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Cystic fibrosis is an autosomal progressive disease affecting the lung, pancreas, and liver. Some patients develop end-stage respiratory and liver failure. For such patients, combined lung-liver transplantation remains the only therapeutic option. In this article we present the first simultaneous lung-liver transplantation in Poland, as well as in Central and Eastern Europe, with detailed clinical history, surgical aspects, and postoperative course.

Lung transplantation remains the ultimate treatment for patients who have exhausted all other therapeutic options in the course of end-stage lung disease due to cystic fibrosis (CF). The aim of the study was to assess the results of lung transplantations performed via mini-thoracotomy in a single center.This retrospective study assesses the survival and need for reoperation among 56 primary lung transplant recipients due to CF in a single center between 2018 and 2021. Intraoperative death was also assessed, yet it was established as an exclusion criterion for the post-transplant survival analysis.Only one patient died intraoperatively (1.79%). Reoperation at an early postoperative stage was required among 2 patients (3.58%), due to vascular complication for one and pulmonary leakage for the other. Mortality at 30 days was 0%. In-hospital mortality was low (3.58%). Survival at 1, 2, and 3 years was respectively 87%, 85%, and 75%. Mean forced expiratory volume in 1 second as a percentage of predicted value at discharge was approximately 60% and did not decrease after 12 and 24 months. Mean BMI at 12-month follow-up was 20.11 (range, 13-28.7) with 71.4% of patients being qualified as presenting within the normal range of 18.5 to 24.9.Double lung transplantation is a safe and feasible surgical option. Despite being more technically difficult and challenging than clamshell approach for surgeons, it is more beneficial for patients.

Infant respiratory distress syndrome (IRDS) develops among premature infants due to structural immaturity of the lungs and insufficient production of pulmonary surfactant. Nowadays, treatment takes place under conditions of intensive care and includes oxygen therapy, mechanical ventilation, exogenous supplementation of pulmonary surfactant and antenatal corticosteroid therapy. The treatment of IRDS, especially mechanical ventilation, may lead to complications which can contribute to developing a severe dysfunction of the respiratory system. Unavailability of pharmacological treatment of IRDS and development of pulmonary barotrauma due to mechanical ventilation in our patient led to the forming of severe pulmonary interstitial emphysema. In this Case Report, lung transplantation was performed as an only successful therapeutic option.

Background Cystic fibrosis is a congenital, progressive disease affecting many organs. It frequently leads to severe respiratory failure, which can be treated by means of a double lung transplantation. Single lung transplantation is justified only in certain cases. Case report This is a case report describing a 20-year-old female patient who became the recipient of a single lung transplant as a result of cystic fibrosis. The transplant was performed during cardiothoracic surgery, which included an intervention in the right atrium. At the age of 14, the patient underwent left pneumonectomy. In addition, the patient had a percutaneous endoscopic gastrostomy placed and a vascular port implanted. During preoperative evaluation, she presented with clinical symptoms of chronic respiratory failure. The patient was approved for lung transplantation at the age of 16. After 2 years on the national lung transplant waiting list, in 2018, the patient underwent right lung transplantation and removal of numerous thrombi in the right atrium during 1 procedure. This surgery was accomplished with the use of extracorporeal circulation, which is an extracorporeal membrane oxygenator combined with cardiopulmonary bypass. The patient was discharged 3 weeks after the procedure in good general condition. Presently, her pulmonary function is excellent and she presents with normal respiratory capacity. Conclusions Patients with cystic fibrosis often require double lung transplantation. Under normal circumstances, performing only a single lung transplantation would be considered medical malpractice. However, in certain cases, a single lung transplant is a life-saving procedure.

Background Model for End-Stage Liver Disease (MELD) score is used to assess the severity of chronic liver disease. It is implemented in transplantology in the process of qualification for urgent liver transplant. The aim of our study was to assess the liver function of patients qualified for lung transplant using MELD score, taking under consideration mean pulmonary artery pressure as an important risk factor of death. Methods The study group consisted of 123 patients qualified for lung transplant in Silesian Center for Heart Diseases between 2004 and 2017. Data relevant for MELD score calculations and medial pulmonary artery pressure were acquired from medical records. Results The average MELD score among patients qualified for lung transplant was 8.24 points, and mean pulmonary pressure (mPAP) was 35.02 mm Hg. Patients with idiopathic pulmonary artery hypertension acquired the highest MELD and highest mPAP results (13.1 points and 57.7 mm Hg, respectively). Patients with idiopathic pulmonary fibrosis presented higher mean MELD-Na score among those with pulmonary arterial hypertension than those without pulmonary arterial hypertension (36.59 mm Hg; 7.74 points vs 18 mm Hg; 6.5 points). There is strong positive correlation between MELD-Na and mPAP among patients who underwent lung transplant because of idiopathic pulmonary fibrosis. Conclusions This is the first study in the worldwide literature assessing MELD-Na as a predictor of survival among patients qualified for lung transplant and those who already are recipients. Further studies regarding this issue are required as authors will explore this issue in the future.

