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Summary Background: Pediatric scoliosis surgery may require single lung ventilation for surgical access. Current methods of lung isolation are inadequate for some or all of these children. The Arndt endobronchial blocker (EBB) has been described for use in pediatric thoracic surgery to enable single lung ventilation (SLV). There are few data on its use in pediatric spinal deformity surgery. We report the successful use of the Arndt EBB in a series of these patients. Methods: Any patient undergoing surgical correction of scoliosis involving a lateral thoracotomy for an anterior approach was managed with an Arndt EBB (5, 7 and 9 Fr gauge) to facilitate SLV. All cases were undertaken by a pediatric anesthetist trained in pediatric bronchoscopy; a 2.2 or 2.8 mm pediatric fiberoptic scope was used for placement and positional confirmation. Results: Patients’ ages and weights ranged from 18 months to 18 years, and from 9.4 to 71 kg. All had idiopathic or congenital scoliosis; one underwent a vertical expansion prosthetic titanium rib (VEPTR) procedure. In all 20 patients, placement was easily and quickly achieved with no incorrect placements. There was one displacement after inflation, quickly corrected. Right upper lobe deflation proved difficult in one patient with high take-off of the right upper lobe bronchus. The surgical field was excellent in all cases. Conclusions: In our case series, Arndt EBB provided a safe and highly effective means of single lung isolation for children undergoing pediatric scoliosis surgery.

Surgical resection is the treatment of choice of pulmonary metastases from colorectal cancer. We retrospectively reviewed our experience of pulmonary resections of single metastases from colorectal cancer, in order to document postoperative clinical outcome and survival.In the years 1997-2007, in 23 patients we performed 26 curative resections of pulmonary metastases from colorectal cancer (19 rectal and 7 colon; 12 males and 11 females; mean age 64.5 years). All patients had single lung metastasis. Three of the 23 patients underwent re-resection of the lung for treatment of a subsequent lung metastasis. Interval between resection of primary tumor and diagnosis of lung metastasis (disease-free interval (DFI)) was36 months in 19 patients (73%) and was36 months in 7 patients (27%). In 21 patients the metastases were metachronous; in 2 patients metastases were synchronous with primary colorectal cancer. The type of lung resection was wedge resection in 18 cases (70%); lobectomy in 6 cases (23%); pneumonectomy in 2 cases (7%). Of the 18 wedge resections, 12 (66%) were done thoracoscopically. After lung metastasectomy patients were followed up for 5-121 months (median: 61 months).We had 1 early postoperative mortality (after re-resection) from cardiac complication (3.8%). Postoperative morbidity (within 30 days) was observed in 7 cases (27%): 1 pneumonia, 1 empyema, 1 arrhythmia and 4 prolonged air leaks requiring chest drainage7 days. Median survival was 74 months (Kaplan-Meier).Resection of single metachronous lung metastases from colorectal cancer has low mortality and morbidity and in our experience it correlated with prolonged postoperative survival. Re-resection of the lung for treatment of subsequent metachronous metastases carries higher risk.

To improve the efficiency of treatment of single lung destructive tuberculosis.15-year experience of operations for destructive tuberculosis performed by the same surgeon including 18 resections of the single lung and 19 pneumonectomies after previous partial lung resection is presented in the article.Surgical management of patients with destructive tuberculosis of single lung provides positive results in more than 90% of cases. However the frequency of its application is still low according to literature data. In case of destructive tuberculosis of single lung partial resection is more frequently indicated if fibrous-cavernous tuberculosis of the upper lung (up to 4 damaged segments), persistent bacterial excretion on the background of adequate chemotherapy and pathogen's drug resistance are present.Цель - повысить эффективность лечения деструктивного туберкулеза единственного легкого. Материал и методы. В статье приведен 15-летний опыт операций, выполненных одним хирургом по поводу деструктивного туберкулеза, - 18 резекций единственного легкого и 19 пневмонэктомий после предварительной резекции остающегося легкого. Результаты. Хирургический метод лечения больных деструктивным туберкулезом единственного легкого позволяет добиться положительного результата более чем в 90% наблюдений, однако частота его применения, по данным литературы, остается очень низкой. При деструктивном туберкулезе единственного оставшегося легкого показания к его частичной резекции чаще возникают в случае поражения фиброзно-кавернозным туберкулезом верхних отделов легкого в объеме до четырех сегментов и сохраняющихся на фоне адекватной химиотерапии, бактериовыделения и лекарственной устойчивости возбудителя.

