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Pulmonary artery aneurysm (PAA) is a rare disorder that may be classified as congenital, acquired, or idiopathic, in the case of unclear etiology. When associated with severe idiopathic pulmonary arterial hypertension, such a case of PAA may present to the operating room as an indication for lung transplantation. In this article, we present such a case of a patient with a giant main and right PAA that underwent a double lung transplant. We describe the pathophysiology and natural course of this PAA and discuss the role of intraoperative transesophageal echocardiography in the management of patients with this rare diagnosis.

Hyperammonemia after lung transplant is a severe complication that can result in cerebral herniation. It is associated with up to 70% mortality in patients who have had solid organ transplantation. We describe a rare case in which hyperammonemia was emergently and successfully treated with plasmapheresis in a re-do double lung transplant patient who developed shocked liver.

Background Lung transplant remains the only viable treatment for certain patients with end-stage lung diseases. Such patients can become either single or double lung recipients. The 2 procedures are associated with specific risks and benefits. The aim of the study was to assess the survival of patients after lung transplant in a single center. Methods The retrospective study consists of 128 lung transplant recipients. Patients underwent transplant between 2004 and 2017 because of following diseases: chronic obstructive pulmonary disease (28.2%), cystic fibrosis (26.5%), and primary pulmonary hypertension (12.3%), including idiopathic pulmonary arterial hypertension and interstitial lung diseases (33%). Patients with idiopathic pulmonary arterial hypertension were not treated with postoperative extracorporeal membrane oxygenation as left heart conditioning. Results Regardless of underlying disease, 75% of DLT recipients and 51% of SLT recipients reached 5-year survival (P = .0066). A total of 87% of lung transplant recipients with cystic fibrosis reached 1-year survival. Among lung recipients with primary pulmonary hypertension who underwent DLT and SLT, 5-year survival was reached by 84% and 51%, respectively (P = .025). Among patients with chronic obstructive pulmonary disease, 82% of DLT recipients and 62% of SLT recipients reached 1-year survival (P = .22). Patients who received transplants because of primary pulmonary hypertension presented the worst short-term survival among all SLT recipients. Conclusions Patients with CF have the best overall survival among all lung transplant recipients. Double lung transplant provides statistically significantly better outcomes than single lung transplant. This observation is also present among recipients who underwent transplant because of primary pulmonary hypertension, as single lung transplant is not recommended among such patients in particular.

Lung transplant candidates with significant severe pulmonary artery dilation and concomitant pulmonary valve disease present a unique technical challenge. Right Ventricular Outflow Tract (RVOT) replacement at the time of double lung transplant is a feasible and safe option in this population. Reconstruction can be carried out using either the RVOT from the lung donor or a valve homograft conduit.

While bronchial artery embolization is an established, safe, and effective treatment for massive hemoptysis from a variety of causes including cystic fibrosis, patients rarely require more than 2 angiography and embolization treatments during their lifetime. We present a rare case of massive, recurrent hemoptysis requiring a total of 22 angiography and embolization procedures over a period of 8 years, prior to the patient receiving a double lung transplant. Keywords: Hemoptysis, Cystic Fibrosis, Embolization, Bronchial Artery

The clamshell incision (also known as a transverse or crossbow transsternal incision) was the common approach to the heart in the early days of cardiac surgery and was occasionally also used to access mediastinal tumors or both lungs. However, with the introduction of the median sternotomy, the clamshell incision was virtually forgotten, except for cardiothoracic trauma and double lung transplant. However, in rare situations, such as in large space-occupying lesions in the mediastinum, surgeons will resort to the clamshell approach to achieve exposure and complete resection. In this video tutorial, we demonstrate the operative steps for using the clamshell approach in one of those rare clinical scenarios. The resected mass was a giant mediastinal teratoma measuring 21 x 27 x 6 cm.