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.

Background Primary pulmonary hypertension can lead to hypertrophy of the right ventricle and ultimately to its insufficiency. Lung transplantation remains the only viable treatment for patients with certain forms of this disease. Usage of extracorporeal membrane oxygenation in veno-arterial form (VA-ECMO) after transplantation is both protective for left ventricle (enables adaptation to increased blood flow) and right ventricle (provides time to return to appropriate dimensions and in some cases to correct tricuspid regurgitaion). Case Presentation The case study describes 4 patients who were treated with VA-ECMO as a perioperative support. Three patients were diagnosed with idiopathic form of precapillary primary pulmonary hypertension. A fourth patient was a 49-year old woman diagnosed with hypoplastic pulmonary veins representing the postcapillary form of pulmonary hypertension. In all of the cases, VA-ECMO was introduced during the surgery (femoral vein/internal jugular vein and femoral artery) and maintained for several days after the transplantation. Regular echocardiographic and biochemical assessment in postoperative course revealed that cardiac function improved during and after such treatment among all patients. They were successfully weaned off ECMO and finally surgically explanted without any local complications. One patient was treated with awake ECMO protocol. Conclusions VA-ECMO was proved to be a useful tool during the transplantation and postoperative period. It helps to restore proper cardiac function, as well as prevent adverse effects of aforementioned pathologic changes of a heart.

Introduction Lung transplantation (LTx) is the only effective method of treatment to improve the health and quality of life (QoL) of patients with end-stage lung diseases. After LTx, medical examination accompanied by quality of life assessment should be performed on routine follow-up visits. The aim of the study was to assess the QoL of patients after LTx. Material and methods The study group consisted of 60 patients (29 women and 31 men); 20 patients received single lung transplantation (SLT), and 40 received double lung transplantation (DLT). To determine the patient’s QoL, the General Health Questionnaire (GHQ), the World Health Organization Quality of Life Test–BREF (WHOQOL-BREF), and the Saint George Respiratory Questionnaire (SGRQ) were used. Spirometry and the 6-minute walk test were analyzed to examine efficiency of transplanted organs. Results In SGRQ there are differences between patients with cystic fibrosis and interstitial lung disease in symptom domain (20.28% vs 39.26%, P = .025) and total score (19.38% vs 32.47%, P = .028). As reported in the GHQ, men had worse overall results than women in sten scale (5.22 points vs 4.69 points). Patients after SLT achieved similar scores in every questionnaire. Conclusion Studies assessing QoL should be an important addition to lung function tests and an integral part of control during postoperative follow-up visits. This study is one of the important contributions to understanding of how essential QoL is after LTx. The authors of this study realize that their work does not cover the whole issue, and further studies in this area are warranted.

Healing of bronchial anastomoses may sometimes be complicated and require bronchoscopic intervention (BI). The main aim of the study was to assess whether patients who require BI present comparable lung function after reaching 1-year posttransplant survival to those who did not require any BI by means of spirometry and 6-minute walk test (6MWT).This retrospective study included an analysis of 44 primary double lung transplant recipients who underwent transplant for end-stage respiratory failure in the course of cystic fibrosis transplanted in a single center between 2018 and 2021. Bronchoscopic intervention is defined as performing endoscopic bronchoplasty through balloon dilatation, cryoprobe, argon plasma, and/or laser treatment. Group 1 (25 patients who required at least 1 BI) presented similar spirometry parameters at qualification as group 2 (no BI).Statistically significant differences between the groups for the following parameters were reported: forced expiratory volume in 1 second (FEV1), FEV1 (%), Tiffeneau-Pinelli index (FEV1/forced vital capacity percentage of predicted value), oxygen saturation after conclusion of 6MWT (%) and oxygen saturation before 6MWT (%). In each case, the mean for the BI group in the first year was lower. All patients in this group received an average amount of 6.8 ± 4.9 bronchoscopic procedures during the first year (minimum = 1; maximum = 18). Strong negative correlations were observed between the number of balloons in the first year and the FEV1 (%) and FEV1/forced vital capacity percentage of predicted value indicators after the first year.Lung transplant recipients who underwent transplant because of cystic fibrosis and required at least 1 BI during the first posttransplant year presented inferior spirometry and 6MWT results in comparison with those who did not require any.

