Influenza infection may harm lung transplant recipients (LTR) because it potentially triggers allograft rejection. Prolonged viral shedding (PVS) is defined as positive detection of influenza A/H1N1 virus (H1N1) by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) at day 7 or later after diagnosis. The aim was to quantify and characterise PVS of H1N1 infections among LTR in consecutive influenza seasons. Methods: Influenza vaccination is routinely offered at follow-up visits in our outpatient clinic. LTR are also instructed to contact and visit our clinic when signs of infection occur or home lung function deteriorates 10% or more. We then frequently perform nasopharyngeal swabs (NPS) for viral and bacterial analysis. In case of suggestive symptoms for influenza infection we start oseltamivir (Tamiflu) and moxifloxacin treatment pending NPS results. For proven H1N1 infection we continue treatment until weekly NPS return negative. Results: In winter 2009/2010 7 patients had H1N1 infection of which 2 had PVS (28%). No serious complication occurred. 2/7 LTR were vaccinated for H1N1. For 2010/2011 we have so far documented 11 H1N1 infections and PVS in 8 LTR (73%). All LTR were vaccinated with at least 1 dose containing H1N1. Three LTR were hospitalised. 5 LTR had PVS for 2-6 weeks. Quantification of viral results and drug resistance testing are being performed. Influenza B was detected in 4 other LTR. Conclusion: In this ongoing study we report an increase in frequency of PVS for H1N1 infections in LTR from 28 to 73% in consecutive influenza seasons. Most infections occurred despite vaccination and had a favourable outcome rarely requiring hospitalisation.
Background: Our aim was to assess changes in anatomical structures of the upper airways in patients with obstructive sleep apnea syndrome (OSAS) undergoing didgeridoo training to understand the mechanisms by which this treatments exhibits its beneficial effects. Methods: We included patients over 18 years of age with newly diagnosed OSAS and an AHI between 15-45/hour. We excluded patients with central sleep apnea, need for CPAP therapy, planned weight reduction intervention, high alcohol inatke and adiposity. Patients received didgeridoo lessons and practiced for 4 months. To measure compliance a device attached inside the didgeridoo continuously monitored temperature and pressure. Before and after treatment patients underwent polysomnography and MRI imaging for soft-tissue volumetric measurements. Results: In 10 patients included so far (median age 52 years, BMI 27 kg/m 2 ) the median AHI decreased from 31 to 19/hour and Epworth sleepiness score from 12 to 10. Figure 1 shows very strong associations between the extent of playing digeridoo and a decrease in AHI (r= -0.85) and in the volume of parapharyngeal fat pads (r= -0.90) but a moderate association only with decrease in daytime sleepiness (r= -0.34). A decrease in AHI was strongly associated with a decrease in the volume of parapharyngeal fat pads (r=0.70). Conclusion: The data strongly suggest that didgeridoo playing decreases the AHI by downsizing parapharyngeal fat pads.
There is a lack of data regarding use of ECMO in children undergoing lung transplantation. We evaluated our experience of ECMO in pediatric lung transplant recipients. All patients (<18 yr) who underwent lung transplants between 1997 and 2011 were included (17 children; nine males; median age 16 yr), and the use of intra-operative ECMO evaluated. Transplant procedures were carried out with intra-operative ECMO in seven children (all bilateral lung transplants). Demographics of ECMO and non-ECMO patients were comparable. One child was already on ECMO pre-operative. Lung graft size reduction was undertaken in five ECMO and four non-ECMO cases, respectively. Five patients were taken off ECMO intra-operatively; the other patients were weaned off ECMO within 48 h post-operatively. Three-months survival was 100%. By 12 months post-transplantation, one patient each died in the ECMO and in the non-ECMO group. At the end of the study, six of seven ECMO cases were still alive (median survival 48.5 months); one patient required a retransplant at 53 months. Our small case series suggests that lung transplant procedures can be safely carried out in selected children on intra-operative ECMO support; however, our pediatric experience regarding this scenario is very limited but probably almost unique.
Lung transplant recipients (LTRs) are prone to medical complications and emergencies due to the transplanted organ being in constant direct contact with the environment and the need for life-long profound immunosuppression (IS). As a result of these specific circumstances, the medical and surgical management of LTRs frequently differs from usual standard care. Therefore, we outline here some of the principles we take into account when dealing with the most frequent medical emergencies encountered in our lung transplant cohort in Zurich. The main topics dealt with are: diagnostics and treatment of infections, gastrointestinal emergencies, IS and other medication issues as well as work-up of unclear inflammatory signs and peri-operative precautions in LTRs. Early post-operative transplant complications, rare medical emergencies and surgical problems are not covered. Our report is intended to help internists and pulmonologists new to the field to obtain a better understanding of the peculiarities of LTRs and their management.