Pain caused by wounds of different etiology is usually treated with oral analgesics. New topical use of products such as the ether anesthetic sevoflurane shows good results for pain control and has additional benefits. Pressure ulcers are painful and patients may benefit from the use of sevoflurane. We present the case of a double-lung transplant patient with a long-standing sacral pressure ulcer with poor pain control, for which sevoflurane dressings were used. The number of pain-free hours after application, the amount of daily analgesics and the size of the wound were monitored with the mobile wound application MOWA. After several days of sevoflurane application, the patient reduced analgesic consumption, remained longer free of pain, and the size of the wound decreased. Unfortunately, the patient had serious complications due to multiple comorbidities and died before the wound healed completely. Topical use of sevoflurane in pressure ulcers may be a good option to treat pain and improve patient quality of life.

Background The cold ischemia time (CIT) is a period of time between harvesting an organ for transplant and its reperfusion just after implantation. CIT may have an impact on frequency of complications after lung transplant that can be treated by means of bronchoscopic intervention. The aim of the study was to investigate the correlation between CIT and frequency of bronchoscopic intervention. Methods The retrospective study consists of 91 patients: 22 single lung recipients (24%) and 69 double lung recipients (76%) who underwent lung transplant from March 2012 to June 2019. All statistical analyses were performed in SPSS 25.0 and R 3.5.3. The P levels less than .05 were deemed statistically significant. Results The average CIT in single lung transplant was 5.91 hours, and in double lung transplant it was 8.61 hours. For the 4- to 8-hour CIT the percentages were 80.95% for single lung recipients and 46.38% for double lung recipients. For CIT longer than 8 hours, the following percentages were observed: 9.53% in single lung transplant and 53.62% in double lung transplant. Each subsequent hour of CIT exponentially increases the risk of intervention 1505 times (50.05%). Conclusions Prolonged CIT seems to be a risk factor for airway complication, especially in the double lung recipient group.

Over the last three decades, lung transplantation has evolved from an experimental procedure to definitive treatment option for patients with end-stage pulmonary disease, especially when all other therapeutic measures have been unsuccessful. Lung transplant (LT) has provided to a large number of patients an increased survival benefit [1] along with improved health-related quality of life [2], as observed after other solid organ transplantations [3]. Lung transplantation encompasses lobar, single lung, sequential bilateral lung and combined heart lung transplantation. Double lung transplant is a more frequently performed procedure worldwide, [4] with better long-term survival observed in comparison to single lung transplantation when done for certain specific diseases [5].

Invasive fungal infections in immunosuppressed transplant patients are associated with significant morbidity and mortality. We present a case of splenic mucormycosis post-double lung transplant, presenting as uncontrolled near-fatal upper gastrointestinal haemorrhage, to remind clinicians of the need to consider pre-transplant invasive fungal infection risk factors if an unexpected fungal infection arises in the post-transplant period. This case also highlights the valuable contribution of molecular technology for fungal identification but also the need for clinical correlation. Keywords: Gastrointestinal mucormycosis, Splenic mucormycosis, Lung transplantation, Haemorrhage

Interstitial Lung disease, Nephrotic syndrome and Epidermolysis Bullosa, also referred to as ILNEB syndrome is an extremely rare autosomal recessive condition, caused by pathogenic variants in ITGA3. 11 patients have previously been diagnosed with ILNEB syndrome of whom 7 died in infancy or early childhood. We report the only patient with ILNEB syndrome who survived past adolescence, partly due to a double lung transplant. Additionally, our patient showed oral, nasal and gynecological symptoms not previously reported in patients with ILNEB syndrome.

Purpose The uniqueness and immunological complexity, makes double lung transplantation a challenging high end surgical management for end stage lung disease. Finding the ideal donor organ offers a multitude of logistical barriers., and when that happens, a size mismatch should never be an excuse to waddle the opportunity. The objective of this retrospective review was to observe the clinical outcomes of double lung transplant recipients who underwent non anatomical pulmonary resections. Methods Our team had done 67 double lung transplantations in 2019 and 20 double lung transplants in 2020. A significant reduction by volume was possibly because of lesser donor organ availability in a covid inflicted scenario,thereby creating greater momentum to salvage every donor organ available. A total of sixteen recipients (11 in 2019, 5 in 2020)had undergone size reduction to accomodate oversized lungs. We reviewed the data (case series) of all the sixteen patients who had undergone non anatomical pulmonary resections prior to primary chest closure. Results Out of the 87 double lung transplantation recipients, 16 recipients had to undergo size reduction, 10 recipients underwent resections isolated to right lung, the segments resected were the anterior part of middle lobe, and lower lobe basal and posterior segments.6 patients had both right and left lung resections, the lingulae being the resected segment . Linear endovascular stapples were used for resection, enhanced with bovine pericardium or donor pericardium. Fifteen of the recipients had no post-operative air leak, one had trivial air leak that settled with conservative management and did not require an additional intercostal drainage. Conclusion With good prerequisites, non anatomical resection in an oversized donor organ does not add to the morbidity in the short follow up.