Patients with end-stage lung disease owing to cystic fibrosis may require lung transplant, provided other therapeutic options were exhausted. During the posttransplant period, bronchial anastomoses' healing may sometimes be complicated and require bronchoscopic intervention (BI). The main aim of this study was to assess BI and its effect on long-term lung function among cystic fibrosis lung transplant recipients who have reached 2-year survival.This retrospective study includes 22 patients with cystic fibrosis who underwent primary double lung transplant in a single center between 2018 and 2020 and have checked in for their 2-year follow-up visit. BI is defined as performing endoscopic bronchoplasty through balloon dilatation, cryoprobe, argon plasma, and/or laser treatment.All patients, who did not require BI during the first year, did not need bronchoplasty during the second posttransplant year as well. Results of forced expiratory volume in 1 second as percentage of predicted value and the 6-minute walk distance were similar at 2-year follow-up to those obtained at the end of 1 year for all patients. Significant time effects were observed for forced vital capacity (FVC) (weak effect), FVC as percentage of predicted value (weak effect), and forced expiratory volume in 1 second/FVC (moderate effect).Patients who had never had bronchoscopic intervention owing to airway stenosis, as well as those who did in the first posttransplant year, maintained forced expiratory volume in 1 second as percentage of predicted value at a comparable level at the second posttransplant year follow-up visit. The number of BIs significantly decreased among patients, who were undergoing such procedures during the first posttransplant year.

The aim of the study was to assessment serologic status of Epstein-Barr virus (EBV) infections in patients qualificated for lung transplantation in the first half of 2021.The study included 72 patients qualified for lung transplantation from January to June 2021. The youngest patient was aged 14 years and the oldest was aged 65 years. The study group consisted of 36 women and 36 men. In the serum of patients, a multi-parameter, comprehensive diagnosis of EBV infections was performed using the IIFT BIOCHIP EBV sequence tests. This test is based on a combination of several substrates, enabling the simultaneous evaluation of antibodies against capsid antigens (anti-CA antibodies), both in the IgG and IgM class, early antigens (anti-EA), nuclear antigens and the assessment of the avidity of anti-CA antibodies. The analysis of all diagnostically significant antibodies specific for EBV infections, including the avidity of anti-CA antibodies, increases the diagnostic accuracy in differentiating active and past infection with EBV.In the studied group it was shown that 58 had past EBV infection (80.6%). Twelve patients (16.6%) have anti-EA antibodies, which indicate that the virus is reactivated. Only 2 patients (2.8%) had no antibodies to EBV.Comprehensive assessment of antibodies against various EBV antigens in patients qualified for lung transplantation is important in the management and further diagnosis of this infection, especially after transplantation, due to the risk of developing post-transplant lymphoproliferative disease.

Background Lung transplantation remains the only viable option for patients with end-stage lung diseases. However, due to an insufficient number of lung donors, many potential candidates die without undergoing the procedure. In the cases of some patients, bridges to transplantation can be implemented. One such method is extracorporeal membrane oxygenation (ECMO), which, depending on the type, has the ability to replace patients’ circulatory and respiratory function. Case presentation This case study describes 4 cases of patients, who were successfully bridged to lung transplantation. The first patient developed respiratory failure as a result of acute pulmonary embolisms. His respiratory function was insufficient and he had ECMO implanted for 84 days until he was transplanted. Another patient presented respiratory failure due to massive bleeding, which occurred during transbronchial lung biopsy. Such event led to extensive exacerbation, which resulted in using ECMO as a bridge to recovery at first, but later a bridge to lung transplantation. The patient became a lung graft recipient after 14 days on ECMO. The third patient was a woman who developed severe respiratory failure during the course of the progression of her underlying disease. She was treated with ECMO for 14 days as well, and she also underwent lung transplantation. The fourth patient was qualified for retransplantation. She was bridged to retransplantation via veno-venous ECMO. Conclusion ECMO can be used a bridge to lung transplantation for suitable patients even for a long period of time, given that it is maintained in accordance with the guidelines.

