07). Conclusions: Whereas our study did not show a significant difference in the incidence of malignancies among the two groups of lung transplant recipients, our results suggest that treatment with everolimus may prolong survival and decrease the rates of acute rejection and CMV infection episodes.

The use of direct oral anticoagulants (DOACs) provides immediate and useful anticoagulation without the need of monitoring. The recent expansion in use of DOACs might change the therapeutic approaches in venous thromboembolism (VTE).To evaluate the treatment of VTE as well as the 90-days compliance with anticoagulants in the pre-DOACs era.A retrospective study was conducted at Beilinson Hospital, Rabin Medical Center. Inclusion criteria entailed: patients18 years old; new lower extremities deep vein thrombosis or pulmonary embolism, diagnosed at ER between May, 2014 and May, 2015. Patients with previous diagnosis; upper extremities or inner organs thrombosis or with missing data were excluded. Data collected included: gender and age, comorbidity with active malignancy, provoked/unprovoked events, hospitalization and length of stay, anticoagulation treatment during hospitalization and discharge, recommendations for duration of treatment or further hematologist's evaluation and 90-days compliance with anticoagulation treatment.The study group included 208 patients, 29% with active malignancy. All were hospitalized. In 54% of the subjects without active malignancy the event was provoked, whereas in 46% unprovoked. This detail was not discussed in any of the cases. The average length of stay tended to be longer in patients with a complete switch to warfarin than in ones on DOACs (10.3+7.5 vs. 6.4+5.2 days, p=0.09). Recommendations for the length of treatment or the need for further evaluation by a hematologist were not found in the majority. The overall 90-days compliance with anticoagulants was 47%.Most of the therapeutic approach errors might be resolved during the expanded use of DOACs, along with the simplicity of the recommendations at discharge. The study was supported by an educational grant from Pfizer, Inc.

Purpose The world SARS-CoV-2 pandemic has affected global health, including the health of lung transplant recipients. There is very little data reported on the outcomes of SARS-CoV-2 on this gruop of patients Methods Retrospective cohort study approved of all LTx recipients with symptoms consistent with COVID-19 investigated with naso-pharyngeal swabs and reverse PCR for SARS-COV-2. Postive test for SARS-COV-2 Inserted to our cohort and investigated their files. We also conducted pooled analysis of published cases of covid 19 cases of lung transplant recipients Results We identified eleven cases of COVID-19 among a cohort of 348 LTx recipients. All but two patients were hospitalized. Seven patients required intensive care and six died (55% mortality). Non-survivors had lower baseline FEV1 than survivors and worse and/or deteriorating chest radiographic scores during admission. No effect of medical therapy including steroids and remdesivir could be determined. This mortality rate compared poorly general hospitalized COVID-19 patients at our institution (13%) and national mortality rate of 0.3% in the general population. Incidence of COVID-19 was similar to the general population (0.3%). In a pooled analysis of published cases, we determined mortality of 28% across different reports of lung transplant patients with COVID-19. Conclusion COVID-19 disease is very severe in lung transplant recipients. In the absence of effective therapy and vaccination, transplant physicians should concentrate their efforts on prevention of disease and encourage meticulous preventative behavior by recipients under their care.