Voriconazole is a triazole antifungal agent commercially approved in 2002. It is commonly used in immunocompromised patients as a therapeutic and prophylactic agent. We present the case of a 26-year-old Caucasian female who is a double lung transplant recipient who presented with complaints of generalized left lower extremity swelling and extreme tenderness of her left thigh. Although her muscle enzymes were not significantly elevated, inflammatory changes were noticed on T2-weighted fat-suppressed short-TI inversion recovery (STIR) sequence magnetic resonance imaging (MRI). These findings were later confirmed with tissue biopsy. We hereby present the case of drug-induced myositis as a rare complication of voriconazole used as chemoprophylaxis in a double lung transplant recipient patient.

Purpose Due to the high mortality of idiopathic pulmonary fibrosis (IPF) patients on the waiting list, potential older donors are considered frequently for lung transplantation. We investigated the survival outcome of IPF patients receiving lungs from donors aged Methods We retrospectively studied IPF transplant recipients that underwent either a single or double lung transplant at our center (Mar-2012 to Jun-2019) and divided patients into two groups (donors age Results Patients (n=388) were separated into two groups based on donor age: 8-49 years old (n=322) vs. 50-65 years old (n=66). Demographic data showed no significant differences between groups for recipients’ age (p=0.49), sex (p=0.64), height (p=0.90), BMI (p=0.10), and donors’ sex (p=0.20). Clinical parameters such as LAS (p=0.46), LOS (p=0.34), CPB on vs off (p=0.40), Campath vs. Simulect induction (p=0.40), and antero-apical, clamshell, median sternotomy surgical approaches (p=0.59) were not significantly different between groups. Log-rank test for equality of survivor functions demonstrated no significant difference between cohorts (p=0.65; KM curve). Survival probability at 30 days, 3, 6, 12 months, 2, and 3 years was 98%, 96%, 92%, 87%, 76%, and 69% for Conclusion In idiopathic pulmonary fibrosis patients, survival outcomes after lung transplantation using donors below 50 years old were similar to using donors ≥50-65 years old. Utilizing suitable older donor lungs has the potential to increase the donor pool for IPF patients.

For the first time, bacteria-killing viruses called phages have been genetically engineered to treat a drug-resistant infection. The treatment used a cocktail of three phages and was also the first directed at Mycobacterium, a genus that includes tuberculosis (TB). Researchers gave the cocktail to a 15-year-old cystic fibrosis patient who developed the infection, M. abscessus, following a double lung transplant. Once the cocktail was administered, the patient9s condition improved dramatically with no serious side effects. Researchers are hopeful the treatment could one day be adapted to treat drug-resistant TB.

