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Lung transplantation at Duke University.

Publication ,  Journal Article
Hartwig, MG; Snyder, LD; Finlen-Copeland, A; Lin, SS; Zaas, DW; Davis, RD; Palmer, SM
Published in: Clin Transpl
2009

Clinical lung transplantation continues to grow worldwide. Advances in donor selection and management have been critical to support the expanded growth of lung transplant as a therapeutic option for patients with advanced lung disease. In recent years, allocation in the US has changed to a disease severity based system that has led to a dramatic reduction of deaths on the waiting list with concomitant increases in transplantation of recipients who are now sicker, older, and more likely to have interstitial lung disease. Increased experience with the LAS will help to further refine optimal recipient selection and balance urgency with utility. Our center's experience demonstrates survival is comparable post-LAS as compared to pre-LAS despite transplantation of increasingly ill recipients. After transplantation, the incidence of severe PGD has decreased in recent years with advances in donor lung management and perseveration. In cases of severe PGD, VV ECMO has provided our center with a successful method of supporting patients and reducing mortality immediately following transplantation. Long-term outcomes after lung transplantation continue to be limited by BOS, a condition of progressive allograft dysfunction. Our center has led research that identified gastric reflux as a potential contributing factor to posttransplant allograft dysfunction and suggested that Nissen fundoplication surgery might help prevent the development of BOS. Continued refinements in donor management and selection, prevention and treatment of PGD, and enhanced understanding of the mechanisms of BOS will support further growth of lung transplantation and further improvements in overall posttransplant outcomes.

Duke Scholars

Published In

Clin Transpl

ISSN

0890-9016

Publication Date

2009

Start / End Page

197 / 210

Location

United States

Related Subject Headings

  • Tissue Donors
  • Survivors
  • Survival Analysis
  • Resource Allocation
  • Patient Selection
  • North Carolina
  • Middle Aged
  • Male
  • Lung Transplantation
  • Humans
 

Citation

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Hartwig, M. G., Snyder, L. D., Finlen-Copeland, A., Lin, S. S., Zaas, D. W., Davis, R. D., & Palmer, S. M. (2009). Lung transplantation at Duke University. Clin Transpl, 197–210.
Hartwig, Matthew G., Laurie D. Snyder, Ashley Finlen-Copeland, Shu S. Lin, David W. Zaas, R Duane Davis, and Scott M. Palmer. “Lung transplantation at Duke University.Clin Transpl, 2009, 197–210.
Hartwig MG, Snyder LD, Finlen-Copeland A, Lin SS, Zaas DW, Davis RD, et al. Lung transplantation at Duke University. Clin Transpl. 2009;197–210.
Hartwig, Matthew G., et al. “Lung transplantation at Duke University.Clin Transpl, 2009, pp. 197–210.
Hartwig MG, Snyder LD, Finlen-Copeland A, Lin SS, Zaas DW, Davis RD, Palmer SM. Lung transplantation at Duke University. Clin Transpl. 2009;197–210.

Published In

Clin Transpl

ISSN

0890-9016

Publication Date

2009

Start / End Page

197 / 210

Location

United States

Related Subject Headings

  • Tissue Donors
  • Survivors
  • Survival Analysis
  • Resource Allocation
  • Patient Selection
  • North Carolina
  • Middle Aged
  • Male
  • Lung Transplantation
  • Humans