BACKGROUND: Cystic fibrosis (CF) is congenital multisystem disorder, that leads to gradual deterioration of pulmonary function. Advancements in therapy of CF-related lung disease have delayed its progression. However, lung transplantation remains the only therapeutic option for majority of such patients. Aim of the study was to assess qualification process and outcome of lung transplantation as a treatment of CF patients qualified in a single center between 2011 and 2018. MATERIAL AND METHODS: This retrospective study assessed 41 patients who were qualified to be treated by means of lung transplantation due to CF in Lung Transplant Program of Silesian Center for Heart Diseases between 2011 and 2018. Analysis of patients during qualification process and after lung transplantation was performed. Lung recipients were observed during 1-year follow-up by means of pulmonary function tests. RESULTS: 1-year survival was noted among 80% of the patients; 3-year survival and 5-year survival were noted among 70% of the recipients. Mean forced expiratory volume in 1 second (FEV1) increased after lung transplantation: 21.19% at qualification; and 76.67% at 12 months after lung transplantation. Mean forced vital capacity (FVC) results also improved: 34.18% at qualification and 78.34% at 12 months after lung transplantation. The 6-minute walk test (6MWT) before and after treatment noted an increase of 175.55 m. CONCLUSIONS: Lung transplantation improves respiratory capacity of CF patients and prolongs their life.

BACKGROUND Lung transplant recipients may suffer from airway stenosis (AS). The aim of this study was to assess whether pulmonary function (as measured by spirometry and a 6-minute walk test [6MWT]) in patients with AS treated consistently with bronchoscopic interventions (BIs) was comparable to that in their AS-free counterparts at the 1-year follow-up visit. MATERIAL AND METHODS Fifty patients who underwent primary double-lung transplantation between January 2015 and March 2019 at a single center (23 who received BIs and 27 who did not) were enrolled in this retrospective study. Graft function was assessed with spirometry, based on forced expiratory volume (FEV₁) and forced vital capacity (FVC), both measured in liters (L) and percentages (%), and the Tiffeneau-Pinelli index (FEV₁/FVC), and a 6MWT and parameters such as oxygen saturation measured before and after the test. RESULTS Patients in need of BIs had significantly lower FEV₁% compared with individuals who did not receive BIs during their first post-transplant year. Airway obstruction was present in 22% of patients who did not receive BIs and 65.23% of those who did receive the interventions. There were statistically significant, strong, negative correlations pertaining to the number of balloon BIs and 1-year FEV₁% (rs=0.67) as well as the number of balloon BIs and 1-year FEV₁/FVC (rs=0.72). A statistically significant, strong, negative correlation (rs=0.75) was found between the number of balloon bronchoplasty treatments and oxygen saturation after the 6WMT. CONCLUSIONS Despite receiving BIs, patients who experience bronchial stenosis may not obtain the expected ventilatory improvement at their 1-year follow-up visit. Their AS may recur or persist despite use of various procedures. Further study in that regard is required.

A 44-year-old male with no history of underlying diseases was referred to academic hospital due to ARDS with confirmed SARSCoV-2 infection after 7 days of mechanical ventilation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was initiated as no improvement was noted in prone position. Mechanical ventilation was continued with TV of 3–4 mL/kg. A gradual decline of static lung compliance was observed from baseline 35 mL/cm H2O to 8 mL/cm H2O. The chest CT scan revealed extensive ground-glass areas with a significant amount of traction bronchiectasis after 3 weeks since admission. When the patient was negative for SARS-CoV-2 during the 4th week of ECMO, the decision to perform an emergency lung transplantation (LTx) was made based on the ongoing degradation of lung function and irreversible damage to lung structure. The patient was transferred to the transplant center where he was extubated, awaiting the transplant on passive oxygen therapy and ECMO. Double lung transplantation was performed on the day 30th of ECMO. Currently, the patient is self-reliant. He does not need oxygen therapy and continues physiotherapy. ECMO may be life-saving in severe cases of COVID-19 ARDS but some of these patients may require LTx, especially when weaning proves impossible. VV ECMO as a bridging method is more difficult but ultimately more beneficial due to insufficient number of donors, and consequently long waiting time in Poland.

