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Aim. Although donorship issues and the integration of the new organs are the most distinguishing aspects of lung transplantation (LTx) compared to other kinds of 'high-tech' medicine, there is a paucity of papers on that matter. Therefore, we aimed to evaluate these aspects in young adult LTx recipients with at least 1-year survival. Methods. Semi-structured interviews; content analysis of specific parts of the interviews; frequency distributions of resulting categories. Sample. Forty-five adults aged 18-42 years (mean: 32 +/- 5.5 years). Post-transplant survival ranged from 1 to 11 years. Results. The majority of recipients (60%) fulfilled criteria of denial towards the foreign organ and/or the donor. However, they were rather sensitive towards the ethical and psychological impact of the upcoming option of living donorship in LTx. Also, the majority of recipients (79%) understood that there might as well be good reason not to opt for a LTx. Conclusions. LTx recipients appeared at first sight 'pragmatic' towards the gift of life, but they remained sensitive to its ethical and psychological challenges. [ABSTRACT FROM AUTHOR]

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Background: A high prevalence of asplenia has been observed in patients with unexplained pulmonary hypertension.Objective: To describe the clinical and histopathologic characteristics of patients with postsplenectomy pulmonary hypertension and to compare the prevalence of surgical asplenia in patients with idiopathic pulmonary hypertension and patients with other pulmonary diseases.Design: Case series and case-control study.Setting: University hospital in Hannover, Germany.Patients: 61 patients with pulmonary hypertension and 151 lung transplant recipients.Results: The prevalence of asplenia in patients with pulmonary hypertension was 11.5% (95% CI, 4.7% to 22.2%) compared with 0% (CI, 0% to 3.2%) in those without pulmonary hypertension (P < 0.001). Histopathologic examination of lung specimens from patients with postsplenectomy pulmonary hypertension showed intimal fibrosis, plexiform lesions, and abundant thrombotic lesions.Conclusion: Patients who have had splenectomy may be at increased risk for developing pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Background: Application of exogenous surfactant has been proposed to ameliorate lung ischemia-reperfusion injury. Experimentally, donor pretreatment has been favored over posttransplant application. We now report on the first prospective randomized clinical study of donor surfactant instillation in lung transplantation. Methods: Lung donors were randomly assigned to the surfactant (Surf, n=14) or the control group (Co, n=15). Bovine surfactant (100 mg/kg BW) was instilled segmentally via bronchoscopy within 30 min before organ harvest. Diagnostic bronchoalveolar lavage (BAL) was performed before surfactant instillation and 8 h after reperfusion of the graft. Surface-tension lowering properties of surfactant and the ratio of small to large surfactant aggregates (SA/LA) were determined as indicators for preservation of surfactant function from BAL fluid. Clinical outcome of the surfactant group was compared to 187 consecutive cases with otherwise similar treatment. Results: Surface tension of BAL fluid after transplantation was slightly increased in the Surf group but markedly increased in the Co group, indicating loss of surfactant function (9.6±2.1 vs. 17.5±1.9 mN/m; Surf vs. Co, respectively; P<0.05). The SA/LA ratio, as a marker for metabolic conversion of the surfactant material, was high in both groups before explant (0.86±0.4 vs. 0.78±0.31). This ratio was improved after transplant in Surf lungs, but further deteriorated in controls (0.42±0.28 vs. 1.58±0.44). Early clinical outcome showed no death in both groups and was without significant differences between groups due to low sample size, but when compared to our overall recipient population, spirometry in the Surf group revealed higher FEV1 2 weeks after transplant (2.81±0.71 vs. 1.77±0.91; P<0.05). Conclusion: Exogenous surfactant is safe and markedly improves post transplant surfactant function. Its application before organ harvest is therefore encouraged, especially in borderline donors. [ABSTRACT FROM AUTHOR]