RESUMEN
The prevalence of sleep-disordered breathing (SDB) after lung transplantation (LTX) is high. It is well-established that SDB is associated with decreased health-related quality of life (HRQoL), but the impact of SDB on exercise capacity is less clear. In this study we investigated HRQoL and exercise capacity in LTX recipients with or without SDB. In addition, we also investigated associations between sleep parameters and both HRQoL and exercise capacity. There were 53 stable LTX recipients (age > 18 years, 31 males, time from LTX 9-120 months) enrolled into the study. They all underwent polysomnography examination. HRQoL was assessed using the Short Form-36 (SF-36). Exercise capacity was measured using the 6-min walk test and cardiopulmonary exercise testing (CPET). We found inverse correlations between severity of SDB and both the predicted maximal workload (r = 0.24, p = 0.04) and maximal oxygen uptake (r = -0.26, p = 0.03) during CPET. Relative oxygen uptake positively correlated with sleep efficiency (r = 0.27, p = 0.03). SF-36 scores did not differ between patients with and without SDB, and were not significantly associated with SDB parameters. In conclusion, the presence of SDB is associated with a slight reduction in maximal exercise capacity in LTX recipients, and there is no appreciable relationship between SDB and HRQoL.
Asunto(s)
Tolerancia al Ejercicio , Trasplante de Pulmón , Calidad de Vida , Síndromes de la Apnea del Sueño , Receptores de Trasplantes , Adulto , Femenino , Humanos , Trasplante de Pulmón/psicología , Trasplante de Pulmón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Polisomnografía , Receptores de Trasplantes/psicología , Receptores de Trasplantes/estadística & datos numéricosRESUMEN
BACKGROUND: Dental status has been implicated in several systemic inflammatory diseases and is a potential focus for systemic infections. Therefore, most lung-transplant centers have recommendations regarding pre-transplant dental care and follow-up, but there are no official clinical guidelines. To date there is little information on oral health status in lung transplant (LTx) recipients. The aim of this study was to systematically assess oral health status in LTx recipients. OBJECTIVES: The aim of this study was to assess oral health status, including periodontal disease, oral health behavior, and awareness of the need for good oral health after LTx. METHODS: LTx recipients were recruited during follow-up outpatient visits at a university clinic transplant unit. Oral health status was quantified using the count of Decayed, Missing, and Filled Teeth (DMF-T) and the grade of periodontal disease was measured by probing depth. Patients' oral health behavior was assessed using a questionnaire. RESULTS: Seventy-three patients were included at 5.8 ± 3.4 years after lung transplantation. The mean DMF-T was 21.9 ± 5.5. Patients with cystic fibrosis as the indication for transplantation had a significantly lower DMF-T than patients with chronic obstructive pulmonary disease as the transplant indication. Of the 66 patients with teeth, 97% had moderate or severe periodontal disease. The prevalence of moderate or severe periodontal disease was significantly higher in LTx recipients (mean age 55.9 years) compared with older individuals (age 65-74 years) from the German general population (P < .005). CONCLUSIONS: This single center study shows deficits in oral health and oral health behavior in patients after LTx. There is a strong need for interdisciplinary collaboration and clinical guidelines to foster better oral health education of the transplant recipient and better oral health.
Asunto(s)
Conductas Relacionadas con la Salud , Estado de Salud , Trasplante de Pulmón/métodos , Salud Bucal , Adulto , Anciano , Estudios Transversales , Atención Odontológica/normas , Atención Odontológica/tendencias , Caries Dental/diagnóstico , Caries Dental/epidemiología , Caries Dental/terapia , Femenino , Estudios de Seguimiento , Alemania , Humanos , Trasplante de Pulmón/efectos adversos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Educación del Paciente como Asunto , Periodontitis/diagnóstico , Periodontitis/epidemiología , Periodontitis/terapia , Sistema de Registros , Encuestas y CuestionariosRESUMEN
BACKGROUND: The aim of our study was to determine the prevalence and clinical predictors of obstructive sleep apnea in lung transplantation recipients. METHODS: In a cross-sectional analysis we studied 77 clinically stable lung transplant recipients (45 men, time range after lung transplantation [LTX]: from one month to 15 years). Indications for LTX were 36 chronic obstructive lung disease (COPD), 27 idiopathic pulmonary fibrosis (IPF), eight cystic fibrosis, and six others. In-lab polysomnography (PSG) was performed to investigate sleep characteristics. Obstructive sleep apnea (OSA) and central sleep apnea were defined by an apnea-hypopnea index (AHI) ≥ 10/h. RESULTS: The prevalence of OSA and central sleep apnea (CSA) were 42.9% and 6.5%, respectively. OSA was present in 61% of patients with pre-transplant COPD and 52% of patients with pre-transplant IPF. Univariate analysis showed that OSA was significantly associated with neck circumference per 1-cm size increment (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.04-1.42, p = 0.01) and pre-transplant COPD/IPF vs other lung diseases (cystic fibrosis, pulmonary arterial hypertension, α-1 antitrypsin deficiency, and lymphangioleiomyomatosis) (OR = 6.89, 95% CI = 1.41-33.56, p = 0.02), whereas age ≥57 years (OR = 1.76, 95% CI = 0.69-4.48, p = 0.24), male gender (OR = 2.33, 95% CI = 0.89-6.01, p = 0.08), and BMI ≥ 24.6 kg/m(2) (OR = 1.73, 95% CI = 0.68-4.40, p = 0.25) did not reach a level of statistical significance. In a multivariate analysis neck circumference per 1-cm size increment (OR = 1.20, 95% CI = 1.02-1.41, p = 0.025) and pre-transplant COPD/IPF (OR = 5.34, 95% CI = 1.01-28.13, p = 0.048) remained independently associated with OSA. CONCLUSIONS: The prevalence of OSA is high in stable lung transplant recipients. Pre-transplant COPD is an independent predictor of OSA.
