Surgical approaches to end stage disease: lung transplantation and volume reduction
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1997
|
| Schriftenreihe: | Clinics in chest medicine
18,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XI S., S. 173 - 419 Ill., graph. Darst. |
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| 650 | 7 | |a Longen |2 gtt | |
| 650 | 7 | |a Transplantatie |2 gtt | |
| 650 | 2 | |a Transplantation pulmonaire | |
| 650 | 4 | |a Emphysema |x surgery | |
| 650 | 4 | |a Lung Transplantation | |
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Datensatz im Suchindex
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| adam_text | 1 i SURGICAL APPROACHES TO END STAGE DISEASE:
I LUNG TRANSPLANTATION AND VOI.UMF. RI DUCTTON
CONTENTS
Preface xiii
Janet R. Maurer
Pulmonary Rehabilitation and Surgery for End Stage Lung Disease 173
Steven Kesten
Pulmonary rehabilitation is a multidisciplinary approach to the compre¬
hensive management of patients with end stage lung disease. Components
of the pulmonary rehabilitation program include education, exercise, nutri¬
tion, and psychosocial support. Published data indicate improvements in
functional capacity and quality of life following a program of pulmonary
rehabilitation. The recommendation for pulmonary rehabilitation prior to
lung volume reduction surgery or lung transplantation is based on several
assumptions without corroborating data. Nevertheless, given the relatively
benign nature of pulmonary rehabilitation and the documented benefits,
it is reasonable to recommend such a program to patients who are
awaiting surgical intervention.
Patient Selection, Evaluation, and Preoperative Management for
Lung Transplant Candidates 183
Cecilia M. Smith
The selection process to assess candidacy for transplant is based on medi¬
cal and psychosocial criteria and surgical considerations. The degree of
disease severity requiring transplantation for survival has become more
apparent as the disparity in survival outcome widens between patients
with and without transplant. The contraindications to transplant surgery
have been modified over time. Candidate selection is considered in the
context of the risks and benefits of the surgical procedure on a case by
case basis. The wait for transplant has increased as the growth in the
number of candidates for transplant exceeds available donors. As much
as 30% of patients die on the UNOS waiting list.
Evaluation and Preoperative Management of Lung Volume
Reduction Surgery Candidates 199
Roger D. Yusen, Stephen S. Lefrak, and Elbert P. Trulock
The efficacy of lung volume reduction surgery has been demonstrated by
improvements in functional status, dyspnea, pulmonary function, alveolar
f CLINICS IN CHEST MEDICINE
VOLUME 18 • NUMBER 2 • JUNE 1997 vii
gas exchange, and exercise tolerance. However, surgery has a significant
morbidity, mortality, and cost. Surgical outcome is dependent on the
clinical, anatomical, and physiological features of the patients and their
emphysema. Therefore, the patient evaluation process and the preopera
tive optimization of medical therapy are crucial for success. Though under¬
standing mechanisms for improvement have added insight to the selection
process, patient selection needs further clarification.
Indications: Unilateral, Bilateral, Heart Lung, and Lobar
Transplant Procedures 225
G. Alexander Patterson
Indications for unilateral, bilateral, heart lung, and lobar transplant proce¬
dures for emphysema, cystic fibrosis, primary pulmonary hypertension,
and pulmonary fibrosis are presented, and a brief historical perspective of
the procedures is supplied.
Donor Criteria and Evaluation 231
Adaani E. Frost
Limited donor availability for organ transplantation has led to the progres¬
sive reevaluation and liberalization of donor acceptance criteria. This arti¬
cle discusses the existing and expanding criteria for the evaluation and
use of donated organs for lung transplantation.
Donor Considerations in Living Related Donor Lung Transplantation 239
George B. Mallory, Jr and Alan H. Cohen
Living donor lung transplantation has been performed in the United States
since 1990. Based on the experience in living donor kidney transplantation
which began in 1954, and living donor liver transplantation which began
in 1989, considerable progress has occurred in surgical technique, selection
of recipients and donors, and the indications for and timing of the proce¬
dure. The vast majority of living donor lung transplantations have been
performed in patients with cystic fibrosis. Early results concerning graft
function, donor recovery, and recipient outcome are encouraging.
Early and Long Term Functional Outcomes in Unilateral, Bilateral,
and Living Related Transplant Recipients 245
Trevor J. Williams and Gregory I. Snell
Lung transplantation offers the possibility of improved quality of life
and survival in patients with severe pulmonary and pulmonary vascular
disease. Since the first human lung allotransplantation in 1963, survival
has moved from hours or days into the present era of long term (years)
survival in many recipients. Measurement of outcome has now extended
to measurement of exercise capacity and quality of life. A substantial
improvement in quality of life is seen; however, exercise capacity remains
moderately impaired in spite of the return (in many) of near normal
cardiopulmonary function, suggesting peripheral limitation to exercise.
Recently, fiber type changes and abnormal oxidative metabolism have
been shown in the skeletal muscle of stable lung transplant recipients.
This suggests a persistence of a pretransplant skeletal muscle injury and/
or the effects of post transplant immunosuppression (particularly
Cyclosporin A and corticosteroids).