Introduction Secondary pulmonary hypertension (PH) is a serious complication of end-stage lung disease and is associated with unfavorable prognosis. The aim of the study was to evaluate the incidence and severity of secondary PH among patients qualified for lung transplantation (LTx). Material and Methods The study population consisted of 143 patients qualified for LTx between 2004 and 2019. Analyzed medical records included results collected during the qualification process (eg, echocardiography parameters, right heart catherization [RHC]). There were 37.8% (n = 54) of patients with chronic obstructive pulmonary disease (COPD), 58.7% (n = 84) of patients with interstitial lung diseases (ILDs), and 3.5% (n = 5) of patients with combined pulmonary fibrosis and emphysema (CPFE). The inclusion criteria were ILDs, COPD or CPFE diagnosis, and the presence of RHC data preformed during qualification for LTx. The exclusion criteria were lack of RHC results and diagnosis of idiopathic pulmonary artery hypertension, pulmonary artery hypertension associated with connective tissue disease, cystic fibrosis, or bronchiectasis. Results PH was detected among 60.1% (n = 86) of patients qualified for LTx. The prevalence of PH was 39% (n = 18) vs 76.19% (n = 64) in the COPD vs ILDs groups, respectively. Both ILDs and COPD patients presented with similar mean artery pulmonary pressure (36.3 ± 9.61 vs 34.78 ± 11.47 mm Hg; not statistically significant). Severe PH was more frequent in the ILDs group than in the COPD group (60.94% vs 38.89%). Conclusions PH is commonly diagnosed in patients with chronic lung diseases qualified for LTx and more often observed among patients qualified because of ILDs. It is important to assess the pulmonary pressure because of frequent occurrence of PH among patients referred for LTx.

Lung transplant (LTx) is a procedure associated with risk of complications related to airway stenosis that can be treated with bronchoscopic interventions (BIs). The aim of the study was to assess the frequency and risk factors associated with increased need of bronchial interventions in the post-transplant period.The retrospective study reviewed cases of 165 patients (63 women) who underwent LTx from April 2013 to June 2019. For dichotomous discrete variables (occurrence or lack of intervention) multivariate logistic regression analysis was performed to assess the aforementioned risk factors.BIs were required among 38.55% of lung recipients (n = 65). The number of interventions/patient/y decreases between years 1 and 2 (P .001), 2 and 3 (P = .013), and 3 and 4 (P .001); after the fourth year post LTx the differences are not statistically significant. Each 1 mm Hg above 25 mm Hg of mean pulmonary arterial pressure causes statistically significant elevation in the number of interventions by 0.7% in the first year after the procedure. The number of BIs per patient among lung recipients who received a transplant because of idiopathic pulmonary arterial hypertension was statistically significantly higher compared with patients with another underlying lung disease.Airway complications developed in the post-transplant period caused a significant number of patients to be in need of BI, especially balloon bronchoplasty. The highest number of interventions occurred within the first year after LTx, and BI decreases over time. Mean pulmonary arterial pressure measured during qualification may have the ability to predict whether the patient would require BI after LTx.

Background Lung transplant is a surgical procedure for end-stage lung disease. Many factors related to lung donors influence the outcome of transplant. The main aim of this single-center study was to assess which donor-related and procedure-related factors would influence the 30-day or hospital mortality of the recipients. Methods This retrospective study group consisted of 110 donor-recipient pairs undergoing lung transplant between 2012 and 2017 (group 1) and 2018 and 2019 (group 2) in Silesian Center for Heart Diseases. Both groups of donor- and procedure-related factors were included in the analysis: oxygenation index at reporting of the donor, time donor spent in the intensive care unit (ICU), presence of cardiac arrest while being in the ICU, donor age, type of transplant, cumulative ischemia time, duration of the operation, and time of mechanical ventilation. Results The type of surgery was significantly associated with an increase in the chance of death within 30 days. Patients who underwent single lung transplant had a 20.217 times greater chance of dying within 30 days than patients after double lung transplant (interquartile range, 2.116-193.125). Conclusions Single lung transplant increases the risk of death during the first 30 days after lung transplant, and using lungs from older donors may increase the rate of hospital mortality. Oxygenation index, sudden cardiac arrest of the donors, and donor time spent in the ICU do not impact the short-term mortality of lung graft recipients.

