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Thymomas sometimes require treatment for various recurrence patterns, despite their relatively good survival rates after resection. We focused on their maximum standardised uptake value (SUVmax) on preoperative 18F-fluorodeoxyglucose positron emission tomography as a tumour recurrence predictor in completely resected thymomas. Those with a high SUVmax might be at an increased recurrence risk, irrespective of tumour size. We categorised cases into axes (tumour size and SUVmax) and determined whether cluster analysis predicts recurrence patterns and freedom from recurrence (FFR). Of the 115 patients who underwent primary surgery for thymoma between 2005 and 2018, 66 were evaluated. According to the Masaoka stage and World Health Organization (WHO) histological type, all histological diagnoses were obtained after resection. All recurrences were diagnosed using computed tomography and categorised into three patterns: distant, local and regional recurrences. A multiple regression analysis was carried out to identify predictors for each recurrence pattern. Cluster analysis was carried out based on tumour size and SUVmax. The FFR rate was evaluated. All patients with preoperative SUVmax <3.4 were free from recurrence regardless of Masaoka stage, WHO histological classification and tumour size. Multiple regression analysis revealed that the SUVmax was the only significant predictor for distant recurrence. All cases were divided into three clusters. Cluster 3, with average tumour size and a high SUVmax, showed a higher risk of distant recurrence rate (60%) and a significantly lower FFR rate (P = 0.003). The preoperative positron emission tomography/computed tomography SUVmax could be a useful thymoma recurrence predictor, especially for distant recurrences. In addition, cluster analysis revealed that cases with average tumour sizes and extremely high SUVmax were identified to have a higher recurrence risk and a significantly lower FFR rate than those in other clusters. Even after complete resection, such cases should be closely followed-up and screened for distant recurrence. • Finding predictors for postoperative thymoma recurrence is important. • PET/CT is useful for predicting distant thymoma recurrences. • No study has examined the SUVmax of PET/CT impact on predicting completely resected thymoma recurrence regarding tumour size. [ABSTRACT FROM AUTHOR]

We report a very rare case of pulmonary chromomycosis caused by Scedosporium prolificans that developed after lung transplantation and was successfully treated with endobronchial topical amphotericin B instillation. The subject was a woman in her 50s with a history of bilateral lobar lung transplantation from living donors for idiopathic pulmonary hypertension. Eight years after the lung transplantation, chest radiography X-ray and computed tomography showed an abnormal shadow in the right lung. Bronchoscopic findings showed obstruction by a fungal component at the laterobasal bronchus B9. She was diagnosed with pulmonary chromomycosis after S. prolificans was detected in the bronchial aspirate. Systemic antifungal treatment with itraconazole was ineffective. Therefore, we administered topical amphotericin B weekly via endobronchial instillation and replaced oral itraconazole with voriconazole. The endobronchial procedure was safe and tolerable. Bronchial obstruction improved after three 3 instillations. We continued topical amphotericin B instillation once every 3 months for 2 years, and the abnormal shadow nearly disappeared. This case report describes infection by S. prolificans , which rarely becomes an etiologic agent in lung transplant patients, and shows that endobronchial topical amphotericin B instillation is a therapeutic option when systemic antifungal treatment is ineffective. [ABSTRACT FROM AUTHOR]

Because the shortage of donor organs is especially serious in Japan, since 2002 a unique partnership between transplant consultant physicians and local physicians has been developed to maximize the organ utilization rate. Since 2011, more than 25 lung consultant physicians have been registered to specifically assess donor lungs and provide advice on intensive respiratory care to donors. In this study, we retrospectively reviewed the efficacy of this system for lung transplantation opportunities and outcomes. One hundred eighty-seven brain-dead lung donor candidates were chronologically divided into 3 phases: I (May 1998–November 2006) and II (December 2006–January 2011), before and after medical consultants requested that local physicians administer aggressive bronchial suctioning using bronchoscopy, respectively; and phase III (February 2011–January 2013), after the emergence of lung consultants. The lung utilization rate, Pa o 2 /F io 2 ratio at the first and second brain death examinations and at the tertiary assessment before recovery, and graft survival were analyzed. The lung utilization rate was significantly higher in phases II and III than in phase I. In phases I and II, the Pa o 2 /F io 2 ratio at the tertiary assessment was significantly lower than that at the first or the second brain death examination, whereas it did not worsen with time in phase III. Graft survival was significantly better in phases II and III than in phase I. Graft death due to primary graft dysfunction was significantly more frequent in phase I than in phases II and III. In conclusion, this system is effective in improving lung transplantation opportunities and outcomes. [ABSTRACT FROM AUTHOR]

Clamshell incision is a standard approach for bilateral lung transplantation, providing a good operative field; however, once wide dehiscence occurs, its management is sometimes difficult because of intense immunosuppression and malnutrition of the recipient. A 22-year-old man with idiopathic pulmonary arterial hypertension underwent cadaveric bilateral lung transplantation through a clamshell incision using standard cardiopulmonary bypass. He developed wound dehiscence on postoperative day (POD) 20 that resulted in exposure of the bilateral fifth ribs and open pneumothorax. Considering the extreme malnutrition and emaciation of the recipient, we avoided initial closure of the dehiscence. After the debridement of necrotic tissue, negative pressure wound therapy was initiated on POD 25 and was continued for approximately 6 months with trafermin spray application. Eventually, the wound, including the fifth ribs, was completely covered with granulation tissue except for the wire tying the sternum. On POD 217, the patient underwent removal of the sternal wire followed by split-thickness skin grafting. His wound was successfully closed and he was discharged without activity limitation on POD 265. [ABSTRACT FROM AUTHOR]

Abstract: Background: Bronchiolitis obliterans (BO) is a major cause of morbidity and mortality after lung transplantation. BO is pathologically characterized by neovascularized fibro-obliteration of the allograft airway. A recent study has shown that aberrant angiogenesis during fibro-obliteration contributes to the pathogenesis of BO. Vasohibin-1 (VASH1) has been isolated as a vascular endothelial growth factor–inducible gene in endothelial cells (ECs) that inhibits migration and proliferation of ECs and exhibits anti-angiogenic activity in vivo. Purpose: This study examines whether VASH1 inhibits fibro-obliteration of the allograft in a murine intrapulmonary tracheal transplantation model. Method: Tracheal allografts of BALB/c mouse were transplanted into the left lung of recipient C57BL/6J mouse. We performed gene transfer to the recipient lungs using an adenovirus vector encoding human VASH1 (Ad-VASH1) or beta- garactosidase (Ad-LacZ) as the control. Tracheal allografts were harvested and pathological on days 21 and 28. Result: Ad-VASH1 treatment reduced the vascular area on day 21 (4.6% versus 13.0%, P = .037) and day 28 (5.4% versus 13.4%, P = .022) compared with the control group. This was accompanied by significantly inhibited luminal obliteration of the tracheal allografts in the animals transferred with Ad-VASH1 compared with the control (69% versus 93%, P = .028) on day 21. We were not able to observe this effect on day 28 (92% versus 97%, P = .48). Conclusion: Transgene expression of VASH1 in the recipient lung significantly attenuated luminal obliteration of the tracheal allograft; this was associated with significantly reduced aberrant angiogenesis in the fibro-obliterative tissue in a murine model intrapulmonary tracheal transplantation. [Copyright &y& Elsevier]