The occurrence of complications such as pneumothorax after a transthoracic needle biopsy is well known. This event may be life threatening in patients with a single aerated lung, thus altering the risk/benefit assessment of the physician when considering whether to attempt an otherwise indicated biopsy. We review our results in 6 single-lung patients who underwent a transthoracic needle biopsy for pulmonary nodules.

Hypoxic pulmonary vasoconstriction is the pulmonary circulation's homeostatic mechanism for matching regional perfusion to ventilation and optimizing systemic PaO2. The role of hypoxic pulmonary vasoconstriction in anesthesiology is reviewed.In hypoxic pulmonary vasoconstriction, airway hypoxia causes resistance pulmonary arteries to constrict, diverting blood to better-oxygenated alveoli. Hypoxic pulmonary vasoconstriction optimizes O2 uptake in atelectasis, pneumonia, asthma, and adult respiratory distress syndrome. During single-lung anesthesia, hypoxic pulmonary vasoconstriction helps maintain systemic oxygenation. When hypoxic pulmonary vasoconstriction is weak, systemic hypoxemia is exacerbated. Although not widely used, the peripheral chemoreceptor agonist almitrine enhances hypoxic pulmonary vasoconstriction and improves PaO2 during single-lung anesthesia. The mechanism of hypoxic pulmonary vasoconstriction involves a redox-based O2 sensor within pulmonary artery smooth muscle cells. Pulmonary artery smooth muscle cells mitochondria vary production of reactive O2 species in proportion to PaO2. Hypoxic withdrawal of these redox second messengers inhibits voltage-gated potassium channels, depolarizing the pulmonary artery smooth muscle cells. Depolarization activates L-type calcium channels, increasing cytosolic calcium and triggering hypoxic pulmonary vasoconstriction.An understanding of hypoxic pulmonary vasoconstriction is clinically relevant for anesthesiologists. Randomized clinical trials with robust endpoints are required to assess strategies for enhancing hypoxic pulmonary vasoconstriction in thoracic surgery patients.

Destructed lung and pneumonectomy are associated with anatomic and physiologic changes that may interfere with the conduct of subsequent open heart surgery. Here we report a case of an autopneumonectomized patient who required open heart surgery. The preoperative, intraoperative and postoperative management of this patient was unique. Open heart procedures on patients with a single lung can be performed with acceptable operative mortality and morbidity.

BACKGROUND AND PURPOSE: Lung tissue is a special challenge for a dose calculation algorithm, especially in the case of extracranial stereotactic radiotherapy (ESRT) due to small field sizes in combination with large variations in tissue density. The present study investigates the choice of dose calculation algorithm for 18 patients with a single lung tumor and 8 patients with a single liver tumor. The dose calculation is performed with both the pencil beam convolution algorithm and the collapsed cone convolution algorithm with the same number of monitor units in both cases. In addition, the dose calculation with the collapsed cone convolution algorithm is also performed with modified field sizes in order to match the Planning Target Volume (PTV) peripheral dose of the pencil beam based treatment.RESULTS: For liver tumors, the mean Clinical Target Volume (CTV) dose calculated by the collapsed cone convolution algorithm and the pencil beam convolution algorithm is almost identical. For lung tumors, the mean CTV dose determined by the collapsed cone convolution algorithm differs up to 20%. Plans obtained by the two algorithms have field sizes which differ up to 8mm for the same number of monitor units and minimum dose to the lung PTV.CONCLUSIONS: The choice of dose calculation algorithm can have a large influence on a treatment plan for ESRT of the lungs.