Background Lung transplant remains the only viable treatment for most of the end-stage lung diseases. It is believed that extending criteria for donor lungs would increase the number of lung transplants. The aim of the study was to compare the graft function by means of oxygenation index among recipients who received the lungs from donors of extended criteria with those whose received lungs from donors who met the standard criteria. Methods This retrospective study analyzed 71 donors whose lungs where transplanted into 71 first-time double lung recipients of 2 groups: patients who received transplants before and after 2018. The objective was to assess whether there is a significant difference in quality of the donor pool after applying extended criteria. The second objective was to compare results of recipients with lungs from donors of oxygenation index > 400 mm Hg with those obtained among recipients with this parameter Results In the case of transplants performed in 2018 to 2019, oxygenation indices were significantly lower in donors but significantly higher in recipients on the first day than those observed in 2015 to 2017. The number of transplants increased from 9 per year to 22 per year. Irrespective of whether the donor had Pa O 2/fraction of inspired oxygen above or below 400 mm Hg, recipients showed similar oxygenation index values after transplant (mean oxygenation index, 462 vs 412 mm Hg, respectively). Short-term mortality did not differ either. Conclusions Extended criteria of lungs suitability as a potential grafts not only increases the donor pool but also proves that suboptimal donors are not associated with producing inferior results of the recipients.

Background Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. Lung transplantation (LTx) is often the only therapeutic option for patients with end-stage COPD. The aim of the study was to establish whether patients with end-stage COPD benefited from lung transplantation and assess the pulmonary function by the 6-Minute Walk Test (6MWT) and forced expiratory volume in 1 second (FEV1). Methods A retrospective study was carried out in the group of 69 patients (40 recipients, 18 patients currently waiting, and 11 patients who died while waiting for a lung graft) diagnosed with end-stage COPD, referred to the Silesian Center for Heart Diseases’ Lung Transplant Ward, and qualified to be treated by means of lung transplantation between 2006 and 2018. The beginning of the observation for all 69 patients was a qualification date. Results Kaplan-Meier estimation determined that graft recipients noted 50% probability of survival at approximately 5.5 years, whereas patients from the other group had such parameters at about 1.4 years. The average results FEV1 obtained at qualification were 23.69% for single lung transplantation (SLT); and 22.06% for double lung transplantation (DLT). Average patient acquired 158.07m in the 6MWT. One year after procedure the average values of FEV1 were SLT, 55.83%; DLT, 79.54%; and 430.7 m in the 6MWT overall. Conclusions Qualified patients who underwent lung transplantation lived longer than those who did not undergo such a procedure. We observed a difference in SLT and DLT recipients.

Introduction Long-term outcomes of airway complications (AC) after lung transplantation are unknown. The incidence of AC varies from 1.6% to 32% with the related mortality rate of 2% to 4%. The management of most AC is based on endobronchial methods, including balloon bronchoplasty, endobronchial stent placement, and ablative techniques. The aim of the study was to assess the connection between airway complications treated by bronchial intervention (BI) and the survival of lung transplant recipients. Materials and Methods The single-center retrospective study reviewed the cases of 165 patients (63 women [38.18%], 103 men [61, 82%]; median age at referral for lung transplantations (LTx), 41 years [range, 15-68 years]). The cohort was stratified into 2 groups comprising those whose procedures were complicated by ACs and those without. The primary outcome measured was mortality, with survival endpoints calculated at 6 months. Results The comparison of the survival of recipients regarding underlying disease (cystic fibrosis [CF], chronic obstructive pulmonary disease [COPD], idiopathic pulmonary artery hypertension [IPAH], and others) with the use of the Kaplan-Meier estimator indicated that the only statistically significant (P = .0194) differences between patients who underwent BI and patients without BI performed were observed in CF patients (Fig 1). In any other diagnosis, the results were not statistically significant (P > .05). Conclusions Bronchoscopic intervention because of airway complications after lung transplantation are often-used procedures, but they have no impact on the survival of patients with cystic fibrosis.

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.