Asunto(s)
Pulmón , Apnea Obstructiva del Sueño/epidemiología , Receptores de Trasplantes , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica , Factores de Riesgo , Fases del SueñoRESUMEN
PURPOSE: Bilateral lung transplantation results in complete denervation of the lung and might impair hypercapnic ventilatory response (HCVR). However, experimental and clinical findings are scarce and conflicting. Therefore, this study investigated the relationship between HCVR and exercise capacity after long-term bilateral lung transplantation. METHODS: This cross-sectional analysis enrolled 46 bilateral lung transplant recipients between October 2011 and July 2012 who underwent cardiopulmonary exercise testing to evaluate maximum workload, and carbon dioxide (CO2) rebreathing. CO2 rebreathing was also evaluated in 35 control subjects. RESULTS: In lung transplant recipients age was 54 ± 11 years, body mass index (BMI) 25.4 ± 4.1 kg/m(2), and time after transplantation 4.5 ± 2.5 years (range 9 months to 10 years). Controls were aged 41 ± 12 years and had a BMI of 24.9 ± 4.0 kg/m(2). There were significant differences between lung transplant recipients and controls in forced expiratory volume in 1 s (76 ± 22 vs. 94 ± 12 % predicted, p < 0.001) and inspiratory vital capacity (91 ± 20 vs. 105 ± 14 % predicted, p = 0.001). Blood gases did not differ significantly in patients versus controls. HCVR in lung transplant recipients was 1.44 ± 1.07 L/min/mmHg compared with 2.09 ± 1.14 L/min/mmHg in controls (p = 0.001). Exercise capacity in lung transplant recipients (73 ± 24 W) was 49 % predicted. Linear regression analysis showed that exercise capacity was significantly associated with HCVR. A 1 L/min/mmHg decrease in HCVR decreased exercise capacity by 50 W. CONCLUSION: HCVR is reduced in long-term bilateral lung transplant recipients and this might explain the observed impairment of exercise capacity.
Asunto(s)
Dióxido de Carbono/fisiología , Tolerancia al Ejercicio/fisiología , Hipercapnia/fisiopatología , Trasplante de Pulmón , Adulto , Anciano , Análisis de los Gases de la Sangre , Dióxido de Carbono/sangre , Estudios de Casos y Controles , Estudios Transversales , Prueba de Esfuerzo , Femenino , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Capacidad VitalRESUMEN
Lung transplantation has the worst outcome compared to all solid organ transplants due to chronic rejection known as obliterative bronchiolitis (OB). Pathogenesis of OB is a complex interplay of alloimmune-dependent and -independent factors, which leads to the development of inflammation, fibrosis, and airway obliteration that have been resistant to therapy. The alloimmune-independent inflammatory pathway has been the recent focus in the pathogenesis of rejection, suggesting that targeting this may offer therapeutic benefits. As a potent anti-inflammatory agent, epigallo-catechin-galleate (EGCG), a green tea catechin, has been very effective in ameliorating inflammation in a variety of diseases, providing the rationale for its use in this study in a murine heterotopic tracheal allograft model of OB. Mice treated with EGCG had reduced inflammation, with significantly less neutrophil and macrophage infiltration and significantly reduced fibrosis. On further investigation into the mechanisms, inflammatory cytokines keratinocyte (KC), interleukin-17 (IL-17), and tumor necrosis factor-α (TNF-α), involved in neutrophil recruitment, were reduced in the EGCG-treated mice. In addition, monocyte chemokine monocyte chemoattractant protein-1 (MCP-1) was significantly reduced by EGCG treatment. Antifibrotic cytokine interferon-γ-inducible protein-10 (IP-10) was increased and profibrotic cytokine transforming growth factor-ß (TGF-ß) was reduced, further characterizing the antifibrotic effects of EGCG. These findings suggest that EGCG has great potential in ameliorating the development of obliterative airway disease.
Asunto(s)
Bronquiolitis Obliterante/tratamiento farmacológico , Catequina/análogos & derivados , Animales , Bronquiolitis Obliterante/etiología , Bronquiolitis Obliterante/patología , Catequina/farmacología , Catequina/uso terapéutico , Citocinas , Fibrosis/prevención & control , Inflamación/tratamiento farmacológico , Trasplante de Pulmón/efectos adversos , Ratones , Infiltración Neutrófila , TéRESUMEN
Increased levels of MMP-8 (neutrophil collagenase) have been reported in OB, but the biological role of MMP-8 in OB is not known. MMP-8 is an interstitial collagenase highly expressed by polymorphonuclear leukocytes, which are prominent in early OB. Here, we show that MMP-8 promotes migration of PMNs through the collagen-rich matrix in a mouse heterotopic airway transplant model of OB. Overall, MMP-8(-/-) mice had significantly fewer PMNs in the airway lumen 2 and 14 days post-transplantation, and the percentage of PMNs traversing the matrix to the lumen was decreased markedly in the MMP-8(-/-) compared with WT mice at 14 days. There were significantly more PMNs outside of the lumen in the ECM in the MMP-8(-/-) mice compared with WT mice. In vitro, significantly fewer MMP-8(-/-) PMNs migrated through 3D cross-linked collagen gels than WT PMNs. MMP inhibitor GM6001 was also able to impede migration of WT PMNs through collagen gels. The decreased migration was likely a result of pericollagenase activity of MMP-8, as WT PMNs expressing MMP-8 were not able to migrate effectively through collagen that was resistant to the collagenase. Protection from OB was seen in the MMP-8(-/-) mice, as the airway lumen had significantly less obliteration and collagen deposition, suggesting that MMP-8 plays an important role in the pathogenesis of OB.