We report an unusual case of epigastric heteropagus in a female neonate. The parasite had a single lung as well as a liver, stomach, intestine, pancreas, ovaries, a single kidney, and a bladder. These visceral organs were located in the abdominal and pelvic space of the autosite, and the pelvic bone and lower legs of the parasite were fused with the respective organs in the autosite. The infant underwent operations to remove the central leg and some of the intra-abdominal organs of the parasite, but she must still undergo further surgery to remove the genitourinary organs and pelvic bones of the parasite, and repair her very abducted and rotated right leg.

PURPOSE OF REVIEW Interstitial lung disease includes a heterogeneous group of disorders that leads to respiratory insufficiency and death in a significant number of patients. Lung transplantation is a therapeutic option in select candidates. RECENT FINDINGS The indications, transplant procedure options, and outcomes continue to evolve. Various recipient comorbidities influence the choice of procedure in patients with interstitial lung disease. Single lung transplants are used as the procedure of choice and bilateral transplants are reserved for patients with suppurative lung disease and patients with pulmonary hypertension. Issues unique to patients with interstitial lung disease affect the morbidity, mortality and recurrence of the disease. SUMMARY Lung transplantation is an effective therapy for respiratory failure in interstitial lung disease with survival following transplant being similar to that achieved in transplant recipients with other diseases.

Lung transplantation is currently a suitable option for patients with end-stage lung disease. Since the early 1980s the surgical technique and immunosuppressive protocols have been progressively modified to improve results and favor long-term survival. The original heart-lung transplantation under cardiopulmonary bypass is now rarely performed and single or bilateral lung transplantation is the procedure of choice. Bilateral transplantation is performed with two single lung transplants performed in sequence. Extracorporeal support is rarely employed and in most cases it is instituted through the femoral approach. Also, the surgical approach has been modified and the original clam shell incision has been replaced by two small anterior thoracotomies. The use of marginal donors has been increasingly proposed to enlarge the number of organs potentially available for transplantation. Immunosuppressive protocols have evolved to patient-specific regimens that can be quickly modified if required by the clinical status. Induction is now more aggressive and also rescue protocols for obliterative bronchiolitis can contribute to improved outcomes. Overall, lung transplantation is now performed with encouraging long-term results.

Recipients of organ transplants are at increased risk for infection both because of immunosuppression and because of the transfer of microbes through the donor organs. We report two cases of M. tuberculosis disease in recipients of single lung transplants who shared a common donor. Both recipients developed pulmonary tuberculosis, one having fever and pulmonary infiltrates and the other having subclinical disease with M. tuberculosis organisms being recovered from bronchoalveolar lavage. Restriction fragment length polymorphism analysis on both isolates of M. tuberculosis revealed a common source. The donor of both lungs had a normal chest radiograph and no known prior history of M. tuberculosis infection of disease. These cases are the first report of two single lung recipients developing pulmonary tuberculosis from a common donor.

We report a case of a 20-year-old man with a functional single left ventricle who underwent a successful Fontan operation into a single left pulmonary artery, the right pulmonary artery being atretic. The literature of a single-lung Fontan procedure is also reviewed.

RATIONALE AND OBJECTIVES The ability of motion corrected dynamic 3He-magnetic resonance imaging (MRI) to discriminate distributional patterns of inhaled hyperpolarized 3He between different groups of lung transplant recipients was evaluated. METHODS An ultrafast low-angle shot 2D sequence (temporal resolution 128 ms) was used for ventilation 3He-MRI of 11 single and 6 double lung transplant recipients. After digital motion correction, signal kinetics were evaluated in a tracheal and 7 pulmonary regions of interest. Results from grafts and native lungs as well as from normal and rejected grafts were compared with each other and to reference values from healthy subjects. RESULTS In emphysema patients, median alveolar rise time, a parameter for increase of alveolar signal, was 0.28 seconds for the graft and 0.48 seconds for the native lung, in fibrosis patients its median was 0.46 seconds for the graft and 0.21 seconds for the native lung. In double lung recipients, alveolar rise time was 0.29 seconds in normal and clinically rejected grafts. CONCLUSIONS Dynamic ventilation 3He-MRI discriminated normal lung grafts from diseased native lungs in single lung recipients. Graft rejection in double lung recipients could not be discriminated.