Purpose Donor to recipient (D-R) lung size matching using predicted total lung capacity (pTLC) has been shown to be associated with the risk of primary graft dysfunction (PGD) following lung transplant (LTx) but the effect varies with underlying recipient diagnosis, potentially owing to differences in actual TLC. Chest x-ray (CXR) measurements to estimate true D-R TLC could account for disease-related effects, but their role in D-R size matching is unknown. We hypothesized that CXR measurements would estimate actual TLC values and that mismatches would increase PGD risk. Methods We retrospectively reviewed adult double lung transplant recipients between 2007 and 2016. We measured lung size on pre-transplant donor and recipient CXRs using apex to costophrenic angle (ACPA) distance (Figure 1A), taking the mean of the left and right (donors the largest of the 3 most recent CXRs; recipients the most recent CXR prior to LTx). We defined “oversized” as D-R ratio > 1 and “undersized” ≤ 1. The primary outcome was grade 3 PGD (presence of edema on CXR + PaO2/FiO2 Results 206 patients met inclusion criteria, 32 (16%) of whom developed grade 3 PGD at 48 or 72 hours. Median D-R ACPA ratio was 0.92 (IQR 0.83-1.09) and recipient ACPA was strongly related to recipient actual TLC (Figure 1B, R2 0.7297 [quadratic]). D-R ACPA ratio was larger in those patients who developed PGD vs. non-PGD cases (1.01 [IQR 0.91-1.18] vs. 0.91 [IQR 0.83-1.07] p = 0.01). Oversizing (ACPA ratio > 1) increased grade 3 PGD risk (adjusted OR 2.3 [95% CI 1.0-5.2], p = 0.04). Conclusion Oversizing via CXR was associated with increased PGD risk. CXR measurement appears to serve as an estimate of true TLC. D-R ACPA ratio shows promise as a size matching tool in donor allocation and requires further investigation.

Lung transplantation (LTx) has been accepted therapy for end-stage pulmonary disease for over two decades now. Lung transplant operations, unlike other solid organ transplants, are somewhat unique in the fact that the donor block may be utilized for one recipient for a bilateral transplant or split to potentially benefit two patients with a single lung transplant each. The technical aspects of both operations have been well described and do not pose significant challenges. (1, 2) Vocal proponents of both approaches cite benefits for each, yet there remains a lack of high-quality evidence comparing the two approaches. In the absence of quality data to guide decisions, practice patterns remain largely institution or individual-specific and disparate. In this article, we examine the relative benefits and drawbacks of single versus bilateral lung transplantation for specific lung diseases supplemented by a summary of the available evidence. (Tables 1 and ​and22) Table 1 Gross evaluation of relative advantages of single lung transplant and double lung transplant based upon published literature.

Introduction: To extend the number of available organs for lung transplantation (LTx), donors with a smoking history are increasingly accepted. Previous studies show conflicting results as to whether this impairs recipient survival. Aims and objectives: The aim was to assess the effects of using lungs from donors with a smoking history for LTx for recipients with cystic fibrosis (CF). Methods: All recipients of bilateral LTx in Norway and Denmark 1990-2013 were included. Donor information and data about recipient survival and lung function was extracted from existing registries. Results: While there was no negative effect of donor smoking status when including all LTx recipients (n=388), we found a negative association between donor smoking status and post-LTx survival in the CF patients (n=86), in whom one-year survival was 82 % vs 90 % and five year survival was 49 % vs 73 % comparing smoking to non-smoking donors (Log-rank p-value 0.005). The negative effects of using organs from smoking donors remained significant when adjusting for donor and recipient age and sex, organ ischemia time and transplant center location in multivariate cox regression analysis. Conclusion: Using donors with a positive smoking history in double lung transplant recipients with cystic fibrosis is associated with inferior survival and decreased lung function.

In 1902, the first successful kidney transplant ever was performed by E. Ullmann in Vienna. Also, the first clinical renal transplant in Austria was performed on June 17, 1965, by F. Piza in the same city. The first combined pancreas–kidney transplant was performed by R. Margreiter in 1979 in Innsbruck. H.J. Bohmig did the first liver transplant in 1972 in Vienna. The world’s first combined liver–kidney transplant was carried out by R. Margreiter in 1983 in Innsbruck. The same year as the first heart transplant, in 1985 the first combined heart–lung transplant and in 1986 the first double lung transplant were performed in Innsbruck by R. Margreiter and F. Gschnitzer, respectively. In 1989, for the first time, a single lung was transplanted in Vienna by W. Klepetko and E. Wolner. In 1989, the first successful multivisceral transplant including the entire small bowel worldwide took place in Innsbruck, with R. Margreiter and A. Konigsrainer being the surgeons. An isolated bowel transplant was performed in Vienna by F. Muhlbacher in 1983. The world’s second double-hand transplant was performed in Innsbruck in 2000 by a team led by H. Piza and R. Margreiter. These pioneering transplants led to three multiorgan- and two kidney-transplant programs in Austria and generated activities that are among the best worldwide in terms of volume, and also quality.

