Pulmonary Sarcoidosis: Typical and Atypical Manifestations at High-Resolution CT with Pathologic Correlation
Identifying Patients At Risk For Early Mortality After Lung Transplant In IPAH
Photo Credit: Phira Phonruewiangphing
ECMO or ventilator use was the most significant predictor of mortality in patients undergoing lung transplant for idiopathic pulmonary arterial hypertension.
A prediction model incorporating factors associated with advanced pulmonary vascular disease effectively categorized 74% of lung transplant candidates with idiopathic pulmonary arterial hypertension (IPAH) as low- versus high-risk for 90-day mortality after transplant, according to a study published in Pulmonary Circulation.
"Identification of high-risk candidates may allow the application of more intensive strategies to mitigate complications that ultimately result in early mortality," wrote corresponding author Reda E. Girgis, MD, and study coauthors.
The study included 693 adults with IPAH from the United Network for Organ Sharing database. The patients underwent lung transplantation between 2005 and 2021. Most patients were young to middle-aged women. Researchers examined factors associated with early mortality, specifically within 90 days of transplant.
Early mortality was high compared with other major diagnostic groups, with 10.2% of patients dying within 90 days of transplant. Causes included pulmonary/graft failure (28%), multiorgan failure (17%), infection (14%), cerebrovascular (13%), cardiovascular (11%), hemorrhage (8%), and other (9%).
The model identified several independent recipient factors that predicted early mortality. Odds ratios for 90-day mortality were:
"Our linear regression model was able to distinguish 25% of the cohort with a predicted 90-day mortality of [at least] 20% from 49% of the cohort with a mortality of 5% [or less], thereby identifying high-risk versus low-risk recipients," the researchers wrote.
Among transplant recipients, 10% required extracorporeal membrane oxygenator (ECMO) and/or ventilator use before transplant. The need for this type of advanced life support was the strongest risk factor for early mortality.
"There has been increasing application of ECMO as a bridge to transplant in recent years for all indications," Dr. Girgis and colleagues wrote. "While outcomes can be satisfactory relative to the dire hemodynamic derangement, early post-transplant mortality is considerably higher compared with non-supported recipients."
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Research Digest: Diagnosing And Managing Tuberculosis In Immunocompromised Children
A new study has shown children and adolescents with immunocompromise who contract tuberculosis (TB) experience increased rates of non-respiratory TB and more severe forms of the disease, leading to a higher incidence of associated long-term health complications.
The study also revealed that standard immune-based TB detection tests are not accurate in immunocompromised children and therefore the researchers highlight a need to design prevention and management plans for these children who contract TB to minimise later health issues.
The researchers conducted a retrospective, multicentre, case-control study within the Pediatric Tuberculosis Network (pTBnet) European Trials Group. All participants were aged under 18 and had been treated for or diagnosed with TB at a European centre between 2000 and 2020.
Of the 417 TB cases included, 139 were immunocompromised, including those with human immunodeficiency virus, inborn errors of immunity, drug-induced immunosuppression and other immunocompromising conditions. A control group of 278 non-immunocompromised patients with TB was also included. All data was sourced from the pTBnet database.
Increased rates of non-respiratory TB were found in immunocompromised children compared to controls (32.4% vs 21.2%), and these patients had an increased likelihood of presenting with severe disease (57.6% vs 38.5%).
These children also had significantly higher rates of false-negative tuberculin skin test (31.9% vs 6.0%) and QuantiFERON-TB Gold assay (30.0% vs 7.3%) results at diagnosis. However, the microbiological confirmation rate was similar in immunocompromised and control cases (58.3% vs 49.3%).
Overall, the mortality rate of immunocompromised children was low (<1%), but the rate of long-term health complications resulting from the TB infection was significantly higher in immunocompromised children versus children in the control group (14.8% vs 6.1%).
To improve the long-term health outcomes and decrease the severity of the infection for immunocompromised children, the researchers suggest that future studies focus on better immune-based tests to diagnose TB in these children effectively.
In addition, the researchers emphasise the need for a better understanding of why immunocompromised children have an increased rate of associated long-term health so these children can be better managed at diagnosis and prevention strategies can be put in place to improve outcomes.
ReferenceRodrÃguez-Molino, P et al. Tuberculosis Disease in Immunocompromised Children and Adolescents: A Pediatric Tuberculosis Network European Trials Group Multicenter Case-control Study. Clinical Infectious Diseases 2024; Jul 15: doi.Org/10.1093/cid/ciae158.
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