http://hdl.handle.net/20.500.11768/96532

Lung transplantation and lung volume reduction surgery (LVRS) have become intimately related as clinical experience with each procedure has increased. Revitalization of LVRS was a direct consequence of single-lung transplantation when it was observed that even when the single lung allograft functioned poorly after transplantation there was improvement in hemithoracic diaphragmatic position, reduction of chest hyperinflation, and diminution in patient sensation of dyspnea (1). This clinical “success” despite the apparent “failure” of the single-lung allograft provided the insight to thoracic surgeons to revisit the question of surgically reducing the thoracic hyperinflation characteristic of pulmonary emphysema. The subsequent early success of lung volume reduction has fostered a productive and continually evolving relationship between lung transplantation and LVRS for the treatment of advanced pulmonary emphysema.

Lung Cancer Evolution Lung cancer poses a formidable challenge to clinical oncologists. It is often detected at a late stage, and most therapies work for only a short time before the tumors resume their relentless growth. Two independent analyses of the human lung cancer genome may help explain why this disease is so resilient (see the Perspective by Govindan). Rather than take a single “snapshot” of the cancer genome, de Bruin et al. and Zhang et al. identified genomic alterations in spatially distinct regions of single lung tumors and used this information to infer the tumor's evolutionary history. Each tumor showed tremendous spatial and temporal diversity in its mutational profiles. Thus, the efficacy of drugs may be short-lived because they destroy only a portion of the tumor. Science , this issue p. [251][1], p. [256][2]; see also p. [169][3] [1]: /lookup/volpage/346/251?iss=6206 [2]: /lookup/doi/10.1126/science.1256930 [3]: /lookup/doi/10.1126/science.1259926

Background and methods Simultaneous, paired single-lung transplants from a single organ donor is one way to maximize lung transplant opportunities. Paired transplants allow comparison between left and right single-lung transplants and also provide insight into the relevance of donor vs recipient factors in rejection outcomes. Results Of 76 paired transplants (38 pairs) performed at the Alfred Hospital, 68 patients have survived >30 days. We observed no significant differences between left and right single-lung transplants in ICU stay (median, 3.1 vs 3.0 days; range, 0.5 to 83 vs 0.5 to 76 days), hospital stay (median, 19.5 vs 24.0 days; range, 1 to 118 vs 11 to 144 days), airway complications (5 vs 3), and 5-year survival (60% vs 50%). The 6 month, and 1- and 2-year survivals were lower in left single-lung transplant recipients, primarily related to increased mortality from airway complications. In 28 pairs, both recipients survived 90 days, and the incidence, frequency, and time of onset of acute rejection and chronic rejection (bronchiolitis obliterans syndrome [BOS]) were not significantly different. When sequentially performed lung transplants were separately analyzed, the incidence of acute rejection was not related to graft ischemic time. Conclusions The general outcomes of right and left transplants are similar, although we observed increased 6-month to 2-year mortality associated with left lung transplantation. The lack of correlation between the incidence of acute rejection episodes or the severity of BOS in paired allograft recipients suggests that “donor factors” are not the dominant cause.

