Hyperbaric oxygen therapy to prevent central airway stenosis after lung transplantation.
Hyperbaric oxygen therapy to prevent central airway stenosis after lung transplantation.
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DOI：
10.1016/j.healun.2021.01.008
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Shofer SL
中科院分区：
文献类型：
--
作者：
Kraft BD;Mahmood K;Harlan NP;Hartwig MG;Snyder LD;Suliman HB;Shofer SL
中央气道狭窄（CAS）是肺移植后与支气管缺血和坏死相关的严重气道并发症。我们试图确定高压氧疗法（HBOT）（一种既定的组织缺血治疗方法）是否可以减轻移植后支气管损伤。我们对移植后 4 周出现广泛气道坏死的受试者进行了一项随机对照试验，比较常规护理与 HBOT（2 小时×20 次，绝对气压 2 个大气压）。移植后 4、7 和 10 周收集支气管内活检用于定量 PCR。共同主要结果是一年内气道支架置入术和急性细胞排斥反应（ACR）的发生率。该试验在招募了 20 名受试者（每组 10 名）后停止，预先计划的中期分析显示常规治疗组和 HBOT 组在支架置入术（均为 40%）、ACR（分别为 70% 和 40%）或 CAS（分别为 40% 和 60%）方面没有差异。 HBOT 组的首次支架置入时间（中位 [IQR]）显着缩短（150 [73–150] 天 vs. 186 [167–206] 天，P<0.05）。移植后 4、7 和 10 周时，供体组织中缺氧诱导的基因表达显着增加，但 HBOT 并未改变。发生 CAS 或需要支架置入术的受试者在 4 周时 HMOX1 和 VEGFA 表达显着升高（均 P<0.05）。发生 ACR 的受试者在 4 周时有显着的 FLT1、TIE2 和 KDR 表达（均 P<0.05）。移植后出现严重的气道坏死后，CAS 的发病率很高。 HBO 治疗不会减轻 CAS 严重程度或支架置入术。 HMOX1 和 VEGFA 表达升高似乎与气道并发症相关。
Central airway stenosis (CAS) is a severe airway complication after lung transplantation associated with bronchial ischemia and necrosis. We sought to determine if hyperbaric oxygen therapy (HBOT), an established treatment for tissue ischemia, attenuates post-transplant bronchial injury. We performed a randomized, controlled trial of usual care vs. HBOT (2 atmospheres absolute for 2 hours × 20 sessions) in subjects with extensive airway necrosis 4 weeks post-transplant. Endobronchial biopsies were collected at 4, 7, and 10 weeks post-transplant for quantitative PCR. Co-primary outcomes were incidence of airway stenting and acute cellular rejection (ACR) at one year. The trial was stopped after enrolling 20 subjects (n=10 per group) after a pre-planned interim analysis showed no difference between usual care and HBOT groups in stenting (both 40%), ACR (70% and 40%, respectively), or CAS (40% and 60%, respectively). Time-to-first-stent placement (median [IQR]) was significantly shorter in the HBOT group (150 [73–150] vs. 186 [167–206] days, P<0.05). Hypoxia-inducible gene expression was significantly increased in donor tissues at 4, 7, and 10 weeks post-transplant, but was not altered by HBOT. Subjects that developed CAS or required stenting had significantly higher HMOX1 and VEGFA expression at 4 weeks (both P<0.05). Subjects that developed ACR had significantly FLT1, TIE2, and KDR expression at 4 weeks (all P<0.05). Incidence of CAS is high after severe, established airway necrosis post-transplant. HBO therapy does not reduce CAS severity or stenting. Elevated HMOX1 and VEGFA expression appears to associate with airway complications.
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影响因子：
2.1
作者：
Mahmood K;Kraft BD;Glisinski K;Hartwig MG;Harlan NP;Piantadosi CA;Shofer SL
通讯作者：
Shofer SL
影响因子：
15.9
作者：
Jiang, Xinguo;Khan, Mohammad A.;Nicolls, Mark R.
通讯作者：
Nicolls, Mark R.
影响因子：
4.6
作者：
Benhamed, Lotfi;Bellier, Jocelyn;Porte, Henri
通讯作者：
Porte, Henri
影响因子：
0.9
作者：
Ma, X.;Lu, Y. P.;Li, Y. P.
通讯作者：
Li, Y. P.
DOI：
10.1080/13651820601175926
发表时间：
2007-01-01
期刊：
HPB : the official journal of the International Hepato Pancreato Biliary Association
影响因子：
--
作者：
Muralidharan, Vijayaragavan;Christophi, Chris
通讯作者：
Christophi, Chris