Background Lung transplantation (LTx) is the only treatment for patients with end-stage lung disease. This procedure is associated with a risk of complications related to airway stenosis, which can be treated by means of bronchoscopic interventions (BI). Microbiological colonization may have an impact on airway complications. The aim of the study was to investigate the effect of presence of microbiological pathogens in graft among lung recipients and frequency of BI, considered as the indicator of severe complications. Materials and Methods The study design was single-center retrospective cohort research; cases of 116 patients with complete microbiological data who underwent LTx from April 2013 to June 2019 were reviewed (70.3% of transplanted patients). All statistical analyses were performed with SPSS version 25.0 and R 3.5.3. For analyses involving the number of bronchoscopy interventions, univariate and multivariate Poisson regression were used. Interaction effect of variables in multivariate Poisson regression was assessed with partial response plot. Results The mean number of pathogens colonizing each patient was approximately 4.66 (range, 0 to 19) with Candida albicans (n = 42, 36.2%), Aspergillus spp. (n = 33, 28.4%), Pseudomonas aeruginosa (n = 32, 27.59%), and methicillin-sensitive Staphylococcus aureus (MSSA) (n = 29, 25%) being the most prominent. Microbiological agents causing the greatest increase in the risk of intervention are as follows: Proteus mirabilis by 3.84 times, Aspergillus spp. by 3.53 times, and Stenotrophomonas maltophilia by 3.09 times. Burkholderia multivorans, Enterococcus spp., and Klebsiella spp. do not have a statistically significant impact on the number of BI. Conclusions Some pathogens increase the frequency of complications, which are associated with deterioration of the general condition. Therefore, patients should be monitored for the presence of pathogens in the airways.

Background Interstitial lung diseases (ILDs) are a heterogeneous group of more than 200 diseases manifested by progressive exercise dyspnea, radiological lung changes, and ventilation restrictive disorders. ILDs are the second most common indication for lung transplantation (LTx). Our study group consisted of 139 patients who qualified for LTx at the Silesian Center for Heart Diseases between 2004 and 2018. Of the 139, 92 patients died while on the waiting list, and 47 patients underwent LTx. Medical records including laboratory test results, spirometry, and the 6-minute walk test (6MWT) were analyzed to determine eligibility for LTx. We also assessed quality of life post-LTx. Results Patients who qualified for LTx showed decreased values of parameters measured by spirometry (43.69 ± 19.05% of forced expiratory volume in the first second [FEV1] and 43.07 ± 20.55% of forced vital capacity [FVC] and severe desaturation during the 6MWT (SpO2 = 88.78% before 6-minute walk test and 73.23% after the test). After LTx, longer distances were achieved in the 6MWT (235.47 ± 159.57 m during qualification vs 533.2 ± 34.15 m 12 months after LTx) and increased values of spirometry. On average, patients had stopped working 6 years prior to LTx. Conclusion There is no effective medical treatment for patients with end-stage ILDs. Therefore, lung transplantation is a lifesaving procedure for patients that also extends patients’ lives and improves their quality of life.

Despite significant advancements in pharmacological treatment, interventional and surgical options are still viable treatments for patients with pulmonary arterial hypertension (PAH), particularly idiopathic PAH. Herein, we review the interventional and surgical treatments for PAH. Atrial septostomy and the Potts shunt can be useful bridging tools for lung transplantation (Ltx), which remains the final surgical treatment among patients who are refractory to any other kind of therapy. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the ultimate bridging therapy for patients with severe PAH. More importantly, VA-ECMO plays a crucial role during Ltx and provides necessary left ventricular conditioning during the initial postoperative period. Pulmonary denervation may potentially be a new way to ensure better transplant-free survival among patients with the aforementioned disease. However, high-quality randomized controlled trials are needed. As established, obtaining the Eisenmenger physiology among patients with severe pulmonary hypertension by creating artificial defects is associated with improved survival. However, right-to-left shunting may be harmful after Ltx. Closure of the artificially created defects may carry some risk associated with cardiac surgery, especially among patients with Potts shunts. In conclusion, PAH requires an interdisciplinary approach using pharmacological, interventional, and surgical modalities.