The lung has developed dedicated structures and cell types to accomplish its particular functions. An elaborate exchange of both information and matter takes place between the lung and other organs of the body, which in total is a system of utmost complexity. In order to be able to study this perplexing system at least some of the complexity has to be eliminated. In this sense the isolated perfused lung represents a system much less complicated than the whole animal while preserving most of the integrity of the organ. As an experimental approach the isolated perfused lung (IPL) stands in between experiments in vivo with whole animals and in vitro with cultured cells. As such it combines assets and shortcomings of both. The present chapter will describe a set-up for the isolated per-fused rat lung that allows to study four important aspects of lung physiology: respiratory mechanics, vessel mechanics, gas exchange and edema formation. Here, we will focus on the perfused rat lung, however, most of the equipment can also be used for isolated lungs from rabbits [1] or guinea pigs [2]. In a number of aspects the present text supplements our previous papers on the method of the rat IPL [3, 4]. A good compilation of earlier papers on perfused lungs is given in the introduction of the paper by Kroll et al. [2]. Previous reviews on the method of the isolated lung can be found in [5–9]. In addition, more specialized systems such as single lung perfusion [10] or perfusion through the bronchial artery [11] have also been described.

Purpose Although double lung transplantation may offer a small survival advantage in chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF), single lung transplantation allows two patients to receive a life-saving intervention with excellent long-term results. However, there remains substantial hesitation to single lung transplantation in patients that also have severe pulmonary arterial hypertension (PAH), and outcomes in this population based on diagnosis have yet to be well described. Methods and Materials We retrospectively reviewed the United Network of Organ Sharing database for all single lung transplants between 1996 and 2011 performed for COPD or IPF. Demographic data, pre- and post-transplant characteristics, and outcomes were compared for this population based on the presence or absence of severe PAH by right heart catheterization (PASP >50mmHg). The primary outcome analyzed was all-cause mortality. Results 5,982 patients were identified (COPD, N=3,580; IPF, N=2,402). Severe PAH was present in 838 (23%) and 538 (22%) patients with COPD and IPF, respectively. For COPD, survival at 30 days, 1 year and 3 years was 94%, 80% and 60% in patients with severe PAH, and 97%, 85% and 67% without severe PAH (p=0.264). For IPF, survival at 30 days, 1 year and 3 years was 91%, 70% and 51% in patients with severe PAH, and 95%, 79% and 61% without severe PAH (p=0.001). Using a Cox proportional-hazards regression, severe PAH was an independent predictor of mortality in patients with IPF (HR=1.29, p Conclusions In this study, the presence of severe PAH was associated with an increased risk of mortality in patients with IPF, but not COPD. These results suggest that acceptable outcomes for single lung transplantation may be achieved in this population with COPD, but should be considered with caution in patients with IPF.

Background: Pulmonary vein stenosis or thrombosis (PVST) following lung transplantation is a rare but seriouscomplication thatmay lead tograft failure.Diagnosis is challenging, as its radiographical featuresmimic infection or other causes of pulmonary oedema. Transoesophageal echocardiography is often requested to evaluate anastamoses to exclude PVST, though reference ranges for normal Doppler flow in this setting are not widely known, and pulmonary vein velocities are often elevated in the immediate post-transplant period. Aims: To determine pulmonary vein Doppler flow ranges in patients not suspected to have PVST in the post transplant period. Methods: All lung transplants performed in the last six years were identified from a database. The pulmonary vein Doppler velocities were recorded from the left and the right pulmonary vein ‘buttons’. Clinical details were reviewed to determine if a clinical suspicion of PVS was present. Velocities recorded on the first transthoracic echocardiogram (TTE) or transoesophageal echocardiogram (TOE) post transplant were recorded. Results: There were a total of 108 patients (five single lung transplants, 103 double), with baseline characteristics age 44± 13years, 50/108 female. Velocities were able to be measured in 43 patients (17 TOE, 26TTE), a median of 11 days post transplant. Two patients were diagnosed with PVS (systolic/diastolic velocities 120/180 cm/s and 120/220 cm/s) and these values were excluded from calculations.

