Academic Journal
Long-term outcomes of patients with pulmonary arteriovenous malformations considered for lung transplantation, compared with similarly hypoxaemic cohorts
| العنوان: | Long-term outcomes of patients with pulmonary arteriovenous malformations considered for lung transplantation, compared with similarly hypoxaemic cohorts |
|---|---|
| المؤلفون: | Shovlin, CL, Buscarini, E, Hughes, JMB, Allison, DJ, Jackson, JE |
| بيانات النشر: | BMJ Publishing Group |
| سنة النشر: | 2017 |
| المجموعة: | Imperial College London: Spiral |
| مصطلحات موضوعية: | Ambulatory Oxygen Therapy, Imaging/CT MRI etc, Lung Transplantation, Paediatric Lung Disaese, Rare lung diseases, Systemic disease and lungs, Thoracic Surgery |
| الوصف: | INTRODUCTION: Pulmonary arteriovenous malformations (PAVMs) may not be amenable to treatment by embolization or surgical resection, and many patients are left with significant hypoxemia. Lung transplantation has been undertaken . T here is no guidance on selection criteria. METHODS : To guide transplantation listing assessments , the outcomes of the six patients who had been considered for transplantation were compared to a similarly hypoxemic patient group recruited prospectively between 2005 - 2016 at the same UK institution. RESULTS : Six patients had been formally considered for lung transplantation purely for PAVMs . One underwent a single lung transplantation for diffuse PAVMs and died within 4 weeks of surgery. The other five were not transplanted, in four c ases at the patients’ request . Their current survival ranges from 16 - 27 (median 21) years post transplant assessment. Of 444 consecutive patients with PAVMs recruited between 2005 - 2016, 42 were similarly hypoxemic to the “ transplant - considered ” coho rt ( SaO 2 <86.5%). H ypoxemic cohorts maintained arterial oxygen content through secondary erythrocytosis and higher haemoglobin. Th e “transplant - considered” cohort had similar CaO 2 to the hypoxemic comparator group, but higher MRC dyspnea scores (p= 0.023 ) , higher rates of cerebral abscesses (p=0.0043) and higher rates of venous thromboemboli (p=0.0009) that were evident before and after the decision to list for transplantation. CONCLUSIONS : The non - transplanted patients demonstrated marked longevity . Symp toms and co - morbidities were better predictors of health than oxygen measurements. While a case - by - case decision, weighing survival estimates and quality of life will help patients in their decision making, the data suggest a very strong case must be made before lung transplantation is considered. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | unknown |
| تدمد: | 2052-4439 |
| Relation: | BMJ Open Respiratory Research; http://hdl.handle.net/10044/1/48609; https://dx.doi.org/10.1136/bmjresp-2017-000198 |
| DOI: | 10.1136/bmjresp-2017-000198 |
| الاتاحة: | http://hdl.handle.net/10044/1/48609 https://doi.org/10.1136/bmjresp-2017-000198 |
| Rights: | © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
| رقم الانضمام: | edsbas.54F50C4F |
| قاعدة البيانات: | BASE |
Full Text Finder | تدمد: | 20524439 |
|---|---|
| DOI: | 10.1136/bmjresp-2017-000198 |