Alpha1-antitrypsin deficiency (AATD) disease is associated with several inflammatory conditions due to unprotected proteolytic activity of neutrophil elastase and proteinase 3. We observed that patients with ATTD develop early complications post-transplant. The aim of the study was to identify potential differences in outcomes between AATD and emphysema without AATD (E) following lung transplant. We retrospectively reviewed the data of 41 patients (27 E and 14 AATD) transplanted between 2005 and 2017. Data collection includes functional baseline of recipients and complications as primary outcome, and secondary end points of survival. The majority (79%) of AATD patients received double lung transplant. Main complications in AATD cohort included 3 bowel ischemia and perforation, 1 liver cirrhosis and 4 anastomotic complications causing death in 2 patients. Comparison rate of FEV1 decline in AATD and E group in year 1, 5 and 10 showed no statistical difference (P=0.18; P=0.67), same as FEV1 pre and post-transplant between groups. Mortality was higher in AATD (36%) compare to E (30%). Survival curve showed no difference between both groups with median survival AATD 10.8 years (95% CI 0.54 to 5.336) and E 6.4 years (95% CI 0.19 to 1.86, P=0.64). AATD transplant recipients are predisposed to complications related to their primary underlying disease when compare to E group. However, FEV1 decline had similar trends in both groups with no difference in overall survival.
Alpha1-antitrypsin deficiency (AATD) is characterized by low level of apha-1 antitrypsin, which predispose lung to unprotected proteolytic activity. We observed in our centre that patients with AATD suffer from severe bronchial anastomotic complication. We wanted to determine whether there is difference in post-transplant airway complications between AATD emphysema and emphysema without AATD (EMPH). We performed a retrospective analysis to compare the post-transplantation course of patients with AATD and EMPH. Data collection includes demographic and functional baseline of recipients, primary outcome as bronchial anastomotic complication and secondary end points as survival data. A total of 163 patients were transplanted from January 2005 to May 2016 in our centre, with follow up until August 2016. Out of these, 34 patients had either diagnosis of AATD (35.3%) or EMPH(64.7%). There was a male preponderance of 75% in AATD. Both groups had predominantly double lung transplant. Population with AATD was younger compare to EMPH (mean age 53.5 ± 7.9 vs 60 ± 4.6, p ‹ 0.01). There was no statistical difference in FEV1 pre and post-transplant between groups. 4 (33%) AATD patients had bronchial anastomotic complication (versus 0 in EMPH, p value = 0.011) with median onset 4 months post-transplant, and odd ratio of 1.5 (95%CI, 1.005-2.238). Survival curve showed no difference between both group (p=0.512) with mean survival AATD 29.6 ± 4.3 months and EMPH 44.2 ± 10.8 months. This observation study extends the available knowledge. The findings indicate that AATD patients may have higher risk for developing bronchial anastomotic complication. More robust data and multicentre analysis would be needed for further confirmation.
Influenza is a significant cause of morbidity and mortality following lung transplant. We employ trivalent vaccination as per National Policy in our centre. The trivalent inactivated vaccine (TIV) is not protective against the 2017-18 circulating stain of Influenza B. We reviewed the outcomes in 221 lung transplants recipients post vaccination. All Patients are subject to influenza surveillance. Data include viral swabs, severity of symptoms, history of vaccination, immunosuppression and outcomes for lung transplant patients from November 2017 to date. Ten patients have Influenza DNA detection of which 2 Influenza A and 8 Influenza B. The 10 cases had been vaccinated with the TIV vaccine. The cases presented in January 2018, were stratified as 1) mild, which were discharge home, or 2) severe, which required hospitalisation. All cases were treated with Oseltamivir (nebulised Zanamivir was added in the one of the Influenza B cases). Admission rates from Influenza B were 40%, and 1 patient admitted to intensive care unit died. All Influenza B cases were confirmed as B/Phuket/3073/2013-like (B/Yamagata lineage) virus. The costs for admission were €60,000 as per HSE reimbursement versus a total of €6000 Quadrivalent vaccination (QIV). In our cohort, 80% were infected by Influenza B/Yamagata strain, poorly covered by TIV. Immunocompromised patients may benefit from QIV vaccination leading to a cost benefit by reducing hospitalization, morbidity and mortality.
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