Infections occur frequently after pulmonary transplantation. They account for at least 1/3 of the deaths. Many bacterial, fungal and viral agents can cause those infections. Rare agents are more difficult to identify and may, in some instances, raise issues regarding the management of transplanted patients. Among 100 pulmonary transplants performed between july 1988 and december 1994 (31 heart lung, 52 single lung and 17 double lung), 3 developed such rare infections.

The first report of lung transplantation dates back to 1906 and is due to A. Carrel and C. Guthrie who performed a heterotopic heart-lung transplant in the cat. However, it was not until 1950 that Iuvenelles and Metras proved in an autotransplantation model in the dog that lung transplantation was technically feasible. It is noteworthy that these authors employed atrial instead of single pulmonary vein anastomosis as well as bronchial artery revascularization.

OBJECTIVE: Because of intrinsic limitations of transverse cross-sectional imaging methods, CT sometimes is insufficient for adequate evaluation of complex tracheobronchial anomalies. This article describes a complementary 3D procedure specifically dedicated to the study of the tracheobronchial tree. MATERIALS AND METHODS: The procedure combines a specific spiral CT acquisition with 2 or 4 mm collimation, 3D surface rendering of the tracheobronchial aerial content, and double obliquity multiplanar reformats directly planned on the 3D virtual object. It was performed in 11 complex cases including 3 stented benign or malignant stenoses and 2 single lung transplantations. RESULTS: Easier understanding of the tracheobronchial status was achieved in all cases. In three cases, the procedure yielded relevant diagnostic information that neither fiberoptic endoscopy nor transverse CT had provided, leading to significant modification of patient management. CONCLUSION: Three-dimensional spiral CT of the bronchial tree with secondary reformation seems suitable in clinical practice for selected cases.

Pulmonary transplantation is peculiar in the sense that with the heart and lung from a single donor, multiple procedures can be performed. For instance,the heart-lung en bloc can be transplanted to a single recipient, a double lung and a heart transplantation can be performed in two recipients, two single lung and one heart transplants can be performed in three recipients. Thus, the number of recipients benefiting from a single heart-lung donor can vary according to the type of procedure choosen.

Compared to other major organs such as the kidney, liver, and heart, transplantation of the lung has not enjoyed widespread application until just recently. Despite the first attempts at both experimental and clinical pulmonary transplantation coinciding with those for other major organs, clinical success with the lung did not keep pace with that for these other organs. In fact, a long string of failures resulted in virtual abandonment of lung transplantation by 1978. This short review will recount the history of lung transplantation, the principal causes of the spectacular early failures, the advances which heralded in the modern era of pulmonary transplantation, and the refinements that permitted the burst of activity that has occurred over the last five years. Finally, the formidable challenges that now threaten to cause the “burst ” to implode will be presented.

During the past 25 years, remarkable strides have been made in organ transplantation—the success of which can be regarded as one of the outstanding achievements of 20th century biomedical science. From a fascinating experiment in human immunobiology, organ transplantation has evolved into the best opportunity for rehabilitation for patients with end-stage disease of an increasing number of organs: today, the kidney, heart, liver, and lungs; tomorrow, the pancreas or pancreatic islets and small bowel (two organs being successfully transplanted in increasing numbers today, but not yet regarded as the standard of care for the diseases that affect these organs). In the United States at the present time, the 1-year graft and patient survival for these organs are as follows: cadaver donor kidney allograft, 77%, with 93% patient survival; living related kidney allograft, 90%, with 97% patient survival; heart allograft, 81%, with 82% patient survival; liver allograft, 64%, with 72% patient survival; single lung allograft, 52%, with 54% patient survival; heart-lung allograft, 53%, with 53% patient survival; and pancreas allograft (usually in association with a kidney allograft), 70%, with 89% patient survival (in the case of the liver and heart recipients, the fact that patient survival is higher than graft survival reflects success of re-transplantation for failing allografts in selected patients).