Early and Long Term Functional Outcomes Following Lung Volume
Reduction Surgery 259
Frank C. Sciurba
In the past 3 years, lung volume reduction surgery has become the most
controversial topic in the clinical management of patients with emphy
Viii CONTENTS
sema. Although literature has added to the understanding of the proce¬
dure, many important issues remain unclear. This article emphasizes func¬
tional and basic physiologic changes that occur following lung volume
reduction surgery in patients with emphysema.
Perioperative Management in Lung Transplantation 277
Kevin P. Simpson and Edward R. Garrity
The perioperative management of the lung transplant recipient requires
close collaboration on the part of all members of the transplantation team,
meticulous attention to detail, and careful monitoring for complications.
A general perioperative treatment plan is reviewed in this article, and a
synopsis is included that discusses the most frequently occurring compli¬
cations. Despite the many potential pitfalls which may arise during the
perioperative period, a comprehensive multidisciplinary approach to the
management of these patients with complications results in an uneventful
postoperative course, with discharge home within 10 to 14 days in the
majority of patients.
Perioperative Management of Lung Volume Reduction Patients 285
Cesar A. Keller and Keith S. Naunheim
Over the last 2 to 3 years, surgical lung volume reduction via sternotomy
or thoracoscopy has been widely explored as an alternative to improve
dyspnea, exercise tolerance, and lung mechanics in patients with severe
emphysema. In this article, the authors describe the intra and postopera¬
tive management of patients with severe airflow obstruction who undergo
this procedure. Anesthesia techniques, extubation, ventilatory manage¬
ment, and overall medical and surgical care are reviewed. The most
common postoperative complications also are reviewed, and management
of these complications is discussed.
Acute Pulmonary Allograft Rejection: Mechanisms, Diagnosis,
and Management 301
Melissa B. King Biggs
Rejection is a common complication following lung transplantation, and
can lead to considerable short and long term morbidity. As numbers and
survival rates of lung transplant recipients increase, it is apparent that
acute rejection can occur months or years after transplantation, and may
be resistant to standard therapies. Mechanisms of acute rejection have
been well studied in other solid organ transplant recipients, and are
beginning to be addressed in the lung recipient. This article addresses
some of the common issues of diagnosis and management of acute
rejection which arise frequently during the care of lung transplant recipi¬
ents.
Prophylaxis Post Transplant: The Role of Monitoring Surveillance
Bronchoscopy and Antimicrobials 311
Paul A. Corris
Successful pulmonary transplantation depends upon monitoring of both
graft and patient for early identification of problems that can otherwise
progress rapidly, leading to morbidity and mortality. The strategies used
to monitor patient and graft function vary among institutions, and differ¬
ent strategies are employed according to the amount of time elapsed after
surgery. This article discusses surveillance and prophylaxis in immediate,
early, and late periods after transplantation.
CONTENTS ix
Obliterative Bronchiolitis 319
Keith Kelly and Marshall I. Hertz
Up to one half of all lung transplant recipients eventually develop irrevers¬
ible and disabling graft dysfunction due to obliterative bronchiolitis. This
disease is thought to represent chronic airway rejection, although its patho
genesis is poorly understood. Effective treatment is painfully lacking.
This article discusses the current concept of obliterative bronchiolitis with
respect to its pathology, pathogenesis, and current and future treatment
strategies.
Infections in Lung Transplant Recipients 339
Cecilia Chaparro and Steven Kesten
The optimal prescription of immunosuppressive pharmacotherapy bal¬
ances the benefit of allograft tolerance and the risk of invasion from
unwanted organisms. Advances in antimicrobial prophylaxis and treat¬
ment strategies have resulted in a decrease in the incidence and severity
of certain infections; however, infections along with allograft rejection
continue to be leading causes of morbidity and mortality among lung
allograft recipients. Ultimately, a careful monitoring protocol and a high
index of suspicion for infection requiring investigation and treatment are
necessary in the ongoing care of lung transplant recipients. The approach
to infections should be guided by the knowledge of the various factors
that increase susceptibility to microorganisms and any previous culture
and sensitivity results.
Review of Immunosuppression for Lung Transplantation: Novel
Drugs, New Uses for Conventional Immunosuppressants, and
Alternative Strategies 353
Bernard Hausen and Randall E. Morris
The history, pharmacokinetics, mechanisms of action, and experimental as
well as clinical data on the immunosuppressive potential of the novel
drugs tacrolimus (FK506), sirolimus (rapamycin), mycophenolic acid (my
cophenolate mofetil), and leflunomide (and its malononitriloamide ana¬
logues) are provided. Novel approaches with the following conventional
immunosuppressants are outlined: methotrexate, aerosolized immunosup¬
pression and the implementation of steroid taper. Total lymphoid irradia¬
tion and photopheresis for treatment of recurrent rejection are also dis¬
cussed.