Pulmonary cement embolism (PCE) is a complication of percutaneous vertebral augmentation techniques. PCE in lung transplant patient population has not been reported. We report a case 57-year-old male patient with double lung transplant secondary to idiopathic pulmonary fibrosis presented with shortness of breath after vertebroplasty. CTA chest showed thin dense opacities within the bilateral pulmonary arteries consistent with pulmonary cement embolism. The patient was treated with therapeutic enoxaparin and remained stable at one year follow up.

Purpose The objective of this study was to review the reasons lung transplant recipients discontinue antifungal prophylaxis, as documented by treating physicians. Methods We retrospectively reviewed patients who received a single or double lung transplant at Mayo Clinic Rochester from 2002 to 2010 examining the type of antifungal medication and reasons for discontinuation. Lung transplant recipients at our institution receive triazole therapy, voriconazole or itraconazole, for prevention of invasive fungal infections. Results We identified 102 patients who underwent lung transplant at Mayo Clinic from 2002 to 2010; 11 patients died within 6 months of transplant and were excluded. Of the 91 patients who survived longer than 6 months post lung transplant: 86 received itraconazole, 44 received voriconazole, and 37 received both (Table 1). A significantly higher proportion of patients discontinued voriconazole than itraconazole [31 out of 44 (70.5%) versus 41 out of 86 (47.6%), p=0.01]. Side effects (gastrointestinal intolerance, hepatitis, and fluorosis) were the most common reason for discontinuing voriconazole [20/44 (45.5)] compared to one of the least common reasons itraconazole was discontinued [6/86 (8.4), p Conclusion Itraconazole was discontinued prior to the prophylactic end point significantly less often than voriconazole and appeared to be better tolerated; although, several patients were diagnosed with an invasive fungal infection while on itraconazole prophylaxis.

We present the case of a 56-year-old double lung transplant recipient with chest pain who underwent an attempted endovascular retrieval of what was described as a retained guide wire in the azygos vein. After successfully grasping the tip, the object further migrated to the right pulmonary artery complicating the retrieval. It was realized that the “wire” was extravasated methyl methacrylate from a recent percutaneous kyphoplasty. This is believed to be the first report of attempted endovascular retrieval of extravasated methyl methacrylate in the azygos system. We include the details of this case and briefly review the current literature on the management of extravasated methyl methacrylate from vertebral augmentation procedures. Extravasated methyl methacrylate in the venous system is a common finding after vertebral augmentation procedures and any radiopaque stripe arising from a cemented vertebral body should be first described as probable cement leakage.

Introduction: For the diagnosis of Restrictive CLAD (rCLAD), a subtype of Chronic Lung Allograft Dysfunction (CLAD), a persistent decline in FEV1 with a concomitant decline in TLC >10% or a decline in FVC>20% is required. This study aims describe the changes in DLCo and propose a cutoff value for decline in DLCo. Methods: This is a retrospective 2 centre study comprising all double lung transplant recipients with onset of CLAD between 2010 and 2014 in Leuven and 2007-2014 in Copenhagen Including all pulmonary function variables Results: A total of 101 patients were included. 52 had BOS, 49 had rCLAD (based on either TLC and/or FVC decline). The change in DLCo from baseline to CLAd was different in the two groups with a median decline of -0.440±1.10 mmol/min/kPa in patients with BOS and a median of -1.280±1.01 mmol/min/kPa in all patients with rCLAD, p=0.006. ROC analysis demonstrated an area under the curve of 0.674 with an optimal threshold of 20% decline in DLCO. Survival after onset of CLAD stratified for DLCO decline ≥than 20% showed an impaired survival when DLCo has declined ≥20% at the onset of CLAD (p=0.012). Conclusion: This study demonstrates that recipients with rCLAD had a significantly larger decline in DLCo at the onset of CLAD compared to those with BOS. At a proposed cut-off value of 20% decline in DLCo there was an impaired survival after onset of CLAD, suggesting that the use of DLCo might be helpful diagnosing CLAD.