To investigate new modalities in the treatment of pulmonary metastases we developed a model of isolated single-lung perfusion in the rat. In this study we compare the pharmacokinetics of isolated lung perfusion and intravenous doxorubicin. In the first experiment, designed to evaluate lung tissue levels of doxorubicin, 35 rats were randomized into seven groups (n = 5). The first five groups underwent isolated lung perfusion with 72.1 +/- 6.9, 118.4 +/- 12.1, 255.2 +/- 12.8, 384.1 +/- 46.2, and 457.6 +/- 32.5 micrograms/mL of doxorubicin, respectively, for 10 minutes. Groups 6 and 7 received 5 mg/kg and 7 mg/kg of intravenous doxorubicin, respectively. A second study was designed to measure heart tissue level of doxorubicin in 3 groups of 5 rats each. Two groups received 5 or 7 mg/kg of intravenous doxorubicin and a third group underwent isolated lung perfusion with 255.2 +/- 12.8 micrograms/mL of doxorubicin for 10 minutes. A third study, designed to evaluate toxicity in vivo, had a similar design, and the animals were followed up for 21 days after treatment. Lung doxorubicin concentration after isolated lung perfusion was significantly higher than after intravenous doxorubicin (p0.01). Tissue doxorubicin concentration was 25 and 20 times higher after isolated lung perfusion with 255.2 +/- 12.8 micrograms/mL than after 5 or 7 mg/kg of intravenous doxorubicin, respectively. Heart concentration of doxorubicin was significantly lower after isolated lung perfusion with 255.2 +/- 12.8 micrograms/mL of doxorubicin as compared with 5 or 7 mg/kg of intravenous doxorubicin (p0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Multi-organ thoracic transplantation, although beneficial to one recipient, has an opportunity cost of denied transplants to others. This paper compares population based outcomes of splitting lung blocks for two single lung transplants compared to doing one bilateral lung transplant, and suggests that the benefit of splitting lung blocks may not necessarily be double that of using each block for one recipient.

[Figure][1] Pursuing your prey can be metabolically challenging at the best of times, but diving seals and sea lions have to do all that on a single lung full of air. Andreas Fahlman, from the Marine Mammal Research Unit at the University of British Columbia, is intrigued by the fine

Purpose: Pre-formed HLA antibodies have historically been detected by complement dependent cytotoxicity (CDC) assays. The introduction of Luminex assays to detect HLA antibodies has resulted in increased detection of sensitisation, however, the clinical impact of Luminex detected HLA antibodies is unclear. The purpose of this study has been to analyse pre-transplant Luminex detected HLA antibodies, their ability to fix human C4d and to determine the effect on lung allograft survival. Methods and Materials: Pre-transplant serum from 394 lung transplant patients (144 Heart-Lung, 103 Double Lung and 147 Single Lung) was retrospectively tested for the presence of HLA antibodies using Labscreen (One Lambda) and Lifematch (Tepnel) Luminex assays. All sera had previously been screened by CDC at the time of transplant. C4d deposition on HLA coated Luminex beads was also measured. Results were analysed and correlated with graft survival using Kaplan-Meier and Logrank statistics. Results: Prior to transplantation 6 patients had produced HLA antibodies by CDC, all of which were donor specific (DSA). The Luminex assays detected HLA antibodies in a further 50 patients, 16 of which were donor specific. The one year actuarial graft survival for CDC ve DSA patients (n 6) was 0% compared to 56.3% for Luminex ve DSA (n 16), 82.4% for Luminex non-donor specific (n 34) and 71% for Negative patients (n ), p 0.0001. Ten % of the luminex positive sera (44 tested to date) fixed C4d. The one year graft survival for C4d ve/DSA (n 4) was 0%, C4d-ve DSA ve (n 12) 50%, C4d-ve DSA-ve (n 28) 78.6%, compared with 71% for antibody negative patients(p 0.0004). Conclusions: Detection of Luminex ve donor specific HLA antibodies is a prognostic indicator for poor graft survival. The development of a technique to detect C4d fixing donor specific Luminex detected antibodies may be a useful tool to identify patients at high risk of accelerated graft failure.