Nonpulmonary Medical Complications in the Intermediate and
Long Term Survivor 367
Janet R. Maurer and Sanjiv Tewari
This article deals with the nonpulmonary, non infectious complications in
intermediate and long term survivors of lung transplantation. Although
they are an infrequent cause of mortality, these disorders can cause sig¬
nificant morbidity in this population. Diseases associated with the gamut
of medications used post transplant are specifically discussed, as are dis¬
eases caused by the direct immunosuppressive action of some of these
drugs. General care of transplant patients also entails attention to their
underlying diseases, and to routine medical considerations common to
all patients.
Psychosocial and Ethical Issues in Surgical Approaches to End Stage
Lung Disease 383
Jan D. Manzetti, Rachel Ankeny, and David Miller
Heart lung transplantation became a treatment option for end stage lung
parenchymal and vascular disease in 1981. Although many advances have
occurred in the field surrounding donor selection, allograft preservation,
surgical techniques, immunosuppression, and rejection and infection treat¬
ments, a shortage of cadaveric donors continues. This results in increased
waiting times for the candidates, which in itself introduces an array of
physical and psychological issues that must be addressed before trans¬
plant. This article examines the psychological factors evident in this period.
In addition, ethical issues related to the allocation system and their impact
on organ availability and, therefore, the time spent waiting for a lung
transplant are presented.
The Cost of Lung Transplantation and the Quality of Life Post
Transplant 391
Cynthia R. Gross and Ganesh Raghu
Current information on lung transplantation indicates that successful lung
transplantation largely reverses the energy and physical mobility deficits
reported by transplant candidates, and these improvements are sustained
for at least several years after transplant. Recipients report improved
health perceptions, fewer problems, and greater life satisfaction than can¬
didates. Lung transplantation surgery is an expensive procedure initially,
and costs remain high during follow up. Little information is currently
available on long term quality of life outcomes or on cost effectiveness.
Quality of life and cost measures must be incorporated into large, longitu¬
dinal, multicentered clinical trials and observational studies.
Pediatric Lung Transplantation 405
Paul C. Stillwell and George B. Mallory, Jr
Pediatric lung transplantation is becoming more common, and with in¬
creasing experience there is increasing success. The most common indica¬
tions for considering lung transplantation are cystic fibrosis, pulmonary
vascular disease (usually due to congenital heart disease), and fibrotic
lung disease. The contraindications and complications are similar to adult
transplant patients, although post transplant lymphoproliferative disease
and airway complications may occur more frequently. The patients with
cystic fibrosis face additional obstacles to the success of transplantation:
airway colonization with Gram negative organisms, pancreatic insuffi¬
ciency, glucose intolerance, and osteoporosis. The survival for children is
comparable to adults, reaching about 65% at 1 year, and 69% at 2 years.
Index 415
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| spelling | Surgical approaches to end stage disease lung transplantation and volume reduction Janet R. Maurer guest ed. Philadelphia [u.a.] Saunders 1997 XI S., S. 173 - 419 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in chest medicine 18,2 Chirurgie (geneeskunde) gtt Emphysème - Chirurgie Longen gtt Transplantatie gtt Transplantation pulmonaire Emphysema surgery Lung Transplantation Lungs Surgery Lungs Transplantation Lungentransplantation (DE-588)4231574-8 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Lungentransplantation (DE-588)4231574-8 s DE-604 Maurer, Janet R. Sonstige oth Clinics in chest medicine 18,2 (DE-604)BV000001084 18,2 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007658071&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Surgical approaches to end stage disease lung transplantation and volume reduction Clinics in chest medicine Chirurgie (geneeskunde) gtt Emphysème - Chirurgie Longen gtt Transplantatie gtt Transplantation pulmonaire Emphysema surgery Lung Transplantation Lungs Surgery Lungs Transplantation Lungentransplantation (DE-588)4231574-8 gnd |
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| title | Surgical approaches to end stage disease lung transplantation and volume reduction |
| title_auth | Surgical approaches to end stage disease lung transplantation and volume reduction |
| title_exact_search | Surgical approaches to end stage disease lung transplantation and volume reduction |
| title_full | Surgical approaches to end stage disease lung transplantation and volume reduction Janet R. Maurer guest ed. |
| title_fullStr | Surgical approaches to end stage disease lung transplantation and volume reduction Janet R. Maurer guest ed. |
| title_full_unstemmed | Surgical approaches to end stage disease lung transplantation and volume reduction Janet R. Maurer guest ed. |
| title_short | Surgical approaches to end stage disease |
| title_sort | surgical approaches to end stage disease lung transplantation and volume reduction |
| title_sub | lung transplantation and volume reduction |
| topic | Chirurgie (geneeskunde) gtt Emphysème - Chirurgie Longen gtt Transplantatie gtt Transplantation pulmonaire Emphysema surgery Lung Transplantation Lungs Surgery Lungs Transplantation Lungentransplantation (DE-588)4231574-8 gnd |
| topic_facet | Chirurgie (geneeskunde) Emphysème - Chirurgie Longen Transplantatie Transplantation pulmonaire Emphysema surgery Lung Transplantation Lungs Surgery Lungs Transplantation Lungentransplantation Aufsatzsammlung |
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