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether double lung transplantation should be performed with or without cardiopulmonary bypass (CPB) in order to improve postoperative clinical outcomes. Altogether 386 papers were found using the reported search, of which 14 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 14 papers assessed a range of postoperative outcomes and broadly speaking, six papers found significantly worse outcomes with CPB use, six found no difference and two found a mixture of both depending on the specific outcomes assessed. Dalibon et al. [J Cardiothorac Vasc Anesth 2006;20:668-672] found that mortality was significantly worse in the CPB group at 48 h, one month and one year [P = 0.001, odds ratio (OR) = 246.1; P = 0.083, OR = 2.6; P = 0.001, OR = 5.3, respectively]. Other papers revealed poor outcomes in the CPB group in a range of measures including diffuse alveolar damage (P = 0.009), chest radiograph infiltrate score (P = 0.005), longer intubation time (P = 0.002), longer intensive care unit stay (P = 0.05), and greater incidence of pulmonary reimplantation response (P = 0.03). However, Myles et al. [J Cardiothorac Vasc Anesth 1997;11:177-183] found that only acute postoperative outcomes were significantly worse in their CPB group (P0.001); medium- and long-term survival outcomes were not significantly different (P = 0.055). de Boer et al. [Transplantation 2002;73:1621-1627] even found that there was an improved one-year survival rate with CPB use (OR = 0.25, P = 0.038) and that the number of human leukocyte antigen DR (HLA-DR) mismatches influenced this effect. Those papers suggesting no deleterious effects of CPB generally measured similar postoperative outcomes to those mentioned above, with one study also assessing incidence of primary graft failure, which was not significantly different (P = 0.37). We conclude that CPB should continue to be used where clinically indicated for a specific reason (for example, where there is pulmonary hypertension or a requirement for concomitant cardiac repair). However, given that the evidence for using CPB for all elective cases is relatively weak, and the fact that there are strong arguments in the literature for both methods, either approach would be clinically acceptable.

A persistent colonization with Scedosporium apiospermum (S. apiospermum) often results in disseminated infection with a high mortality rate in immunosuppressed patients. We present the first case of successful prevention of scedosporiosis in an adolescent female cystic fibrosis patient post double lung transplant, with a combination of local and systemic voriconazole therapy and surgical intervention.

s S15 Purpose: Ex vivo lung perfusion (EVLP) is being increasingly used as a method of evaluating high-risk lungs for transplantation. Previous reports comparing EVLP outcomes with standard transplantation did not match for recipient and transplant characteristics. We examined the outcomes of a large cohort of patients who received EVLP lungs with a propensity score matched conventional cohort. Methods: Patients (1/06-4/15) who received at least one EVLP lung were included in the study. Of the 958 transplants performed, 133 utilized EVLP lungs. 170 lung blocks were evaluated by EVLP during the same period. Propensity matching (1:1, nearest neighbor) was used to identify a matched cohort of 133 patients from patients receiving a conventional lung. Matching factors included age at transplant, pulmonary disease, cold ischemic time, and single vs double lung transplant. Quantile-quantile plots were used to check balance. Re-transplant, heart-lung transplant, and transplant of patients bridged with extracorporeal life support were excluded. Results: Both groups had similar distributions of propensity scores. The EVLP group had lower donor pO2s (408.3 +/95.5 mmHg vs 451.3 +/74.3 mmHg, p< 0.0001), a higher proportion of DCD donors (53 [39.8%] vs 7 [5.2%], p< 0.0001), and a higher number of donor smokers (74 [55.6%] vs 59 [44.4%], p= 0.04). Mean EVLP time was 278 +/62.9 min. Kaplan-Meier survival was similar between the two groups (p= 0.30, Fig 1). Freedom from PGD2/3 at 72h was better in the EVLP group (110 [82.7%] vs 91 [68.4%], p= 0.01) with a trend towards lower 30-day mortality (4 [3%] EVLP, 9 [6.8%] non-EVLP, p= 0.17). Median [95%CI] ICU stay (4[3-6]days non-EVLP vs 4[3-4]days EVLP, p= 0.83) and median [95%CI] hospital stay were similar between groups (23[20-27] days non-EVLP vs 21[19-23] days EVLP, p= 0.21). Conclusion: EVLP is a reliable technique for selecting lungs suitable for transplantation. Short and long term outcomes are excellent and comparable or superior to conventionally selected and preserved donor lungs.