Objectives Lung transplantation not only saves a patient’s life but also creates the opportunity for becoming more self-reliant and getting back to work. The aim of this single center study was to assess the prospects of employment, as well as its influence on the quality of life and physical activity, of the lung transplant recipients of the Silesian Center for Heart Diseases in Zabrze, Poland. Material and Methods A retrospective study covered 67 lung transplant recipients of the Silesian Center of Heart Diseases. Only patients with ≥ 6-month follow-up were included. All of the patients gave their written consent to be included in the study before filling out the questionnaire containing questions about employment, income, education and how work affected their quality of life before and after lung transplantation. A physical capability assessment was performed by climbing flights of stairs and by means of a 6-min walk test, and spirometry parameters were also measured. Results Twenty of the patients included in the study (31.7%) were employed after lung transplantation, 63.2% of whom worked full-time. Profession was changed by 2 patients (14.3%). The patients diagnosed with cystic fibrosis were found to have the highest chance of finding employment after lung transplantation. The statistical analysis revealed that the employed patients were able to cover longer distances during the 6-min walk test (556 m, on average) than the unemployed ones (494 m, on average). Conclusions One in 3 patients finds employment after lung transplantation. Work improves the quality of life of the majority of lung transplant recipients. The patients who are employed are also in a better physical condition, and they are more self-reliant in comparison to those who remain unemployed. Lung transplant recipients with cystic fibrosis are most likely to find employment, and so are patients with higher education. Int J Occup Med Environ Health. 2019;32(3):379–86

The aim of the study was to investigate the skin microcirculation blood flow and flowmotion response to heat stress in normotensive subjects with familial predisposition to hypertension and in hypertensive patients.Normotensives without [NT(-)] or with [NT(+)] familial predisposition and subjects with newly diagnosed hypertension (HT) were studied. Clinic blood pressure (BP) measurements and ambulatory BP monitoring as well as laboratory assessments were performed. Resting (RF), heat (HF) and maximal heat (MHF) blood flows were measured using PeriFlux laser Doppler flowmetry (LDF) and expressed as absolute units (AU) and as index of cutaneous vascular conductance (CVC). Spectral analysis of the skin LDF signal was performed by means of the Perisoft dedicated software. Kruskall-Wallis analysis of variance, χ(2) statistic and multivariate reverse regression analysis were used for calculation.The studied population consisted of 70 persons (mean age 36.1 ± 10.3 years, 44.3% women): 17 NT(-), 22 NT(+) and 31 HT, age and gender matched. Higher values of body mass index (BMI), and insulin, glucose and triglyceride levels were observed in HT than in NT groups. RF, HF and MHF were similar in all study groups, but CVC of maximal heat flow differed (p=0.02); in particular, lower values were observed in the HT than in NT(-) group (p=0.01). The study groups differed with regard to total power (p=0.01) and myogenic (p=0.03) origin flowmotion with the lowest values in the NT(+) group. BMI and night BP characteristics were strong predictors of reduction of CVC, MHF and myogenic origin flowmotion.Skin microcirculation response to local heat stress is altered in hypertensive patients with decrease in maximal heat CVC values. Moreover, normotensive subjects with familial predisposition to hypertension are characterized by diminished myogenic origin of skin blood flowmotion.

Fractal analysis has been shown to be capable of characterizing irregular time series generated in non-linear systems. Fluctuations in skin flow signals have a fractal nature, but to date there has been no analysis of subjects with hypertension. The aim of this study is to assess the fractal dimensions of skin microcirculation flows in subjects with a familial predisposition or newly diagnosed hypertension.A four-minutes rest flow (RF), minimal flow (BZ) during three-minutes ischemia and eight-minutes heat flow (HF) were recorded (using laser Doppler flowmetry) in patients with untreated hypertension, and in normotensives with no [NT(-)] or with a familial predisposition to hypertension [NT(+)]. Average one-minute surface areas under the curve of flow records and box dimensions (D) were calculated. Anova Kruskall-Wallis, c2 statistic and multivariate reverse regression analysis were used for calculation.We studied 70 people (average age 36.1 ± 10.3 years, 39 men). Hypertensives (n = 31) had significantly higher values of both clinical blood pressure and 24-hour ambulatory blood pressure, body mass index, glucose, triglycerides and insulin than the NT(-), (n = 17) and NT(+), (n = 22) groups. Mean values of flows and surface area under the curve of RF, BZ, HF records, D RF and D HF were comparable in studied groups, but D BZ differed (1.13 ± ± 0.05 vs 1.15 ± 0.05 vs 1.11 ± 0.05, respectively; p = 0.04). A family history of hypertension, insulin level and variability of 24-hour diastolic blood pressure were significant predictors of D BZ lower values in the multiple regression model.Subjects with a familial predisposition to hypertension reveal altered homeodynamics of microvascular flow, with diminished chaotic ischemic flow.