At the University of Washington we consider a solitary pulmonary nodule to be a discrete, single lung abnormality with well-defined margins. It can be calcified or cavitary and small or large. We do not exclude a lesion over 4 cm, as some authors do, and we do not exclude a lesion when there is accompanying disease in the lungs, as long as the nodule is distinguishable.

Purpose: The Calypso 4D Localization® system uses non‐ionizing AC electromagnetic technology to localize implanted Beacon® transponders. The system is capable of real‐time measurement of internal motion. Effective use of this technology in the lung requires placing the transponders in fixed positions that will not change over time. This study compares inter‐transponder distance over an implantation time period of 0–57 days in canine lung.Method and Materials: A pulmonologist bronchoscopically implanted three transponders in a single lung lobe of five canines under an institutionally approved protocol. Distances between transponder pairs were measured over 0–57 days using the Calypso system. The positions were measured both when the dogs were breathing freely and during varied ventilatory amplitudes and frequencies, variable ventilation. In animals with at least two transponders, inter‐transponder distances were calculated. Results: The mean inter‐transponder distances during breathing patterns were stable on the same day, at 2.32cm (free breathing) and 2.40cm (variable ventilation). One animal retained all 3 transponders at 57 days and exhibited significant change in inter‐transponder distance from day 1–9. Changes in mean inter‐transponder distance from day 9–29 ranged from 0.2–1.9mm. For reasons not understood, transponder distances on day 57 for one animal were larger at 2.0–6.5mm. Conclusion: The inter‐fiducial distance was stable regardless of breathing pattern on the same day. Measurements taken on the first day post‐implant varied significantly from later measurements, probably due to local tissuetrauma. Up to 30 days post‐implant, the inter‐transponder distances were stable. However, in one animal after 30 days, the relationship between transponder positions changed. More work is required to improve implant retention and to understand optimal transponder placement relative to a lungtumor target. Future studies will acquire more frequent transponder positions to be a more representative model of clinical patient data. This work was supported by Calypso Medical Technologies.

Portions of lungs transplanted from living donors function as well in the recipient as whole lungs and should be considered as an option for people waiting for an organ. Dr Michael Bowdish of the University of Southern California said that data collected at his transplantation centre supported the wider use of partial lungs from living donors. Lung transplantations may involve two lungs, a single lung, or a lobe of a lung (the lungs are divided into lobes, three in the right lung and two on the left). Most of the lobe transplantations have been done in patients with cystic …

Aim: To analyze the outcome of transbronchial lung biopsy (TBB) according to a standard follow-up protocol (protocol TBB), or, on clinical indications (diagnostic TBB) performed at least one year after lung transplantation. Methods: A retrospective review of all protocol and diagnostic TBBs beyond the first year after trans-plantation was conducted in patients transplanted between 1994 – 1999 at Sahlgrenska University Hospital (46 single lung, 26 double lung and 8 heart-lung tx). Results: A total of 357 TBBs were assessed in 80 patients during a follow-up between 1 - 6 years post transplant, 257 were protocol TBBs and the remaining 100 diagnostic TBBs. Protocol TBBs revealed histopathological findings in 26% of the procedures at 1-year follow-up, 17% at 2-year, 18% at 3-year and 8% at 4-year, whereas no findings appeared at 5 and 6-year follow up. Of the histopathological findings 77 % were acute rejection grade 1–2. Diagnostic TBBs were most common between the first and second year post transplant (n=66). Of all diagnostic TBBs, 63% revealed histopathology, they were mainly acute rejections grade 1–3 (31%), nonspecific inflammation (27%) and infections (19%). Conclusion: This study supports the usage of protocol TBB examinations during the first 3 years after lung transplantation. However, beyond this time interval, TBB may only be performed on clinical indications.