Background Atrial arrhythmias (AA) are observed frequently early after lung transplant and also late after the surgery. Several predictive factors of post-operative AA after lung transplant have been already identified whereas those of late AA are still not known. Whether AA after lung transplant impacts mortality and the optimal strategy of rhythm management are still debated. The Purpose of the study was to assess in a large cohort of lung transplanted patients the incidence of AA early and late after surgery, their predictive factors and their impact on mortality. Methods and results We included 271 consecutive patients single or double lung-transplanted over a 9-years period in a large French center. We collected baseline clinical, surgery and post-operative data. The follow-up was 2,9±2,4 years. 33% patients developed post-operative AA. Age (HR=2,35; CI [1,31-4,24]) and chronic obstructive pulmonary disease (HR=1,028; CI [1,12-4,03]) were independant predictive factors of post-operative AA. Late AA occurred 2,2±2,7 years after transplant in 8.8% of the patients. Systolic pulmonary arterial pressure was the only independent predictive factor of late AA (HR=1,028; CI [1,001; 1,056]). Double lung transplant was associated with long term freedom from AF compared with single transplant (p=0,05) whereas the Kaplan-Meier curve for the development of late atrial flutter was similar in single and double lung transplant. Early and late AA after surgery showed no impact on mortality. Bilateral lung transplant was associated with a better survival. Conclusion Post-operative AA after lung transplantation are common with good outcome and contrast with the low occurrence of late organized AA. Double lung transplantation protects against AF but not AFL. Underlying electrophysiological mechanisms may explain these observations. Predictive factors of early and late AA after transplantation are different. Nevertheless these AA do not impact mortality after lung transplant (figure next page). Download : Download high-res image (108KB) Download : Download full-size image Abstract 0376 – Figure: Survival free of late AF and AFL by transplant

The purpose of this study was to investigate the role of afferent input from the lung and lower airways in magnitude estimation of inspiratory resistive loads (R). To assess the role of lung vagal afferents in respiratory sensation, sensations related to inspiratory R, reflected by subjects' percentage of handgrip responses (HG%), were compared between double-lung transplant (DLT) recipients with normal lung function and healthy control (Nor) subjects. Perceptual sensitivity to the external load was measured as the slope of HG% as a function of peak mouth pressure (Pm), and the slope of HG% as a function of R, after a log-log transformation. The results showed that the DLT group had a similar HG% response, as well as the slopes of log HG%-log Pm and log HG%-log R, compared with the Nor group. Furthermore, the ventilatory responses to external loads were also similar between the two groups. These results suggest that lung vagal afferents do not play a significant role in magnitude estimation of inspiratory resistive loads in humans.

When exposed in the perioperative period to blood components containing immunoglobulin (Ig)A IgA-sensitized IgA-deficient patients are at an increased risk of transfusion-associated anaphylaxis. We present the case of an IgA-deficient patient whose candidacy for double-lung transplantation was under review in the preoperative period.A 49-yr-old patient with end-stage chronic obstructive lung disease secondary to deficiencies in IgA and IgG subclasses was being assessed for double-lung transplantation. Early recognition of the ramifications of perioperative transfusion prompted consultation with the transfusion medicine service. This in turn facilitated specialized laboratory testing and the coordinated provision of appropriate blood products for the unpredictable date of transplantation. The theoretical systemic risks of a non-IgA-deficient graft on the sensitized IgA-deficient host were considered. To affirm the patient's candidacy for transplantation, he was ultimately challenged preoperatively with IgA-containing products in a controlled intensive-care setting.Through a multidisciplinary approach [corrected], a successful transplantation outcome was achieved in an IgA-deficient patient undergoing major surgery. Strategies to mitigate risk include the procurement and transfusion of IgA-deficient components, which may be challenging or untenable in emergent perioperative settings.